Unsatisfactory Glycemic Control Research Articles

Ultrasound Features of the Peroneal Nerve in Type 2 Diabetes Mellitus

The aim of the work is to study the ultrasound features of the peroneal nerves in people with type 2 diabetes mellitus and compare them with the symptoms of diabetic peripheral neuropathy and the characteristics of diabetes. The study included 67 patients (average age 59,4 ± 9.7 years) with type 2 diabetes mellitus duration least 7 years. All patients underwent standard general clinical and biochemical examinations, insulin and proinflammatory biomarkers blood levels were assessed. Diabetic peripheral neuropathy was diagnosed by assessing pain, tactile and vibration sensitivity. The presence and severity of neuropathic pain were determined on the basis of a DN4 questionnaire and a visual analog scale. All patients underwent ultrasound examination of the peroneal nerves: the cross-sectional area of the nerve, its echogenicity and structure were studied. The results of the study allow us to state in the overwhelming majority of people with a long course of type 2 diabetes mellitus and unsatisfactory glycemic control the presence of significant changes in peripheral nerves according to ultrasound examination (92,5 % of cases), including in the absence of clinical manifestations of diabetic peripheral neuropathy. Among patients with clinical manifestations of diabetic peripheral neuropathy (49,3 %), significant ultrasound changes in the peroneal nerves were more common than in those with no symptoms of this complication and correlated with the prescription of diabetes mellitus, glycated hemoglobin levels, age, manifestations of metabolic syndrome and the presence of other micro- and macrovascular complications. The study results suggest the possibility of wider use of peroneal nerves ultrasound examination for early diagnosis of diabetic peripheral neuropathy, its course prediction and, probably, can be used to improve the principles of choosing therapeutic tactics in patients with type 2 diabetes mellitus.

Investigation and Analysis of Elderly Inpatients with Type 2 Diabetes in Liuzhou, China

At present, diabetes has become a serious public health problem that is of increasing concern to countries all over the world, and diabetes has become the top five chronic diseases that affect human health including cancer, cardiovascular diseases, chronic respiratory diseases, etc. Thus, this paper investigated and analyzed the current status of elderly patients with type 2 diabetes in Liuzhou and the related influencing factors. 240 cases of elderly patients with type 2 diabetes were selected from a hospital in Liuzhou, and the patients were divided into two groups according to the HbA1c and FPG levels. The differences were compared and analyzed, and the interaction between the observed indexes and the elderly patients with type 2 diabetes was analyzed through correlation analysis and binary logistic regression. Correlation analysis and binary logistic regression were used to analyze the correlation between each observation index and HbA1c in elderly type 2 diabetes patients. The HbA1c compliance rate of 240 elderly type 2 diabetic patients included in this study reached only 29.17 %, with a low level of compliance and unsatisfactory glycemic control. Diabetic patients should improve the ability of glycemic control levels to prevent complications. This paper aims to provide a reference for the management and treatment of diabetic patients, improve the level of glycemic control and quality of life of patients, and provide data support in clinical treatment.

Cardiometabolic Effects of Empagliflozin in Patients Undergoing Elective Percu-taneous Coronary Intervention for Type 2 Diabetes Mellitus.

Aim To evaluate cardiometabolic effects of empagliflozin in patients with ischemic heart disease and type 2 diabetes mellitus (DM) following elective percutaneous coronary intervention (PCI).Materials and methods Patients meeting the inclusion/non-inclusion criteria were randomized into two groups of equal number using simple randomization with successively assigned numbers. Group 1 included 37 patients (18 men and 19 women) who gave their consent for the treatment with empagliflozin 10 mg/day in addition to their previous hypoglycemic therapy. The drug administration started one month prior to the elective PCI and continued for the next 11 months (treatment duration, 12 months). Group 2 (comparison group) consisted of age- and DM duration-matched patients (37 patients; 18 men and 19 women) who continued on their hypoglycemic therapy previously prescribed by endocrinologists during the entire study period. Before the study, 36.11 % patients of the empagliflozin group and 27.03 % of the comparison group had unsatisfactory glycemic control as shown by the level of glycated hemoglobin (HbA1c).Results At 6 and 12 months of the study, fasting glycemia and HbA1c were significantly lower in the empagliflozin treatment group. The groups were comparable by the incidence of adverse outcomes: 8 (22.24 %) patients in the empagliflozin group and 10 (27.04 %) patients in the comparison group (р=0.787). The 12-month empagliflozin treatment reduced total cholesterol (C) by 5.56 % (p<0.05), low density lipoprotein (LDL) C by 3.67 % (p<0.05), visceral adipose tissue area (VATA) by 5.83 % (p<0.05), and subcutaneous adipose tissue area (SATA) by 3.54 % (p<0.05).Conclusion The empagliflozin treatment for 30 days prior to and after elective PCI can enhance the effectiveness of myocardial revascularization due to the demonstrated beneficial cardiometabolic effects.

