Target Blood Glucose Research Articles

Frequency of Insulin Omission and It’s Associated Factors in Patients with Type 2 Diabetes Mellitus on Insulin Therapy

ABSTRACT Background: Poor adherence to prescribed insulin regimen leads to poor glycemic control. This study was intended to see the frequency of insulin omission and it's associated factors among patients with inadequate glycemic control on insulin therapy. Methods: This cross-sectional observational study enrolled 384 patients with type 2 diabetes on insulin therapy recruited by convenient sampling from the Department of Endocrinology of BIRDEM General Hospital. As per study protocol, investigation reports were collected from patient records. Data were analyzed by SPSS version 25. Results: Forty-six percent of patients had some form of insulin omission. A documented event of one or more episodes of hypoglycemia (70.7%) was found to be the prime reason behind the omission of insulin. Worsened glycemic control (fasting plasma glucose, 2-h postprandial glucose, and glycated hemoglobin) and health hazard (obesity) were statistically significantly higher among the subjects who omitted their insulin. Only a few people in the insulin omission group were compliant with diet (2.8%), exercise (5.1%), and weekly self-monitoring of blood glucose (2.8%). Only 22.5% and 21.3% knew about target blood glucose and the insulin dose adjustment, respectively, in the omission group. Conclusions: High frequency of insulin omission due to several lifestyle-related factors and lack of structured diabetic education predisposed the patients to poor glycemic control.

Effects of the Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor Empagliflozin Added to Metformin in Patients with Type 2 Diabetes

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic progressive disease characterized by a progressive decline in pancreatic beta-cell function and insulin resistance. Multiple blood glucose-lowering agents targeting the main pathogenic mechanisms of insulin deficiency and insulin resistance are available for the management of type 2 diabetes. However, many patients do not achieve or maintain recommended blood glucose targets even with combination therapies, which are often delayed. Therefore, this study aimed to observe the effects of Empagliflozin as an add-on to Metformin in patients with type 2 diabetes. Methods: This was a retrospective observational study and was conducted in the Department of Medicine, Popular Medical College Hospital, Dhaka, Bangladesh during the period from January 2023 to December 2023. In our study, we included 255 type 2 diabetes mellitus patients who came to receive treatment at the outdoor department of medicine of our hospital. The patients were divided into three groups- Group A (Patients who received the combination of Empagliflozin 10 mg and Metformin 1000 mg), Group B (Patients who received Empagliflozin 10 mg), and Group C (Patients who received Metformin 1000 mg). Result: We found the mean age was 55.8 ± 11.3 years. Most of our patients were male (60%). Among our patients, the majority (57.25%) of them had HbA1c of 8% to 9%. Most patients (60%) got < 8% HbA1c level in Empagliflozin 10 mg combined with metformin 1000 mg group at the end of our study. The majority (9.41%) of patients in the Empagliflozin 10 mg group had >9% HbA1c level compared to other groups. Dizziness, dyspepsia, diarrhea, nasopharyngitis, hyperglycemia, and hypoglycemia were the most common adverse events. Conclusion: The findings of the study showed that in people with Type 2 diabetes and insufficient glycaemic control, 52 weeks’ treatment with empagliflozin 10 mg as an add-on to metformin 1000 mg resulted in sustained and clinically substantial decreases in HbA1c, body weight,FPG, systolic and diastolic blood pressure.

Management of people after stroke in 383 Victorian general practices, 2014-2018: analysis of linked stroke registry and general practice data.

