Uncontrolled Type Research Articles

Uncontrolled Diabetes Mellitus Type II Prevalence among Young, Middle, and Old-Aged Adults in Perambalur District Population of Tamil Nadu, India.

This study is aimed to approximate the prevalence of uncontrolled diabetes mellitus among Perambalur District population of South TamilNadu. Diabetes mellitus (DM) is a chronic metabolic disorder due to insulin deficiency or resistance which can affect multiple organs of the body such as heart, kidneys and eyes. Uncontrolled diabetes mellitus (DM), refers to having high blood sugar levels (hyperglycemia). Uncontrolled diabetes is at a greater risk of diabetic complications and a significant health concern in Perambalur District of Tamil Nadu, Southern India, India. A study conducted in Dhanalakshmi Srinivasan Institute of Medical Sciences & Hospital, Perambalur district of Tamil Nadu, Southern India, India. The study included 454 uncontrolled diabetes mellitus subjects of which 60.35% uncontrolled diabetes mellitus in female population and 39.65% uncontrolled diabetes mellitus in male population. The study included 274 female subjects was further divided into three age groups, age group I (25 to 44 years) of 23.38% uncontrolled diabetes mellitus population, age group II (45 to 60 years) of 47.46% uncontrolled diabetes mellitus population, and age group III (61 to 85 years) of 29.20% uncontrolled diabetes mellitus population. The 180 uncontrolled diabetes mellitus male subjects was further divided into three age groups: age group I (25 to 44 years) of 32.22% uncontrolled diabetes mellitus population, age group II (45 to 60 years) of 42.22% uncontrolled diabetes mellitus population, and age group III (61 to 85years) of 25.56% uncontrolled diabetes population. This uncontrolled diabetes mellitus was confirmed by estimating glycated hemoglobin (HbA1C) in these diabetes mellitus population. Our study confirmed that there may be a significant burden of diabetes mellitus related both micro vascular and macro vascular complications in this Perambalur district region of Tamil Nadu, Southern India, India.

Effects of collaborative learning-based food literacy program on healthy eating behavior and hemoglobin A1c among older adults with uncontrolled type 2 diabetes: A randomized controlled trial study in Thailand.

Uncontrolled type 2 diabetes mellitus (T2DM) is a prevalent issue among older adults. Healthy eating behavior (HEB) is a significant factor contributing to blood sugar control. It is a complex behavior that requires knowledge, attitudes, and skills in food literacy, which can be achieved through collaborative learning by nurses. Although collaborative learning has successfully improved food literacy and HEB among adults and older adults in general, its effectiveness has not been investigated among older adults with uncontrolled T2DM. This randomized controlled trial aimed to examine the effects of the Collaborative Learning-Based Food Literacy Enhancement Program (CLFLEP) on HEB and hemoglobin A1c (HbA1c) levels among older adults with uncontrolled T2DM. Participants were 80 older adults with uncontrolled T2DM attending primary care units (PCUs) or sub-district health promotion hospitals in northern Thailand. They were randomly assigned to either the experimental group (n = 40) or the control group (n = 40). The experimental group received the CLFLEP to enhance four domains of food literacy through five major elements of collaborative learning, while the control group received standard care. Data were collected between January and June 2023 using the Demographic Data Form, the Eating Behavior Questionnaire, the HbA1c test, and the Short Food Literacy Questionnaire. Data analysis involved descriptive statistics for demographic characteristics and independent t-test and paired sample t-test for HEB and HbA1c based on intention-to-treat (ITT) and per-protocol (PP) analyses. The experimental group had a higher HEB score than the control group (p <0.001 for ITT and PP) and higher than their scores before program participation (p <0.001 for ITT and PP). The effect size (Cohen's d) was 1.46. The experimental group also had a lower HbA1c level than the control group (p = 0.002 for ITT and PP) and lower than their levels before program participation (p = 0.005 for ITT and 0.001 for PP). The effect size (Cohen's d) was 0.70. The CLFLEP was effective in promoting food literacy, HEB, and blood sugar control. Nurses can be trained to use this program to provide collaborative health education for older adults with uncontrolled T2DM. Nursing administrators can use these findings to develop organizational policies that enhance nurses' competencies as educators skilled in collaborative learning. TCTR20221222005 [Thai Clinical Trials Registry].

