Uncontrolled Blood Glucose Levels Research Articles

Determinants of Complications of Diabetic Among Adult with Type 2 Diabetic Patients at Hubaal Specialist Hospital and Libaan Hospital in Mogadishu: Case Control Study

<i>Background</i>: Diabetes mellitus is a major global health issue characterized by persistently high blood sugar levels due to insufficient insulin production or decreased insulin efficacy. Over 422 million adults have diabetes worldwide, with an expected rise to 642 million by 2040. Type 2 diabetes accounts for about 90% of these cases. Sub-Saharan Africa is seeing a notable rise in type 2 diabetes due to lifestyle changes and an aging population In Somalia, the private-sector-dominated healthcare system, exacerbated by prolonged armed conflicts, struggles with affordable diabetes management, leading to increased diabetic complications. With an estimated 5% prevalence of diabetes in Somalia, the lack of routine screening and limited access to affordable healthcare further elevate the prevalence and complications, particularly among those with type 2 diabetes. <i>Objective</i>: This study aimed to identify socio-demographic, healthcare, lifestyle, and clinical factors associated with diabetic complications among adults with type 2 diabetes at selected hospitals in Mogadishu, Somalia. <i>Methods</i>: A case-control study of 187 type 2 diabetes patients used purposive sampling and structured questionnaires to collect data. Analysis was performed using SPSS version 27.0 with bivariate and logistic regression, and significance was set at p ≤ 0.05. <i>Results</i>: The study found that participants aged over 47 years had significantly higher odds of developing diabetic complications compared to those aged 18-27 years (OR: 3.17, 95% CI: 1.26-7.96, p = 0.014). In the multiple regression analysis, the duration of diabetes significantly influenced the risk of complications, with those diagnosed for 5-10 years (AOR: 3.50, 95% CI: 1.19-10.28, p = 0.029) and more than 10 years (AOR: 3.59, 95% CI: 1.36-9.49, p = 0.011) having increased odds. Uncontrolled blood glucose levels were also a significant predictor of complications (AOR: 3.55, 95% CI: 1.82-6.91, p < 0.001). Other factors, such as marital status and monthly income, were not significant in the multiple regression analysis. <i>Conclusion</i>: This study highlights the importance of early detection and management of diabetes to prevent complications, especially among older adults and those with longer disease duration. Interventions should focus on improving glycemic control and managing comorbid conditions. Targeted education and support for patients, especially those at higher risk, are crucial to mitigating the impact of diabetic complications.

Hubungan Tingkat Kepatuhan Pasien pada Penggunaan Obat Antidiabetes terhadap Kadar Glukosa Darah di Puskesmas X Indramayu

Diabetes mellitus (DM) is a global public health threat, and around 90% of all patients suffering from DM throughout the world are type 2 DM. Non-compliance related to Diabetes Mellitus is something that is a problem that should be avoided. This study aims to determine the level of patient compliance with the use of antidiabetic drugs at the Cidemp Indramayu Community Health Center, and to determine the relationship between the level of compliance of Diabetes Mellitus patients with blood glucose levels (fasting and while) at the Cidemp Indramayu Community Health Center. This research is a type of analytical observational research with a research design. cross-sectional. Data analysis in this study used SPSS version 23 software. The results showed that the majority of respondents fell into the "compliant" category, 20 respondents (62.5%) compared to "non-compliant" 12 respondents (37.5%). In addition, when checking blood glucose levels it was found that 62.5% of "compliant" patients had controlled fasting blood glucose levels, while only 28.1% of "compliant" patients had uncontrolled fasting blood glucose levels. Regarding the relationship between the level of absolute compliance with fasting blood glucose levels (P= 0.005), the results of compliance with glucose levels when controlled were (0.003). Keywords: diabetes mellitus, patient compliance, blood glucose levels.

3D printing and bioprinting in the battle against diabetes and its chronic complications.

