Target Blood Glucose Research Articles

Improving inpatient hyperglycaemia in non-critically ill adults in resident wards through audit and feedback

Inpatient hyperglycaemia is associated with an increase in morbidity and mortality, number of rehospitalisations and length of hospitalisation. Although the advantages of proper glycaemic control in hospitalised patients with diabetes...

The Impact of Diabetes Education on Continuous Glucose Monitoring in SUS-Dependent Patients in a Northeastern Brazilian City.

Diabetes Mellitus (DM) is an important chronic disease that occurs worldwide. This study aims to investigate how the use of the FreeStyle® Libre system in Unified Health System (SUS) patients impacts diabetes parameters in patients who receive education on proper insulin administration and the use of the continuous monitoring device, as well as how this affects patients without any concomitant multidisciplinary support in Sergipe, Brazil. We conducted a prospective randomized study in a diabetes clinic in Sergipe, Brazil, using the flash method FreeStyle® Libre (Abbott). The participants were divided into two groups: one receiving diabetes education on CGM (continuous glucose monitoring), while the other did not. Before the intervention, the patient's treatment motivation and quality of life were assessed using a questionnaire, and baseline levels of glycated hemoglobin were measured using high-performance liquid chromatography (HPLC) and the point of care AlereTM Afinion with boronate fixation. We compared first- and second-phase data with respect to glycated hemoglobin, mean interstitial blood glucose, time on and above target for hypoglycemic and hyperglycemic events, and mean hypoglycemic duration. In group A, which received the diabetes education intervention, there was a significant reduction in average HbA1c levels from 8.6% to 7.9% after 3 months (p = 0.001). However, there was no significant difference in average glycemic values. Time above target decreased significantly from 50.62% to 29.43% (p = 0.0001), while time below target decreased from 22.90% to 20.21% (p = 0.002). There was no significant change in the number of hypoglycemic events, but the duration of hypoglycemia decreased significantly from 130.35 min to 121.18 min after 3 months (p = 0.0001). In Group B, there was no significant difference in mean HbA1c levels before (7.07%) and after (7.28%) sensor installation. This group maintained lower HbA1c levels compared to the other group. Average blood glucose levels also remained similar before (148.37 mg/dL) and after (154.65 mg/dL) the intervention. Although the time above the target glucose level increased significantly from 35.94% to 48.17%, the time at target decreased from 50.40% to 37.97%. No significant changes were observed in the time below target, the number of hypoglycemic events, or the duration of hypoglycemia. Our findings indicate that utilizing continuous glucose monitoring technology can enhance glycemic control, particularly in motivated, educated, low-income patients dependent on the SUS. To achieve positive results with FreeStyle Libre, it is imperative to allocate resources for multidisciplinary support.

Glycemic Management in Insulin-Naive Patients in the Inpatient Setting.

The ideal inpatient insulin regimen efficiently attains the target blood glucose range, effectively treats hyperglycemia, and minimizes the risk of hypoglycemia. The objective of this study was to compare glycemic targets achieved by using correctional monotherapy (CM) and basal-bolus therapy (BBT) in insulin-naive patients in the inpatient setting to determine optimal blood glucose management for these patients. This was a retrospective observational cohort study of 792 patients with diabetes not on home insulin therapy who were admitted to an academic hospital over a 5.5-month period. The percentages of hyperglycemic and hypoglycemic values in each group were compared. Among the 3,112 measured blood glucose values obtained from 792 patients within the first 24 hours of insulin administration, 28.5% were hyperglycemic in the BBT group compared with 23.5% in the CM group. When adjusted for covariates, there was a 23% decrease in hyperglycemia in the BBT group (incidence rate ratio = 0.77, 95% CI 0.64-0.95, P = 0.006). Increases in A1C and admission blood glucose, as well as decreases in admission creatinine and inpatient steroid use, were independently associated with higher rates of hyperglycemia, adjusted for all other covariates. There was no significant difference between the groups in the rate of hypoglycemia in the first 24 hours, which was 1.9% in the BBT group and 1.4% in the CM group (P = 0.301). Utilizing BBT in insulin-naive patients admitted to the hospital within the first 24 hours of insulin administration results in lower rates of hyperglycemia without higher rates of hypoglycemia when compared with CM.

Optimising antidiabetic medication management for type 2 diabetes and renal dysfunction in Can Tho City, Vietnam.