9332 Breathless Struggle: Unraveling The Interplay Between DKA And Acute Respiratory Distress Syndrome

Abstract Disclosure: S. Zahra: None. R. Subramani: None. M. Abbas: None. K.Y. Hasan: None. F. Manas: None. C. Bajracharya: None. Introduction: Diabetic Ketoacidosis (DKA) is a life threatening emergency with mortality rate of 0.15%-0.30%. Acute Respiratory Distress Syndrome (ARDS) is a rare complication of DKA which presents as a sudden onset of dyspnea and progressive hypoxia. It is an inflammatory process that damages the alveolar-capillary membrane leading to the fluid leakage into the alveolar space. The incidence of ARDS in DKA remains unknown. It is more commonly seen in adolescents and young adults. The exact pathogenesis of ARDS in DKA is currently unknown. Some proposed mechanisms are that a severe metabolic acidosis in DKA along with increased cytokines production due to long standing hyperglycemia leads to increased capillary membrane permeability allowing fluid to accumulate in the alveolar space. TNF-a and IL-6 along with other pro-inflammatory cytokines are known to cause endothelial damage and increase pulmonary permeability leading to pulmonary edema. However most DKA patients with severe metabolic acidosis do not develop ARDS. Case Presentation:Case 1: A 19 year old male with uncontrolled type I diabetes mellitus presented with altered mental status. On examination, he was tachycardic and tachypneic with dry mucous membranes. Lab workup revealed leukocytosis, severe hyperglycemia, and severe anion gap metabolic acidosis with beta hydroxybutyrate level of 14.20 mmol/L (normal: 0.02-0.27 mmol/L). He was diagnosed with DKA and started on intravenous fluids, and insulin as per institutional DKA protocol. Approximately 12 hours post-admission, the patient experienced sudden-onset dyspnea with deteriorating hypoxia, necessitating emergent intubation and mechanical ventilation. Chest radiography displayed bilateral patchy ground-glass opacifications consistent with acute respiratory distress syndrome (ARDS). Despite the administration of 8 liters of intravenous fluids, the patient exhibited a negative net fluid balance of 2.3 liters, implicating fluid shift. Further investigations, including bronchoscopy and bronchoalveolar lavage, revealed an unobstructed airway, minimal secretions, and no evidence of hemorrhage or infection. Comprehensive infectious work-ups yielded negative results as well, reinforcing the diagnosis of DKA as the underlying cause of ARDS. Conclusion: Acute Respiratory Distress Syndrome is a rare but potentially fatal complication of Diabetic Ketoacidosis. Early recognition of this serious pulmonary complication of DKA and its prompt management is essential to prevent respiratory failure and mortality. Presentation: 6/1/2024

12262 Pheochromocytoma Masquerading As An Acute Myocardial Infarction And Takotsubo Cardiomyopathy In A Hispanic Woman: A Case Report

Abstract Disclosure: A. Hoskote: None. J. Seidenberg: None. V. Gupta: None. Pheochromocytoma is a rare neuroendocrine tumor (&amp;lt;1 per 100,000 person-years) that occurs sporadically or due to mutations. While most patients do not have the classic headache, sweating and tachycardia, about 50% have paroxysmal hypertension and 90% have headaches. We present a rare case of pheochromocytoma masquerading as myocardial infarction (MI) and cardiomyopathy. A 67-year-old Hispanic female with history of hypertension and uncontrolled Type 2 DM, presented to the ER for chest pain and diaphoresis. Home medications were metformin, sitagliptin, lisinopril, simvastatin and aspirin. EKG showed non-specific ST elevations in chest leads without STEMI, and labs revealed a dynamic troponin and hemoglobin A1C of 13.6%. CT angiography ruled out pulmonary embolism. A left heart catheterization and echocardiogram revealed non obstructive coronary artery disease (CAD), a left ventricular ejection fraction of 25%, apical ballooning and a laminar thrombus. She was diagnosed with acute myocardial infarction and Takotsubo cardiomyopathy and discharged on metoprolol and apixaban. During our evaluation 7 months later, we noted several ER and hospital admissions for symptomatic hypertensive emergency with a pattern of labile blood pressures and on review of initial CT scan, a sequentially growing left adrenal mass (3.9cm 29HU) was present. A careful history using Spanish interpretation revealed episodic headaches, diaphoresis and palpitations. Subsequently, on two separate occasions, plasma normetanephrine was 2006 pg/mL (ULN&amp;lt;148 pg/mL) and urine normetanephrine was 12516 mcg/g cr (ULN &amp;lt;524 mcg/g cr). Prazosin was prescribed with stabilization of hypertension. An adrenalectomy is now scheduled. Symptoms of pheochromocytoma and paraganglioma (PPGs) are caused by hypersecretion of one or combinations of catecholamines: norepinephrine, epinephrine and dopamine. In one study 27% were discovered due to symptoms while 61% were found incidentally. PPGs occur in up to 1:500 patients with arterial hypertension and can also be a secondary cause of diabetes. MI and acute or chronic cardiomyopathy are rare presenting features of PPGs. Takotsubo cardiomyopathy is the most common phenotype. In one acute MI study, Hispanic women were significantly more likely to receive delayed care as compared to non-Hispanic women, due to misinterpretation of symptoms by patients and providers. A meticulous history with formal interpretation in patients with limited English proficiency can lead to prompt diagnosis of this surgically curable cause of hypertension. Pheochromocytomas rarely present as acute myocardial infarction and stress cardiomyopathy. A high suspicion for PPGs must be maintained in patients with labile hypertension, cardiomyopathy and an incidental adrenal mass. History should be carefully revisited especially in patients with limited English proficiency. Presentation: 6/3/2024