Diabetes is a metabolic disorder characterized by high blood sugar. Uncontrolled blood glucose affects the circulatory system in an organism by intervening blood circulation. The high blood glucose can lead to macrovascular (large blood vessels) and microvascular (small blood vessels) complications. Due to this, the vital organs (notably brain, eyes, feet, heart, kidneys, lungs and nerves) get worsen in diabetic patients if not treated at the earliest. Therefore, acquiring treatment at an appropriate time is very important for managing diabetes and other complications that are caused due to diabetes. The root cause for the occurrence of various health complications in diabetic patients is the uncontrolled blood glucose levels. This review presents a consolidated account of the applications of various types of three-dimensional (3D) printing and bioprinting technologies in treating diabetes as well as the complications caused due to impaired blood glucose levels. Herein, the development of biosensors (for the diagnosis), oral drug formulations, transdermal drug carriers, orthotic insoles and scaffolds (for the treatment) are discussed. Next to this, the fabrication of 3D bioprinted organs and cell-seeded hydrogels (pancreas engineering for producing insulin and bone engineering for managing bone defects) are explained. As the final application, 3D bioprinting of diabetic disease models for high-throughput screening of ant-diabetic drugs are discussed. Lastly, the challenges and future perspective associated with the use of 3D printing and bioprinting technologies against diabetes and its related chronic complications have been put forward.

Android-Based Lifestyle Management Application for Type-2 Diabetes Mellitus Patients

Diabetes Mellitus (DM) Type-2 is a chronic disease that occurs due to uncontrolled blood glucose levels in the body. Uncontrolled glucose levels in people with Type-2 Diabetes Mellitus can cause various kinds of complications, therefore this research aims to create an Android application that can help people with Type-2 Diabetes Mellitus in controlling blood glucose levels. This application creation method includes the stages of preparation and application creation by conducting previous literature studies, which produce a theoretical model. The result of this research is a lifestyle management application for type 2 diabetes mellitus patients called Selfcare Glucose Management (SCGM), which has 4 kinds of features, including a feature that can calculate daily calorie needs by displaying various types of food with a predetermined weight and number of calories, an alarm feature that functions to remind patients to take medication and inject insulin, a physical activity training feature and a feature that contains educational material about Diabetes Mellitus. This application has been tested using application measurement methods in the form of repeated manual calculations or calibration and obtained results that match the expected values. It is hoped that this application can be developed to be more interactive and communicative in its use.

Self-management challenges of adults with type 2 diabetes mellitus in Ekurhuleni district primary health care facilities amid COVID-19 lockdown.

Self-management is highly recommended in managing type 2 diabetes mellitus (T2DM). Amid the coronavirus disease 2019 (COVID-19) lockdown, many restrictions were imposed, which might have affected the continuum of care and self-management. However, little is known about how people with T2DM experienced self-management during COVID-19 lockdown within the primary health care (PHC) facilities. The study explored and described the self-management challenges of adults with T2DM in Ekurhuleni PHC facilities amid COVID-19 level 5 and 4 lockdowns. The study was conducted in three community health centres in Ekurhuleni which are rendering PHC services. A phenomenological, qualitative, exploratory, and descriptive design was utilised. Purposive sampling was used to select adult patients with T2DM. Data were collected telephonically between July 2022 and August 2022 using semi-structured interviews. Inductive content analysis was used to analyse data. Two themes emerged from the interviews, namely, uncontrolled blood glucose levels and financial challenges. The patients with T2DM experienced uncontrolled blood glucose levels and financial challenges during the COVID-19 lockdown. Guidelines to improve self-management programmes during restrictions are needed to promote good health during future pandemics to prevent complications and mortality. The telehealth model can be designed to monitor chronic patients at home during lockdown as a two-way communication.Contribution:More knowledge and insight into self-management and health promotion of patients with T2DM was provided by this study. Increased training needs arose for PHC nurses in managing and monitoring patients.

Interplay between Senescence and Macrophages in Diabetic Cardiomyopathy: A Review of the Potential Role of GDF-15 and Klotho.

Type 2 diabetes mellitus (T2DM) is a critical health problem, with 700 million diagnoses expected worldwide by 2045. Uncontrolled high blood glucose levels can lead to serious complications, including diabetic cardiomyopathy (DCM). Diabetes induces cardiovascular aging and inflammation, increasing cardiomyopathy risk. DCM is characterized by structural and functional abnormalities in the heart. Growing evidence suggests that cellular senescence and macrophage-mediated inflammation participate in the pathogenesis and progression of DCM. Evidence indicates that growth differentiation factor-15 (GDF-15), a protein that belongs to the transforming growth factor-beta (TGF-β) superfamily, is associated with age-related diseases and exerts an anti-inflammatory role in various disease models. Although further evidence suggests that GDF-15 can preserve Klotho, a transmembrane antiaging protein, emerging research has elucidated the potential involvement of GDF-15 and Klotho in the interplay between macrophages-induced inflammation and cellular senescence in the context of DCM. This review explores the intricate relationship between senescence and macrophages in DCM while highlighting the possible contributions of GDF-15 and Klotho.