The research aimed to delineate and investigate the utilisation of antidiabetic drugs in type 2 diabetes patients with kidney failure at a hospital in Can Tho City, Vietnam. The research analysed the use of antidiabetic drugs at various time points, determined the drug interaction rate, and evaluated the appropriate use of drugs and the relationship with the achievement of target blood glucose and HbA1c levels. A two-tailed Student's t-test was employed to compare continuous variables, an ANOVA test was used to assess multiple values, and an χ2 test was utilised to evaluate categorical variables. Insulin monotherapy was the predominant regimen for treating type 2 diabetes in patients with impaired kidney function. Metformin was the most prescribed oral medication. Approximately 85.78% of patients received safe and appropriate diabetes treatment. Statistical analysis revealed a significant relationship between achieving target blood glucose and HbA1c after 3 months and factors such as safe drug use and minimal drug interactions (p < 0.05). Patients with chronic kidney disease demonstrated better blood glucose control compared to those with acute kidney disease. The most common drug used for type 2 diabetes patients with impaired kidney function was insulin monotherapy, with usage increasing with the severity of chronic kidney disease. The chronic kidney disease group exhibited a higher rate of achieving target blood glucose and HbA1c compared to the acute kidney disease group. Rational, safe, and interaction-free drug use significantly contributed to better blood sugar control compared to less prudent medication choices.

Food insecurity and glycemic goals among Medicare beneficiaries with type 2 diabetes.

To examine the association between food insecurity and achieving glycemic goals among Medicare beneficiaries with type 2 diabetes. This study analyzed the nationally representative 2019 Medicare Current Beneficiary Survey of 1340 beneficiaries aged ≥65 years with type 2 diabetes. The binary dependent variable was whether beneficiaries' blood glucose was at target (A1C ≤ 7.5% or average fasting blood glucose of ≤140 mg/dL, all/most of the time). Food insecurity, a binary variable, was adapted based on the USDA's food security questions. A survey-weighted multivariable logistic model, adjusted for sociodemographics and comorbidities, was conducted to estimate predictive margins for comparing prevalence of having above-target blood glucose levels across groups. Of study beneficiaries, 20.9% reported not achieving glycemic targets. The predictive marginal prevalence of having higher than target blood glucose levels was significantly greater in females over males (23.8% [95% confidence interval [CI], 20.1-27.4] vs 17.6% [14.3-20.9]); those with less than high school education over those with college education (31.0% [23.6-38.3] vs 18.6% [14.8-22.3]); and those reporting food insecurity over their counterparts (33.4% [24.5-42.3] vs 19.1% [16.6-21.7]). Sociodemographic disparities related to achieving blood glucose goals were observed. Screening for food insecurity and related interventions should be considered for at-risk beneficiaries with diabetes.

Роль самоконтроля гликемии у подростков с сахарным диабетом 1-го типа: клинический разбор

Type 1 diabetes mellitus (dm) is a disease characterized by chronic hyperglycemia and the development and progression of severe microvascular complications. The results of the AdVAnce, Accord and VAdT large-scale research studies have definitely proved that glycemic control plays a role in prevention of the dm microvascular complications. A number of studies have shown that glycemic variability parameters play a separate role in prediction of diabetic retinopathy, nephropathy and cardiovascular complications. Adolescents with type 1 dm are characterized by the labile disease course and the tendency to develop hypoglycemia and ketoacidosis. modern approach to type 1 dm management, especially in adolescents, includes the need for mandatory self-monitoring of blood glucose (BG). Adolescents with type 1 dm are unable to achieve target glucose levels themselves at home without BG monitoring. Glycemic control in type 1 dm should be accurate, simple and convenient, allowing patients to adjust insulin therapy for dm on their own. Selection of BG monitor is one of the main aspects of self-monitoring of BG. From the doctor's point of view, compliance with accuracy standards is the most important criterion for choosing the glucose meter, while from the patient’s perspective it is convenience and ease of use. With improvements in technology, the accuracy of BG measurement increases, the self-monitoring of BG procedure gets simpler, which results in higher adherence to treatment and treatment efficacy. It is impossible to achieve and maintain target BG levels without active full-fledged participation of patient with type 1 dm, self-monitoring of BG using the advanced, accurate and convenient for patient glucose meter, such as contour Plus one.