To evaluate the management in Victorian general practice of people who have been hospitalised with stroke or transient ischaemic attacks (TIA). Retrospective observational study; analysis of linked Australian Stroke Clinical Registry (AuSCR) and general practice data. 383 general practices in the Eastern Melbourne, South Eastern Melbourne, and Gippsland primary health networks (Victoria), 1 January 2014 - 31 December 2018. Adults who had been hospitalised with acute stroke or TIA and had at least two encounters with the same general practice during the observation period (7-18 months after the acute event). Assessment of cardiometabolic risk factors (blood pressure, serum lipids, blood glucose, urinary protein); prescribing of guideline-recommended prevention medications (blood pressure-, lipid-, or glucose-lowering, antithrombotic agents); attainment of guideline targets for cardiometabolic risk factors at final assessment during observation period. During 2014-2018, 3376 eligible AuSCR registrants (1465 women, 43.4%) had at least two encounters with one of the 383 general practices during the observation period; median age at stroke onset was 73.9 (interquartile range, 64.4-81.9) years, 737 events were TIAs (21.8%). Blood pressure was assessed in 2718 patients (80.5%), serum lipids in 1830 (54.2%), blood glucose in 1708 (50.6%). Prevention medications were prescribed for 2949 patients (87.4%), including lipid-lowering (2427, 71.9%) and blood pressure-lowering agents (2363, 70.0%). Blood glucose targets had been achieved by 1346 of 1708 patients assessed for this risk factor (78.8%), blood pressure targets by 1935 of 2717 (71.2%), and serum lipid targets by 765 of 1830 (41.8%). The incidence of having risk factors assessed was lower among patients aged 60 years or younger (incidence rate ratio [IRR], 0.97; 95% confidence interval [CI], 0.92-1.03) and those over 80 years of age (IRR, 0.92; 95% CI 0.88-0.97) than for those aged 61-80 years, and for women (IRR, 0.91; 95% CI, 0.87-0.95) and people with dementia (IRR, 0.89; 95% CI, 0.81-0.98). The likelihood of having classes of prevention medication prescribed was lower for patients aged 60 years or younger (IRR, 0.92; 95% CI, 0.88-0.97) and those over 80 years of age (IRR, 0.96; 95% CI, 0.92-0.997) than for patients aged 61-80 years, and for women (IRR, 0.95; 95% CI, 0.91-0.98) and people with dementia (IRR, 0.88; 95% CI, 0.78-0.98). The general practice management of people who have been hospitalised with stroke or TIA could be improved. Effective monitoring of cardiometabolic risk factors will enable general practitioners to optimise care for people who need careful attention to prevent adverse secondary events.

Risk factors for Relative and Absolute Hypoglycemia in Patients Treated for Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome.

Introduction: Glycemic management in the intensive care unit is an evolving practice area. This evolution has included the refinement of blood glucose targets, matching glycemic management to premorbid status, and investigations into the impact of glycemic variability and relative hypoglycemia on ICU outcomes. The interplay between these phenomena and absolute hypoglycemia has yet to be investigated in hyperglycemic emergencies. Objectives: To examine the incidence of and risk factors for relative hypoglycemia and absolute hypoglycemia in patients admitted to an intensive care unit for the management of hyperglycemic emergencies. Methods: This was a retrospective, single-center, exploratory analysis of adults admitted to the medical intensive care unit for diabetic ketoacidosis or hyperosmolar hyperglycemic syndrome. The primary outcome was the incidence of relative hypoglycemia, defined as a blood glucose level 30% lower than baseline. The baseline was determined by the estimated average blood glucose calculated from hemoglobin A1c within 3 months of index admission. Secondary outcomes were ICU length of stay, glycemic variability, and incidence of absolute hypoglycemia.Results: Relative hypoglycemia was observed in 60% of patients in the cohort. Longer insulin infusion duration and higher hemoglobin A1c levels were found to statistically increase the risk of developing relative hypoglycemia. Higher glycemic variability and longer ICU length of stay were associated with the risk of developing absolute hypoglycemia. Conclusions: Relative hypoglycemia is a frequent occurrence in this patient population. Hemoglobin A1c and duration of the insulin infusion statistically influenced the risk of developing relative hypoglycemia. Higher glycemic variability and longer ICU stay were significantly associated with developing absolute hypoglycemia. While relative hypoglycemia is common in hyperglycemic emergencies, the clinical impact remains uncertain and warrants additional investigation.

Glycemic Management in Patients with COVID-19 Admitted to the Intensive Care Unit: Evaluation of Glycemic Control and Drug Therapy.

Emerging evidence describes the high incidence and strong impact of hyperglycemia on the outcomes of critically ill patients with a diagnosis of COVID-19. Given resource limitations during the COVID-19 pandemic, clinicians moved away from using continuous IV infusions of insulin to manage hyperglycemia. To evaluate glycemic control in critically ill patients receiving various medication regimens to manage their hyperglycemia. This retrospective cohort study involved 120 mechanically ventilated adult patients (> 18 years) with COVID-19 who were admitted to the intensive care unit (ICU) between February 2020 and December 2021. The following data were collected for the first 14 days of the ICU admission: blood glucose values (up to 4 times daily), hypoglycemia events, and antihyperglycemic medication regimens. The use of IV insulin infusions maintained glucose measurements within the target range of 4 to 10 mmol/L more often than any other medication regimen, with 60% of measured values falling within the target range. The use of a sliding-scale insulin regimen maintained 52% of glucose measurements within the target range. Oral hypoglycemic agents performed relatively poorly, with only 12% to 29% of glucose measurements within range. The coadministration of corticosteroids led to worse glycemic control across all medication regimens. This study confirmed that ICUs should continue using the standard protocol of IV insulin infusion to achieve recommended blood glucose targets in critically ill patients with COVID-19, particularly those receiving corticosteroids.