Correlation between cardiovascular risk and glycemic control among patients with diabetes

Abstract Background: Cardiovascular diseases (CVD) continue to be the leading cause of mortality in patients with diabetes. Uncontrolled blood glucose levels are thought to increase the likelihood of CVD in individuals with diabetes. Therefore, stratification of cardiovascular risk in people with diabetes is crucial. Objective: To assess the relationship between cardiovascular risk, as measured by the Jakarta Cardiovascular Score (JCS), and blood glucose control, as shown by hemoglobin A1c (HbA1c) levels, in individuals with diabetes. Materials and Methods: A cross-sectional analytic analysis was undertaken in a private clinic between April and June 2022. This study examined 110 diabetes patients who had not experienced any cardiovascular complications. Correlation analysis was employed to investigate the association between the risk of CVD and levels of HbA1c. Results: According to JCS, a significant proportion of patients (86.4%) were classified as high risk for CVD. The recorded HbA1c values varied from 5% to 16.20%. Around 90% of the study participants exhibited uncontrolled blood glucose levels, as evidenced by an HbA1c value exceeding 7%. Nevertheless, individuals with HbA1c levels below 7% exhibited a more excellent average total risk score. The JCS and HbA1c levels showed a weak negative connection, with a correlation coefficient (r) of -0.198 and a P value of 0.038. Conclusion: There is a weak negative correlation between the cardiovascular risk score of diabetic patients and their blood glucose control.

Atezolizumab in Combination With Carboplatin and Survival Outcomes in Patients With Metastatic Triple-Negative Breast Cancer

Agents targeting programmed death ligand 1 (PD-L1) have demonstrated efficacy in triple-negative breast cancer (TNBC) when combined with chemotherapy and are now the standard of care in patients with PD-L1-positive metastatic disease. In contrast to microtubule-targeting agents, the effect of combining platinum compounds with programmed cell death 1 (PD-1)/PD-L1 immunotherapy has not been extensively determined. To evaluate the efficacy of atezolizumab with carboplatin in patients with metastatic TNBC. This phase 2 randomized clinical trial was conducted in 6 centers from August 2017 to June 2021. Patients with metastatic TNBC were randomized to receive carboplatin area under the curve (AUC) 6 alone or with atezolizumab, 1200 mg, every 3 weeks until disease progression or unacceptable toxic effects with a 3-year duration of follow-up. The primary end point was investigator-assessed progression-free survival (PFS). Secondary end points included overall response rate (ORR), clinical benefit rate (CBR), and overall survival (OS). Other objectives included correlation of response with tumor PD-L1 levels, tumor-infiltrating lymphocytes (TILs), tumor DNA- and RNA-sequenced biomarkers, TNBC subtyping, and multiplex analyses of immune markers. All 106 patients with metastatic TNBC who were enrolled were female with a mean (range) age of 55 (27-79) years, of which 12 (19%) identified as African American/Black, 1 (1%) as Asian, 73 (69%) as White, and 11 (10%) as unknown. Patients were randomized and received either carboplatin (n = 50) or carboplatin and atezolizumab (n = 56). The combination improved PFS (hazard ratio [HR], 0.66; 95% CI, 0.44-1.01; P = .05) from a median of 2.2 to 4.1 months, increased ORR from 8.0% (95% CI, 3.2%-18.8%) to 30.4% (95% CI, 19.9%-43.3%), increased CBR at 6 months from 18.0% (95% CI, 9.8%-30.1%) to 37.5% (95% CI, 26.0%-50.6%), and improved OS (HR, 0.60; 95% CI, 0.37-0.96; P = .03) from a median of 8.6 to 12.6 months. Subgroup analysis showed PD-L1-positive tumors did not benefit more from adding atezolizumab (HR, 0.62; 95% CI, 0.23-1.65; P = .35). Patients with high TILs (HR, 0.12; 95% CI, 0.30-0.50), high mutation burden (HR, 0.50; 95% CI, 0.23-1.06), and prior chemotherapy (HR, 0.59; 95% CI, 0.36-0.95) received greater benefit on the combination. Patients with obesity and patients with more than 125 mg/dL on-treatment blood glucose levels were associated with better PFS (HR, 0.35; 95% CI, 0.10-1.80) on the combination. TNBC subtypes benefited from adding atezolizumab, except the luminal androgen receptor subtype. In this randomized clinical trial, the addition of atezolizumab to carboplatin significantly improved survival of patients with metastatic TNBC regardless of PD-L1 status. Further, lower risk of disease progression was associated with increased TILs, higher mutation burden, obesity, and uncontrolled blood glucose levels. ClinicalTrials.gov Identifier: NCT03206203.