6486 Gastroparesis Exacerbation by a GLP-1 Agonist

Abstract Disclosure: J.M. Deirmenjian: None. C. Dagher: None. Gastroparesis is characterized by a delay in gastric emptying that may present with nausea, vomiting, satiety, abdominal pain, and anorexia. The most common cause of gastroparesis is diabetes mellitus due to vagal autonomic neuropathy which prevents coordinated gastric contractions. Medications may also induce gastroparesis. Glucagon-like peptide (GLP)- 1 agonists such as semaglutide are being prescribed for diabetes control but also due to benefits of cardiovascular disease and weight loss. Concerns of GLP-1 agonists causing gastroparesis are valid as the mechanism of action includes delaying gastric emptying, especially with newly developed analogs that are more potent with longer half-lives. Patient is a 43-year-old female with a history of hypertension, uncontrolled diabetes mellitus type 2, diabetic gastroparesis, diabetic neuropathy, hyperlipidemia, and obesity who presented with a one-month history of postprandial abdominal pain, nausea, vomiting, and a 40-pound unintentional weight loss with decreased oral intake. Her abdominal pain was sharp and was exacerbated with eating. While she had several gastroparesis flares in the past, she was in remission for almost two years until she was transitioned from dulaglutide to semaglutide after which she had a recurrent flare after two doses. On physical examination, her abdomen was diffusely tender to palpation.On admission, her hemoglobin A1c was 9.7%. She was made NPO, started on peripheral fluids, and initiated on scheduled metoclopramide given high suspicion of a gastroparesis flare. She underwent a gastric emptying study with the gastric amount retained as follows: 97% (at 1 hour), 88% (at 2 hours), and 79% (at 4 hours). Her hospital course was complicated by persistent symptoms of gastroparesis. Gastroenterology recommended scheduled metoclopramide and erythromycin for motility and dietary adjustments including small volume liquid calories. Her oral intake was insufficient and she opted for total peripheral nutrition until symptoms improved. She was advised to never take a GLP-1 agonist again and should her symptoms not improve the next step would be to pursue a gastric pacemaker. The etiology of the patient’s gastroparesis was uncontrolled diabetes. The proximity between starting semaglutide and symptom onset is compelling as an inciting factor in this flare. This admission’s gastric emptying study results showed higher gastric retention for a longer period of time, which may shed light to the potency of these new GLP-1 analogs. The patient tolerated maximum dose dulaglutide for months but not even two doses of semaglutide. With the race to invent more potent GLP-1 agonists for diabetes control and weight loss on the horizon, knowing their side effects and mechanism of action is crucial. While not listed as a contraindication, there should be hesitancy to offer these agents to anyone with significant gastroparesis. Presentation: 6/2/2024

5176 Time In Range Preferred Over A1c And Fructosamine To Monitor Glycemic Control In Sickle Cell Disease

Abstract Disclosure: A. Patel: None. B. Simon: None. Introduction: In sickle cell disease, hemoglobin A1c is unreliable due to anemia, hemolysis, transfusions, and increased red blood cell turnover. In this population, plasma glucose should be used to make a diagnosis of diabetes, but there are no reliable long-term measures of glycemic control. Measures of serum protein glycation such as fructosamine are often used as markers of short-term control[1]. Continuous glucose monitoring (CGM) time in range (TIR) may offer another more reliable metric of control in this population2. Case: A 58-year-old male presented to the office for uncontrolled type 2 diabetes mellitus. His medical history included sickle cell anemia (Hb SS disease), hypertension, monoclonal gammopathy, and priapism. He was diagnosed with type 2 diabetes mellitus approximately one year prior based on a fructosamine level of 470 umol/L (0-285 umol/L) and elevated fasting glucose level of 128 mg/dL. He started metformin 500 mg daily. Three months later, repeat fructosamine was 401 umol/L, and metformin was increased. Months later, fructosamine levels remained elevated at 419 umol/L; metformin was increased to 2 grams daily and he was referred to endocrinology. The patient was given a CGM (Freestyle Libre 2 system, Abbott Diabetes Care) as an additional method to assess control. CGM showed an excellent 2-week TIR (70-180mg/ dL) of 98%. Repeat fructosamine after 2 weeks of CGM wear was elevated at 500 umol/L. It was hypothesized that the history of IgG kappa monoclonal gammopathy was falsely elevating his fructosamine level. A glycated albumin level was 13.5% (10.7-13.5%). The patient was advised to discontinue his metformin. Four months later, his glycated albumin remained in range, and a 2-week TIR was 100%. Discussion: This case demonstrates how sickle cell disease and monoclonal gammopathy affect laboratory values typically used to diagnose and monitor type 2 diabetes. Fructosamine, a measure of non-enzymatic glycation of serum proteins, is non-specific2. Increased protein from monoclonal gammopathy (giving more protein glycation sites) was the probable cause of the persistently elevated fructosamine, leading to overtreatment of what may not have been a true diagnosis of diabetes. This case also demonstrates the value of CGM, with glucose values and TIR indicating near normoglycemia. Diagnostic CGM may be a useful measure of glucose control in patients with hemoglobinopathies.

