Glycemic Control Therapy Research Articles

GLP-1 Receptor Agonists and Risk of Paralytic Ileus: A drug-target Mendelian Randomization Study.

Paralytic ileus (PI), a condition characterized by reduced bowel motor activity without physical obstruction, can be affected by complications from type 2 diabetes (T2D) and anti-diabetic medications. It is unclear of the causal associations of glucagon-like peptide-1 receptor agonists (GLP-1RAs) with the risk of PI in the context of T2D management. To investigate the causal relationship of GLP-1RAs with PI, we conducted a 2-sample mendelian randomization (MR) study based on summary statistics from genome-wide association studies (GWAS). Genetic variants in the GLP1R were identified as genetical proxies of GLP-1RAs by the glycemic control therapy, based on genetic associations with glycated hemoglobin (GWAS n=344,182) and T2D (n cases/controls =228,499/1,178,783). The effects of GLP-1RAs were estimated for PI risk (n cases/controls =517/182,423) using GWAS data from the FinnGen project. Based on MR analysis, GLP-1RAs are causally associated with a decreased risk of PI (OR per 1 mmol/mol decrease in glycated hemoglobin: 0.21; 95% confidence interval [CI]=0.06-0.69). The magnitude of these benefit exceeded those expected from improved glycemic control more generally. Our study's findings show that GLP-1RAs are causally associated with a lower risk for PI, which provides information to guide clinicians in the selection of appropriate therapies for individuals with T2D while mitigating the risk of developing PI. Investigating the underlying mechanisms that contribute to the lower PI risk associated with GLP-1RAs is essential for a deeper understanding of these associations.

Lemierre syndrome due to Klebsiella pneumoniae: a rare case report with review of literature

Lemierre’s syndrome, a forgotten clinical entity, is characterised by septic thrombophlebitis of the internal jugular vein due to oropharyngeal infection. In the past, it was mainly associated with Fusobacterium necrophorum infections. We present a unique case report of Lemierre’s syndrome due to Klebsiella pneumoniae. Patient reported with progressive swelling involving right side of the neck that eventually increased in size. After confirming the diagnosis through CECT, patient was managed through combined medical and surgical therapy in the form of incision and drainage, targeted antibiotic therapy, glycaemic control and anticoagulation therapy. This case report highlights the association of poor glycaemic control in the pathogenesis and the isolation of Klebsiella pneumoniae as the rare organism of Lemierre’s syndrome.

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.

Diabetes treatment satisfaction among a multi-ethnic Aotearoa New Zealand population with uncontrolled type 2 diabetes mellitus

aims: To assess whether diabetes treatment satisfaction differs by ethnicity among participants with insufficient glycaemic control of type 2 diabetes mellitus in a clinical trial involving additional oral diabetes medications. Patient satisfaction is used as an indicator of healthcare quality. However, data on patients’ diabetes treatment satisfaction in the context of insufficient glycaemic control is limited. methods: Individuals with type 2 diabetes and an HbA1c of 58–110mmol/mol (7.5–12.5%) were recruited across Aotearoa New Zealand to participate in an 8-month randomised crossover study of vildagliptin and pioglitazone as add-on therapy to metformin and/or sulfonylurea. Participants completed the Diabetes Treatment Satisfaction Questionnaire (DTSQ) at baseline pre-randomisation. Treatment satisfaction scores were compared between ethnic groups and other characteristics using the analysis of variance and linear regression. Perceived hyper- and hypoglycaemia were summarised separately. results: Between February 2019 and March 2020, 346 participants (41% women, 32% Pacific peoples, 23% Māori, 26% European) completed the DTSQ. Mean (SD) age was 57.5 (10.9) years, diabetes duration was 9 (6.3) years and HbA1c was 75 (12)mmol/mol (9.0[3.2]%). At study entry, 40% were receiving monotherapy for diabetes. Treatment satisfaction was rated highly, with a score of 29(6) (interquartile range 25–33). Pacific peoples and older people reported greater treatment satisfaction than other groups (p <0.001). conclusions: Diabetes treatment satisfaction was high, particularly among Pacific peoples, despite suboptimal glycaemic control and insufficient glucose-lowering therapy.