Efficacy and safety of basal-bolus insulin at 1:1.5 ratio compared to 1:1 ratio using a weight-based initiation and titration (WIT2) algorithm in hospitalized patients with type 2 Diabetes: a multicenter, randomized, clinical study

BackgroundMost studies initiated basal-bolus insulin in a ratio of 1:1 and titrated based on glucose. This study aimed to investigate the effectiveness and safety of a weight-based and ratio of 1:1.5 basal-bolus insulin using an algorithm for both initiation and titration in hospitalized patients with type 2 diabetes (T2D).MethodsHospitalized patients with T2D were randomly assigned to two groups in equal numbers to receive 1:1.5 and 1:1 ratios of basal-bolus insulin using a weight-based algorithm for both initiation and titration. The primary outcome was the time taken to reach the fasting blood glucose (FBG) target and 2-h postprandial blood glucose (2hBG) targets after three meals. The secondary outcome included insulin dosage to achieve glycemic control and the incidence of hypoglycemia during hospitalization.Results250 patients were screened between October 2021 and June 2022, 220 were randomly grouped, and 182 completed the trial (89 in the 1:1.5 and 93 in the 1:1 groups). The time taken to reach FBG targets was comparable between the two groups (3.4 ± 1.7 vs. 3.0 ± 1.3 days, p = 0.137) within about 3 days. The 2hBG after three meals was shorter in the 1:1.5 group than in the 1:1group (2.9 ± 1.5 vs. 3.4 ± 1.4 days, p = 0.015 for breakfast, 3.0 ± 1.6 vs. 3.6 ± 1.4 days, p = 0.005 for lunch, and 3.1 ± 2.1 vs. 4.0 ± 1.5 days, p = 0.002 for dinner). No significant difference in insulin dosages was found between the two groups at the end of the study. The incidence of hypoglycemia was similar in both groups.ConclusionsWe demonstrated that fixed dose-ratio basal-bolus insulin at 1:1.5 calculated using a weight-based initiation and titration algorithm was simple, as effective, and safe as ratio at 1:1 in managing T2D in hospitalized patients.Trial Registration ChiCTR 2,100,050,963. Date of registration: September 8, 2021.

RESULTS OF GLYCEMIC CONTROL AMONG SEVERE STROKE PATIENTS

Background: Hyperglycemia is a relatively common condition in stroke patients, whether they have diabetes or not, and it is associated with adverse outcomes. Achieving target blood glucose levels has a partial impact on the results, but it is not the sole determinant. Objectives: We assessed the result of glycemic control among severe stroke patients. Materials and methods: A prospective study was conducted in the Stroke Department, Can Tho Central General Hospital, from June 2020 to April 2022, with 72 severe stroke patients monitored the capillary blood glucose every 3 hours. Nineteen patients who had persistent hyperglycemia were controlled with continuous intravenous insulin. We determined the average blood glucose level for each patient, the time needed to reach the glycemic target range, the frequency of hypoglycemia, and the glycemic variability from all measured blood glucose concentration. R programming was used to analyze the data. Results: The average age of patients was 65.1±16.1. The percentage of ischemic stroke, accounting for 55.6%, was the highest, followed by cerebral hemorrhage at 34.7%, 1.4% of these patients was attributed to cerebral venous thrombosis. In admission, the median Glasgow score was 8 (IQR: 7-9), and the median modified Rankin score was 5 (IQR: 4-5). Enteral nutrition was the primary nutritional therapy. Among 53 severe strokes without persistent hyperglycemia, blood glucose levels fluctuated around the mean value of 143 mg/dL. In 19 patients with persistently elevated blood glucose concentration, the mean blood glucose levels preinfusion and post-insulin infusion were 299±117mg/dL and 165±43.2mg/dL, respectively; time to glycemic target was 8.25 hours (95% CI: 3.50-14.75 hours), the minimum was 3 hours, and the longest was 189 hours; 5.3% of these patients developed hypoglycemia, and 13.3% of persistent hyperglycemia patients did not obtain the target range. Conclusions: Blood glucose levels fluctuate within the target range among patients with nonhyperglycemia or non-persistent hyperglycemia. In patients with persistent hyperglycemia controlled with intravenous insulin, the mean blood glucose levels were achieved close to the upper limit of the glycemic target.

Blood glucose monitoring devices: current considerations.

