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SUMMARY: This study assessed the effects of Acacia Senegal (AS) combined with insulin on Na+/K+-ATPase (NKA) activity and mRNA expression, serum glucose, renal function, and oxidative stress in a rat model of diabetic nephropathy (DN). Sixty rats were equally divided into six groups: normal control, normal+AS, diabetic (DM), DM+insulin, DM+AS, and DM+insulin+AS groups. Diabetes mellitus (type 1) was induced by a single injection of streptozotocin (65 mg/kg), and insulin and AS treatments were carried until rats were culled at the end of week 12. Serum glucose and creatinine levels, hemoglobin A1c (HbA1c) were measured. Renal homogenate levels of NKA activity and gene expression, malondialdehyde, superoxide dismutase (SOD), catalase and reduced glutathione (GSH) were evaluated as well as kidney tissue histology and ultrastructure. Diabetes caused glomerular damage and modulation of blood and tissue levels of creatinine, glucose, HbA1c, malondialdehyde, NKA activity and gene expression, SOD, catalase and GSH, which were significantly (p<0.05) treated with AS, insulin, and insulin plus AS. However, AS+insulin treatments were more effective. In conclusion, combined administration of AS with insulin to rats with DN decreased NKA activity and gene expression as well as oxidative stress, and improved glycemic state and renal structure and function.
Este estudio evaluó los efectos de Acacia senegal (AS) combinada con insulina sobre la actividad Na+/K+- ATPasa (NKA) y la expresión de ARNm, la glucosa sérica, la función renal y el estrés oxidativo en un modelo de nefropatía diabética (ND) en ratas. Sesenta ratas se dividieron equitativamente en seis grupos: control normal, normal+AS, diabética (DM), DM+insulina, DM+AS y DM+insulina+AS. La diabetes mellitus (tipo 1) se indujo mediante una única inyección de estreptozotocina (65 mg/kg), y los tratamientos con insulina y AS se llevaron a cabo hasta que las ratas fueron sacrificadas al final de la semana 12. Se midieron niveles séricos de glucosa y creatinina, hemoglobina A1c (HbA1c). Se evaluaron los niveles de homogeneizado renal de actividad NKA y expresión génica, malondialdehído, superóxido dismutasa (SOD), catalasa y glutatión reducido (GSH), así como la histología y ultraestructura del tejido renal. La diabetes causó daño glomerular y modulación de los niveles sanguíneos y tisulares de creatinina, glucosa, HbA1c, malondialdehído, actividad y expresión génica de NKA, SOD, catalasa y GSH, los cuales fueron tratados significativamente (p<0,05) con AS, insulina e insulina más AS. Sin embargo, los tratamientos con AS+insulina fueron más efectivos. En conclusión, la administración combinada de AS con insulina a ratas con DN disminuyó la actividad de NKA y la expresión genética, así como el estrés oxidativo, y mejoró el estado glucémico y la estructura y función renal.
Subject(s)
Animals , Male , Rats , Plant Extracts/administration & dosage , Sodium-Potassium-Exchanging ATPase/drug effects , Diabetic Nephropathies/drug therapy , Acacia/chemistry , Superoxide Dismutase , Glycated Hemoglobin/analysis , Plant Extracts/pharmacology , Gene Expression , Rats, Sprague-Dawley , Sodium-Potassium-Exchanging ATPase/genetics , Oxidative Stress , Microscopy, Electron, Transmission , Disease Models, Animal , Drug Therapy, Combination , Glycemic Control , Insulin/administration & dosage , Kidney/drug effects , MalondialdehydeABSTRACT
ABSTRACT Objective: To perform a systematic review of randomized controlled trials, evaluating the effect of probiotics, prebiotics or symbiotics supplementation on glycemic and inflammatory control in children with Type 1 Diabetes Mellitus (T1DM). Data source: The Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SciELO) databases were searched. Randomized clinical trials of pediatric patients with DM1 using probiotics, prebiotics or symbiotics were included, regardless of year or language of publication. Studies that did not evaluate glycated hemoglobin (HbA1c) were excluded. Metabolic results (HbA1c, total insulin dose and C-peptide) and inflammatory control [interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ)] during probiotic supplementation or similar, related to modification of the intestinal microbiota, were analyzed. PROSPERO ID: CRD42022384485. Data synthesis: Five studies were selected for a systematic review. Regarding metabolic markers, only one of the articles that analyzed HbA1c showed a significant decrease (p=0.03) in the intervention group. One study identified a reduction in the total dose of insulin and increased C-peptide levels. Regarding the evaluation of inflammatory parameters (IL-10, TNF-α, INF-γ), there were no statistical relevant modifications. Conclusions: Current data from the literature were not conclusive in identifying an improvement in glycemic control and did not observe changes in inflammatory parameters with the use of probiotics, prebiotics or symbiotics in pediatric patients with T1DM.
