Improvement of Na+-K+ ATPase Activity and Gene Expression Associated with Glomerular Ultrastructural Protection in Diabetic Nephropathy by Acacia senegal: Role of Oxidative Stress Disturbances / Mejora de la actividad Na+-K+ ATPasa y la Expresión Génica Asociada con la Protección Ultraestructural Glomerular en la Nefropatía Diabética por Acacia senegal: Papel de las Alteraciones del Estrés Oxidativo

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.

Use of probiotics and similar in pediatric patients with Type 1 Diabetes Mellitus: a systematic review / Uso de probióticos e similares em pacientes pediátricos com Diabetes Mellitus tipo 1: uma revisão sistemática

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.

Intensive glucose control in critically ill adults: a protocol for a systematic review and individual patient data meta-analysis / Controle intensivo da glicose em adultos em estado grave: um protocolo de revisão sistemática e metanálise de dados individuais de pacientes

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

Correlación entre tiempo en rango y hemoglobina glicosilada en personas con diabetes mellitus: revisión sistemática / Correlation between time on target and glycated hemoglobin in people with diabetes mellitus: systematic review / Correlação entre tempo no alvo e hemoglobina glicada de pessoas com diabetes mellitus: revisão sistemática

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.

El control glicémico perioperatorio: principal factor en la disminución de complicaciones postoperatorias en pacientes diabéticos

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.

Carbohydrate counting as a strategy to optimize glycemic control in type 1 diabetes mellitus

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.

Flash glucose monitoring system in patients with type 1 diabetes in healthcare center in Brazil: real world data from a short-term prospective study

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.

Adesão às recomendações de boas práticas em insulinoterapia: relação com o controle glicêmico / Adherence to good practice recommendations for insulin therapy: relation with glycemic control / Adherencia a las recomendaciones de buenas prácticas en insulinoterapia: relación con el control glucémico

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

Glycemic Control and Its associated Determinants among Type II Diabetic Patients at Tertiary Care Hospital in North India

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.

Hypovitaminosis D causes suboptimal glycemic control in type 2 diabetic patients

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.

Proposal for Educational Intervention in People Living with Type 2 Diabetes Mellitus and in their Family Caregiver

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.

Physical Activity in Control of Diabetes Mellitus: An Underrated Entity

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.

Role of Counselling and its Impact on the Dietary Habits, Glycemic Control and Diabetic Awareness of Newly Diagnosed Type 2 Diabetes Mellitus Patients

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.

Role of low-carbohydrate diet in type 1 diabetes / 中华内分泌代谢杂志

Low-carbohydrate diet is becoming popular recently. It requires carbohydrate intake lower than 130 g/d(or <26% of total energy intake) while fat and protein intake are not defined. Low-carbohydrate diet contributes to better glycemic control in patients with type 1 diabetes: lowering HbA 1C and glycemic variability, and improving time in range(TIR). Low-carbohydrate diet reduces insulin dosage in type 1 diabetic patients and does not increase the risks of hypoglycemia and diabetic ketoacidosis. This review summarized the research evidence of low-carbohydrate diet to explore the role and safety in disease management.

The association between blood glucose levels of children with type 1 diabetes mellitus and parental educational levels based on mobile health APP / 中国医师杂志

Objective:To explore the correlation between blood glucose level and parental education level in children with type 1 diabetes mellitus (T1DM) based on mobile health APP.Methods:The data of T1DM children enrolled in China′s T1DM registration management program and registered to use TangTangquan ? were collected, as well as the blood glucose monitoring information uploaded quarterly after registration. Children were divided into low education group (middle school or below) and high education group (junior college or above) according to their parents′ education level. Blood glucose levels were compared between the two groups at different time points. Spearman correlation analysis and multivariate logistic regression analysis were used to evaluate the correlation between blood glucose level and parents′ education level in children with T1DM. Results:A total of 2 263 eligible children with T1DM were included and 1 246 were female (55.1%). The median age was 7.9(4.4, 11.4)years and T1DM duration was 0.07(0.02, 0.46)years. Among them, 1 513 cases were in the low-education group while 750 cases were in the high-education group. Within three years after registration, the glucose levels of each interval in the low-education group were increasing gradually (all P<0.05 except post-breakfast glucose). The glucose levels of each interval in the high-education group in the third year were lower than those in the low-education group (all P<0.05 except nocturnal glucose). The result of multivariate logistic regression analysis showed that after the adjustment of factors including T1DM duration and treatment, parental educational levels were still the separate related factors of premeal glucose, bedtime glucose and nocturnal glucose (premeal glucose: OR=0.385, 95% CI: 0.164-0.874, P=0.025; bedtime glucose: OR=0.444, 95% CI: 0.204-0.949, P=0.038; nocturnal glucose: OR=0.226, 95% CI: 0.582-0.747, P=0.020). Conclusions:The blood glucose levels of children with T1DM were negatively associated with parental educational levels. It is suggested that parental educational levels should be taken into consideration in the management of T1DM for children.