Strategies for Cardiovascular Disease Prevention in Type 1 Diabetes: A Comprehensive Review.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with type 1 diabetes (T1D), necessitating effective prevention strategies. This comprehensive review consolidates current knowledge and evidence on preventing CVD in T1D patients. It begins by exploring the pathophysiological mechanisms that link T1D to an increased risk of CVD, highlighting factors such as chronic hyperglycemia, hypertension, dyslipidemia, and inflammation. The review also examines the epidemiology and specific risk factors for CVD in this population, emphasizing the need for rigorous risk assessment and screening. Lifestyle modifications, including dietary interventions, regular physical activity, and smoking cessation, are evaluated for their effectiveness in reducing CVD risk. Additionally, the review discusses pharmacological interventions, such as insulin therapy for glycemic control, antihypertensive medications, lipid-lowering agents, and antiplatelet therapy, underscoring their critical role in CVD prevention. Emerging therapies and future research directions are explored, focusing on novel pharmacological agents, advances in insulin delivery systems, and personalized medicine approaches. The importance of integrated care models involving multidisciplinary teams and the use of technology is highlighted as essential for comprehensive management. Challenges and barriers to implementing these strategies, including healthcare system limitations, patient adherence, and socioeconomic factors, are also addressed. This review provides a detailed synthesis of current strategies and future directions for preventing CVD in individuals with T1D, serving as a valuable resource for clinicians, researchers, and policymakers dedicated to improving cardiovascular outcomes in this high-risk population.

Salivary fructosamine in diabetic and non-diabetic individuals with healthy and diseased periodontium and its changes after non-surgical periodontal therapy.

A bidirectional relationship has been reported between diabetes mellitus and periodontitis. The present study aimed to estimate salivary fructosamine in diabetic and non-diabetic individuals with healthy and diseased periodontium and to measure its changes after non-surgical periodontal therapy. Another aim was to identify the cut-off value of salivary fructosamine to diagnose diabetes mellitus and to correlate it with glycated hemoglobin. Salivary fructosamine and HbA1c were assessed in periodontally healthy individuals and periodontitis patients (n = 60 in each group). Both groups comprised of equal number of patients with and without diabetes mellitus. Salivary fructosamine estimation was repeated 4weeks after non-surgical periodontal therapy in periodontitis patients. HbA1c and Salivary fructosamine were significantly higher in the periodontally diseased compared to the healthy group. Significantly higher values of these biomarkers were noticed in diabetic patients with periodontitis compared to the non-diabetic group. Periodontal therapy significantly reduced salivary fructosamine in both diabetic and nondiabetic periodontitis patients. A significant positive high correlation was noticed between salivary fructosamine and HbA1c (r = 0.76). The cut-off value of salivary fructosamine was found to be 68µg/mL with 95% sensitivity, 81.67% specificity, 83.82% positive predictive value, and 94.23% negative predictive value. Periodontitis can contribute to glycemic control and periodontal therapy can bring about improvement in glycemic status. Salivary fructosamine could be used as an alternate glycemic biomarker and its advantages over HbA1c include simple and non-invasive collection of saliva and it can provide intermediate glycemic status. 2020/11/038496.

Efficacy and Safety of Bromocriptine-QR as an Adjunctive Therapy on Glycemic Control in Subjects with Uncontrolled Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis.