RESUMO Objetivo: Realizar uma revisão sistemática de ensaios clínicos randomizados controlados avaliando o efeito da suplementação de probióticos, prebióticos ou simbióticos no controle glicêmico e inflamatório em crianças com diabetes mellitus tipo 1 (DM1). Fontes de dados: As bases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Clinical Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Scientific Electronic Library Online (SciELO) foram pesquisadas. Foram incluídos ensaios clínicos randomizados de pacientes pediátricos com DM1 em uso de probióticos, prebióticos ou simbióticos, independentemente de ano ou idioma de publicação. Foram excluídos os trabalhos que não avaliaram hemoglobina glicada (HbA1c). Os resultados metabólicos (HbA1c, dose de insulina total e peptídeo C) e o controle inflamatório [interleucina-10 — IL-10), fator de necrose tumoral-alfa (TNF-α) e interferon-gama (IFN-γ)] durante a suplementação de probióticos ou similares, relacionados à modificação da microbiota intestinal, foram analisados. ID PROSPERO: CRD42022384485. Síntese dos dados: Cinco estudos foram selecionados para revisão sistemática. Com relação aos marcadores metabólicos, apenas um dos artigos que analisaram a HbA1c apresentou diminuição significativa (p=0,03) no grupo intervenção. Um estudo identificou redução da dose total de insulina e aumento dos níveis de peptídeo C. Quanto à avaliação dos parâmetros inflamatórios (IL-10, TNF-α, INF-γ), não houve modificações de relevância estatística. Conclusões: Os dados atuais da literatura não foram conclusivos em identificar melhora no controle glicêmico e não observaram mudanças nos parâmetros inflamatórios com o uso de probióticos, prebióticos ou simbióticos em pacientes pediátricos com DM1.
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Objetivo: analizar la correlación entre el tiempo en rango y la hemoglobina glicosilada de personas que viven con diabetes mellitus y realizan la monitorización continua de la glucemia o el automonitoreo de la glucemia capilar Método: revisión sistemática de etiología y riesgo basada en las directrices del JBI e informada según los Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abarcando seis bases de datos y la literatura gris. La muestra incluyó 16 estudios y la calidad metodológica fue evaluada utilizando las herramientas del JBI. Protocolo registrado en Open Science Framework, disponible en https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tiempo en rango (70-180 mg/dl) mostró una correlación negativa con la hemoglobina glicosilada, mientras que el tiempo por encima del rango (>180 mg/dl) mostró una correlación positiva. Los coeficientes de correlación variaron entre -0,310 y -0,869 para el tiempo en rango, y entre 0,66 y 0,934 para el tiempo por encima del rango. Un estudio se realizó en una población que hacía el automonitoreo. Conclusión: hay una correlación estadísticamente significativa entre el tiempo en rango y el tiempo por encima del rango con la hemoglobina glicosilada. Cuanto mayor sea la proporción en el rango glucémico adecuado, más cerca o por debajo del 7% estará la hemoglobina glicosilada. Se necesitan más estudios que evalúen esta métrica con datos del automonitoreo de la glucemia.
Objective: to analyze the correlation between time on target and glycated hemoglobin in people living with diabetes mellitus and carrying out continuous blood glucose monitoring or self-monitoring of capillary blood glucose. Method: systematic review of etiology and risk based on JBI guidelines and reported according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses, covering six databases and grey literature. The sample included 16 studies and methodological quality was assessed using JBI tools. Protocol registered in the Open Science Framework, available at https://doi.org/10.17605/OSF.IO/NKMZB. Results: time on target (70-180 mg/dl) showed a negative correlation with glycated hemoglobin, while time above target (>180 mg/dl) showed a positive correlation. Correlation coefficients ranged between -0.310 and -0.869 for time on target, and between 0.66 and 0.934 for time above target. A study was carried out on a population that performed self-monitoring. Conclusion: there is a statistically significant correlation between time on target and time above target with glycated hemoglobin. The higher the proportion in the adequate glycemic range, the closer to or less than 7% the glycated hemoglobin will be. More studies are needed to evaluate this metric with data from self-monitoring of blood glucose.
Objetivo: analisar a correlação entre o tempo no alvo e a hemoglobina glicada de pessoas que vivem com diabetes mellitus e realizam a monitorização contínua da glicemia ou a automonitorização da glicemia capilar. Método: revisão sistemática de etiologia e de risco pautada nas diretrizes do JBI e reportada conforme Preferred Reporting Items for Systematic Reviews and Meta-Analyses, abrangendo seis bases de dados e a literatura cinzenta. A amostra incluiu 16 estudos e a qualidade metodológica foi avaliada utilizando as ferramentas do JBI. Registrado protocolo no Open Science Framework, disponível em https://doi.org/10.17605/OSF.IO/NKMZB. Resultados: tempo no alvo (70-180 mg/dl) apresentou correlação negativa com a hemoglobina glicada, enquanto o tempo acima do alvo (>180 mg/dl) mostrou correlação positiva. Os coeficientes de correlação variaram entre -0,310 e -0,869 para o tempo no alvo, e entre 0,66 e 0,934 para o tempo acima do alvo. Um estudo foi efetuado com população que realizava a automonitorização. Conclusão: há correlação estatisticamente significativa entre o tempo no alvo e o tempo acima do alvo com a hemoglobina glicada. Quanto maior a proporção na faixa glicêmica adequada, mais próxima ou inferior a 7% estará a hemoglobina glicada. São necessários mais estudos que avaliem essa métrica com dados da automonitorização da glicemia.