Growing importance of urogenital candidiasis in individuals with diabetes: A narrative review.

Both diabetes and fungal infections contribute significantly to the global disease burden, with increasing trends seen in most developed and developing countries during recent decades. This is reflected in urogenital infections caused by Candida species that are becoming ever more pervasive in diabetic patients, particularly those that present with unsatisfactory glycemic control. In addition, a relatively new group of anti-hyperglycemic drugs, known as sodium glucose cotransporter 2 inhibitors, has been linked with an increased risk for colonization of the urogenital region with Candida spp., which can subsequently lead to an infectious process. In this review paper, we have highlighted notable virulence factors of Candida species (with an emphasis on Candida albicans) and shown how the interplay of many pathophysiological factors can give rise to vulvovaginal candidiasis, potentially complicated with recurrences and dire pregnancy outcomes. We have also addressed an increased risk of candiduria and urinary tract infections caused by species of Candida in females and males with diabetes, further highlighting possible complications such as emphysematous cystitis as well as the risk for the development of balanitis and balanoposthitis in (primarily uncircumcised) males. With a steadily increasing global burden of diabetes, urogenital mycotic infections will undoubtedly become more prevalent in the future; hence, there is a need for an evidence-based approach from both clinical and public health perspectives.

Analysis of clinical features of patients with type 2 diabetes mellitus with different levels of glomerular filtration rate

Aim to improve the dispensary follow-up of patients with type 2 diabetes (DM) by identifying clinical signs, available during examination in the outpatient clinic, that suggest the development of chronic kidney disease (CKD).
 Material and methods. A cross-sectional study included a population sample of patients with type 2 diabetes and focused on the clinical indices available during an outpatient consultation. 150 protocols of outpatient consultations were selected using the compliance criteria, including data on 72 clinical indices. The general sample was divided into groups in two ways: by the level of glomerular filtration rate (GFR) and by achieving the goals of glycemic control (calculated parameter delta HbA1c).
 Results. The following indices differed most significantly in the groups divided by stages of CKD: gender, age, duration of diabetes and insulin therapy, achievement of target values of glycemic control, blood pressure level, comorbid cardiovascular pathology, pulse on the popliteal artery. In patients with preserved GFR and the early stages of CKD, the fact of unsatisfactory glycemic control was associated with an increase in plasma creatinine and a decrease in GFR, higher blood pressure values. In the advanced stages of CKD, the impact of glycemic control on kidney function was practically absent.

Integrated Approach to Cardio-Vascular Risk in Insulin-Treated People with Diabetes based on the "Heart Project" and on Metabolic Complications Expected from Incorrect Injection Practice-Related Lipohypertrophy

Type 2 diabetes (T2DM) is known to be associated with increased cardiovascular (CV) morbidity and mortality. Over time, the CV Risk of patients with T2DM has been assessed according to various methods, often borrowed from different populations. Nevertheless, never have been evaluated changes in insulin absorption due to improper injection technique and responsible for further, well recognized CV-R factors as high glycemic variability, frequent hypoglycemia, and unsatisfactory glycemic control. Aim of the study was to intensify diabetes and its own comorbidities treatment, and in addition reduce the impact of injection technique of insulin to evaluate possible improvement in the CV-R score and NHYA score in 4499 insulin-treated T2DM subjects with (LH+) and without lipohypertrophy (LH-) due to improper injection habit. The educational training and the treatment intensification significantly reduced glycemic control, hypoglycemia rate and the mean amplitude of glycemic variability, expecially in LH+ subjects, adding new knowledge to a global intervention addressed to reduce the devastating impact to the increased cardiovascular risk of diabetic people, inclusive of the risk due to LHs