THU374 Fulminant Type 1 Diabetes Mellitus And DKA Secondary To Pembrolizumab

Abstract Disclosure: I. Iqbal: None. M. Khan: None. M. Ahmad: None. R. Mehreen: None. Introduction: Pembrolizumab is a programmed cell death receptor (PD-1) binder on T cells, which promotes their activation against cancer cells. It can also cause unwanted T cell activation against the body’s own cells, leading to type 1 diabetes mellitus (DM1), among other autoimmune phenomena. We are reporting a case of a new onset pembrolizumab-induced fulminant DM1 who presented with diabetic ketoacidosis (DKA). Despite the emerging data on immune checkpoint inhibitors (ICPI), fulminant DM1 with DKA in a previously nondiabetic patient is still uncommon. Case Presentation: A 66-year-old female with a history of recurrent metastatic non-small cell lung cancer (NSCLC) presented to the emergency room (ER) with an extensive itchy rash. She was enrolled in a clinical trial for NSCLC, where she received immunotherapy with pembrolizumab for five months. Rash was treated outpatient for scabies, with no improvement. She was then started on prednisone 40mg daily and betamethasone 0.05% cream. She applied the cream daily but took prednisone orally for only one day, after which she could not tolerate it due to anxiety and restlessness. She ran out of betamethasone three days before coming to ER. On admission, vitals were: Heart rate 90 beats per minute, blood pressure 119/95 mmHg, respirations 20/minute. The exam showed flushed cheeks, red and dry macules on the skin with excoriations, and dry mucus membranes. Random blood glucose levels (BSL) were 660mg/dl. Labs were; HCO3 16mmol/L, Beta-hydroxy butyrate 20mmol/L, anion gap 17mmol/L, Hemoglobin A1c: 5.6%. For DKA, we started an insulin drip. Workup revealed very low C-peptide levels of 0.2ng/ml, with a concomitant BSL of 500mg/dL. Anti-islet cell and anti-glutamic acid decarboxylase antibodies (anti-GAD) were positive with levels of 0.04 nmol/L and 0.07 nmol/L, respectively. Once she stabilized and the anion gap closed, she was transitioned to subcutaneous insulin and discharged on 42 units of Lantus, along with 12 units of premeal Lispro and sliding-scale insulin. She was removed from the clinical trial due to complications. Unfortunately, she got readmitted with influenza A, Staphylococcus aureus bacteremia, and another episode of DKA, complicated with respiratory failure, and she decided on hospice. The patient passed away after two days. Conclusion: Immune-related adverse event of new-onset fulminant DM1, leading to DKA, is a serious and potentially fatal complication of pembrolizumab. For patients receiving pembrolizumab, who have uncontrolled BSL, we suggest checking the anti-islet cell and anti-GAD antibody levels and DKA risk stratification to allow the timely initiation of insulin and prevent further complications. Presentation: Thursday, June 15, 2023

Automated blood glucose regulation for nonlinear model of type-1 diabetic patient under uncertainties: GWOCS type-2 fuzzy approach.