Subject(s)
Humans , Blood Glucose , Glycated Hemoglobin , Blood Glucose Self-Monitoring , Diabetes Mellitus, Type 2ABSTRACT
ABSTRACT Objective: The optimal target for blood glucose concentration in critically ill patients is unclear. We will perform a systematic review and meta-analysis with aggregated and individual patient data from randomized controlled trials, comparing intensive glucose control with liberal glucose control in critically ill adults. Data sources: MEDLINE®, Embase, the Cochrane Central Register of Clinical Trials, and clinical trials registries (World Health Organization, clinical trials.gov). The authors of eligible trials will be invited to provide individual patient data. Published trial-level data from eligible trials that are not at high risk of bias will be included in an aggregated data meta-analysis if individual patient data are not available. Methods: Inclusion criteria: randomized controlled trials that recruited adult patients, targeting a blood glucose of ≤ 120mg/dL (≤ 6.6mmol/L) compared to a higher blood glucose concentration target using intravenous insulin in both groups. Excluded studies: those with an upper limit blood glucose target in the intervention group of > 120mg/dL (> 6.6mmol/L), or where intensive glucose control was only performed in the intraoperative period, and those where loss to follow-up exceeded 10% by hospital discharge. Primary endpoint: In-hospital mortality during index hospital admission. Secondary endpoints: mortality and survival at other timepoints, duration of invasive mechanical ventilation, vasoactive agents, and renal replacement therapy. A random effect Bayesian meta-analysis and hierarchical Bayesian models for individual patient data will be used. Discussion: This systematic review with aggregate and individual patient data will address the clinical question, 'what is the best blood glucose target for critically ill patients overall?' Protocol version 0.4 - 06/26/2023 PROSPERO registration: CRD42021278869
RESUMO Objetivo: Não está claro qual é a meta ideal de concentração de glicose no sangue em pacientes em estado grave. Realizaremos uma revisão sistemática e uma metanálise com dados agregados e de pacientes individuais de estudos controlados e randomizados, comparando o controle intensivo da glicose com o controle liberal da glicose em adultos em estado grave. Fontes de dados: MEDLINE®, Embase, Cochrane Central Register of Clinical Trials e registros de ensaios clínicos (Organização Mundial da Saúde, clinical trials.gov). Os autores dos estudos qualificados serão convidados a fornecer dados individuais de pacientes. Os dados publicados em nível de ensaio qualificado que não apresentem alto risco de viés serão incluídos em uma metanálise de dados agregados se os dados individuais de pacientes não estiverem disponíveis. Métodos: Critérios de inclusão: ensaios clínicos controlados e randomizados que recrutaram pacientes adultos, com meta de glicemia ≤ 120mg/dL (≤ 6,6mmol/L) comparada a uma meta de concentração de glicemia mais alta com insulina intravenosa em ambos os grupos. Estudos excluídos: aqueles com meta de glicemia no limite superior no grupo de intervenção > 120mg/dL (> 6,6mmol/L), ou em que o controle intensivo de glicose foi realizado apenas no período intraoperatório, e aqueles em que a perda de seguimento excedeu 10% até a alta hospitalar. Desfecho primário: Mortalidade intra-hospitalar durante a admissão hospitalar. Desfechos secundários: Mortalidade e sobrevida em outros momentos, duração da ventilação mecânica invasiva, agentes vasoativos e terapia de substituição renal. Utilizaremos metanálise bayesiana de efeito randômico e modelos bayesianos hierárquicos para dados individuais de pacientes. Discussão: Essa revisão sistemática com dados agregados e de pacientes individuais abordará a questão clínica: Qual é a melhor meta de glicose no sangue de pacientes graves em geral? Protocolo versão 0.4 - 26/06/2023 Registro PROSPERO: CRD42021278869
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Introdução:A doença periodontal corresponde àcondição que acomete os tecidos de proteção e/ou suporte do dente através de uma inflamação crônica causadapor patógenos.Estacondição pode ser modificada ou associada às doenças sistêmicas, como por exemplo, o diabetes mellitus tipo II (DM2).Objetivo:Avaliar quais os efeitos da terapia periodontal não cirúrgica sobre o controle glicêmico de pacientes diagnosticados com DM2.Metodologia:Revisão integrativa elaborada a partir de pesquisas clínicas randomizadas indexadas nas bases de dados Pubmed, Embase, Cochrane, Web of Science e BVS, na qual foram utilizados os descritores "periodontal diseases treatment", "glycemic control" e "metabolic control".Resultados:Dos trabalhos avaliados, seis foram selecionados para compor a revisão, tendo em vista os critérios de inclusão e exclusão estabelecidos. Logo, é notório que a terapia periodontal básica indica melhora no controle glicêmico dos pacientes com DM2, de acordo comanálise da HbA1c e PCR,portanto, com base nos resultados dessa pesquisa, o tratamento periodontal não cirúrgico parece contribuir para o controle metabólico. Apesar disso, alguns estudos se opõem aoresultadodo controle glicêmicodesses pacientes, reforçando a existência de variáveis que interferem nos resultados da pesquisa, como os níveis de hemoglobina, estágio da doença periodontal, amostra, dietae atividade física dos pacientes.Conclusões:O resultado deverá ser avaliado com maior cautela, tendo em vista as possibilidades de variáveis presentes nesse tipo de pesquisa. Por fim, ensaios controlados devem ser realizados para alcançar um maior esclarecimento a respeito dos efeitos da terapia periodontal não cirúrgica no controle glicêmico de pacientes com DM2 (AU).
Introduction:Periodontal disease is a condition in which protective or supportive tissues of the tooth are affected by chronic inflammation caused by pathogens. This condition may be modified or associated with systemic diseases such as type 2 diabetes mellitus (T2DM).Objective:To evaluate the effects of nonsurgical periodontal therapy on glycemic control in patients diagnosed with T2DM. Methodology:An integrative review was performed using randomized clinical trials indexed in PubMed, Embase, Cochrane, Web of Science, and BVS databases. The descriptors "periodontal disease treatment," "glycemic control," and "metabolic control" were used. Results:From the reviewed studies, six were selected for the review considering the established inclusion and exclusion criteria.Basic periodontal therapy improves glycemic control in patients with T2DM, as evidenced by analysis of glycated hemoglobin (HbA1c) and polymerase chain reaction (PCR). Therefore, based on the results of this research, nonsurgical periodontal treatment contributes to metabolic control. However, some studies contradict the effect of glycemic control in these patients, reinforcing the presence of variables that interfere with research results, such as hemoglobin levels, stage of periodontal disease, sample, dietand physical activity of patients. Conclusions:The results should be evaluated with more caution considering the potential variables present in this type of research. Finally, controlled trials should be conducted to understand better the effects of nonsurgical periodontal therapy on glycemic control in patients with T2DM (AU).