Association between skin manifestations and glycemic control in patients with diabetes mellitus type II

Background/Aim. Diabetes mellitus (DM) can be associated with numerous skin diseases. This study aimed to determine the pattern and incidence of skin manifestations in patients with type 2 DM and their link to glycemic control. Methods. This cross-sectional study was conducted at the Skin and Venereal Diseases Clinic, University Clinical Centre of the Republic of Srpska in Banja Luka, Bosnia and Herzegovina, from January 2016 to January 2018. Adult patients of both genders suffering from type 2 DM and cutaneous manifestations participated in the study. Glycemic control was assessed according to the values of glycated hemoglobin (HbA1c) of 7%. Results. The mean age of 105 study participants (46% m ale and 5 4% female) was 6 8.4 ? 10 years, while the mean HbA1c was 8.3 ? 1.6%. Unsatisfactory glycemic control was found in 74.3% of patients with the mean HbA1c at 8.9 ? 1.4%, while satisfactory glycemic control was found in 25.7% of patients, with the mean HbA1c at 6.7 ? 0.2% (p < 0.001). Infections were the most frequent skin diseases (43.9%). Bacterial infections were most common (26.7%), followed by fungal infections (24.8%), xerosis (17.1%), psoriasis (15.2%), fibroma molle (14.3%), diabetic ulcer (7.7%), prurigo (6.7%), and stasis dermatitis (5.7%). Other skin manifestations were found at a lower rate. A significant association was found between unsatisfactory glycemic control and skin infections (p = 0.009). Conclusion. The most common skin manifestations in patients with type 2 diabetes are infections. They occurred more often in patients with unsatisfactory glycemic control.

Indicies of body composition and uric acid metabolism as markers of metabolic phenotype in normouricemic type 2 diabetic man

The purpose of the workisto investigate the relationship between body composition parameters and uric acid metabolism and lipid spectrum in obese type 2 diabetic male compared with non-obese patients. Materials and methods. In 34 patients with type 2 diabetes, aged 45 to 75 years, with unsatisfactory glycemic control (HbA1c from 7.1 to 12.6 %), mainly with abdominal obesity, anthropometric parameters, characteristics of body composition (percentage of total and abdominal fat, segmental distribution of adipose and muscle tissue, by bioimpedance method), level of HbA1c, C-peptide, concentration of uric acid (UA), 24 h UA excretion, and serum lipid fractions were measured. Patients were divided into 2 groups depending on the degree of obesity: group 1—15 men with overweight without obesity (BMI 25.0—29.9 kg/m2); group2—19 obese men (BMI ≥ 30.0 kg/m2). The groups did not differ in age and disease duration. Results and discussion. Normouricemia was observed in almost all examined patients, without a significant difference in uricemia levels between two groups. In 42 % of obese patients, elevated UA excretion was significantly higher than in the non-obese group, which may reflect increased UA production during the day and increased urate elimination, which leads to normal uricemia. Comparison of body composition between groups with different phenotypes showed that obese patients had significantly higher percentages of total fat and visceral fat than non-obese individuals. Adipose tissue in both groups was evenly distributed between body segments. In obese patients, there was a significant increase in muscle mass, especially in the lower extremities, with some dehydration, as indicated by a decrease in the % water content. Conclusions. It has been shown that both variants of metabolic phenotypes in patients with type 2 diabetes (with and without obesity), under conditions of central fat accumulation and normouricemia, in many cases were accompanied by hyperexcretion of UA, which ensured the preservation of normal uricemia.