Regulating blood glucose level (BGL) for type-1 diabetic patient (T1DP) accurately is very important issue, an uncontrolled BGL outside the standard safe range between 70 and 180mg/dl results in dire consequences for health and can significantly increase the chance of death. So the purpose of this study is to design an optimized controller that infuses appropriate amounts of exogenous insulin into the blood stream of T1DP proportional to the amount of obtained glucose from food. The nonlinear extended Bergman minimal model is used to present glucose-insulin physiological system, an interval type-2 fuzzy logic controller (IT2FLC) is utilized to infuse the proper amount of exogenous insulin. Superiority of IT2FLC in minimizing the effect of uncertainties in the system depends primarily on the best choice of footprint of uncertainty (FOU) of IT2FLC. So a comparison includes four different optimization methods for tuning FOU including hybrid grey wolf optimizer-cuckoo search (GWOCS) and fuzzy logic controller (FLC) method is constructed to select the bestcontroller approach. The effectiveness of the proposed controller was evaluated under six different scenarios of T1DP using Matlab/Simulink platform. A 24-h scenario close to real for 100 virtual T1DPs subjected to parametric uncertainty, uncertain meal disturbance and random initial condition showed that IT2FLC accurately regulate BGL for all T1DPs within the standard safe range. The results indicated that IT2FLC using GWOCS can prevent side effect of treatment with blood-sugar-lowering medication. Also stability analysis for the system indicated that the system operates within the stability region of nonlinear system.

EDUKASI-PENDAMPINGAN BUERGER ALLEN EXERCISE DAN 5 PILAR TERHADAP PERUBAHAN PENGETAHUAN DAN PERFORMA KESEHATAN FISIK PASIEN DIABETIK NEUROPATI PERIFER

Introduction & Aim: Diabetes Mellitus patients with uncontrolled blood glucose levels for a long time will experience peripheral neuropathy complications with symptoms of tingling, numbness, pain in the feet, and disability in carrying out daily activities. The purpose of this community service was to evaluate Buerger Allen Exercise and 5 Pillars’ education on the knowledge and physical health performance of peripheral neuropathy diabetic patients. Method of Activity: Buerger Allen Exercise and 5 Pillars’ education was conducted on 28 diabetic patients with peripheral neuropathy who had previously been examined at the Gundih regional health center. This community service was carried out for 6 weeks at Jalan Kedinding RT 10 RW 01 Bubutan Surabaya with several stages of activity, namely: initial survey, education, application, assistance, and evaluation. Evaluated community behavior includes knowledge and physical health performance of diabetic peripheral neuropathy patients through measurement of the Ankle-Brachial Index (ABI), peripheral oxygen saturation in the feet (StO2), and physical activity ability. Data were analyzed using the Wilcoxon signed rank test and Paired t-test to evaluate the results of the service. Results: There were changes in community behavior such as knowledge increased by 21.5% (p=0.000); normal ABI by 57.1% (p=0.004); totally independent physical activity ability 92.9% (p=0.003), and normal StO2 100% (p=0.000). Discussion: Buerger Allen Exercise Education Assistance and 5 Pillars of Diabetes Mellitus provide optimal results in the management of diabetic peripheral neuropathy patients to prevent other complications such as diabetic ulcers, and amputation due to foot tissue death.

Relationship between self-efficacy with self-management and quality of life among Type 2 Diabetes Mellitus: A systematic review

Objective: Self-efficacy is one aspect predicted to influence the self-management of type 2 Diabetes Mellitus (DM) patients. Low self-efficacy will impact DM patients’ motivation to carry out self-care, causing uncontrolled blood glucose levels and decreasing the quality of life. This study aimed to determine the relationship between self-efficacy, self-management, and quality of life in type 2 DM patients using a systematic review.

Carbohydrate and Fiber Intake on Fasting Blood Glucose Levels In Patients with Type 2 Diabetes Mellitus after Intervention of Brown Rice Diet

Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by hyperglycemia that occurs due to a decrease in insulin secretion by pancreatic beta cells and insulin resistance. One of the pillars in the management of T2DM is medical nutrition therapy in the form of a balanced diet. A good intake of carbohydrates and fiber can help control fasting blood glucose levels of diabetic patients. This study aims to determine the relationship between carbohydrate and fiber intake on fasting blood glucose levels in patients with T2DM after the intervention of brown rice diet. The type used in this study was pre-experimental without control variables and the sample was not selected randomly. The design was one-shot case study by looking at the post-test results. The number of samples was 18 people aged 48–60 years. Data analysis used the Shapiro Wilk normality test and Spearman correlation test. The results showed that most of the respondents had normal carbohydrate intake (88.9%) and all respondents had good fiber intake (100%). Most of the respondents had uncontrolled fasting blood glucose levels (55.6%). There is no relationship between carbohydrate and fiber intake on fasting blood glucose levels after the intervention of a brown rice-based diet menu.