Introducción: La enfermedad periodontal es una condición en la cual los tejidos protectores o de soportedel diente se ven afectados por una inflamación crónica causada por patógenos. Esta condición puede modificarse o asociarse a enfermedades sistémicas como la diabetes mellitus tipo 2 (DM2). Objetivo: Evaluar los efectos de la terapia periodontal no quirúrgica en el control glucémico en pacientes diagnosticados con DM2. Metodología: Se realizó una revisión integradora utilizando ensayos clínicos aleatorizados indexados en las bases de datos de PubMed, Embase, Cochrane, Web of Science y BVS. Se utilizaron los descriptores "tratamiento de enfermedades periodontales", "control glucémico" y "control metabólico". Resultados: De los estudios revisados, se seleccionaron seis para la revisión, considerando los criterios de inclusión y exclusión establecidos. La terapia periodontal básica mejora el control glucémico en pacientes con DM2, como se evidencia en el análisis de la hemoglobina glicosilada (HbA1c) y la reacción en cadena de la polimerasa (PCR). Por lo tanto, basándose en los resultados de esta investigación, el tratamiento periodontal no quirúrgico contribuye al control metabólico. Sin embargo, algunos estudios contradicen el efecto del control glucémico en estos pacientes, lo que refuerza la presencia de variables que interfieren en los resultados de la investigación, como los niveles de hemoglobina, el estadio de la enfermedad periodontal, la muestra, la dieta y la actividad física de los pacientes. Conclusiones: Los resultados deben evaluarse con mayor precaución, considerando las posibles variables presentes en este tipo de investigación. Por último, se deben realizar ensayos controlados para comprender mejor los efectos de la terapia periodontal no quirúrgica en el control glucémico en pacientes con DM2 (AU).
Subject(s)
Periodontal Diseases/therapy , Glycated Hemoglobin , Glycemic IndexABSTRACT
Introducción. La calidad de los carbohidratos consumidos juega un papel importante en la prevención de las enfermedades crónicas no transmisibles (ECNT). Objetivo. Analizar el índice de calidad de los carbohidratos (ICC) en la población urbana costarricense y su relación con las variables sociodemográficas, antropométricas y la calidad y la diversidad de la dieta. Materiales y métodos. Los datos provienen del Estudio Latinoamericano de Nutrición y Salud, en una muestra representativa de 798 personas entre 15 y 65 años que residen en zonas urbanas de Costa Rica (2014- 2015). En una visita domiciliaria se administró un cuestionario para recolectar los datos sociodemográficos y se pesó y midió a los participantes. El consumo dietético se obtuvo mediante dos recordatorios de 24 horas en días no consecutivos. El ICC se calculó mediante el consumo de fibra, el índice glicémico, la relación carbohidratos sólidos/líquidos y la relación granos enteros/granos totales. Se comparó el ICC según el sexo, el grupo de edad, el nivel socioeconómico, el estado nutricional, la circunferencia de cintura y la calidad y diversidad de la dieta de los participantes. Resultados. El ICC se asoció positivamente con un mayor consumo de energía, carbohidratos totales, proteínas, grasas, colesterol, frutas, vegetales y leguminosas (p<0,001). Un mayor ICC se asoció positivamente con un mayor porcentaje de adecuación de micronutrientes y mayor índice de diversidad y calidad de la dieta (p<0,001), así como con un menor índice de masa corporal y una menor circunferencia de cintura al ajustar por sexo y edad (p<0,005). Conclusiones. El presente estudio demostró que un mayor ICC se asocia significativamente con mejores indicadores dietéticos e índice de masa corporal, por lo que resulta fundamental establecer en Costa Rica pautas dietéticas que permitan aumentar la calidad de los carbohidratos de la dieta con el fin de contribuir en la prevención de las ECNT(AU)
Introduction. The carbohydrate quality index (CQI) plays an important role in the prevention of chronic non-communicable diseases (NCD) and adequate macro and micronutrient intake. Objective. To analyze the carbohydrate quality index (CCI) in the Costa Rican urban population and its relationship with sociodemographic and anthropometric variables and the quality and diversity of the diet. Materials and methods. Data come from the Latin American Nutrition and Health Study (ELANS), in a representative sample of 798 people between 15 and 65 years of age who reside in urban areas of Costa Rica (2014-2015). During a home visit, a questionnaire was administered to collect sociodemographic data, and participants were measured and weighed. Dietary intake was obtained through two 24-hour recalls in non- consecutive days. The CQI was calculated using fiber intake, glycemic index, liquid/solid carbohydrate ratio, and whole grain/total grains. CCI was then compared according to sex, age-group, socioeconomic level, nutritional status and diet quality and diet diversity. Results. The CQI was positively associated with energy intake, total carbohydrates, proteins, fats, cholesterol, fruits, vegetables, and legumes (p<0,001). Also, CQI was associated with a higher percentage of micronutrient adequacy and diet quality and diversity (p<0,001), as well as with a lower body mass index and lower waist circumference when adjusting for sex and age (p<0,005). Conclusions. The present study showed that higher CQI is associated with better dietary and body mass index, which shows that it is essential to establish dietary guidelines for public health in Costa Rica that allows increasing the quality of carbohydrates in the diet to contribute to the prevention of chronic NCD(AU)
Subject(s)
Humans , Male , Female , Adult , Middle AgedABSTRACT
La incidencia y prevalencia de la diabetes mellitus ha aumentado exponencialmente a nivel mundial en las últimas décadas. Los pacientes diabéticos presentan mayor probabilidad de sufrir graves complicaciones, en los procedimientos quirúrgicos en relación a la población general. El presente artículo tiene como objetivo, describir la repercusión del estado hiperglucémico perioperatorio en la etapa postoperatoria en pacientes diabéticos. Para el logro del objetivo planteado se realizó la consulta de diversas obras, que abarcan los resultados de investigación con diferentes modalidades relacionadas con la temática. Se pudo apreciar que la hiperglucemia perioperatoria se vincula con resultados adversos en pacientes a los que se les realiza cirugía general y que padecen diabetes mellitus, sin embargo, en los pacientes que se ha logrado control glicémico con terapia insulínica antes de la intervención, no presentaron mayor riesgo, que el que aparece en sujetos con buen control metabólico. La regulación de la glucosa en la etapa perioperatoria es un parámetro importante en el paciente diabético, que reduce considerablemente las complicaciones en los procedimientos quirúrgicos, las prolongadas estancias en las Unidades de Cuidados Intensivos, e incluso, la muerte.