7087 An Unusual Movement Disorder, Case of Diabetic Striatopathy!

Abstract Disclosure: S. Azmat: None. O. Lodhi: None. R. Safi: None. H. harb: None. H. Ashok: None. M.F. Siddiqui: None. J.L. Gilden: None. Background: Non-ketotic Hyperglycemia Hemichorea-Hemiballismus Syndrome (NKH-CB) is rare complication of poorly controlled diabetes mellitus (DM) characterized by continuous, irregular jerky movements localized to one side of the body. It is commonly seen in type 2 DM and is often presented in females of East Asian descent. NKH-CB is often misdiagnosed due to its rarity and radiographic features easily mistaken for intracerebral hemorrhage.Case: A 70-year-old Latino male with type 2 diabetes mellitus, hypertension, bipolar disorder and past history of two cerebrovascular accidents presented to ED with non-radiating, midsternal chest pain. ACS was ruled out with negative serial troponins and normal EKG. Vital signs were significant for elevated blood pressure 151/64 mmHg. Labs showed blood glucose=447 mg/dL. Physical examination revealed large amplitude involuntary movements in left upper and lower extremities and facial region. He also veered to the left when ambulating. The patient reported that these abnormal movements were occurring for last three weeks although sensation was preserved bilaterally. Code stroke was called; non-contrast CT showed unilateral hyper density of the right caudate and putamen with no evidence of acute intracranial hemorrhage or large arterial territory infarction. CT Angiogram did not show any signs of stenosis or occlusion. He received intravenous fluids and 8 units lispro insulin in ED. Was admitted for further evaluation and received basal/bolus insulin therapy with target blood glucose of 140-160 mg%. He also received risperidone for his mental condition. Subsequent testing revealed hemoglobin A1C of 16.9% (reference range: < 5.7%). MRI Brian showed unilateral T1 hyperintensity involving right caudate and putamen corresponding to the hypodensity seen on CT. Neurology service was consulted. Based on clinical signs/symptoms coupled with neuroimaging, he was diagnosed with non-ketotic Hyperglycemia Hemichorea-Hemiballismus Syndrome. On day 2 with resolution of hyperglycemia, amplitude and frequency of involuntary arm movements were minimal. The patient was discharged with Lantus 7 and metformin 1000 mg for DM and risperidone for symptoms management. Conclusion: Diabetic neuropathy is commonly known to result in small and/or large fiber sensorimotor polyneuropathy, proximal motor, and acute mononeuropathies as well as entrapments, radiculopathies, autonomic neuropathies, and even cognitive disorders. This case describes rare case of simultaneous NKH-CB with history of CVA and antipsychotic medication use in a patient with poorly controlled DM which resolved with treatment of hyperglycemia. Thus offers valuable insights into the diagnostic challenges associated with this condition as well as potential links to other neurological complications. One should also remain vigilant of potential onset of seizures commonly seen with NKH. Presentation: 6/3/2024

Exercise intensities and metabolic health: Targeting blood glucose, insulin, and C-peptide levels in adults with prediabetes in the postprandial state

ObjectiveExercise improves postprandial glycemia and insulin sensitivity in individuals with prediabetes, but the optimal intensity for this metabolic regulation remains unclear. The current study explored the impact of various exercise intensities on blood glucose, insulin, and C-peptide levels in prediabetic individuals to identify the optimal intensity for improving these metabolic indicators. MethodsIn this crossover study, 25 individuals with prediabetes participated in exercise sessions at four different intensities 50 %, 60 %, 70 %, and 80 % of their predicted maximum heart rate using a treadmill. Each session lasted 30 min, including a 5-min warm-up and 5-min cool-down period. Blood samples were collected at four time points: during fasting, immediately before exercise, and 30 and 60 min post-exercise. These samples were analyzed for glucose, insulin, and C-peptide levels. The effects of exercise intensity on these parameters were evaluated using repeated measures analysis of variance (ANOVA), with post hoc tests conducted to determine specific differences between the intensities. ResultsThe participants had an average age of 34.88 years, mean height of 170 cm, and body mass index of 30.34 kg/m2. A significant reduction in insulin and glucose levels post-exercise was observed at 70 % intensity (p ≤ 0.001). Despite high fasting blood glucose levels (110–115 mg/dL), significant reductions were noted at 30 and 60 min post-exercise (p ≤ 0.001). Insulin levels approached near baseline at 70 % intensity, from fasting (26.74 ± 20.83) to 60 min post-exercise (28.47 ± 20.79), indicating a positive response at this intensity. C-peptide levels also showed significant changes, with 70 % intensity exercise bringing them closest to fasting levels by 60 min post-exercise. ConclusionThis study highlights the importance of exercise intensities in enhancing metabolic parameters in individuals with prediabetes. Specifically, 70 % of the predicted maximum heart rate was beneficial, optimizing insulin sensitivity and potentially reducing the risk of progressing from prediabetes to diabetes.