Korelasi Tingkat Kepatuhan Pengobatan terhadap Kadar Glukosa Darah pada Pasien Geriatri Diabetes Melitus Tipe 2 di Puskesmas Kota Padang

Uncontrolled blood glucose levels in DM patients can cause various microvascular and macrovascular complications. One of the main problems causing uncontrolled blood glucose in type 2 DM patients is non-adherence to medication therapy, especially in geriatric patients. This study aims to assess the rate of medication adherence and blood glucose levels, then to analyze the relationship between the rate of medication adherence and blood glucose levels among geriatric patients with type 2 DM at the Nanggalo Health Center, Padang. Medication adherence was assessed using the ARMS-D questionnaire which had been tested for validity and reliability. Prospective data collection using a cross-sectional quantitative design with purposive sampling technique, data were analyzed by fisher's exact test. The results showed that of the 45 patients, most were classified as suboptimal adherence patients (82.2%), and the majority of patients had uncontrolled blood glucose levels (62.2%). Based on the results of the correlation test, the value of p = 0.003 (p <0.05). Hence, there is a significant relationship between the rate of medication adherence and blood glucose levels among geriatric patients with type 2 DM at the Nanggalo Health Center, Padang.

Prevalence of Erectile Dysfunction Among Men with Type 2 Diabetes Mellitus in Indonesia: An Observational Study

Background: Diabetes mellitus (DM) is a chronic metabolic disorder that can lead to multiple long-term complications in the human body including erectile dysfunction (ED). ED is a condition that commonly affects men and may reduce their quality of life. However, ED amongst men with type 2 DM (T2DM) has rarely been assessed and addressed by nurses who have an essential role in providing holistic patient care.Objective: This study aimed to describe ED among men with T2DM based on their demographic characteristics and health profiles.Methods: This was a descriptive study with a cross-sectional approach of 32 male respondents who were selected through convenience sampling in the outpatient department of PKU Muhammadiyah Hospital Yogyakarta, Indonesia. The data was collected by using the erectile function’s domain of Indonesian version of International Index of Erectile Function (IIEF). Descriptive statistics were used to present this study’s findings.Results: The results showed that 62.5% of the participants had uncontrolled blood glucose levels with an average random blood glucose of 207.75 ± 77.21 mg/dl. Only four respondents (12.5%) had received sexual counselling. Twenty-nine respondents (90,6%) had ED which were categorized into mild (17.2%), mild to moderate (6.9%), moderate (24.1%) and severe (51.7%).Conclusion: ED levels varied across age, duration of T2DM, random blood glucose levels, previous history of smoking, current smoking status, sexual counselling experience, complications, and occupation levels. Severe ED was common amongst men with T2DM in this study. Nurses should assess patient’s sexual function regularly and identify the effects of ED in men with T2DM. Early detection of ED could allow nurses to plan adequate intervention and health education to provide better outcomes for men with T2DM.

Nanofibrous Scaffolds for Diabetic Wound Healing

Chronic wounds are one of the secondary health complications that develop in individuals who have poorly managed diabetes mellitus. This is often associated with delays in the wound healing process, resulting from long-term uncontrolled blood glucose levels. As such, an appropriate therapeutic approach would be maintaining blood glucose concentration within normal ranges, but this can be quite challenging to achieve. Consequently, diabetic ulcers usually require special medical care to prevent complications such as sepsis, amputation, and deformities, which often develop in these patients. Although several conventional wound dressings, such as hydrogels, gauze, films, and foams, are employed in the treatment of such chronic wounds, nanofibrous scaffolds have gained the attention of researchers because of their flexibility, ability to load a variety of bioactive compounds as single entities or combinations, and large surface area to volume ratio, which provides a biomimetic environment for cell proliferation relative to conventional dressings. Here, we present the current trends on the versatility of nanofibrous scaffolds as novel platforms for the incorporation of bioactive agents suitable for the enhancement of diabetic wound healing.