There has been an increasing awareness of the effects of combining bromocriptine-QR with other medications for diabetes mellitus type 2. This study aimed to assess the efficacy and safety of bromocriptine-QR as an adjunctive therapy for patients with uncontrolled type 2 diabetes mellitus. This systematic review is registered at the International Prospective Register of Systematic Reviews (CRD42022360326). Literature search was done via MEDLINE, NCBI, Google Scholar, Science Direct, Europe PMC and Cochrane Library databases. We included randomized controlled trials with participants 18 years old and above with uncontrolled type 2 diabetes mellitus. The primary outcome of interest is the efficacy and safety of bromocriptine-QR as an adjunctive therapy for glycemic control. Case reports, case series, reviews and animal studies were excluded. The risk of bias was reviewed using the Cochrane Risk of Bias tool. Meta-analysis was performed using Review Manager 5.4 and presented as a weighted mean difference and 95% confidence interval for changes from the baseline level. Nine studies were included in the systematic review with a total of 2709 participants. The baseline HbA1c in the bromocriptine-QR group was 7.42% and 7.51% in the control group. The bromocriptine-QR group was favoured, outperforming the control group in terms of reducing hemoglobin A1c(HbA1c), with a statistically significant difference (weighted mean difference -0.6%; 95% CI [-0.83,-0.36]; p<0.00001). The most common side effects were nausea (33.75% vs 6.92%), fatigue (13.11% vs 5.94%), and headache (11.17% vs 6.87%). Administration of bromocriptine-QR at a dose range of 1.6 to 4.8 mg/day as an adjunctive therapy reduced HbA1c and FBG in patients with uncontrolled type 2 diabetes mellitus (T2DM). However, there were also statistically greater odds of the occurrence of adverse events such as nausea, vomiting, and headache compared to controls.

Haptoglobin Phenotype and Intensive Glycemic Control for Coronary Artery Disease Risk Reduction in People With Type 2 Diabetes: The ADVANCE Study.

Intensive glycemic control reduced coronary artery disease (CAD) events among the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study participants with the haptoglobin (Hp)2-2 phenotype but not in participants without the Hp2-2 phenotype. It is unknown whether and how these results translate across different demographic/clinical characteristics and treatment strategies. Haptoglobin phenotype was measured in available samples from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) biomarker case-cohort study. Weighted multivariable-adjusted Cox regression models were used to evaluate the association between intensive glycemic control (HbA1c target of ≤6.5%) versus standard therapy (based on local guidelines) and major CAD events among participants with (n = 1,327) and without (n = 2,077) the Hp2-2 phenotype separately and within prespecified stratifications by sex, race, previous cardiovascular disease (CVD), diabetes duration, and HDL-cholesterol. While the hazard ratios (HRs) were in the hypothesized differing directions, compared with standard therapy, intensive glycemic control was not significantly associated with risk of CAD events among participants without (1.04, 95% CI 0.82-1.32) or with (0.84, 0.63-1.14, Pinteraction = 0.27) the Hp2-2 phenotype overall. Intensive therapy was associated with lower CAD risk among participants with the Hp2-2 phenotype who had no previous CVD (0.47, 0.29-0.76, Pinteraction = 0.01). Our findings suggest that intensive glycemic control contributes to the prevention of major CAD events among ADVANCE participants with the Hp2-2 phenotype and no previous CVD and are in alignment with our hypothesis that intensive glycemic control may be beneficial in a subset of people with the Hp2-2 phenotype.

Dental Stem Cell-Based Therapy for Glycemic Control and the Scope of Clinical Translation: A Systematic Review and Meta-Analysis