The incidence and prevalence of diabetes mellitus has increased exponentially worldwide in recent decades. Diabetic patients are more likely to suffer serious complications in surgical procedures compared to the general population. The objective of this article is to describe the repercussion of the perioperative hyperglycemic state in the post-surgical stage in diabetic patients. In order to achieve the stated objective, various works were consulted, which include the results of research with different modalities related to the subject. It was possible to appreciate that perioperative hyperglycemia is associated with adverse results in general surgery patients with diabetes mellitus, however, in patients who have achieved glycemic control with insulin therapy before the intervention, they did not present a greater risk than that which appears in subjects with good metabolic control. Glucose regulation in the perioperative stage is an important parameter in diabetic patients, which considerably reduces complications in surgical procedures, long stays in Intensive Care Units, and even death.
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Background: This study was conducted to evaluate the effect of various oral hypoglycemic agents in the control of plasma blood glucose levels among Type 2 diabetes mellitus (T2DM) patients. Aims and Objectives: This study is aimed to evaluate the blood glucose controlling efficacy of various oral hypoglycemic drugs in T2DM patients. Materials and Methods: This randomized and control study was conducted among the cases attending Department of General Medicine at Research cell of Chennai Medical College Hospital and Research Centre, during the period of June 2014 to July 2015. A total of 180 cases were randomly allotted to six groups. Group I was treated with Glibenclamide, Group-II was treated with Glibenclamide + Sitagliptin, Group-III was treated with Glibenclamide + Vildagliptin, Group-IV was treated with Metformin, Group-V was treated with Metformin + Sitagliptin, and Group-VI was treated with Metformin + Vildagliptin. Fasting, postprandial, and glycated hemoglobin (HbA1c) levels were assessed before and at 4, 8, and 12th weeks and the data were analyzed using Statistical Package for the Social Sciences. Results: Fasting and postprandial sugars were significantly reduced in Group V and Group VI during 4th, 8th, and 12th weeks. However, HbA1c levels were significantly reduced after 12 weeks of treatment in Group III, Group V, and Group VI. Conclusion: We conclude that metformin in combination with either Vildagliptin or Sitagliptin can help to reduce fasting, postprandial, and HbA1c levels (both in short-term and in long-term); however, Glibenclamide along with Vildagliptin could reduce only HbA1c levels (long-term alone).
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Objetivo: Analisar a relação entre os níveis de adesão às recomendações de boas práticas em insulinoterapia e as métricas de controle glicêmico em pacientes com diabetes mellitus. Métodos: Estudo descritivo, transversal e quantitativo, realizado com 102 pacientes com diabetes mellitus. A coleta de dados ocorreu por meio de entrevista semiestruturada e, em caráter complementar, com dados obtidos dos prontuários. Aplicaram-se quatro instrumentos de coleta: I) formulário de caracterização sociodemográfica e clínica, II) recordatório de orientações sobre insulinoterapia, III) folha de registro da automonitorização da glicemia capilar e IV) formulário de registro das métricas de avaliação do controle glicêmico. Resultados: Houve associação estatística significativa entre nível de não adesão (100%) às recomendações em insulinoterapia e tempo no alvo estimado ≤ 70%, assim como entre 80% de não adesão e desvio padrão ≥ 50 mg/dl. Conclusão: Esses achados validam que a não adesão às recomendações de boas práticas de insulinoterapia contribui para o descontrole glicêmico.