7289 An interesting case of Diabetes Mellitus Type 1 induced Renal Tubal Acidosis Type 1

Abstract Disclosure: R. Ripa: None. A. Itani: None. S.K. Patel: None. Introduction: Renal Tubular Acidosis (RTA) are a group of disorders that involve dysfunctional transporters and channels in the renal system. These disorders can be acquired (idiopathic, medication side effects, and medical disorders) or inherited. The most common type worldwide is type 4 RTA, the main cause is diabetic nephropathy leading to hypoaldosteronism. The association of type 1 RTA with diabetes has rarely been reported in studies. Here, we report the presentation, diagnosis and management of a rare case of type 1 RTA in a patient with a history of diabetes mellitus type 1. Case: A male in his 50s with a 30-year history of uncontrolled type 1 diabetes mellitus on insulin pump and coronary artery disease presented to his cardiologist with worsening chest pain, fatigue, polyuria, weight loss of 15 lbs, and recent insulin pump change. Blood tests revealed serum bicarbonate of 10 mmol/L and he was sent to the hospital. On examination, he was hypotensive and bradycardic with dry mouth and decreased skin turgor. His blood tests were consistent with type 1 RTA, he was treated with intravenous fluids containing bicarbonate plus potassium and transitioned to oral potassium citrate on discharge. He underwent renal biopsy as work up was unrevealing for a cause of type 1 RTA. Biopsy revealed normal glomeruli with negative immunofluorescence and Congo red stain. The biopsy, however, did show mild patchy chronic interstitial fibrosis with lymphocytes and mild tubular atrophy. At one year follow up, he remained on oral potassium citrate with resulting serum bicarbonate of 26 mmol/L and a normal renal function. Discussion: Diabetes mellitus can lead to a variety of renal pathologies, specifically metabolic acidosis that can be either seen as diabetic ketoacidosis or hyporeninemic hypoaldosteronism (Type 4 RTA). In our patient, despite being a diabetic, he did not present with either elevated anion gap, ketonuria or hyperkalemic hyperchloremic acidosis typical of type 4 RTA. He was noted to have hypokalemic hyperchloremic acidosis, with a positive urine anion gap, and an alkaline urine, all characteristic of type 1 RTA. Acquired distal RTA occurs more commonly due to certain medications or autoimmune diseases as in Sjögren’s syndrome. The relationship between distal RTA and Sjögren’s syndrome has already been established, unlike the relationship with type 1 diabetes. There have been few case reports of distal RTA in association with type 1 diabetes mellitus, implying a possible autoimmune pathology. Prior case reports also not only had patients who were insulin dependent, but diabetes was present for more than a decade at least suggesting chronicity of disease is needed. Traditional management consists of alkaline therapy and treatment of the underlying disease, or removal of offending medication. In this case, we hope to highlight distal RTA in a diabetic who doesn’t meet criteria for DKA or type 4 RTA. Presentation: 6/1/2024

Exploring the association of social connections and food security among adults with uncontrolled type 2 diabetes: a population-based study

BackgroundPrimary health care professionals are held accountable for various quality measures in the treatment of patients with chronic diseases such as diabetes. Uncontrolled type 2 diabetes (T2D) remains a considerable health problem; thus, further studying patients with this condition is important for delivering effective interventions. Social determinants of health (SDoH) have been shown to affect various aspects of diabetes care in different subpopulations. We studied the association of SDoH with uncontrolled T2D in a population of adult primary care patients.MethodsWe retrospectively searched our electronic health record for adult patients (≥18 years) with a diagnosis of T2D and a hemoglobin A1c (HbA1c) level of 8% or higher. Patients were empaneled to 2 primary care clinic sites between January 1, 2021, and January 31, 2022. Patients were grouped by HbA1c level to stratify patients according to the extent of uncontrolled T2D. Patient characteristics were compared among groups. Unadjusted and adjusted multinomial logistic regression analysis was used to estimate the odds of various SDoH factors among patient groups with different levels of uncontrolled T2D.ResultsThe study cohort included 1,596 patients. Most patients were White (79%), and the median age was 58.8 years. The median HbA1c level was 8.9%, and approximately 68% of patients were obese (body mass index [BMI] ≥30). When the study population was grouped by HbA1c level (8% to < 9% [n = 806], ≥9% to < 12% [n = 684], and ≥12% [n = 106]), significant differences among groups were observed in age group (P < .001), marital status (P < .001), race (P < .001), ethnicity (P = .001), and BMI category (P = .01). In groups with higher HbA1c levels, we noticed a higher percentage of patients who were aged 51 to 65 years or single. Among patients with uncontrolled HbA1c levels, more patients were obese than overweight. Patients in the intermediate HbA1c group had increased odds of food insecurity and some decreased social connections, even after adjusting for age, sex, race, ethnicity, and marital status.ConclusionsAmong patients with uncontrolled T2D, higher HbA1c levels were associated with decreased social connections and increased food insecurity. Our findings provide insight into the role of these SDoH in managing T2D and have important implications for primary care practice.