Background: The tooth is a repository of stem cells, garnering interest in recent years for its therapeutic potential. The aim of this systematic review and meta-analysis was to test the hypothesis that dental stem cell administration can reduce blood glucose and ameliorate polyneuropathy in diabetes mellitus. The scope of clinical translation was also assessed. Methods: PubMed, Cochrane, Ovid, Web of Science, and Scopus databases were searched for animal studies that were published in or before July 2023. A search was conducted in OpenGrey for unpublished manuscripts. Subgroup analyses were performed to identify potential sources of heterogeneity among studies. The risk for publication bias was assessed by funnel plot, regression, and rank correlation tests. Internal validity, external validity, and translation potential were determined using the SYRCLE (Systematic Review Center for Laboratory Animal Experimentation) risk of bias tool and comparative analysis. Results: Out of 5031 initial records identified, 17 animal studies were included in the review. There was a significant decrease in blood glucose in diabetes-induced animals following DSC administration compared to that observed with saline or vehicle (SMD: −3.905; 95% CI: −5.633 to −2.177; p = 0.0004). The improvement in sensory nerve conduction velocity (SMD: 4.4952; 95% CI: 0.5959 to 8.3945; p = 0.035) and capillary-muscle ratio (SMD: 2.4027; 95% CI: 0.8923 to 3.9132; p = 0.0095) was significant. However, motor nerve conduction velocity (SMD: 3.1001; 95% CI: −1.4558 to 7.6559; p = 0.119) and intra-epidermal nerve fiber ratio (SMD: 1.8802; 95% CI: −0.4809 to 4.2413; p = 0.0915) did not increase significantly. Regression (p &lt; 0.0001) and rank correlation (p = 0.0018) tests indicated the presence of funnel plot asymmetry. Due to disparate number of studies in subgroups, the analyses could not reliably explain the sources of heterogeneity. Interpretation: The direction of the data indicates that DSCs can provide good glycemic control in diabetic animals. However, methodological and reporting quality of preclinical studies, heterogeneity, risk of publication bias, and species differences may hamper translation to humans. Appropriate dose, mode of administration, and preparation must be ascertained for safe and effective use in humans. Longer-duration studies that reflect disease complexity and help predict treatment outcomes in clinical settings are warranted. This review is registered in PROSPERO (number CRD42023423423).

An Observational Study of Glycemic Status in New Onset Acute Stroke and Their Clinical Outcome in a Tertiary Care Teaching Hospital

Abstract Objective The study was aimed to test the blood glucose level in acute stroke patients to find out any correlation with types and prognosis of different glycaemic groups. Method It was a prospective observational study of patients admitted to hospital in Nizamabad due to an acute ischemic or hemorrhagic stroke (&lt;24Hrs after the onset). Clinical parameters including history and clinical examination findings were recorded. CT scan of brain, blood glucose level, HbA1c, and other laboratory tests were taken in all the patients. 2D echocardiography (2D-ECHO) and X-Ray chest picture were also performed. According to glycaemia, the patients were classified into four groups such as Nondiabetic/euglycemic, known Diabetics on glycemic control therapy with or without glycemic control, Newly detected diabetics, and Stress hyperglycemia patients. On the day 1 and 15 National Institutes of Health Stroke Scale (NIHSS) was calculated to evaluate the severity of stroke and its outcome. Good prognosis was considered when NIHSS 5, moderate prognosis when NIHSS was 6–15, and poor prognosis when NIHSS was 16–20. Patients with NIHSS 20 died within 3 days of admission. Results Finally, 158 patients with acute stroke were included. Hemorrhagic stroke was seen in 43 (27.2%) and ischaemic stroke in 115 (72.8%) patients. Maximum cases were found in 51–60 years age group (37.9%) followed by 41–50 (20.3%) and 61–70 years age group (20.3%). Majority of study subjects were males, 65.8 % (n=104). Maximum cases were Euglycemics (44.3%), followed by stress hyperglycemic (27.8%), known diabetes (15.9%), and newly diagnosed diabetes (12%) presenting with acute stroke. Higher NIHSS score was found in stress hyperglycemic patients (19.4%) followed by known diabetics (17.3%), newly detected diabetics (16.3%), and euglycemics (9.5%). Maximum proportion (81.8%) of ischaemic stroke cases were found with stress hyperglycemia compared to other glycemic conditions but in hemorrhagic stroke maximum proportion (47.3%) were newly diagnosed diabetics. Maximum proportion of large size of lesion (47.4%) was found in newly diagnosed diabetes followed by stress hyperglycemia (45.55). Medium size of the lesions was found more in newly diagnosed diabetes (52.6%) followed by known diabetes cases (52%). Good outcome was found in 51 cases (32.2%), moderate outcome in 34 (21.5%), and poor outcome was in 30 (18.9%). 43 patients with NIHSS score &gt;20 died within 3 days of admission (27.2%). Maximum proportion of death cases in ischemic group those belongs to newly diagnosed diabetes cases (8/9=88.8%). Higher deaths were found in blood sugar &lt;110 mg/dl and blood sugar &gt;199 mg/dl with an incidence rates of 41.2% and 53.4%. Conclusion Hyperglycaemia in non-diabetic patients after acute stroke is a stress response reflecting more severe neurological damage. Elevated HbA1c presenting stroke glycaemia status has a significant trend in increasing the risk of cause mortality. The management of hyperglycaemia in patients with diabetes and non-diabetes is an important aspect of the emergency management of stroke.