Role of the screening with coronary computed tomography angiography on lipid management and risk factors control in an asymptomatic Chinese population: a community-based, parallel-group, open-label, randomized clinical trial (RESPECT2).

Lipid management based on cardiovascular risk level is the cornerstone of primary prevention of coronary artery disease (CAD), while the accuracy and adherence of traditional cardiovascular risk stratification have been questioned. Prevention strategies based on imaging screening for atherosclerotic plaques are found to be more objective and adherent in recent studies. This trial aims to investigate the role of coronary computed tomography angiography (CCTA) in guiding the primary prevention of CAD in a randomized controlled design. Approximately 3400 middle-aged asymptomatic community participants will be recruited and randomized in a 1:1 ratio to a traditional cardiovascular risk score-guided (usual care group) or CCTA-guided (CCTA group) strategy. Participants with cardiovascular disease, prior lipid-lowering therapy, CCTA contraindication, or serious diseases that affect life span will be excluded. The intervention strategy includes blood pressure, blood glucose, and lipid management and lifestyle modifications. Blood pressure and glucose targets and lifestyle modification recommendations keep the same in both strategies, while lipid management is personalized based on traditional risk level or CCTA results, respectively. The primary outcome is the proportion of participants taking lipid-lowering medication regularly at both 6 and 12months. The secondary outcomes include the proportion of participants achieving low-density lipoprotein cholesterol lowering targets at 12months, mean changes in lipid levels from baseline to 12months, barriers to adherence, adverse reactions related to CCTA examination, and cardiovascular events. The study is the first randomized clinical trial to examine the effectiveness of a CCTA-guided versus a traditional risk score-guided primary prevention strategy in an asymptomatic community-based population. ClinicalTrials.gov NCT05725096. Registered on 2 February 2023.

Management of Early Post-Transplant Hyperglycemia by Dedicated Endocrine Care Improves Glycemic Outcomes.

Early post-transplant hyperglycemia (EPTH) is an independent risk factor for hospital readmissions, acute rejection, infections and developing post-transplant diabetes mellitus (PTDM). Close glycemic control is prudent in the early post-transplant period. The management of EPTH was evaluated among a cohort of kidney transplant recipients, who either received routine care (RC) or dedicated endocrine care (DEC). A retrospective analysis was conducted on kidney transplant recipients from 2019 to 2023. The impact of DEC on post-transplant glycemic control was investigated. Hospitalized patients receiving post-transplant insulin therapy were included. DEC involved at least twice-daily blood glucose (BG) assessment by an endocrinologist, while the RC received usual care. A mixed-model analysis was employed to assess differences in BG trajectories between DEC and RC over an eight-day period. Additionally, various glycemic control metrics were compared, including glucose variability, time-in-range for target BG, rates of hypoglycemia and response to hyperglycemia. The cohort comprised 113 patients. In the DEC group, 91% had pre-transplant DM compared to 15% in the RC group (p < 0.001). Patients under DEC had higher baseline BG and glycated hemoglobin compared to those under RC (p < 0.001, for both). The DEC group displayed a lower trajectory of BG over time compared to the RC group (p = 0.002). Patients under DEC were more likely to receive insulin if BG measured above 200 mg/dL (66% vs. 46%) and displayed less below-range BG (<110 mg/dL) compared to those under RC (12.9% vs. 23.6%, p < 0.001). Management of EPTH by DEC improves glycemic outcomes in renal transplant recipients.

Whole Day Workload: Evaluation of a New Outcome Measure in Occupational Therapy for Adults With Type 1 Diabetes.