Bacteriological Profile and Antibiotic Sensitivity Pattern in Infected Diabetic Foot Ulcers

Objectives: To identify the common bacterial pathogens responsible for infection in diabetic foot ulcer and their sensitivity pattern to different antibiotics. Methods: This prospective observational study was conducted from 24th June 2019 to 27th December 2019 at Services Institute of Medical Sciences Lahore. Specimens of discharge from diabetic foot ulcers (DFU) were received from Diabetes Management Centre (DMC). Cultures were put up and bacteria isolated were identified by standard methods. Antibiotic sensitivity was determined by Kirby-Bauer disc diffusion method. Results: Samples from DFU of 50 patients were processed. Thirty-six (72%) samples were from males and 14(28%) were from females; mean age of patients was 53±9.5 years. Forty-nine (98%) patients had unsatisfactory glycemic control. Forty three (86%) samples were growth positive while 07(14%) were bacteriologically sterile. Monomicrobial infection was observed in 38 (76%) cases while polymicrobial infection was seen in 12 cases (24%). The most common isolates were Staphylococcus aureus 14(28%), Pseudomonas species 11 (22%) and Proteus species 10 (20%). Forty three percent of Staphylococcus aureus, were methicillin resistant (MRSA). All MRSA remained sensitive to vancomycin and linezolid. In Pseudomonas species, resistance to third generation cephalosporins, ceftazidime , was 27%, while resistance to imipenem was seen in 3 (9%) of isolates. In Proteus species, resistance to third generation cephalosporins was 90% while to imipenem resistance was 60%. Resistance to commonly prescribed quinolones was more than 70% among all the bacterial isolates. Conclusions: Common Gram positive and Gram negative organisms responsible for infection in DFU were Staphylococcus aureus, Pseudomonas species and Proteus species. The isolates were multi-drug resistant (MDR). Resistance to antibiotics used as empiric therapy was high. Keywords: Diabetic foot ulcer, antibiotic resistance, empiric therapy

Effect of COVID19 pandemic and national lockdown on persons with diabetes from rural areas availing care in a tertiary care center, southern India

Background and aimsCOVID-19 pandemic and lockdown measures to contain it have affected health care services globally. This study aims to assess the effect and urban-rural differences of COVID19 pandemic on diabetes care. MethodsThis cross-sectional study was conducted among persons with diabetes (PWDs) registered for care at a diabetes clinic of a tertiary care center in Southern India. We collected following information by telephonic interviews: physician consultations, access to diabetes medications and blood sugar tests, use of telemedicine services, out of pocket expenditure and psychological morbidity. ResultsA total of 350 PWDs were interviewed. Majority were male (78%) and from rural areas (79%). One fourth (24%) met any physician for diabetes care at least once during lockdown. PWDs from rural areas mainly consulted a physician in a private clinic (55%) compared to urban areas (26%). Two third (65%) availed medications from private medical shops. Almost half (46%) got their blood sugar tested during and majority of them (81%) reported unsatisfactory glycemic control. Only few (5%) was aware and three utilized telemedicine services. Almost all (99%) spent money (US $ 8.3) for diabetes care. One third (33%) had moderate or high psychological distress. ConclusionsMajority of PWDs did not consult a physician during lockdown. Cost of care was high. Measures to improve utilisation of telemedicine services and peripheral health facilities are needed.

IDegLira fixed-ratio combination in the real world: a retrospective observational single-center Italian experience.

An improvement of type 2 diabetes treatment is represented by the recent availability of a fixed-ratio combination of slow insulin degludec and GLP-1 RA liraglutide (IDegLira), which shows encouraging clinical trial results. This work represents a real-world evidence study to evaluate if the obtained clinical results are also confirmed in the clinical practice, in an Italian type 2 diabetes patients' population. This retrospective observational study was conducted in the Diabetology Service of the Umbria local sanitary agency (USL Umbria 1) in Perugia. The study investigated all diabetic patients >18 years, who underwent anti-diabetic treatment with basal insulin with or without the concomitant consumption of one or more oral anti-diabetic agent (BOT group) or GLP-1 RA or rapid-acting insulin bolus (BB group), with unsatisfactory glycemic control for either hypoglycemic episodes or weight gain. The observation period was February 2018 to April 2019. IDegLira results to be effective in reducing HbA1c and fasting plasma glucose, especially among GLP-1 RA and BOT subgroup. In BOT group, a statistical difference was noted from the first month of treatment, also for post-prandial glycemia. Obtained results were achieved at a moderate dose of IDegLira reported during the study, which also represents a significant reduction of the amount of basal insulin in BB patients. Obtained results suggest that in a real-world setting, the switch to IDegLira treatment is a valid option for patients with unsatisfactory glycemic control, or who experienced side effects such as weight gain and hypoglycemia of other insulin therapies.