THU383 “My Hands Are Always Stiff”: A Common But Underrecognized Mimicker Of Inflammatory Arthritis.

Abstract Disclosure: I. Iqbal: None. A. Minalyan: None. M. Khan: None. Introduction: Inflammatory arthropathies are often identified in patients by their characteristic patterns, including symmetric small joint involvement, joint stiffness that can improve with physical activity, and others. However, it is crucial to address comorbidities and their impact on symptom presentation when assessing these patients. Here we present a case of a relatively common but underrecognized mimicker of inflammatory arthropathies. Case: A 63-year-old man with Type 1 Diabetes Mellitus (DM1) and seronegative rheumatoid arthritis (RA) was referred to a rheumatology clinic by his family physician to manage RA. He was previously treated with prednisone and methotrexate for six months for presumed seronegative rheumatoid arthritis without any relief. He reported chronic pain and stiffness in his joints: wrists, metacarpophalangeal (MCP), proximal and distal interphalangeal (PIP and DIP) joints, ankles, and feet. His symptoms were worse in the morning. However, on further questioning, he admitted that the stiffness did not improve throughout the day. He denied joint swelling or redness over the affected joints. On exam, his hand joints had significant stiffness. We obtained hand radiographs which did not show erosive changes or significant joint space narrowing. He had negative rheumatoid factor (RF), normal anti-cyclic citrullinated peptide (CCP) antibodies, and antinuclear antibody (ANA) levels, which ruled out the diagnosis of rheumatoid arthritis. A detailed physical exam demonstrated a positive “prayer sign” and “tabletop sign.” Further lab review showed that his hemoglobin A1c (HbA1C) had been ranging between 8% to 10% over several years. Eventually, the patient was diagnosed with limited joint mobility due to the poorly controlled DM1. We discontinued his methotrexate and referred him to an endocrinologist to manage the uncontrolled DM1. He was referred to physical therapy for hand stretching exercises. After six months of treatment, his symptoms improved but did not resolve completely. Conclusion: It is essential to identify the impact of diabetes on the musculoskeletal system. Limited joint mobility, previously known as diabetic cheiroarthropathy (DCA), is a common but frequently missed manifestation of poorly controlled diabetes. It is characterized by a limited ability to flex or extend the MCP and IP joints. It may or may not be painful and can progress to fixed flexion contractures of the finger joints. Early recognition is essential for correct diagnosis. Treatment is with tighter glycemic control and physical therapy. Presentation: Thursday, June 15, 2023

Efficacy of automated insulin delivery (AID) systems in type 1 diabetes: protocol of a systematic review and network meta-analysis of outpatient randomised controlled trials

IntroductionAutomated insulin delivery (AID), also known as artificial pancreas system or ‘closed-loop system’, represents a novel option for current treatments for type 1 diabetes (T1D). The objective of this systematic...

The Impact of COVID 19 on Glycemic Control in Children with Type 1 Diabetes on Insulin Pump Therapy: A Single Centre Study