Objective: To analyze the relation between adherence levels to good practice recommendations for insulin therapy and glycemic control metrics in patients with diabetes mellitus. Methods: A descriptive, cross-sectional, quantitative study was conducted with 102 patients with diabetes mellitus. Data were collected by means of semi-structured interviews and complemented by information obtained from medical records. Participants answered four collection instruments: I) a sociodemographic and clinical characterization form, II) a reminder of insulin therapy guidelines, III) a capillary blood glucose self-monitoring record sheet and IV) a record form of glycemic control assessment metrics. Results: Results showed a statistically significant association between non-adherence level (100%) to insulin therapy recommendations with estimated time on target ≤ 70% and between non-adherence (80%) and standard deviation ≥ 50 mg/dl. Conclusion: These findings corroborate that non-adherence to good insulin therapy recommendations contribute to a lack of glycemic control
Objetivo: Analizar la relación entre los niveles de adherencia a las recomendaciones de buenas prácticas en insulinoterapia y las métricas de control glucémico en pacientes con diabetes mellitus. Métodos: estudio descriptivo, transversal y cuantitativo, realizado con 102 pacientes con diabetes mellitus. Para larecolección de datos se utilizaron entrevistas semiestructuradas y, de forma complementaria, se obtuvieron datos de las historias clínicas. Se aplicaron cuatro instrumentos de recolección: I) formulario de caracterización sociodemográfica y clínica, II) recordatorio de pautas de insulinoterapia, III) formulario de autocontrol de glucemia capilar y IV) formulario de registro de métricas de evaluación del control glucémico. Resultados: hubo una asociación estadísticamente significativa entre el nivel de no adherencia (100%) a las recomendaciones de insulinoterapia y el tiempo estimado ≤ 70%; así como entre el 80% de no adherencia y la desviación estándar ≥ 50 mg/dl. Conclusión: estos hallazgos evidencian que la no adherencia a las recomendaciones de buenas prácticas de insulinoterapia contribuye a la falta de control glucémico
Subject(s)
Humans , Male , Female , Good Manipulation Practices , Treatment Adherence and Compliance , Glycemic Control , InsulinABSTRACT
ABSTRACT Objective: The objective of this study was to verify the impact of carbohydrate counting (CC) on glycemic control and body weight variation (primary and secondary outcomes, respectively) between consultations in patients with diabetes mellitus (T1D) followed at a tertiary hospital in southern Brazil in a public health system environment. We also sought to investigate CC adherence. Materials and methods: This retrospective cohort study included 232 patients with T1D who underwent nutritional monitoring at a referral hospital for diabetes care between 2014 and 2018. To assess primary and secondary outcomes, data from 229 patients, 49 of whom underwent CC during this period and 180 individuals who used fixed doses of insulin, were analyzed. The impact of CC on glycemic control was assessed with the mean glycated hemoglobin (HbA1c) level at all consultations during the follow-up period. Results: In the model adjusted for the most confounders (except pregnancy), the mean HbA1c was better in the CC group (8.66 ± 0.4% vs. 9.36 ± 0.39%; p = 0.016), and body weight variation was lower (0.13 ± 0.28 kg vs. 0.53 ± 0.24 kg; p = 0.024). Adherence to CC was reported in 69.2% of consultations. Conclusion: CC optimized the glycemic control of individuals with T1D, resulting in less weight variation than in the fixed insulin dose group, which indicates that CC is an important care strategy for these patients.
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ABSTRACT Objectives: To evaluate the alternate use of flash glucose monitoring (FGM) with self-monitoring blood glucose (SMBG), in patients with type 1 diabetes (T1D). Materials and methods: Two weeks of open FGM (P2), both preceded (P1) and followed by 2 weeks (P3) of SMBG with a blinded FGM system. Mean absolute relative difference (MARD) was calculated by (-FGMi − SMBGi-) / SMBGi, where it was a paired data sample. Results: In total, 34 patients were evaluated. Time in range (TIR) did not change between P1 and P2. In 12 patients (35.3%), TIR increased from 40% at P1 to 52% at P2 (p = 0.002) and in 22 (64.7%), TIR decreased or did not change. FGM use resulted in decreased % time spent in hypoglycemia (<70 mg/dL) (6.5% vs. 5.0%; p = 0.005), increased % time spent in hyperglycemia (>180 mg/dL) (44.5% to 51%; p = 0.046) with no significant change in % TIR. The proportion of patients who reached sensor-estimated glycated hemoglobin (eA1c) < 7% decreased from 23.5% at P1 to 12.9% at P2, p = 0.028. For the whole sample, the MARD between the two methods was 15.5% (95% CI 14.5-16.6%). For normal glucose range, hyperglycemic levels and hypoglycemic levels MARD were 16.0% (95% CI 15.0-17.0%), 13.3% (95% CI 11.5-15.2%) and 23.4% [95% CI 20.5-26.3%)], respectively. Conclusion: FGM after usual SMBG decreased the % time spent in hypoglycemia concomitant with an undesired increase in % time spent in hyperglycemia. Lower accuracy of FGM regarding hypoglycemia levels could result in overcorrection of hypoglycemia.
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Las harinas de trigo, maíz, lentejas y arroz son elementales para la formulación de distintos alimentos de alto consumo en la población chilena. El proceso de extrusión es ampliamente utilizado por la industria alimentaria para generar propiedades que permitan la reconstitución instantánea de harinas. Sin embargo, dicho proceso tecnológico; afecta la cantidad, la estabilidad y la digestibilidad de los hidratos de carbono (CHO) del ingrediente alimentario. Estas propiedades nutricionales impactan directamente en la respuesta glicémica de los individuos y en el índice glicémico (IG) de los alimentos. La presente revisión analiza el efecto de la extrusión sobre las propiedades nutricionales de los CHO de alimentos elaborados a partir de harinas de consumo habitual en Chile. Factores como la temperatura, y en menor grado, la humedad y velocidad utilizadas en el proceso de extrusión, junto con el origen del grano utilizado, determinan las propiedades nutricionales de CHO presente en harinas extruidas. El estudio, control y estandarización de estas variables operacionales permitiría estandarizar la elaboración industrial de productos extruidos, impactando favorablemente; sobre la velocidad de hidrólisis de almidón y el IG de harinas de trigo, maíz, lentejas o arroz; y de alimentos formulados a partir de ellas.
Flours from wheat, corn, lentils, and rice are essential for the formulation of various high-consumption foods in the Chilean population. The extrusion process is widely used by the food industry to generate properties that allow for the instant reconstitution of flours. However, this technological process affects the nutritional properties of the carbohydrates (CHO) in the food ingredient, including quantity, stability, and digestibility; characteristics that directly impact the glycemic response of individuals and the glycemic index of foods. This review analyzes the effect of extrusion on the nutritional properties of CHO in foods made from commonly consumed flours in Chile. Factors such as temperature, and to a lesser extent, humidity, and speed used in the extrusion process, along with the origin of the grain used, determine the healthy properties of CHO in extruded flours. The utility of adjusting the mentioned variables in the extrusion process would allow for the standardization of industrial scaling in the production of extruded foods that would positively impact the starch hydrolysis rate and glycemic index of wheat, corn, lentil, or rice flours, and foods formulated from them.