968-P: Long-Term Quantitative and Qualitative Effect of Dulaglutide in Type 2 Diabetes Patients

Background: Dulaglutide is a once-weekly glucagon-like peptide-1 receptor agonist GLP-1. Aim: The aim of the study was to investigate dulaglutide’s quantitative and qualitative long-term effects in type 2 diabetes patients with unsatisfactory glycemic control. Material and Methods: 310 patients under treatment with dulaglutide were included in the study. Parameters of glycemic control (HbA1c, Fasting Blood Glucose -FBG) and cardiovascular risk factors (weight, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, LDL, HDL, and triglycerides) were recorded, while treatment satisfaction was evaluated with the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Follow up period was 52±2 weeks with assessment of study’s parameters at 12 ±2 weeks and 24±2 weeks. All the data were collected for 254 patients. Results: Patients’ age was 60.23±10.21 years. A reduction of HbA1c was during the follow-up period. HbA1c was reduced from the baseline at the 3, 6 and 12 month monitoring times (8.0±1.31 vs. 7.0.9±0.9 vs. 6.97±1.1, vs. 6.77±0.9) p<0.0001). Bodyweight was also reduced during the same monitoring times (96.30 ±20.24 vs. 92.41±18.52 vs. 90.04±18.77, vs. 89.49±18.27, p=0.001). Statistically significant change on waist circumference (p=0.010). A statistically significant reduction was noticed on LDL (p=0.022), triglycerides (p=0.016) while the improvement on HDL was not significant (p=0.108). There was a reduction of the systolic blood pressure (p=0.088) and of the diastolic blood pressure (p=0.114). Treatment satisfaction was improved as evaluated via DTSQ on both Group A (p = 0.026) Conclusion: The long-term use of dulaglutide leads to a significant reduction of HbA1c and to significant improvement of cardiovascular risk factors from the first three months of dulaglutide’s use. All these parameters are showing a steady improvement during the first twelve months of dulaglutide’s use in type 2 diabetes with an unsatisfactory glycemic control. Disclosure A. Koutsovasilis: None. A. Sotiropoulos: None. M. Pappa: None. T. Peppas: None.

Efficacy and safety of metformin and sitagliptin‐based dual and triple therapy in elderly Chinese patients with type 2 diabetes: Subgroup analysis of STRATEGY study

Aims/IntroductionTo assess the efficacy and safety of metformin/sitagliptin‐based dual/triple therapy in elderly Chinese patients with type 2 diabetes mellitus.Materials and MethodsThis subgroup analysis included individuals aged ≥65 years from the STRATEGY study, a two‐stage study in which type 2 diabetes mellitus patients with unsatisfactory glycemic control on metformin were first treated with the dual combination of metformin and sitagliptin for 16 weeks (n = 681), and then, if glycemic control had not been achieved, were treated with a third add‐on oral antihyperglycemic drug for another 24 weeks (n = 291). The efficacy end‐point was change in glycated hemoglobin (HbA1c) in each stage, and the safety end‐point was adverse events with a focus on hypoglycemia.ResultsAt week 16, the change in HbA1c was −0.81% from baseline, and the percentages of patients who achieved HbA1c targets of <7% and <7.5% were 44.9 and 67.2%, respectively. After 24 weeks, a further average HbA1c reduction of −0.60% was observed with specific reductions of −0.70% with glimepiride, −0.63% with gliclazide, −0.51% with repaglinide and −0.45% with acarbose. The proportions of patients who achieved HbA1c targets of <7% and <7.5% were 65.4 and 81.3%, respectively, over the entire study. The rates of drug‐related adverse events and hypoglycemia were, respectively, 4.1 and 4.3% in the dual therapy stage, and 5.2% and 7.1% in the triple therapy stage, without occurrence of severe hypoglycemia.ConclusionsIn elderly Chinese type 2 diabetes mellitus patients, metformin/sitagliptin‐based dual and triple oral therapy can provide clinically meaningful glycemic control and is generally well tolerated with a low incidence of hypoglycemia.