Background Children with type 1 diabetes (T1DM) are at risk of glycemic deterioration during the COVID-19 pandemic due to several factors. However, some studies reported glycemic improvement in these children. Aim To assess the impact of COVID-19 on children with T1DM on insulin pump in terms of glycemic control and insulin therapy adjustments. Methodology Forty-two children with T1DM on insulin pump (Medtronic) for at least 3 months were recruited from the Pediatric and Adolescent Diabetes Unit (PADU), Ain-Shams University, Cairo, Egypt. They were assessed for insulin requirements, frequency of diabetic ketoacidosis and clinically significant hypoglycemia. Auxological parameters, HbA1c and lipid profile were assessed. Continuous glucose monitoring was performed using Medtronic i-pro device for 5 days for each patient. Data were compared to previous patients’ data obtained from their medical records. Study period was performed between 29/6/2020 until 29/12/2020. Results This study was carried out on 42 children with T1DM on insulin pump (15 males and 27 females with a male to female ratio of 1: 1.8) with a mean age of 11.31± 3.28 years, mean BMI of 18.80± 3.35 and mean disease duration of 4.40± 2.93 years. The mean insulin requirements of the studied children before the COVID- 19 pandemic was 0.83 ± 0.28 U/kg/d, range 0.5- 1.8 U/Kg/d with a mean basal percentage of 51.19 ± 3.46 %, range 45-60 % .As regards the laboratory data of the studied children with a mean HbA1c of 9.0±1.2%, range: 7-11.8%, mean fasting cholesterol of 184.88 ± 27.03 mg/dl, range: 142-233 mg/dl, mean fasting triglycerides of 89.81 ± 32.69 mg/dl, range: 43-148 mg/dl, mean LDL of 87.77±9.97 mg/dl, range: 68-98 mg/dl, mean HDL of 58.33± 12.28, range: 32-83 and median UACR was 13(10-21.9) mg/g, range: 7.0-94. There was a statistically significant increase in the total daily insulin units(P = 0.001), basal percentage (P = 0.011) and time in range (p = 0.009) with a significant decrease in the frequency of DKA (P = 0.001), hypoglycemia (P = 0.004), HbA1c (p = 0.001) and glycemic variability (p = 0.001) after the COVID-19 pandemic. Conclusion Glycemic control improved during the COVID-19 pandemic among children with T1DM on insulin pump therapy reflected by improvement in TIR and decrease in glycemic variability. Declarations Conflicts of interest disclosure The authors declare that they have no conflict of interest. Funding sources No funding sources

Glycaemic control and insulin therapy are significant confounders of the obesity paradox in patients with heart failure and diabetes mellitus.

A high body mass index (BMI) confers a paradoxical survival benefit in patients with heart failure (HF) or diabetes mellitus (DM). There is, however, controversy whether an obesity paradox is also present in patients with HF and concomitant DM. In addition, the influence of glycaemic control and diabetes treatment on the presence or absence of the obesity paradox in patients with HF and DM is unknown. We identified 2936 patients with HF with reduced ejection fraction (HFrEF) in the HF registries of the universities of Heidelberg, Germany, and Hull, UK (general sample). Of these, 598 (20%) were treated for concomitant DM (DM subgroup). The relationship between BMI and all-cause mortality was analysed in both the general sample and the DM subgroup. Patients with concomitant DM were stratified according to HbA1c levels or type of diabetes treatment and analyses were repeated. We found an inverse BMI-mortality relationship in both the general sample and the DM subgroup. However, the obesity paradox was less pronounced in patients with diabetes treated with insulin and it disappeared in those with poor glycaemic control as defined by HbA1c levels > 7.5%. In patients with HFrEF, a higher BMI is associated with better survival irrespective of concomitant DM. However, insulin treatment and poor glycaemic control make the relationship much weaker.

Diabetic peripheral neuropathy - advances in diagnosis and treatment

Diabetes mellitus is one of the most alarming conditions of the 21st century. The prevalence of both type 1 and 2 diabetes is constantly increasing, which also entails a growing number of patients suffering from its various complications. One of the most common chronic complications is diabetic neuropathy (DN), which is developed by at least 50% of patients with diabetes. Diabetic peripheral neuropathy (DPN) is the most frequent type of DN. Clinically, a non-painful and a painful-DPN can be distinguished. The painful type causes a massive decrease in the quality of life and affects around 30% of individuals with DM. In recent years many instruments have been used to diagnose and treat DPN but none of them seems to be sufficient in early diagnosis and satisfactory symptoms management. To date, there is any gold standard to recognize DNP and usually it is noticed when a patient presents symptoms of neuropathy, which is too late to introduce an effective therapy. The main approaches for patients with DNP focus on improving glycaemic control, lifestyle modifications and pain therapy. Multiple medicaments are used for this purpose, among which SNRIs, TCAs and anticonvulsants are most effective. Non-pharmacologic treatment, such as acupuncture, physical therapy, nerve stimulation, also has been used, however their effectiveness remains uncertain.