Impact of an SMS intervention to support type 2 diabetes self-management: DiabeText clinical trial.

Complications arising from uncontrolled Type 2 Diabetes Mellitus (T2DM) pose a significant burden on individuals' well-being and healthcare resources. Digital interventions may play a key role in mitigating such complications by supporting patients to adequately self-manage their condition. To assess the impact of DiabeText, a new theory-based, patient-centered, mobile health intervention integrated with electronic health records to send tailored short text messages to support T2DM self-management. Pragmatic, Phase III, 12-month, two-arm randomized clinical trial with T2DM primary care patients in Spain. 742 participants with suboptimal glycemic control (HbA1c>7.5) were randomly allocated to a control (usual care) or intervention (DiabeText) group. The DiabeText group received, in addition to usual care, 165 messages focused on healthy lifestyle and medication adherence. glycated hemoglobin (HbA1c). medication possession ratio, quality of life (EQ-5D-5L), diabetes self-efficacy (DSES); and self-reported adherence to medication, Mediterranean diet (MEDAS-14), and physical activity (IPAQ). Over the 12-month period, we observed no significant differences in HbA1c between the intervention and the control groups (Beta=-0.025 (-0.198 to 0.147; p=0.772)). In comparison with the control group, the DiabeText group showed significant (p<0.05) improvements in self-reported medication adherence (OR=1.4; 95%CI: 1.0 to 1.9), DSES (Cohen's d=0.35), and EQ5D-5L (Cohen's d=0.18) scores; but not in the rest of secondary outcomes. DiabeText successfully improved quality of life, diabetes self-management, and self-reported medication adherence in primary care patients with T2DM. Further research is needed to enhance its effects on physiological outcomes.

IGlarLixi effectively reduces residual hyperglycaemia in Chinese people with type 2 diabetes on basal insulin: A post hoc analysis of the LixiLan-L-CN study.

To compare the effects of iGlarLixi versus insulin glargine 100 U/mL (iGlar) on residual hyperglycaemia in Chinese people with uncontrolled type 2 diabetes (T2D) on prior basal insulin (BI) therapy ± oral antidiabetic drugs in the LixiLan-L-CN study (NCT03798080). In this post hoc analysis, residual hyperglycaemia (i.e. HbA1c ≥ 7.0% [≥ 53 mmol/mol] and fasting plasma glucose [FPG] < 7.0 mmol/L) were assessed over 30 weeks. Outcomes were assessed at week 30 in participants with baseline residual hyperglycaemia, including changes from baseline in HbA1c, FPG, 2-hour postprandial glucose (PPG) and daily BI dose, the proportion of participants with HbA1c less than 7.0% (< 53 mmol/mol) and FPG less than 7.0 mmol/L and the incidence of hypoglycaemia. Of 421 participants, 124 (29.5%) had baseline residual hyperglycaemia (iGlarLixi, n = 64 [31.7%]; iGlar, n = 60 [29.1%]). At week 30, the residual hyperglycaemia rate decreased to 7.0% with iGlarLixi and increased to 43.3% with iGlar. Among participants with baseline residual hyperglycaemia, a greater proportion achieved both HbA1c and FPG targets at week 30 with iGlarLixi versus iGlar (43.8% vs. 16.7%), and iGlarLixi provided greater reductions in HbA1c (least squares mean [LSM] difference, -0.9% [-9.4 mmol/mol]) and 2-hour PPG (LSM difference, -4.7 mmol/L; both P < .001). Daily BI dose and incidence of hypoglycaemia were similar in the two groups. The findings of this post hoc analysis suggest that iGlarLixi had greater benefits than iGlar in reducing the rate of residual hyperglycaemia over 30 weeks in Chinese people with suboptimally controlled T2D on prior BI-based therapy.

Correlation between glycemic control and retinal nerve fiber layer parameters in type 2 diabetics without retinopathy: a case control study

Background Retinal neurodegenerative changes were found to develop in patients with diabetes mellitus (DM) before the onset of microvascular changes of diabetic retinopathy (DR). Such changes usually affect inner retinal layers in the form of retinal nerve fiber layer (RNFL) thinning. Aim To correlate the degree of glycemic control [in the form of hemoglobin A1c (HBA1c) levels] with changes in peripapillary RNFL thickness in patients with type 2 DM without DR using optical coherence tomography (OCT). Patients and methods Participants are divided into three groups each including 28 eyes: group 1: uncontrolled type 2 DM without DR (HBA1c≥7%), group 2: controlled type 2 DM without DR (HBA1c&lt;7%), group 3: healthy age and sex-matched controls. Peripapillary RNFL and macular ganglion cell complex (GCC) thickness were evaluated in all participants using RTVue spectral domain OCT device (Optovue, Fremont, USA). Results Peripapillary RNFL and macular GCC were significantly thinner in the uncontrolled type 2 DM group in comparison to both the controlled type 2 DM group and the healthy control group. No significant difference in OCT parameters between the controlled type 2 DM group and the healthy control group. HBA1c shows a statistically significant negative correlation with average, superior and inferior RNFL thickness as well as average, superior, and inferior GCC thickness. Conclusion Early and adequate glycemic control, indicated by HBA1c less than 7%, is of critical importance in delaying and reducing early neurodegenerative changes in the form of RNFL and GCC thinning in patients with type 2 DM without DR.