832-P: Resilience Outstrips the Negative Impact of Diabetes Distress on Glycemic Control and Self-Management among Youth with Type 1 Diabetes

Background: Adolescent with type 1 diabetes (T1D) experience increased diabetes distress, which is linked to poor self-management and glycemic control. Resilience might be able to decrease distress and facilitate disease management. Objective: To determine whether resilience buffers the deleterious consequences of distress on glycemic control and self-management. Methods: A convenience sample of 203 eligible adolescents (mean age 14.60 years) was recruited from a national endocrine center. Data were collected on social clinical characteristics, diabetes distress, resilience, self-management and glycemic. We preformed the simple slope and Johnson-Neyman statistical technique to probe moderating effects of resilience. Results: A total of 42.4% of adolescents reported high diabetes distress. Our results indicated that resilience moderated the association that hazards of severe diabetes distress for higher HbA1c (β = 0.148, t = 4.156, p = 0.000) and worse self-management (β = -0.010, t = -3.000, p = 0.003) were only apparent in the context of low resilience. Conclusions: We highlight the interactive relationship between diabetes distress and resilience in relation to glycemic control and self-management. It suggest that resilience is promising intervention target for distressed T1D adolescents with unsatisfactory glycemic control and self-management behavior. Disclosure D. Luo: None. J. Xu: None. M. Zhu: None. H. Wang: None. Y. Wang: None. Y. Shi: None. M. Zhang: None.

Type 1 diabetes and periodontitis: prevalence and periodontal destruction-a systematic review.

Data about the association between periodontal disease or periodontitis (PD), diabetes and hyperglycemia have been reported mostly in patients with type 2 diabetes. Conversely, information about PD in type 1 diabetes (T1DM) is relatively scarce. The aim of this meta-analysis is therefore: (1) to assess the prevalence and severity of PD in patients affected by T1DM in comparison with the general population and (2) to verify the association between severity of PD and glycemic control in type 1 diabetics. An electronic search was performed on MEDLINE, Cochrane Central Register of Trials and EMBASE, up to October 31, 2019. Estimates of prevalence of PD in T1DM were calculated together with Mantel-Haenszel odds ratios (MH-OR) of the risk of PD associated with T1DM; weighed mean difference in CAL between T1DM and control and weighed mean difference in CAL in patients with T1DM and unsatisfactory glycemic control as compared with those in good glycemic control were also evaluated.. The prevalence of PD in type 1 diabetes was 18.5 [8.0; 37.1] %; the MH-OR for PD is 2.51 (1.32;4.76) in T1DM patients versus general population (p = 0.005). The weighed mean difference in CAL depth between T1DM patients and controls is 0.506 [0.181; 0.832] mm (p < 0.005), and in T1DM patients with good glycemic control CAL depth is -0.71 [-1.00; -0.42] mm less deep than in subjects with HbA1c > 7%. The present data confirm that T1DM is a relevant risk factor for the development of PD. The proportion of patients affected by PD is more than doubled in subjects with T1DM in comparison with non-diabetic individual, and among patients with T1DM, PD seems to be more severe and the differences appear very wide between subjects in optimal and suboptimal glycemic control.