Typical whole day workload is a metric with potential relevance to the occupational balance and well-being of individuals with chronic conditions. To examine the reliability and validity of using multiple daily NASA Task Load Index measures (whole day TLX) as an indicator of typical whole day workload experienced by adults with Type 1 diabetes (T1D). Participants with T1D completed cross-sectional measures and 2 wk of ecological momentary assessments (EMA) and daily diaries. Reliability was assessed across subgroups (e.g., workers vs. nonworkers); validity was evaluated with multilevel confirmatory factor analysis and with tests of convergent and divergent validity with patient-reported outcomes and blood glucose measures. Three outpatient endocrinology clinics in the United States. Data from 164 U.S. adults with T1D (42% Latino, 30% White). Measures used included the whole day TLX (assessed via 2 wk of daily diaries), time in target blood glucose range (assessed with a continuous glucose monitor), illness intrusiveness (measured cross-sectionally), and stress (measured cross-sectionally and with EMA). Number of days required for at least 0.70 reliability of the average whole day TLX ranged between 2 and 6 days depending on the subgroup. Results supported convergent and divergent validity of the average of the whole day TLX, including associations with average stress (r = .63, p < .001) and time in target blood glucose range (r = -.25, p = .002). The whole day TLX was a reliable and valid indicator of typical whole day workload. Plain-Language Summary: The health management responsibilities for Type 1 diabetes can be extremely burdensome. When these responsibilities are experienced, in addition to duties such as work and caregiving, the totality of demands experienced (i.e., whole day workload) can create further issues, such as unhealthy physiological changes and interference with self-care. We tested the psychometric properties of a measurement tool that assesses the typical level of workload people experience. This measure, referred to as the NASA Task Load Index (whole day TLX), was found to be a reliable and valid indicator of typical whole day workload. Occupational therapists may use the whole day TLX to track progress in interventions focused on reducing clients' whole day workload exposure to promote their health and well-being. Occupational therapists' expertise in areas such as activity analysis, task adaptation, and energy conservation makes them especially well-suited to intervene on whole day workload.

Optimal hyperglycemia thresholds in patients undergoing chemotherapy: a cross sectional study of oncologists’ practices

PurposeNeither the United States nor the European oncology guidelines include details for appropriate management of hyperglycemia in cancer patients. The aim was to identify fasting and random blood glucose thresholds, and hemoglobin A1c (HbA1c) targets used by oncologists in clinical practice when managing hyperglycemia in patients with cancer undergoing chemotherapy.MethodsThis national, cross sectional study utilized a questionnaire to collect oncologists’ perceptions about optimal blood glucose thresholds and HbA1c targets in patients with cancer undergoing chemotherapy. Descriptive statistics were calculated to summarize glucose thresholds, HbA1c targets, and sample characteristics. Responses to an open-ended question about oncologists’ approach to hyperglycemia management were analyzed via thematic analysis using an inductive approach.ResultsRespondents (n = 229) were on average 52.1 years of age, 67.7% men, and 91.3% White. For patients without diabetes but experiencing hyperglycemia, oncologists targeted lower and upper fasting blood glucose levels between 75-121 mg/dL and 105-135 mg/dL, respectively. For patients with diabetes, the targets for lower and upper fasting blood glucose levels ranged between 100-130 mg/dL and 128-150 mg/dL, respectively. Fasting blood glucose (95.6%) and HbA1c (78.6%) were the most commonly used clinical indicators to consider chemotherapy dose reduction, delay, or discontinuation due to hyperglycemia in patients receiving chemotherapy with curative intent. Among those receiving palliative intent chemotherapy, the preferred clinical parameters were random blood glucose (90.0%), patient-reported blood glucose readings (70.7%), continuous glucose monitoring readings (65.1%), and patient-reported symptoms of hyperglycemia (65.1%). Three main themes emerged about oncologists’ approach to hyperglycemia management: 1) identification of high-risk patients; 2) need for early identification, screening, and diagnosis of hyperglycemia; and 3) multiple hyperglycemia management strategies.ConclusionOncologists reported a wide variation of target blood glucose ranges considered appropriate in patients undergoing chemotherapy. Lack of clear guidance for hyperglycemia management during chemotherapy in the United States may be contributing to a lack of consistency in clinical practice.

Effectiveness of Blood Glucose Time in Range to Reduce Risk of Blood Glucose Extrusion and Improve Blood Glucose Metrics in Type 1 Diabetic Patients.

With evolving diabetes technology, continuous glucose monitoring (CGM) and time in range have been advanced as critical measurements to assess complications. They have shown improvement in A1C levels and decreased episodes of blood glucose extrusion. This study aimed to assess the awareness and utilization of blood glucose time in range and its effectiveness in reducing the risk of blood glucose extrusion and improving blood glucose metrics among patients with type 1 diabetes mellitus. A retrospective study included 342 patients who met the inclusion criteria and were using the CGM, aiming for a TIR of 70% daily. Glycemic control was followed using TIR data, blood glucose extrusion frequency (including hyperglycemia and hypoglycemia events), active sensor time, average blood glucose, and glucose management indicator (GMI) levels. A total of 342 individuals participated in this study, the majority of whom were below 18 years of age (62.3%). The hypoglycemic frequency was significantly increased compared to the baseline, and most participants experienced hypoglycemia events (p = 0.0001). The incidences increased over time, with 90.9% and 93% having hypoglycemia at 60 and 90 days (p = 0.0001), respectively. The active scan and sensor time were not followed, which led to the blood glucose target not being achieved, with no improvement throughout the study. Consequently, no improvement occurred in glycemic control. CGM technology has been promising and proven effective in improving glycemic. However, our study did not show these benefits as expected, which could be explained by the underutilization and improper use of the CGM.