Measuring blood glucose concentrations via capillary (fingerprick) blood glucose monitoring or continuous (interstitial) glucose monitoring is an important aspect of management for many people with diabetes. Blood glucose monitoring informs patient self-management strategies, which can improve the patient's engagement in their own care and reduce barriers to achieving recommended blood glucose targets. Blood glucose monitoring also informs clinician-guided management plans. Compared to capillary blood glucose monitoring, continuous glucose monitoring in people using insulin significantly improves glycaemic metrics and is associated with improved patient-reported outcomes. Even with good glycaemic metrics, patients using continuous glucose monitoring should still have access to capillary blood glucose monitoring for correlation of hypoglycaemic readings when accuracy may be compromised or if there is a malfunction with the continuous blood glucose monitor.

The Creation of Data-Driven Preoperative Hemoglobin A1c and Same-Day Glucose Strata to Stratify Complication Risk Following Total Hip Arthroplasty

BackgroundThis study identifies data-driven strata for preoperative Hemoglobin A1c (HbA1c) and same-day glucose levels that maximize differences in the likelihood of complications following total hip arthroplasty (THA). MethodsPatients who underwent THA from 2013 to 2022 were identified using a national database. In total, 18,728 patients were identified with a mean age of 67 years (range, 18 to 80). Stratum specific likelihood ratio (SSLR) analysis determined separate strata for HbA1c and same-day glucose levels that minimized the likelihood of 90-day complications following THA. Each stratum was propensity-score matched based on age, sex, hypertension, heart failure, chronic obstructive pulmonary disease, and obesity to the lowest respective stratum. The risk ratio (RR) with respect to the lowest matched stratum was observed. ResultsOur SSLR analysis identified 3 data-driven HbA1c strata (4.5 to 5.9, 6.0 to 6.9, and 7.0+) and two same-day glucose strata (60 to 189 and 190+) that predicted 90-day major complications. For HbA1c, when compared to the lowest strata (4.5 to 5.9), the risk of 90-day major complications sequentially increased as the HbA1c strata increased: 6.0 to 6.9 (RR: 1.21; P = .041), 7+ (RR: 1.82; P < .001). For same-day glucose, when compared to the matched lowest strata (60 to 189), the risk of 90-day major complications was higher for the 190+ strata (RR: 1.5; P < .001). ConclusionsOur results support the use of multiple HbA1c strata that can be incorporated into preoperative risk-stratification models. Additionally, we identified a single cut-off level of 190 as a maximum target blood glucose level perioperatively.

Remission effect of Canagliflozin in patients with newly diagnosed type 2 diabetes mellitus: a protocol for a multicenter, parallel-group, randomized, controlled, open-label trial

BackgroundStudies reporting the effects of metabolic surgery, lifestyle intervention, and intensive insulin therapy for the remission of type 2 diabetes (T2DM) has been increasing, with fruitful results better conducted and yielded. However, there are only a few studies on the remission of T2DM using oral hypoglycemic drugs. Therefore, this study aims to investigate the remission effect of canagliflozin and metformin on participants with newly diagnosed T2DM and its possible underlying mechanism(s) through which these two medications elicit diabetes remission.MethodTo this end, we performed a multicenter, parallel-group, randomized, controlled, and open-label trial. A total of 184 participants with a ≤ 3-year course of T2DM will be enrolled and randomly assigned to the canagliflozin or metformin treatment group in a ratio of 1:1. Participants in each group will maintain their medication for 3 months after achieving the target blood glucose level and then stop it. These participants will be followed up for one year to determine remission rates in both groups.DiscussionIn this study, we will establish that whether canagliflozin is superior to metformin in terms of remission rate in participants with newly diagnosed T2DM. The results of this trial may provide robust evidence regarding the efficacy and mechanisms of the action of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in T2DM remission.Trial registrationChiCTR2100043770(February 28, 2021).

THU027 Challenges In The Management Of Extreme Hyperglycemia In An Acromegalic Patient