6452 Hybrid Closed Loop Insulin Pump Therapy (Omnipod-5, T-Slimx2, Medtronic 780G) in uncontrolled type 1 Diabetes previously treated with multiple daily injections or open loop pumps

6452 Hybrid Closed Loop Insulin Pump Therapy (Omnipod-5, T-Slimx2, Medtronic 780G) in uncontrolled type 1 Diabetes previously treated with multiple daily injections or open loop pumps

Pioglitazone increases risk of ischemic heart disease in patients with type 2 diabetes receiving insulin

AimStudies evaluating the cardiovascular safety of pioglitazone show inconsistent results and ischemic heart disease (IHD) risks associated with different anti-diabetic drugs added to metformin uncontrolled type 2 diabetes mellitus (T2DM) are not assessed. This study aimed to evaluate IHD risk associated with pioglitazone and/or insulin added to patients with metformin uncontrolled T2DM. MethodsData were extracted from the National Health Insurance Research Database of Taiwan. A total of 19,952 patients with T2DM uncontrolled on metformin received pioglitazone and/or insulin added to metformin were included. ResultsCompared to those who never received pioglitazone and/or insulin, patients receiving both insulin and pioglitazone had higher cumulative risk of IHD (adjusted HR [aHR] = 1.911, 95 % confidence interval [CI]: 1.506–2.351), pioglitazone alone (aHR = 1.446, 95 % CI: 1.111–1.775), and insulin alone (aHR = 1.351, 95 % CI: 1.1052–1.684) (all, p < 0.05). Patients who received both pioglitazone and insulin had a higher cumulative risk of IHD than those who received insulin or pioglitazone as well as a similar result in the cumulative defined daily dose (cDDD) of the drugs. ConclusionAdministering pioglitazone plus insulin to patients with T2DM uncontrolled on metformin may increase the risk of IHD, suggesting that other second-line anti-diabetes drugs may be a better choice for patients with T2DM uncontrolled on metformin.

BARRIERS TO INITIATE INSULIN THERAPY AND ITS ASSOCIATION WITH DURATION OF DIABETES MELITIS AND DEMOGRAPHIC FACTORS IN UNCONTROLLED TYPE 2 DIABETIC PATIENTS, A CROSS SECTIONAL STUDY

Objectives: To determine different barriers to initiate insulin therapy and association of duration of diabetes mellitus and demographic factors with barriers in initiation of insulin therapy in Uncontrolled type 2 diabetic patients.Materials and Methods: We conducted a cross sectional study conducted among patients with type 2 diabetic patients presenting to endocrinology outpatient clinics in two Tertiary care hospitals of Peshawar ie. Khyber Teaching hospital and hayatabad medical complex Peshawar. The duration of study was 03 months after approval of synopsis. The sample size was 257.The study population was selected by consecutive non probability sampling technique. The data was collected by pre designed questionnaire. All the included patients were interviewed on pre designed questionnaire. Data was processed in SPSS version 22.Results: In study we found that patients face different barriers to initiate insulin therapy. In our study, side effects of insulin was the barrier for 97(37.7%) of the patient, difficulty in carrying insulin was barrier for 128(49.8%) patients , dose adjustment of insulin was barrier for 90(35%) patients, fear if insulin needle was barrier for 89 (34.6%) patients, self administration of insulin was barrier for 98(38.1%) patients , affordability of insulin was barrier accounting for 114(44%) patients , frightened about insulin therapy by someone was barrier for116 (45.1%) patients. The association between economic status of patient and the barrier that they are frightened by someone was statistically significant. Chi-square test was also run between duration of diabetes with all barriers in which one association was found nearly signifi cant i.e. the association of duration of diabetes with difficulty in carrying insulin with the p value of 0.064.Conclusion: The most common barrier in insulin therapy initiation of patients in the study was difficulty in carrying insulin. We found that there is near to signifi cant association between duration of diabetes and difficulty in carrying insulin. There is significant association between economic status of patient and frightened by someone. The lower the economic status the more frightened about Insulin use.