Can flash glucose monitoring improve glucose management for Aboriginal and Torres Strait Islander peoples with type 2 diabetes? A protocol for a randomised controlled trial

BackgroundAboriginal and Torres Strait Islander peoples are disproportionately impacted by type 2 diabetes. Continuous glucose monitoring (CGM) technology (such as Abbott Freestyle Libre 2, previously referred to as Flash Glucose Monitoring) offers real-time glucose monitoring that is convenient and easy to use compared to self-monitoring of blood glucose (SMBG). However, this technology’s use is neither widespread nor subsidised for Aboriginal and Torres Strait Islander peoples with type 2 diabetes. Building on existing collaborations with a national network of Aboriginal and Torres Strait Islander communities, this randomised controlled trial aims to assess the effect of CGM compared to SMBG on (i) haemoglobin A1c (HbA1c), (ii) achieving blood glucose targets, (iii) reducing hypoglycaemic episodes and (iv) cost-effective healthcare in an Aboriginal and Torres Strait Islander people health setting.MethodsThis is a non-masked, parallel-group, two-arm, individually randomised, controlled trial (ACTRN12621000753853). Aboriginal and Torres Strait Islander adults with type 2 diabetes on injectable therapy and HbA1c ≥ 7.5% (n = 350) will be randomised (1:1) to CGM or SMBG for 6 months. The primary outcome is change in HbA1c level from baseline to 6 months. Secondary outcomes include (i) CGM-derived metrics, (ii) frequency of hypoglycaemic episodes, (iii) health-related quality of life and (iv) incremental cost per quality-adjusted life year gained associated with the CGM compared to SMBG. Clinical trial sites include Aboriginal Community Controlled Organisations, Aboriginal Medical Services, primary care centres and tertiary hospitals across urban, rural, regional and remote Australia.DiscussionThe trial will assess the effect of CGM compared to SMBG on HbA1c for Aboriginal and Torres Strait Islander people with type 2 diabetes in Australia. This trial could have long-term benefits in improving diabetes management and providing evidence for funding of CGM in this population.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12621000753853. Registered on 15th June 2021.

Evaluating the impact of type 2 diabetes mellitus on pulmonary vascular function and the development of pulmonary fibrosis.

The increasing prevalence of type 2 diabetes mellitus (T2DM) is a significant worldwide health concern caused by sedentary lifestyles and unhealthy diets. Beyond glycemic control, T2DM impacts multiple organ systems, leading to various complications. While traditionally associated with cardiovascular and microvascular complications, emerging evidence indicates significant effects on pulmonary health. Pulmonary vascular dysfunction and fibrosis, characterized by alterations in vascular tone and excessive extracellular matrix deposition, are increasingly recognized in individuals with T2DM. The onset of T2DM is often preceded by prediabetes, an intermediate hyperglycemic state that is associated with increased diabetes and cardiovascular disease risk. This review explores the relationship between T2DM, pulmonary vascular dysfunction and pulmonary fibrosis, with a focus on potential links with prediabetes. Pulmonary vascular function, including the roles of nitric oxide (NO), prostacyclin (PGI2), endothelin-1 (ET-1), thromboxane A2 (TxA2) and thrombospondin-1 (THBS1), is discussed in the context of T2DM and prediabetes. Mechanisms linking T2DM to pulmonary fibrosis, such as oxidative stress, dysregulated fibrotic signaling, and chronic inflammation, are explained. The impact of prediabetes on pulmonary health, including endothelial dysfunction, oxidative stress, and dysregulated vasoactive mediators, is highlighted. Early detection and intervention during the prediabetic stage may reduce respiratory complications associated with T2DM, emphasizing the importance of management strategies targeting blood glucose regulation and vascular health. More research that looks into the mechanisms underlying pulmonary complications in T2DM and prediabetes is needed.