Abstract Disclosure: M. Sonbol: None. M. Novitskaya: None. J. Monye: None. S. Jafri: None. E. Japp: None. Introduction: Hyperglycemia in acromegalic patients presents a unique challenge given the disruption GH has on glucose homeostasis. Chronic hypersecretion of GH causes severe insulin resistance which can progress to uncontrolled DM. We describe a patient with acromegaly requiring &amp;gt;180 units/day of insulin in the perioperative period while awaiting transsphenoidal surgery. Clinical Case: A 49-year-old female with HTN and recent diagnosis of uncontrolled type 2 DM presented with several months of blurry vision and headaches. She had several prior admissions for hyperglycemia and DKA (with normal C-peptide, and negative GAD-65 and islet cell autoantibodies) despite compliance with insulin therapy. Her HbA1c was 12.2% on 2 units/kg TDD of insulin. Imaging was significant for a sellar/suprasellar solid mass with cystic components measuring 8.3 x 6.3 x 7.8 cm encasing bilateral internal carotid arteries, encroaching the left orbital apex, and applying mass effect on bilateral frontal lobes, and right temporal lobe and midbrain. Labwork was significant for IGF-1 1083 ng/mL (n&amp;lt;238), and GH of 96.4 ng/mL (n&amp;lt;8). FSH and LH were suppressed, with otherwise normal pituitary hormone levels. Interestingly, the patient did not exhibit classic clinical features of acromegaly such as macroglossia, enlarged digits or coarse facial features. Transsphenoidal biopsy demonstrated mature PIT-1 lineage NET with expression of GH and PRL. Given the significant tumor mass effect, she was placed on dexamethasone 4 mg q12h. Preoperatively, her blood glucose worsened and reached 500 mg/dL despite &amp;gt;180 units of insulin/day on a subcutaneous insulin regimen. Glycemic management was escalated with addition of regular insulin gtt up to 25 units/hr to achieve target blood glucose of 140-180 mg/dL. After successful surgical resection of the tumor, HbA1c decreased to 7.7% on 1.3 units/kg TDD of insulin, metformin and empagliflozin at eight weeks postoperatively. Clinical Lessons: Unusual presentations of rapidly increasing insulin requirements in newly diagnosed DM should raise clinical suspicion for secondary causes such as acromegaly. The degree of insulin resistance is often out of proportion to the patient’s body habitus given the GH-mediated lipodystrophy and adipose tissue dysfunction. In this case, the patient’s insulin requirement was 2 units/kg TDD of insulin, with her BMI being only 22.14 kg/m2. Given the need for semi-urgent surgery due to the tumor’s mass effect, SSA therapy or GH-receptor antagonist was not initiated, and insulin therapy was the mainstay for preoperative glucose management. In severe cases of acromegaly-related hyperglycemia, subcutaneous insulin alone may not be sufficient for adequate glucose control, especially in the setting of preoperative steroids, and large doses of IV insulin may be needed to reach inpatient glucose goals. Presentation: Thursday, June 15, 2023

THU357 A Case Of Recurrent Insulin-induced Edema In A Pediatric Adolescent Patient

Abstract Disclosure: G.J. Mora Calderon: None. R.L. Aguirre: None. D. Preston: None. Introduction: Insulin induced edema is a very rare complication seen after initiation of insulin therapy or after escalation of previous insulin regimen in patients with diabetes. The exact incidence of this condition is unknown. Insulin induced edema seems to have a female predominance and is associated primarily with patients who are underweight. The severity of insulin induced edema can range from mild localized peripheral edema to more severe and generalized complications, including cardiac failure and serosal effusions. There is a higher risk for severe complications in older patients with pre-existing cardiac, hepatic, or renal conditions. Usually, the course is benign and self-resolved without any intervention. Severe and prolonged cases have been reported to need adjuvant therapy (e.g diuretics or sympathomimetic agents) or sodium-restricted dietary regimens. Increasing blood glucose target with a decreased insulin regimen has been proposed as a possible option to prevent insulin induced edema. We present a 14 year-old-male patient with history of poor controlled type 1 diabetes mellitus and recurrent insulin-induced edema after strengthening of his insulin therapy. Case Presentation: A 14-year-old male with poorly controlled type 1 diabetes mellitus presented to the emergency with pitting edema of his face and hands that started a week after intensification of his insulin regimen. His weight increased from 73 kg to 84 kg in about 10 days. His vital signs at presentation were stable and besides the pitting edema, the rest of the physical examination was unremarkable. His mother reported a previous episode of edema that occurred approximately a year before this presentation and about a month after he was first diagnosed with diabetes mellitus. His most recent HbA1c was 14.4%. Patient was admitted for evaluation. Electrocardiogram, transthoracic echocardiogram, chest x-ray, and multiple laboratories (including a comprehensive metabolic panel, complete blood count, B-type natriuretic peptide, urine microalbumin, and thyroid function test ) came back all normal. The edema slowly improved and was eventually discharged. No adjuvant therapy was needed during his hospitalization. Conclusion: The diagnosis of insulin induced edema is primarily based on the exclusion of other etiologies. Most cases reported only one episode after initiation of insulin therapy or after escalation of previous insulin regimen, but it can happen multiple times as noted in our patient. Presentation: Thursday, June 15, 2023

Real-world data analysis for the association of glucose control and mortality in critically ill patients.