Fecal Microbiota Transplantation for Weight and Glycemic Control of Obesity as Well as the Associated Metabolic Diseases: Meta-Analysis and Comprehensive Assessment.

Objectives: An analysis of the weight and blood glucose management associated with fecal microbiota transplantation (FMT) as well as metabolic diseases associated with FMT was conducted by the authors in order to provide clinical recommendations regarding the treatment of nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). Methods: We searched PubMed, Embase, and the Cochrane Library for papers that were published between the creation of the database and October 2022. We reviewed research that investigated how FMT affected weight and glycemic management in cases of obesity and metabolic conditions that are related to obesity. Studies that were published more than once, lacked the entire text, included insufficient information, or were impossible to extract data from were excluded. Additionally, case reports, reviews, and systematic reviews were excluded from the analysis. In order to analyze the data, STATA 15.1 was used. Outcomes: When we combined all of our findings, we discovered that pooled outcomes showed that weight levels (WMD equals -4.77, 95%CI: -7.40~-2.14), BMI levels (WMD equals -1.59, 95%CI: -2.21~-0.97), HOMA-IR (WMD equals -0.79, 95%CI: -1.57~-0.00), and HbA1c (WMD equals -0.65, 95%CI: -0.75~-0.55) after FMT treatment were significantly lower than before treatment. However, FMT treatment may have no effect on glucose and insulin levels in obese patients at fasting and related metabolic diseases. Additionally, subgroup analysis outcomes found that FMT significantly reduced fasting blood glucose in people with diabetes. Conclusions: As a weight loss and glycemic control therapy, FMT helps to prevent and treat metabolic problems linked to obesity, and is a viable alternative to bariatric surgery for patients who do not wish to undergo the procedure.

Relationship between glycemic control and mental health in community-dwelling older people with diabetes mellitus: The SONIC study

The purpose of this study was to examine the relationship between glycemic control and mental health in community-dwelling older people with diabetes mellitus (DM) from insights that contribute to the management of diabetes in consideration of quality of life (QOL). We used the data of the Septuagenarians, Octogenarians and Nonagenarians Investigation with Centenarians (SONIC) study, a prospective cohort study of community-dwelling older people. The present study included 2,051 older subjects of 70±1 years, 80±1 years and 90±1 years of age. We conducted medical interviews, blood sampling, and the subjects were asked to complete a questionnaire (WHO-5-J) at the venue. Three hundred sixty-eight people were diagnosed with DM. The subjects of this study were 192 people who were undergoing drug therapy for glycemic control. A multiple regression analysis was performed to clarify the relationship between glycemic control (divided as follows: HbA1c<7.0%, good control group; HbA1c≥7.0%, poor control group) and the WHO-5-J score, as the dependent variable, after adjusting for any confounding factors. In subjects of 70 years of age, a negative association was found between glycemic control and the WHO-5-J score, with the good control group showing a significantly lower score (β: -0.468, p<0.01) in comparison to the poor control group. In detail, we observed a significant difference in the sub-items of WHO-5-J, question item 3, "I have felt active and vigorous" at 70 years of age (good control group, 2.56±1.37; poor control group, 3.21±1.18; p=0.021) and question item 5, "My daily life has been filled with things that interest me" (good control group, 2.44±1.21; poor control group, 3.11±1.11; p=0.009). As for the two questions, the WHO-5-J scores were lower in the good control group. These associations showed no statistical significance at 80 years of age or 90 years of age. The results obtained in this study indicated that strict glycemic control management of diabetes mellitus may lead to a lower mental QOL in younger elderly individuals (70 years of age). Therefore, it is important to pay attention to the mental burdens of the management of glycemic control in older people with DM.

NAFLD: A pretransplant and post-transplant conundrum.

1_mbm16h84Kaltura.