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Introduction: Good glycemic control has been defined as achieving a target of fasting plasma glucose level of between 80 and 110 mg/dl, or glycosylated haemoglobin (HbA1C) of <7.0%. Poor glycemic control is highly correlated with chronic conditions related to the damaging effects of hyperglycaemia, resulting in serious complications. To restrict and delay the complications of diabetes mellitus, good glycemic control is essential. Objective: To identify the determinants associated with poor glycemic control among Type 2 diabetes mellitus patients. Method: A cross sectional study was conducted among 403 confirmed type 2 diabetic patients who attendedone of the tertiary care hospitals of North India over a period of six months (July- December 2021). The collected data was analysed using IBM SPSS version 28. Chi-square test was applied to compare various determinants of glycemic control. A p-value of <0.05 was considered to be statistically significant. Results: Out of 403 participants, 57.6% had poor glycemic control of diabetic condition. Higher age of participants, illiteracy, being overweight, having positive history of smoking and alcohol, longer duration of diabetes, participants taking both oral and insulin treatment for diabetes, taking medicine irregularly were the significant determinants of poor glycemic control. Conclusion: Higher percentage(57.6%) of poor glycemic control was observed in the study.To improve the glycemic control, efforts should be made towards improving modifiable factors like overweight, smoking, alcohol, regularity of medication etc. Good lifestyle interventions help in control of poor glycemic control.
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Background: Liraglutide, glucagon-like peptide-1 (GLP-1) receptor agonist, has been investigated for safety and effectiveness for blood glucose (BG) control in a surgical setting. However, there are only a few studies specific to cardiac surgery patients. Aims: To primarily compare perioperative 1) BG and 2) glycemic variability (GV) between added liraglutide and only insulin infusion in diabetes mellitus (DM) patients undergoing cardiac surgery. Setting and Design: A randomized control trial was conducted in DM patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Inclusion criteria were age 20� years and DM Type 2. Material and Methods: The recruited patients were randomly assigned to Group 1 (added liraglutide with insulin infusion) and Group 2 (insulin infusion). Insulin infusion was based on institutional protocol. Point of care testing (POCT) glucose was used for the adjustment of insulin and BG analysis. Continuous glucose monitor (CGM) was for GV analysis (using Standard deviation: SD). Statistics: t?test, Chi?square or Fisher?exact test, or Mann朩hitney U test. Results: Finally, 60 patients were in our study (Group 1 = 32 vs Group 2 = 28). Perioperative mean BG levels of Group 1 were significantly lower than Group 2 with a mean difference of 15.9 mg/dL. Nine patients (18.7% vs 10.7%, P = 0.384) had BG of 60� with mean BGs (109.1 vs 147.9, P = 0.001) in the morning. Thirteen patients (9.4% vs 35.7%, P = 0.025) had BG >180 mg/dL at the 1st operative hour. SDs were increasing, but lower SD of Group 1 were observed at the postoperative period. Mean of SDs at postoperative day 2 were 23.65 vs 32.79 mg/dL, P = 0.018. Conclusions: Liraglutide added with insulin infusion can attenuate perioperative BG and is beneficial in the aspect of lowering GV together with BG at the postoperative period in DM patients. Liraglutide can be applied in cardiac surgery but a rearrangement of time and dosage should be further investigated.
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Background: Vitamin D deficiency and associated complications are widely prevalent in the Indian subcontinent. Hypovitaminosis D is known to play deleterious effects on cardiovascular and skeletal functions in human beings. Yet, its effect on carbohydrate metabolism and diabetes mellitus (DM) is less known. Aim and Objectives: In the current case– control study, our primary aim is to find out the potential effect of hypovitaminosis D on glycemic control in type 2 DM (T2DM) patients. Materials and Methods: The study population comprised 250 T2DM patients recruited primarily from Madhya Pradesh, India. The case group of 125 T2DM patients with hypovitaminosis D was compared with a control group of 125 T2DM patients with sufficient vitamin D. We mainly investigated the effect of hypovitaminosis D (both deficiency and insufficiency) on glycemic control in T2DM patients. Results: We observed that both fasting and 2-h postprandial blood glucose were found to be elevated significantly in T2DM patients with hypovitaminosis D (P < 0.01). The glycated hemoglobin level was also elevated (P < 0.01) in the case group suggesting impaired glycemic control for a chronic period. An inverse association is found between glycemic status and serum vitamin D (OH)D3 levels. Conclusions: Our results show the significance of maintaining sufficient plasma vitamin D levels, along with hypoglycemic medication in T2DM patients to improve their glycemic control and avoid diabetic comorbidities.