Existing results regarding the usage of glycemic control in critically ill patients for reduced morbidity and mortality have been based on clinical studies but could not be reproduced in large prospective studies. Current guidelines for glycemic control suggest a target blood glucose of 140-180mg/dL, with lower targets being appropriate for some patients. The current study aims to provide additional evidence to this area, through the usage of real-world retrospective data of everyday clinical practice. We have used the large, credentialed access database MIMIC-IV to assess the effect of glycemic control to patient mortality. Glycemic control has been characterized by the percentage of time that the glucose measurements fall within pre-specified glucose bands. Results from logistic regression and survival analysis are reported, along with visualizations based on methods from the machine learning literature, which all suggest that increased time in low and high glucose values is related to increased ICU mortality and decreased survival.

2023 Clinical Practice Guidelines for Diabetes: Recommendations for Pharmacological Treatment of Type 2 Diabetes

The 2023 clinical practice guidelines for diabetes in Korea are reviewed and updated biennially by the Committee of Clinical Practice Guidelines of the Korean Diabetes Association based on the latest scientific research and clinical trials. The 2023 guidelines include several updates to recommendations for pharmacological treatment of type 2 diabetes. The new guidelines make it clear that the treatment plan should include antidiabetic agents proven to reduce cardiorenal risk in adults with type 2 diabetes and established atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease. When considering injection-based combination therapy, GLP-1 receptor agonists (GLP-1 RAs) are recommended prior to basal insulin. If the target blood glucose level cannot be reached with GLP-1 RAs or basal insulin treatment alone, combination treatment with GLP-1 RAs and basal insulin is recommended. This review summarizes the recommendations for pharmacological treatment for type 2 diabetes in the 2023 Korean Diabetes Association treatment guidelines, focusing on major revisions.

Effects of Ramadan Fasting on Diabetic Nephropathy in Type 2 Diabetic Patients

Abstract Background Type 2 diabetes is a chronic metabolic disease that has a significant impact on the health, quality of life, and life expectancy of patients, as well as on the health care system. Diabetic nephropathy is one of the major complications of diabetes, characterized by proteinuria and renal insufficiency. The development of microalbuminuria is an early marker for diabetic nephropathy, which is potentially modifiable through lifestyle changes and pharmacological interventions targeting blood glucose and blood pressure, specifically through the renin angiotensin system. Aim of the Work The aim of this work is to study the effect of Ramadan fasting on diabetic nephropathy in type 2 diabetic patients. Patients and Methods Our study conducted on 90 type 2 diabetic patients, their age between 40-60 years; all of them are welling to fast the whole month of Ramadan, selected from the outpatient clinic of endocrinology, Ain Shams University Hospitals. Results There was a highly statistically significant increase in Creatinine (p &amp;lt; 0.001) as well as a highly statistically significant increase in urea after Ramdan in all studied group (P &amp;lt; 0.001). The Percentage change in GFR was significantly higher in macroalbuminuria. The Percentage change in A/C ratio in micro and macroalbuminuria were significantly lower when compared to normoalbuminuria, as well as in macroalbuminuria when compared to microalbuminuria groups. (P = 0.001). There were no significant differences found regarding, body mass index;, systolic blood pressure, diastolic blood pressure fasting blood glucose, postprandial blood glucose, HbA1c before and after Ramadan. Conclusion Ramadan fasting has no harmful impact on albuminuria among patients with T2DM. However, fasting leads to a significant decline in renal function parameters among diabetic patients with albuminuria. This decline is more prominent in patients with macroalbuminuria than patients with microalbuminuria. Thus, fasting should be avoided in patients with a severe decline in renal functions. Patients should be advised regarding adequate hydration and dietary modification during Pre-Ramadan health care education. On the other hand, Ramadan fasting has no negative impacts on glycemic control and other metabolic parameters. Nevertheless, further trials that assess the role of fasting in at-risk patients are still needed.