Association of Ego-depletion level with glycemic control and quality of life among adolescents with type 1 diabetes / 中国实用护理杂志

Objective:To investigate the ego-depletion level of adolescents with type 1 diabetes mellitus (T1DM) and to explore its association with glycemic control and quality of life.Methods:This was a cross-sectional survey study. A total of 195 adolescents with T1DM were recruited from the First Affiliated Hospital of Nanjing Medical University from March to September 2022 by convenient sampling method. The Self-Regulatory Fatigue Scale (SRF-S) and Short Form of the Chinese version Diabetes Quality of Life for Youth Scale (C-DQOLY-SF) and the general information questionnaire were collected and the glycated hemoglobin (HbA 1c) value was detected. Results:The total score of self-regulatory fatigue for 195 adolescents with T1DM was (42.23 ± 9.94) points, with a scoring rate of 52.79%, which was at a medium level. Pearson correlation analysis showed that the total score of self-regulatory fatigue was positively correlated with HbA1c ( r = 0.25, P<0.01), and negatively correlated with quality of life ( r = -0.61, P<0.01). The hierarchical linear regression results showed that after controlling for demographic sociolagy and disease variables, ego-depletion had a positive predictive effect on HbA1c ( t = 3.69, P<0.01), while ego-depletion had a negative predictive effect on Quality of life ( t = -8.48, P<0.01). Conclusions:Ego-depletion of adolescents with T1DM may affect their blood glucose control and quality of life, which should be noticed by medical workers.

Fructosamine and glycated hemoglobin as biomarkers of glycemic control in people with type 2 diabetes mellitus and cancer (GlicoOnco study)

Abstract Introduction Glycemic control is important to avoid diabetes complications in individuals with cancer. There is no evidence for HbA1c and fructosamine as reliable biomarkers in these conditions. There are particularities in caring for patients with diabetes and cancer that can alter these biomarkers. Objective The aim of this study was to evaluate HbA1c and fructosamine as glycemic biomarkers in people with type 2 diabetes and cancer, undergoing clinical or surgical oncological treatment. Methods The authors conducted a single-center, retrospective analysis with people who have cancer and diabetes. Comparison of glycemic biomarkers (HbA1c, fructosamine, and Self-Monitoring of Blood Glucose [SMBG]) was performed including evaluation in individuals undergoing chemotherapy, using glucocorticoids, with anemia, hypoproteinemia or with reduced estimated Glomerular Filtration Rate (eGFR). Results There was a strong positive correlation between fructosamine and HbA1c (n = 318, r= 0.66, p < 0.001) in people with diabetes and cancer even in those under chemotherapy (n = 101, r= 0.61, p < 0.001) or using glucocorticoids (n = 96, r= 0.67, p<0.001). There was a strong correlation between HbA1c and fructosamine in subjects with anemia (n = 111, r= 0.66, p < 0.001), hypoproteinemia (n = 54, r= 0.67, p < 0.001), or with eGFR ≥ 60 mL/min/1.73 m2 (n = 189, r= 0.70, p < 0.001), and moderate correlation with hypoalbuminemia (n = 21, r= 0.54, p = 0.001) and with reduced eGFR (n = 67, r= 0.57, p < 0.001). The correlations between fructosamine and HbA1c with SMBG were moderate (n = 164, r= 0.49, p < 0.001; n = 111, r= 0.55, p < 0.001, respectively), strong in subjects undergoing chemotherapy, with hypoalbuminemia or hypoproteinemia, and at least moderate, if eGFR < 60 mL/min/1.73 m2 or with anemia. Conclusions Fructosamine and HbA1c can be used as glycemic biomarkers in people with diabetes and cancer, even in those with anemia, hypoproteinemia, or undergoing chemotherapy.

Knowledge about diabetes and its association with adherence to self-care and glycemic control in patients with type 1 diabetes in Southern Brazil