Effects of Baduanjin Exercise on Glucose and Lipid Metabolism in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

Background: Type 2 diabetes mellitus (T2DM) refers to a metabolic disorder characterized by persistent hyperglycemia. Uncontrolled blood glucose levels over time may lead to serious complications, possibly even death. As an adjunctive treatment for T2DM, increasing numbers of clinical studies have demonstrated that Baduanjin (the Eight Section Brocades)—one of Traditional Asian exercise may effectively control fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), and 2h postprandial plasma glucose (P2hPG) as well as blood lipid levels of diabetic patients. However, the primary evidence demonstrating the clinical benefit of Baduanjin exercise in diabetic patients remains insufficient, especially the intervention effect on glucose and lipid metabolism is not fully understood. Objectives: The purpose of this study is to examine the effects of Baduanjin exercise on glucose and lipid metabolism in individuals with type 2 diabetes in randomized controlled trials (RCTs). Methods: Nine electronic databases were searched from the database’s inception until January 31th, 2023, without regard to language constraints (PubMed, Web of Science, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform (WAN FANG), VIP information resource integration service platform (CQVIP) and China Biology Medicine (CBM)). Furthermore, information concerning unpublished or continuing clinical trials was searched within the National Institutes of Health clinical registry Clinical Trials, the International Clinical Trials Registry Platform, and the Chinese Clinical Trials Registry. RCTs that examined the effect of Baduanjin exercise on glucose and lipid metabolism were identified. The primary outcomes of this study were fasting plasma glucose (FPG), 2h postprandial plasma glucose (P2hPG) and glycosylated hemoglobin (HbA1c). The literature was chosen based on inclusion and exclusion criteria, with the Baduanjin exercise serving as the primary method for the experimental group. Selection, data collection and extraction of studies were conducted separately by at least two reviewers, with disagreements resolved through discussion. The mean difference (MD) with a 95% confidence interval (CI) was employed for continuous outcomes. Analysis of data and subgroups, as well as sensitivity analysis, were performed utilizing Review Manager V.5.4.1 (RevMan V.5.4.1) and Stata/MP 17.0. Results: This meta-analysis comprised twenty-six original studies with 1,779 individuals. Glucose metabolism: As a result of the pooled analysis, it demonstrated that combination treatment resulted in a reduction in the HbA1c (MD: -0.73, 95% CI: -0.91 to -0.55, P<0.00001), FPG (MD −1.14, 95% CI −1.38 to −0.90, P<0.00001), P2hPG (MD: -1.22, 95% CI: -1.66 to -0.78, P<0.00001), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) (MD: -0.59, 95% CI: -1.07 to -0.11, P＝0.02), and Fasting Insulin (FINS) (MD: -2.63, 95% CI: -3.81 to -1.45, P<0.0001). Lipid metabolism: The results revealed that Baduanjin exercise could help T2DM patients improving the level of lipid metabolism, which reduced the level of Total cholesterol (TC) (MD: -0.36, 95% CI: -0.52 to -0.21, P<0.00001), Triglycerides (TG) (MD: -0.56, 95% CI: -0.82 to -0.30, P<0.0001), Low density lipoprotein (LDL-C) (MD: -0.19, 95% CI: -0.29 to -0.10, P＝0.0001) and increased the level of High-density lipoprotein (HDL-C) (MD: 0.11, 95% CI: 0.06 to 0.16, P<0.0001). Simultaneously, the combined findings also demonstrated that the interventions were efficacious in decreasing Body Mass Index (BMI) (MD: -1.14, 95% CI: -1.90 to -0.37, P＝0.004) and Waist-Hip Ratio (WHR) (MD: -0.07, 95% CI: -0.13 to -0.01, P＝0.02). Sensitivity analyses indicated that these results were robust. Conclusions: Current low-quality evidence demonstrated that T2DM patients through Baduanjin exercise could significantly improve the level of glucose and lipid metabolism. The evidence available was insufficient to establish the effects of Baduanjin exercise on T2DM patients. Further high-quality studies are needed to explore its effects of Baduanjin exercise on T2DM patients. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?Record ID=325538.