Effects of Perioperative Glycemic Management Protocol on Glycemic Outcomes of Type 2 Diabetic Patients Undergoing Major Abdominal Surgery: A Prospective Cohort Study

PurposeThis study aimed to reveal the effects of a glycemic control protocol directed by nurses during the perioperative period on glycemic outcomes in diabetic patients undergoing major abdominal surgery. DesignThis was a prospective cohort study MethodsThe study was conducted at the Department of General Surgery of a research and training hospital in Turkey. The study included 47 patients with type 2 diabetes mellitus who underwent elective major abdominal surgery between September 2017 and December 2018. The number of patients in the intervention and the control groups was 22 and 25, respectively. Routine clinical glycemic control was implemented in the control group, whereas a glycemic management protocol developed by a multidisciplinary team was implemented in the intervention group. We collected data on the control group first, followed by the introduction of the glycemic management protocol to clinical staff and glycemia data collection using the new protocol. Blood glucose (BG) levels in patients and the factors that may affect BG were measured in the preoperative, intraoperative, and postoperative periods. Data on glycemic control was also collected. Furthermore, we measured the satisfaction of the nurses implementing the glycemic management protocol. FindingsThe rate of hyperglycemia in intensive care unit was 21% in the intervention group and 59% in the control group (P < .05). Time spent in the target BG range during insulin infusion was 76% in the intervention group and 35% in the control group (P < .05). The time required to achieve target BG range during insulin infusion was 6 hours for the intervention group and 15 hours for the control group, indicating that less time was required to achieve the target BG range in the intervention group (P < .05). Moreover, the insulin consumption rate in the intensive care unit was lower in the intervention group (P < .05). The satisfaction levels of the nurses that used the glycemic management protocol was 92.61 ± 7.93%. ConclusionsResults of this study showed that the implementation of a glycemic management protocol by nurses for patients undergoing major abdominal surgery decreases the rate of hyperglycemia, insulin consumption rate, and the time required to achieve the targeted BG range during the perioperative period. Therefore, it is recommended to use a glycemia management protocol to control glycemia in patients during the surgical process.

Glucose evaluation and management in the ICU (GEM-ICU): Protocol for a bi-centre cohort study.

Hyperglycaemia is common in intensive care unit (ICU) patients. Glycaemic monitoring and effective glycaemic control with insulin are crucial in the ICU to improve patient outcomes. However, glycaemic control and insulin use vary between ICU patients and hypo- and hyperglycaemia occurs. Therefore, we aim to provide contemporary data on glycaemic control and management, and associated outcomes, in adult ICU patients. We hypothesise that the occurrence of hypoglycaemia in acutely admitted ICU patients is lower than that of hyperglycaemia. We will conduct a bi-centre cohort study of 300 acutely admitted adult ICU patients. Routine data will be collected retrospectively at baseline (ICU admission) and daily during ICU stay up to a maximum of 30 days. The primary outcome will be the number of patients with hypoglycaemia during their ICU stay. Secondary outcomes will be occurrence of severe hypoglycaemia, occurrence of hyperglycaemia, time below blood glucose target range, time above target range, all-cause mortality at Day 30, number of days alive without life support at Day 30 and number of days alive and out of hospital at Day 30. Process outcomes include the number of in-ICU days, glucose measurements (number of measurements and method) and use of insulin (including route of administration and dosage). All statistical analyses will be descriptive. This cohort study will provide a contemporary overview of glucose evaluation and management practices in adult ICU patients and, thus, highlight potential areas for improvement through future clinical trials in this area.

Association Between Individualized Versus Conventional Blood Glucose Thresholds and Acute Kidney Injury After Cardiac Surgery: A Retrospective Observational Study

This study was designed to compare individualized and conventional hyperglycemic thresholds for the risk of acute kidney injury (AKI) after cardiac surgery. This was an observational study. The study took place in a single-center tertiary teaching hospital. Adult patients who underwent cardiac surgery between January 2012 and November 2021 were enrolled. Two blood glucose thresholds were used to define intraoperative hyperglycemia. While the conventional hyperglycemic threshold (CHT) was 180 mg/dL in all patients, the individualized hyperglycemic threshold (IHT) was calculated based on the preoperative hemoglobin A1c level. Various metrics of intraoperative hyperglycemia were calculated using both thresholds: any hyperglycemic episode, duration of hyperglycemia, and area above the thresholds. Postoperative AKI associations were compared using receiver operating characteristic curves and logistic regression analysis. Among the 2,427 patients analyzed, 823 (33.9%) developed AKI. The C-statistics of IHT-defined metrics (0.58-0.59) were significantly higher than those of the CHT-defined metrics (all C-statistics, 0.54; all p < 0.001). The duration of hyperglycemia (adjusted odds ratio, 1.09; 95% confidence interval, 1.02-1.16) and area above the IHT (1.003; 1.001-1.004) were significantly associated with the risk of AKI, except for the presence of any hyperglycemic episode. None of the CHT-defined metrics were significantly associated with the risk of AKI. Individually defined intraoperative hyperglycemia better predicted postcardiac surgery AKI than universally defined hyperglycemia. Intraoperative hyperglycemia was significantly associated with the risk of AKI only for the IHT. Target blood glucose levels in cardiac surgical patients may need to be individualized based on preoperative glycemic status.