Impact of repetitive ELM transients on ITER divertor tungsten monoblock top surfaces

Abstract Owing to the high stored energy of ITER plasmas, the heat pulses due to uncontrolled Type I edge localized modes (ELMs) can be sufficient to melt the top surface of several poloidal rows of tungsten monoblocks in the divertor strike point regions. Coupled with the melt motion associated with tungsten in the strong tokamak magnetic fields, the resulting surface damage after even a comparatively small number of such repetitive transients may have a significant impact on long-term stationary power handling capability. The permissible numbers set important boundaries on operation and on the performance required from the plasma control system. Modelling is carried out with the recently updated MEMENTO melt dynamics code, which is tailored to tackle melt motion problems characterized by a vast spatio-temporal scale separation. The crucial role of coupling between surface deformation and shallow angle heat loading in aggravating melt damage is highlighted. As a consequence, the allowable operational space in terms of ELM-induced transient heat loads is history-dependent and once deformation has occurred, weaker heat loads, incapable of melting a pristine surface, can further extend the damage.

The effect of diabetes on the alevel of thyroid gland hormones in patients with uncontrolled type 2 diabetes in Thi-Qar Province,Iraq.

Background: Diabetes mellitus and thyroid dysfunction represent two prominent endocrine disorders frequently encountered in clinical practice. The objective of this research was to examine the prevalence of hypothyroidism among hospitalized individuals diagnosed with type 2 diabetes mellitus, along with its associated factors. Methods: A total of 120 in patients suffering from type 2 diabetes mellitus were admitted to the metabolic diseases unit. The findings of this investigation indicated a notable elevation of T3 and T4 levels in patients with uncontrolled diabetes (GI) when compared to those with controlled diabetes (GII) and the control group. Conversely, the levels of TSH exhibited a significant reduction in patients with uncontrolled diabetes (GI) relative to both the controlled diabetic patients (GII) and the control group. Utilizing a significance threshold of (P ≤ 0.05), this study revealed a substantial decrease in the concentrations of thyroid hormones, alongside a reduction in thyroid stimulating hormone levels in patients with uncontrolled diabetes when contrasted with the controlled diabetic patients and the control group.. Aims of Study: Evaluation the risk degree of developing of metabolic disorders complications in patients with DM and their prevalence in Thi-Qar province. Conclusion: It was concluded from this study that there is a clear relationship between high blood glucose levels and low T3 and T4 levels.

Presepsin Levels in Infection-Free Subjects with Diabetes Mellitus: An Exploratory Study.

Systemic inflammation has been recognized as the cause and consequence of metabolic dysregulation in diabetes mellitus (DM). Presepsin has recently emerged as a promising biomarker for the detection of bacterial infections and sepsis. There is evidence that gut dysbiosis results in the increased circulating concentrations of Gram-negative bacteria lipopolysaccharide, the linkage of presepsin, which in turn promotes insulin resistance and correlates with the risk of diabetic complications. Thus, we hypothesized that presepsin could reflect the magnitude of systemic inflammation and metabolic decompensation in patients with DM even in the absence of infection. In this cross-sectional pilot study, we included 75 infection-free individuals with well-controlled (n = 19) and uncontrolled (n = 23) type 2 diabetes (T2D), well-controlled (n = 10) and uncontrolled (n = 10) type 1 diabetes (T1D), and normoglycemic controls (n = 13). Presepsin levels were compared between the groups and potential associations with demographic, clinical, and laboratory parameters were explored. We observed that the duration of DM was associated with presepsin values (p = 0.008). When the participants were classified into the type of DM groups, the presepsin levels were found to be lower in the patients with T2D compared to those with T1D (p = 0.008). However, significance in that case was driven by the difference between the well-controlled groups. After adjusting for the effects of DM duration, presepsin was significantly lower in the well-controlled T2D group compared to the well-controlled T1D group [1.34 (2.02) vs. 2.22 (4.20) ng/mL, p = 0.01]. Furthermore, we adjusted our findings for various confounders, including age, body mass index, and waist circumference, and found that the difference in the presepsin values between the adequately controlled groups remained significant (p = 0.048). In conclusion, our findings suggest that presepsin could potentially serve as a surrogate marker of inflammation and metabolic control in people with DM.

Type I Interferonopathy among Non-Elderly Female Patients with Post-Acute Sequelae of COVID-19.

The pathophysiological mechanisms of the post-acute sequelae of COVID-19 (PASC) remain unclear. Sex differences not only exist in the disease severity of acute SARS-CoV-2 infection but also in the risk of suffering from PASC. Women have a higher risk of suffering from PASC and a longer time to resolution than men. To explore the possible immune mechanisms of PASC among non-elderly females, we mined single-cell transcriptome data from peripheral blood samples of non-elderly female patients with PASC and acute SARS-CoV-2 infection, together with age- and gender-matched non-PASC and healthy controls available from the Gene Expression Omnibus database. By comparing the differences, we found that a CD14+ monocyte subset characterized by higher expression of signal transducers and activators of transcription 2 (STAT2) (CD14+STAT2high) was notably increased in the PASC patients compared with the non-PASC individuals. The transcriptional factor (TF) activity analysis revealed that STAT2 and IRF9 were the key TFs determining the function of CD14+STAT2high monocytes. STAT2 and IRF9 are TFs exclusively involving type I and III interferon (IFN) signaling pathways, resulting in uncontrolled IFN-I signaling activation and type I interferonopathy. Furthermore, increased expression of common interferon-stimulated genes (ISGs) has also been identified in most monocyte subsets among the non-elderly female PASC patients, including IFI6, IFITM3, IFI44L, IFI44, EPSTI1, ISG15, and MX1. This study reveals a featured CD14+STAT2high monocyte associated with uncontrolled IFN-I signaling activation, which is indicative of a possible type I interferonopathy in the non-elderly female patients with PASC.