Diyabetle Komplike Olmuş Gebeliklerde Maternal Özellikler ve Komplikasyonlar

Abstract
 Aim: Pregnancies complicated with diabetes are risky pregnancies with different maternal characteristics and increased maternal complications compared to the normal pregnant group. In this study, it is aimed to determine maternal characteristics and maternal complications in pregnant women with different glucose intolerance or blood glucose levels, and to compare them with the information in the literature and to investigate the effectiveness of our follow-up and treatment protocols. 
 Material and Method: This study is carried out with 223 patients at Ümraniye Training and Research Hospital between May 2009 and March 2010. Group 1 in the study, normal glycemic group; Group 2, group with 1 value higher in 100 g oral glucose tolerance test (OGTT); Group 3, gestational diabetes mellitus (GDM), is the blood sugar regulated group; Group 4, the uncontrolled group diagnosed with GDM and whose blood sugar is not regulated; Group 5 consisted of patients with pregestational diabetes mellitus, with or without regulated blood sugar. 
 Results: Considering the maternal characteristics, it is seen that the age, gravida, parity, body mass index (BMI) of Group 3, Group 4 and Group 5 patients are significantly higher than the patients in Group 1 and Group 2. The rates of preeclampsia, macrosomic baby and preterm birth are significantly higher in groups 4 and 5. In terms of delivery types, normal birth rate is high in Group 1, while cesarean section rates are high in Groups 4 and 5. According to the groups, the cases with a 1st minute apgar score less than 7 are significantly higher in Group 4 and Group 5. 
 Conclusion: It is revealed that different glucose intolerances cause some problems in pregnancy, increase complications, and uncontrolled blood glucose levels increase these problems and complications. In pregestational and gestational periods; In such cases, it should be aimed and ensured that these problems and complications are reduced to the lowest possible level with appropriate diagnosis and treatment approaches.

Advances in the Design of Phenylboronic Acid-Based Glucose-Sensitive Hydrogels.

Diabetes, characterized by an uncontrolled blood glucose level, is the main cause of blindness, heart attack, stroke, and lower limb amputation. Glucose-sensitive hydrogels able to release hypoglycemic drugs (such as insulin) as a response to the increase of the glucose level are of interest for researchers, considering the large number of diabetes patients in the world (537 million in 2021, reported by the International Diabetes Federation). Considering the current growth, it is estimated that, up to 2045, the number of people with diabetes will increase to 783 million. The present work reviews the recent developments on the hydrogels based on phenylboronic acid and its derivatives, with sensitivity to glucose, which can be suitable candidates for the design of insulin delivery systems. After a brief presentation of the dynamic covalent bonds, the design of glucose-responsive hydrogels, the mechanism by which the hypoglycemic drug release is achieved, and their self-healing capacity are presented and discussed. Finally, the conclusions and the main aspects that should be addressed in future research are shown.

Association between Admission Blood Glucose Levels and Clinical Outcomes among Diabetic Adults Admitted to a Tertiary Care Hospital in Chennai, India: A Retrospective Study

Introduction: Admission blood glucose levels have an impact on hospitalisation and Length Of Stay (LOS). Uncontrolled blood glucose levels have been found to affect patients’ outcomes. Elevation of the initial blood glucose level during critical diagnosis was identified as an independent risk factor for in-hospital mortality in critical cases. Aim: To examine the association between admission blood glucose levels and clinical outcomes in adult diabetic patients. Materials and Methods: This retrospective study was conducted at a tertiary care hospital in Chennai, Tamil Nadu, India. Data were collected between July 1, 2021, and August 31, 2021, using non-probability convenience sampling from 522 records of adult diabetic patients admitted between January 2019 and March 2020. Capillary random blood glucose levels at the time of admission and their effects on LOS, both in the hospital and Intensive Care Unit (ICU), readmission, and mortality data were collected. Statistical analysis was performed using the Chi-square test. Results: Analysis of the records of 522 adult diabetic patients revealed that the mean and standard deviation (SD) of admission Capillary Blood Glucose (CBG) level were 177.46±49.42 mg/ dL, and the mean LOS in the hospital was 4.54±3.89 days. It was found that 340 (65.1%) patients had an admission duration of ≤4 days. There was a statistically significant association between admission blood glucose levels and LOS in the hospital (p-value=0.01), LOS in the ICU (p-value=0.008), readmission to the hospital (p-value=0.001), and mortality rate (p-value=0.0001). Conclusion: The study demonstrates that admission blood glucose levels are associated with the clinical outcomes of patients. These findings substantiate the need for maintaining normal glycemic levels through patient education and a proactive team approach to improve patient outcomes.