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Background: On 18th June 2013, India banned pioglitazone, a peroxisome proliferation activator gamma agonist, and a popular anti-diabetic drug used in the treatment of type 2 diabetes mellitus (T2DM), but on 21st August 2013, ban was revoked after stiff opposition from diabetologists and pioglitazone was reintroduced to the market again. Aim and Objective: The aim of this study was to assess the efficacy and safety of low-dose pioglitazone compared to standard dose pioglitazone in adults with T2DM. Materials and Methods: After obtaining permission from the Institutional Ethics Committee, 50 patients with T2DM who were not under adequate glycemic control with metformin and glimepiride combination therapy were included in the study. The patients were randomly assigned (1:1) into pioglitazone 7.5 mg group and 15 mg group as an add on treatment to the existing therapy. Results: All the glycemic parameters such as Fasting blood sugar (FBS), post prandial blood glucose (PPBS), Glycosylated Hemoglobin (HbA1c) are significantly reduced in both groups from baseline to the end of 12 weeks. FBS reduced from 183.64 ± 20.9 to 152.08 ± 15.2 in the Pioglitazone 7.5 mg group and from 177.32 ± 16.89 to 145.2 ± 11.6 in the pioglitazone 15 mg group (P < 0.05), PPBS was reduced from 260.2 ± 31.09 to 213.8 ± 29.5 and from 256.24 ± 43.72 to 203.52 ± 27.5 (P < 0.05) in 7.5 mg and 15 mg group, respectively. HbA1c was reduced from 8.969 ± 0.88 to 8.508 ± 0.9 in 7.5 mg group (P < 0.05) and in 15 mg group, it was reduced from 8.796 ± 0.79 to 8.19 ± 0.72 (P < 0.05). In the study, Pioglitazone 7.5 mg efficaciously reduced glycemic parameters similar to pioglitazone 15 mg and there was no statistically significant difference between the groups. Three patients reported with pedal edema as adverse effect in pioglitazone 15 mg therapy, whereas only one in 7.5 mg pioglitazone therapy complained of ankle edema. Conclusion: Low-dose pioglitazone offers an attractive alternative option to standard dose pioglitazone as an add on therapy for T2DM due to its effectiveness in reducing glycemic markers and also fewer side effect profile.
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Objective: Design a proposal of educational intervention for both, people who live with Diabetes Mellitus type 2 and their family caregiver. Methodology: Methodology. A case series study was conducted with the participation of 12 people living with type 2 diabetes mellitus and attending a Mutual Help Group in Pachuquilla, Hidalgo. Sociodemographic data, somatometric measurements (weight, height, BMI, waist circumference), blood pressure, and capillary blood samples for glycosylated hemoglobin were collected. Results: The mean age was 64 and range of 39-79 years, O.D. of 12; 67% women; 25% finished secondary school, 50% worked at home, 17% in commerce, 33% unemployed; 58% married, 25% widowed, and 17% divorced and in common law; 33.% with less than 5 years diagnosed, 67% have been diagnosed for more than 5 years; 75% depend economically; 67% have complications, 75% with family support, in diabetes knowledge 33% obtained intermediate score and 67% inadequate score; the weight average was of 77 kg and range of 57-116.5 kg, and O.D. 17 kg; in waist circumference, 100% exceed the recommended limit, in BMI, 50% is classified as overweight and 50% as obese; in blood pressure 50% > 130/80 mmHg and in glycosylated hemoglobin 75% > 7% mg/dl. Conclusion: The currently implemented strategy does not reflect good knowledge and control of the disease. This study invites us to continue with research where an educational intervention is implemented in which family caregivers are included and active participation is encouraged, in addition to implementing the IEP as a theoretical basis for the intervention.
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Glycaemic control and reduction in mortality among diabetes can be easily achieved by a cost-effective intervention, Physical activity. Moderate to vigorous intensity activities are usually rec-ommended for diabetics. Structured engagement of diabetes by combining physical activity and modest weight loss activities their risk can be reduced by 58%. But most of the diabetics prefer to remain inactive. Hence this article highlights the importance of physical activity, acute and chronic effects of physical activity on diabetics, recommended level of activity, recommended type of activi-ty and ways to adhere and maintain those activities.
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Background : Type 2 Diabetes Mellitus is a lifestyle disorders and it leads to complications that are life threatening which can be prevented by proper Counselling and Diet monitoring of patients. Objective : To evaluate effect of Counselling on the Glycemic control, Dietary habits and Diabetes awareness of type 2 DM patients. Method : A randomized clinical trial was conducted at a tertiary hospital. 96 subjects were randomized and baseline data was gathered from all patients included in the study. Out of these 48 patients were given Counselling on various aspects of Diabetes including diet, complications, medication, lifestyle modifications, exercise etc. Lab investigations and Diet calculations were done on first and 4 months later to measure the effect of Counselling on patient抯 Diet and Glycemic control and Diabetes awareness. Results : Diabetic awareness was measured in terms of number of correct responses which increased from 325 to 542 in Intervention group and from 357 to 402 in Control group. The increase in intervention group (22.60%) was more than that of the Control group (4.59%). The amount of calories in the diet of intervention and control group was respectively 2322�1 and 2334�0. Post Intervention it was 2344�0 and 2056�7respectively. Before intervention the difference in the amount of Calories, FBS, PP2BS between the 2 groups was statistically insignificant. But after intervention the difference with reference to total calories (p=0.0003), FBS (p=0.01) and PP2BS (p=0.0001) became statistically significant. Conclusion : Counselling led to a significant improvement in the Diabetic awareness, Glycemic control and Dietary habits of patients in terms of caloric intake.
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In recent years, with the continuous development of glucagon-like peptide-1 receptor agonists(GLP-1RA), its role in the management of blood glucose in hospitalized patients has been explored. GLP-1RA can not only control blood glucose in non-critically ill hospitalized patients, but also inhibit appetite, delay gastric emptying, protect nerves, anti-inflammation, reduce systolic blood pressure and blood lipids. At the same time, many studies have found that it can also improve cardiovascular and renal outcomes and reduce the risk of hospitalization complications. Therefore, this paper analyzes the role of GLP-1RA in glycemic management by reviewing domestic and international studies, consensus and guidelines related to inpatient blood glucose management, and helps to better manage blood glucose of patients in non-critical care setting.