2019 Diabetes Atlas: Achievements and challenges in diabetes care in Taiwan

The 2019 Diabetes Atlas delineated both accomplishments and challenges in diabetes care in Taiwan between 2005 and 2014. The series reported that Taiwan had significantly improved aspects of care quality for patients with diabetes. For example, the mortality rate decreased, the difference between the life expectancies of patients with diabetes and those of the general population decreased, and the rates of hospitalization because of heart diseases, cerebrovascular diseases, chronic kidney diseases, and unsatisfactory glycemic control decreased. However, despite these achievements, the 2019 Diabetes Atlas also reported some substantial challenges that have not been overcome. For example, the incidence of diabetes among women aged <19 years and 20-39 years increased by 27% and 33%, respectively. Furthermore, a high prevalence of macrovascular complications, a continuous increase in the dialysis prevalence rates among men with diabetes of all ages, and a low participation rate (<20%) of patients with diabetes in the pay-for-performance program were observed. The publication of the 2019 Diabetes Atlas is a milestone that demonstrates a strong will in medical societies to improve the quality of diabetes care. We expect this initiative can be reorganized every 5 years to report the results of continuous monitoring and surveillance and update the epidemiological features of diabetes in Taiwan.

Cardiovascular Disease in Patients with Type 2 Diabetes and in Patients Starting Empagliflozin Treatment: Nationwide Survey.

IntroductionWere the participants of the EMPA-REG OUTCOME trial representative of patients receiving empagliflozin in clinical practice? The aim of the present study was to examine the prevalence of cardiovascular disease (CVD) in type 2 diabetes patients starting empagliflozin treatment in routine clinical practice in Sweden.MethodsWe used nationwide data from the Swedish National Diabetes Register (NDR), the Swedish Prescribed Drug Register, and the Swedish National Patient Register to provide clinical characteristics and ongoing treatments.ResultsThe total study cohort included 460,558 patients, of whom 130,508 (28.3%) had a history of CVD. The number of patients starting empagliflozin during the study period was 16,985. Among these, 1952 (11.5%) had a history of CVD. The patients starting empagliflozin were younger than the total cohort and were more likely to have retinopathy despite having a similar duration of diabetes to the overall cohort. They also exhibited higher BMI, HbA1c, and eGFR, and were more likely to be treated with insulin and lipid-lowering and blood-pressure-lowering medications. The patients with CVD who were starting empagliflozin were slightly older and had been diabetic for slightly longer than the patients without CVD who were starting empagliflozin, but they also had lower eGFR. Among the patients with CVD who were starting empagliflozin, 87% had coronary heart disease, 8% had suffered a stroke, 13% had peripheral artery disease, 16% had atrial fibrillation, and 20% had congestive heart failure.ConclusionThe prevalence of CVD in patients with type 2 diabetes in clinical practice in Sweden was 28.3% during the study period, and it was 11.5% in the patients starting empagliflozin treatment. Patients of the latter cohort were, however, younger, more obese, and more likely to have unsatisfactory glycemic control, requiring additional treatment. Overall, a large proportion of type 2 diabetes patients should be considered at high cardiovascular risk.FundingBoehringer Ingelheim AB, Sweden.Electronic supplementary materialThe online version of this article (10.1007/s13300-019-0632-4) contains supplementary material, which is available to authorized users.

Raman spectral signatures of urinary extracellular vesicles from diabetic patients and hyperglycemic endothelial cells as potential biomarkers in diabetes

Raman spectroscopy was applied to the measurement of urinary and in vitro endothelium-derived extracellular vesicles (EVs) isolated by hydrostatic filtration dialysis (HFD) method. Raman spectra obtained for urinary EVs (UEVs) showed distinct differences in the fingerprint region. In contrast, average Raman spectra of endothelium-derived EVs samples were almost identical. Cluster Analysis of UEVs significantly discriminated diabetic samples from control, moreover endothelium-derived EVs revealed stronger similarity between long hyperglycemia and normoglycemia samples compared to short hyperglycemia. Results obtained from Partial Least Squares analysis corresponded well with integral intensities of selected bands. Our proof-of-concept approach demonstrates the potential for Raman spectroscopy to be used both for identification of EVs molecular signatures in urine samples from patients with type 2 diabetes mellitus and good glycemic control and unsatisfactory glycemic control as well as for in vitro hyperglycemic model. This noninvasive technique may be useful in identifying new biomarkers of diabetes and renal complications.