Survey on the Use of Medicines in Patients with Co-existing Hypertension and Type 2 Diabetes at the Internal Medicine Department of E Hospital in 2020-2022

The study aims to describe the situation of using antihypertensive and hypoglycemic drugs; Initial evaluation of the effectiveness of drug used in the treatment regimen of patients with concomitant hypertension and type 2 diabetes. Methods: a cross-sectional, retrospective study was performed on 179 medical records of patients who had hypertension and type 2 diabetes, examination and treatment at the Internal Medicine Department - Hospital E from April 2020 to December 2022. Information collected from medical records was processed using SPSS 26.0 statistical software. Result: the main groups of hypoglycemic drugs used were metformin (74.9%) and insulin (69,3%). The rate of using multi-drug regimen for diabetes (64.8%) is higher than that of monotherapy, in which the two-drug regimen of insulin and biguanide (metformin) is common (32.4%). The main groups of antihypertensive drugs used were ACE inhibitors and Ca channel blockers (72.6% and 57.5%), 60.3% of patients were treated according to a multi-drug regimen in which combination regimens of 2 groups of Ca channel blockers and ACE inhibitors are common (26.3%). There are no clinically significant interactions between antidiabetic and antihypertensive drugs. The rate of patients who reached the target blood pressure was 83.8%. The rate of patients achieving target blood sugar levels when discharged from the hospital was 40.9%. Conclusion: multi-drug regimen is used more than monotherapy in the treatment of hypertension and diabetes. Most patients reached target blood pressure on discharge, however the number of patients achieving target blood glucose was quite limited . No drug interactions were found between drugs used to lower blood pressure and hypoglycemic drugs.&#x0D;

Intensive management from diagnosis improves HbA1c at 12 months postdiagnosis: results from a prospective cohort study in children with newly diagnosed type 1 diabetes

aims: To examine the impact of intensive management of type 1 diabetes (T1D) from diagnosis on HbA1c 12 months from diagnosis. methods: HbA1c measured 12 months after diagnosis for 70 consecutively newly diagnosed children with T1D following implementation of an intensive management protocol was compared with 70 children consecutively diagnosed immediately pre-implementation. Intensive management involved carbohydrate counting and flexible insulin dosing from first meal with subcutaneous insulin, targeted blood glucose levels from 4–8mmol/L irrespective of time of day, avoidance of twice daily insulin regimen and promotion of continuous glucose monitoring (CGM). HbA1c, diabetes technology use and insulin regimen at 12 months post-diagnosis were compared. results: The post-intensive management implementation cohort had an improved mean HbA1c of 58.2±15.3mmol/mol vs 63.7±10.7mmol/mol at 12 months (p=0.014). The proportion of young people with diabetes meeting a target HbA1c of &lt;53mmol/mol at 12 months improved from 11% to 40% (p=&lt;0.001). There was a reduction of twice daily insulin regimen from 66% to 11% (p=&lt;0.001), and increased CGM use from 57% to 76% (p=0.02). conclusion: Intensive management when implemented with consistent messaging from the multi-disciplinary team resulted in clinic-wide improvements in HbA1c and the proportion meeting HbA1c targets.

Роль самоконтроля гликемии в управлении гестационным сахарным диабетом

Gestational diabetes mellitus (GDM) is a disorder characterized by hyperglycemia first recognized during pregnancy that does not meet the criteria of manifest diabetes mellitus (DM). The GDM decompensation can be a common cause of perinatal mortality. GDM is associated with higher rates of preeclampsia and eclampsia, which require emergency caesarean section [1]. Contemporary approach to GDM management includes the need for mandatory self-monitoring of blood glucose. The target blood glucose range cannot be achieved without self-monitoring of blood glucose done by the pregnant woman at home. Glycemic control during pregnancy should be accurate, simple and user-friendly, allowing the pregnant woman to adjust insulin therapy for GDM by herself. Choosing a blood glucose meter is one of the major aspects of blood glucose self-monitoring. From the physician's perspective, compliance with accuracy standards is the most important criterion for blood glucose meter selection, while from the patient’s perspective, the most important criteria are user friendliness, and simplicity of use. Blood glucose level measurement accuracy is improved, and self-monitoring of blood glucose becomes easier due to technical improvements, which results in improved adherence to treatment and higher therapy efficacy. Achieving and maintaining glycemic targets are impossible without active and meaningful participation of the patient with GDM, as well as without self-monitoring of blood glucose with precise and user-friendly blood glucose meter, such as Contour Plus One.