How to evaluate over 60 million blood glucose data — The design of the MÉRY Diabetes Database

AimsThe aim of the article is to describe the method for creating a close to ideal diabetes database. The MÉRY Diabetes Database (MDD) consists of a large quantity of reliable, well-maintained, precise and up-to-date data suited for clinical research with the intention to improve diabetes care in terms of maintaining targeted blood glucose levels, avoiding hypoglycemic episodes and complications and improving patient compliance and quality of life. MethodsBased on the analysis of the databases found in the literature and the experience of our research team, nine important characteristics were identified as critical to an ideal diabetes database. The data for our database is collected using MÉRYkék glucometers, a device that meets all requirements of international regulations and measures blood glucose levels within the normal range with appropriate precision (10 %). ResultsUsing the key characteristics defined, we were able to create a database suitable for the analysis of a large amount of data regarding diabetes care and outcomes. ConclusionsThe MDD is a reliable and ever growing database which provides stable and expansive foundation for extensive clinical investigations that hold the potential to significantly influence the trajectory of diabetes care and enhance patient outcomes.

Perioperative glycaemic control for people with diabetes undergoing surgery.

Perioperative glycaemic control for people with diabetes undergoing surgery.

THE EFFECT OF NEEM GUM ON THE REDUCTION IN RAT BLOOD GLUCOSE LEVELS INDUCED BY STREPTOZOTOCIN

Pharmacological therapy for diabetes, which is primarily made up of chemicals, still causes a lot of side effects. The numerous side effects of pharmacological therapy for diabetes have generated innovations in alternative diabetes therapies using ingredients derived from nature. One of the natural ingredients with an anti-hyperglycemia effect is neem gum (NG), or the sap of the neem plant (Azadirachta indica). The aim of this study was to determine the effect of NG on the reduction of blood glucose levels. Moreover, this study had six groups, including a normal control group and groups with doses of 0, 3.75, 7.5, 15, and 30 grams/kgBW. The results showed that NG reduced blood glucose levels in diabetic rats. The paired t-test showed a significant reduction in blood glucose in all groups administered NG except for the dose 3.75 group (P&lt;0.05). The minimum and maximum effective doses of NG were calculated using the quadratic regression test with the equation y = 1.059x2–46.576x+408. With a target blood glucose level of between 80 and 126 mg/dL, the minimum and maximum effective doses of NG were obtained in the range of 12–15 mg/dL. This study concluded that administering NG to diabetic rats can reduce blood glucose levels. Phytochemical studies and research are needed with serial examinations using the effective dose range of neem gum.

Maternal and fetal outcomes in a retrospective cohort of obstetrical patients that used an insulin pump paired with a continuous glucose monitor

Objective To assess maternal and neonatal outcomes in pregnant pregestational diabetic patients using a continuous subcutaneous insulin infusion (CSII) pump paired with a continuous glucose monitor (CGM). Methods This retrospective cohort study included 55 patients who delivered within one healthcare system from October 2019 to October 2022 with pregestational diabetes managed using CSII pumps paired with CGM. Maternal blood glucose (BG) data were analyzed for the two-week period preceding delivery. The percentage of time spent at a BG level of less than 140 mg/dL was recorded and compared between patients with and without obstetric and neonatal morbidities. Results Patients who delivered with severe preeclampsia (S. PreE) had a significantly lower mean percentage of time spent at BG < 140 mg/dL than those who did not (S. PreE 15/55, 63.1% ± 19.0 vs. 40/55, 73.6% ± 13.8; p = 0.03). Mothers who had a preterm birth (PTB) had a significantly lower mean percentage of time spent at BG < 140 mg/dL than those who delivered at term (PTB 35/55, 66.4% ± 16.4 vs 20/55, 78.3% ± 11.9; p = 0.006). The mean percentage of time spent at a BG < 140 mg/dL among mothers of neonates with respiratory distress syndrome (RDS) was significantly lower than those without RDS (RDS present 13/55, 59.7% ± 20.4 vs 42/55, 74.1% ± 12.7; p = 0.003). There was a significant correlation between a greater neonatal birth weight percentile and worse time spent at BG < 140 mg/dL (r = − 0.31; p = 0.02). No other significant differences were observed between the groups. Conclusion Improved blood glucose levels in pregestational diabetic patients using a CSII pump and CGM is associated with reduced maternal and neonatal morbidity as well as lower birth weight percentile neonates. Future studies are needed to clarify how much time each day a patient needs to spend below a given blood sugar, how long this blood glucose should be maintained, and what specific blood glucose target should be selected.