Diabetes management in patients undergoing total pancreatectomy: A single center cohort study.

Total pancreatectomy (TP) has been increasingly performed in recent years. However, studies on diabetes management after TP during different postoperative periods are still limited. This study aimed to evaluate the glycemic control and insulin therapy of patients undergoing TP during the perioperative and long-term follow-up period. Ninety-three patients undergoing TP for diffuse pancreatic tumors from a single center in China were included. Based on preoperative glycemic status, patients were divided into three groups: nondiabetic group (NDG, n = 41), short-duration diabetic group (SDG, preoperative diabetes duration ≤12 months, n = 22), and long-duration diabetic group (LDG, preoperative diabetes duration >12 months, n = 30). Perioperative and long-term follow-up data, including the survival rate, glycemic control, and insulin regimens, were evaluated. Comparative analysis with complete insulin-deficient type 1 diabetes mellitus (T1DM) was conducted. During hospitalization after TP, glucose values within the target (4.4-10.0 mmol/L) accounted for 43.3% of the total data, and 45.2% of the patients experienced hypoglycemic events. Patients received continuous intravenous insulin infusion during parenteral nutrition at a daily insulin dose of 1.20 ± 0.47 units/kg/day. In the long-term follow-up period, glycosylated hemoglobin A1c levels of 7.43 ± 0.76% in patients following TP, as well as time in range and coefficient of variation assessed by continuous glucose monitoring, were similar to those in patients with T1DM. However, patients after TP had lower daily insulin dose (0.49 ± 0.19 vs 0.65 ± 0.19 units/kg/day, P < 0.001) and basal insulin percentage (39.4 ± 16.5 vs 43.9 ± 9.9%, P = 0.035) than patients with T1DM, so did those using insulin pump therapy. Whether in the perioperative or long-term follow-up period, daily insulin dose was significantly higher in LDG patients than in NDG and SDG patients. Insulin dose in patients undergoing TP varied according to different postoperative periods. During long-term follow-up, glycemic control and variability following TP were comparable to complete insulin-deficient T1DM but with fewer insulin needs. Preoperative glycemic status should be evaluated as it could guide insulin therapy after TP.

Непрерывная подкожная инфузия инсулина в послеоперационном периоде коронарного шунтирования

Aim. To assess an efficacy of continuous glucose monitoring system (CGMS) combined with insulin pump therapy for perioperative glycemic control after coronary artery bypass grafting (CABG). Design. Prospective comparative study. Materials and methods. We used CGMS for 72 hours in 105 patients with coronary artery disease including 52 ones with diabetes mellitus type 2 (DM2). Patients with DM2 were divided into 2 subgroups: insulin pump therapy (subgroup 1) and bolus intravenous insulin according to in-hospital protocol (subgroup 2). We analyzed pro-inflammatory markers, adipokines and incidence of postoperative complications in one hour, 12 hours, 7 days and 1 year after CABG. Results. Insulin pump therapy ensured target glycemia in most cases (62.5%) while bolus intravenous insulin injection was followed by normal glucose level in 21.4% of patients (p = 0.003). Insulin pump therapy significantly decreased highly sensitive C-reactive protein after 12 hours (p = 0.0001), RANTES after 7 days (p = 0.035). In patients on insulin pump therapy the leptin level after 7 days was significantly lower than in the subgroup 2 (p = 0.039). There was a negative relationship between the leptin level after 7 days and the use of CGMS combined with insulin pump therapy (r = –0.73; p = 0.025). In patients on insulin pump therapy the adiponectin level after 1 year was significantly higher than in the subgroup 2 (p = 0.028). Insulin pump therapy decreased the incidence of postpericardiotomy syndrome (p = 0.03) and the period of hospitalization (p = 0.007), but there was no significant difference in the rate of complications in the long-term period. Conclusion. CGMS combined with insulin pump therapy is safe and effective for perioperative glycemic control, as well as decrease of the incidence of postpericardiotomy syndrome. Keywords: coronary artery disease, diabetes mellitus type 2, coronary artery bypass surgery, insulin infusion system.