Prevalence and risk factors of osteosarcopenia in elderly patients with uncontrolled type 2 diabetes.

To assess the prevalence of osteosarcopenia (OS) in elderly patients with type 2 diabetes mellitus (T2DM) and explore the related risk factors for developing this condition. This cross-sectional study enrolled hospitalized T2DM patients aged 60 years and older. Patients underwent assessments of total hip bone mineral density (BMD), grip strength, the Short Physical Performance Battery (SPPB), and body composition. Based on the 2019 Asian Working Group for Sarcopenia (AWGS) criteria, appendicular skeletal muscle mass (ASM), grip strength, and SPPB were measured to diagnose sarcopenia. BMD and T values of the lumbar spine and hip were measured using dual-energy X-ray absorptiometry (DXA). Osteosarcopenia was defined when both sarcopenia and osteoporosis criteria were met. Statistical analysis included binary logistic regression to identify significant risk factors. A total of 254 hospitalized T2DM patients (80 males and 174 females) were included. They were divided into T2DM-OS (n = 58) and T2DM-NOS (n = 196) groups based on the presence of osteosarcopenia. The average ages were 72.724 ± 6.463 and 69.265 ± 6.035 years, respectively. The prevalence of osteosarcopenia in T2DM patients was 22.8%, with 20.7% (12 males) and 79.3% (46 females) in the T2DM-OS group. After adjusting for confounding factors, it was found that male gender (OR: 5.738, 95% CI: 1.602-20.551, P = 0.007), fasting plasma glucose (OR: 0.904, 95% CI: 0.821-0.995, P = 0.038), and ASMI (OR: 0.049, 95% CI: 0.013-0.184, P < 0.001) were major influencing factors for the development of osteosarcopenia in elderly T2DM patients. The prevalence of T2DM-OS is relatively high, with male gender, low fasting plasma glucose, and low ASMI identified as risk factors.

Serum ferritin level and associated factors among uncontrolled adult type II diabetic follow-up patients: comparative based cross-sectional study

BackgroundUncontrolled type 2 diabetes mellitus (UT2DM) and its associated consequences nowadays have been a global health crisis, especially for adults. Iron has the property to oxidize and reduce reversibly, which is necessary for metabolic processes and excess accumulation of iron indicated by serum ferritin levels could have a significant impact on the pathophysiology of T2DM via generation of reactive oxygen species (ROS). However, no conclusive evidence existed about the association of serum ferritin with the state of glycemic control status. Therefore, this study aimed to evaluate serum ferritin levels and associated factors in uncontrolled T2DM patients and compare them with those of controlled T2DM and non-diabetic control groups.MethodsA hospital-based comparative cross-sectional study was conducted among conveniently selected 156 study participants, who were categorized into three equal groups of uncontrolled T2DM, controlled T2DM, and non-diabetic control groups from October 2 to December 29, 2023 at St. Paul’s Hospital Millennium Medical College. A pre-tested structured questionnaire was used to collect socio-demographic and diabetes-related information. The laboratory tests were done using an automated chemistry analyzer and IBM-SPSS statistical software (version-27) was utilized for data entry and analysis with a significance level of p < 0.05.ResultThe mean serum ferritin level was noticeably higher in uncontrolled T2DM patients as compared to controlled T2DM and control groups (p < 0.001). It was significantly correlated with HbA1c [r = 0.457, p < 0.001], fasting blood sugar (FBs) [r = 0.386, p < 0.001], serum iron [r = 0.430, p < 0.001], and systolic blood pressure (SBP) [r = 0.195, p = 0.047] in T2DM patients. A multivariate logistic regression model revealed that a rise in HbA1c (AOR = 3.67, 95% CI(1.50–8.98), serum iron (AOR = 1.02, 95% CI(1.01–1.04), male gender (AOR = 0.16, 95% CI(0.05–0.57) and being on oral hypoglycemic agent (OHA) monotherapy (AOR = 0.26, 95% CI(0.07–0.95) were key associated factors for the elevated serum ferritin among T2DM patients.ConclusionThe present study demonstrated that T2DM patients had elevated serum ferritin levels which might be related to the existence of long-term hyperglycaemia and that serum ferritin had a significant positive association with HbA1c and FBs, implying that it could be used as an additional biomarker to predict uncontrolled T2DM patients.