Peculiar features of life quality in patients with type 2 diabetes mellitus and postmenopausal osteoporosis

Aim. To study the peculiarities of the quality of life in patients with type 2 diabetes mellitus (DM2) and postmenopausal osteoporosis (PO).&#x0D; Materials and methods. 104 postmenopausal women aged 49–67 were examined. They were divided into 3 groups: group 1 (38 persons) – patients with DM2 and PO, group 2 (24 persons) – patients with PO, group 3 (42 persons) – postmenopausal patients with DM2 without any osteoporosis signs. Their quality of life was assessed using SF-36 survey, sensations of pain – with four-component visual analogue scale.&#x0D; Results. Physical component of health (PH) was statistically significantly lower in DM2 and PO group. Most patients of this group had decreased psychical component of health. In DM2 and PO group as compared with PO group statistically significantly lower values according to physical status-conditioned role functioning scales (RP) (p = 0,018), emotional status-conditioned role functioning (p = 0,028), PH (p = 0,038) were detected. When compared with DM2 group, physical functioning (p = 0,04), RP (p = 0,014), pain intensity (p = 0,049), PH (p = 0,014) appeared to be statistically significantly lower. The factors, negatively influencing the quality of life in patients of DM2 and PO group were the following: remoteness of diabetes, comorbidity, level of pain sensations, presence of diabetic polyneuropathy, insulin therapy in treatment, unsatisfactory glycemic control.&#x0D; Conclusions. Osteoporosis in patients with type 2 diabetes mellitus worsens their quality of life, in particular at the expense of elevated intensity of pain sensations.

Cardiac autonomic neuropathy: Risk factors, diagnosis and treatment.

Cardiac autonomic neuropathy (CAN) is a serious complication of diabetes mellitus (DM) that is strongly associated with approximately five-fold increased risk of cardiovascular mortality. CAN manifests in a spectrum of things, ranging from resting tachycardia and fixed heart rate (HR) to development of “silent” myocardial infarction. Clinical correlates or risk markers for CAN are age, DM duration, glycemic control, hypertension, and dyslipidemia (DLP), development of other microvascular complications. Established risk factors for CAN are poor glycemic control in type 1 DM and a combination of hypertension, DLP, obesity, and unsatisfactory glycemic control in type 2 DM. Symptomatic manifestations of CAN include sinus tachycardia, exercise intolerance, orthostatic hypotension (OH), abnormal blood pressure (BP) regulation, dizziness, presyncope and syncope, intraoperative cardiovascular instability, asymptomatic myocardial ischemia and infarction. Methods of CAN assessment in clinical practice include assessment of symptoms and signs, cardiovascular reflex tests based on HR and BP, short-term electrocardiography (ECG), QT interval prolongation, HR variability (24 h, classic 24 h Holter ECG), ambulatory BP monitoring, HR turbulence, baroreflex sensitivity, muscle sympathetic nerve activity, catecholamine assessment and cardiovascular sympathetic tests, heart sympathetic imaging. Although it is common complication, the significance of CAN has not been fully appreciated and there are no unified treatment algorithms for today. Treatment is based on early diagnosis, life style changes, optimization of glycemic control and management of cardiovascular risk factors. Pathogenetic treatment of CAN includes: Balanced diet and physical activity; optimization of glycemic control; treatment of DLP; antioxidants, first of all α-lipoic acid (ALA), aldose reductase inhibitors, acetyl-L-carnitine; vitamins, first of all fat-soluble vitamin B1; correction of vascular endothelial dysfunction; prevention and treatment of thrombosis; in severe cases-treatment of OH. The promising methods include prescription of prostacyclin analogues, thromboxane A2 blockers and drugs that contribute into strengthening and/or normalization of Na+, K+-ATPase (phosphodiesterase inhibitor), ALA, dihomo-γ-linolenic acid (DGLA), ω-3 polyunsaturated fatty acids (ω-3 PUFAs), and the simultaneous prescription of ALA, ω-3 PUFAs and DGLA, but the future investigations are needed. Development of OH is associated with severe or advanced CAN and prescription of nonpharmacological and pharmacological, in the foreground midodrine and fludrocortisone acetate, treatment methods are necessary.