ABSTRACT Objective: To evaluate the association between knowledge about the disease, adherence to self-care, and glycemic control in people diagnosed with type 1 diabetes mellitus. Subjects and methods: A cross-sectional study of patients aged over 18 years diagnosed with type 1 diabetes mellitus, treated at an outpatient clinic of a Brazilian university hospital. Participants with other types of diabetes, cognitive impairment, pregnancy, and outpatient discharge were excluded. Data were collected from January to March 2021 (by telephone call), with questions about the participants' profile, diabetes knowledge questionnaire (DKN-A), and self-care inventory revised (SCI-R) translated into and adapted for Brazilian Portuguese. Data analysis involved chi-square associations, Mann-Whitney U tests, and Poisson regression. Results: Among 198 adult participants, the mean age was 42 ± 12 years, 53.5% were women, the mean glycated hemoglobin was 8.6 ± 1.6%, 140 (70.8%) had satisfactory knowledge about diabetes, 65 (32.8%) had adherence to self-care, and 46 (23.2%) had adequate glycemic control. We found an association between knowledge and adherence to self-care (p < 0.001). Knowledge was not associated with glycemic control (p = 0.705). Conclusion: Knowledge about diabetes was associated with greater adherence to self-care in people with type 1 diabetes mellitus, but it did not reflect in better glycemic control.

Once-Weekly Insulin Icodec vs. Once-Daily Insulin Glargine U100 for type 2 diabetes: a systematic review and meta-analysis of phase 2 randomized controlled trials

ABSTRACT Objective: Insulin Icodec is a novel basal insulin analogue designed for once-weekly administration, therefore might propitiate reduction in the frequency of injections and facilitate treatment adherence. This study aimed to determine the glycemic control and safety profile of Insulin Icodec, compared with Glargine U100 in patients with diabetes mellitus type 2. Materials and methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCT) data comparing Once-Weekly Insulin Icodec and Once-Daily Insulin Glargine U100 in patients with type 2 diabetes mellitus. PubMed, Embase, and Cochrane databases were searched for trials published up to May 14, 2022. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Results: Three studies were included comprising 453 patients, 230 (50.77%) using Once-Weekly Insulin Icodec and 223 (49.22%) using Once-Daily Insulin Glargine U100. In the pooled data, Glycated Hemoglobin (MD -0.20% CI -0.33 to -0.07%; P=0.002) change from baseline demonstrated a significantly higher reduction in the Icodec group. Time with Glucose in Range (MD 6.60% CI 3.63 to 9.57%; P < 0.0001) and Insulin Dose Difference (MD 0.97UI CI 0.76 to 1.18UI; P < 0.0001) were higher in the Icodec group. There was no significant difference in fasting plasma glucose, body weight change, hypoglycemia or any adverse event evaluated. Conclusions: Once-Weekly Insulin Icodec was associated with a small reduction in Glycated Hemoglobin, as well as higher Time with Glucose in Range, with similar hypoglycemic adverse events, when compared with Once-Daily Insulin Glargine U100.

Intermittent high intensity exercise associated with drugs in patients with type 2 diabetes / Exercício intermitente de alta intensidade associado aos fármacos em pacientes com diabetes tipo 2 / Ejercicio intermitente de alta intensidad asociado a fármacos en pacientes con diabetes tipo 2

ABSTRACT Introduction: Some studies point out that high-intensity intermittent training exercises combined with drugs may improve the endurance of patients with type 2 diabetes. However, the information concerning blood glucose control still needs to be better evidenced. Objective: Explore further the effect of intermittent high-intensity exercise combined with drugs on blood glucose control in patients with type 2 diabetes. Methods: Through a control experiment, 100 patients were selected from volunteers, and divided equally into two groups for this experiment. A protocol with high-intensity intermittent exercise for intervention associated with drug treatment was added to the experimental group, while the control received standard drug treatment. Results: The results of each index in the experimental group were: TC pre 4.80±1.00, post 4.56±0.78; TG pre 1.77±1.15, post 1.49±1.16; LDL pre 2.94±0.83, post 2.51±0.73. The experimental results proved that all indices in the experimental group were improved, but the changes in the control group were not evidenced. Conclusion: Intermittent high-intensity exercise combined with drugs positively affected blood glucose control in patients with type 2 diabetes. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: Alguns estudos apontam que exercícios com treinamento intermitente de alta intensidade combinados aos fármacos possam melhorar a resistência dos pacientes com diabetes tipo 2. No entanto, as informações relativas ao controle da glicemia ainda são pouco evidentes. Objetivo: Explorar melhor o efeito do exercício intermitente de alta intensidade combinado com fármacos no controle glicêmico sanguíneo em pacientes com diabetes tipo 2. Métodos: Através de um experimento de controle, 100 pacientes foram selecionados entre os voluntários, divididos igualmente em dois grupos para este experimento. Ao grupo experimental foi adicionado um protocolo com exercício intermitente de alta intensidade para intervenção associado ao tratamento medicamentoso, enquanto o controle recebeu tratamento medicamentoso padrão. Resultados: Os resultados de cada índice no grupo experimental foram: TC pré 4,80±1,00, pós 4,56±0,78; TG pré 1,77±1,15, pós 1,49±1,16; LDL pré 2,94±0,83, pós 2,51±0,73. A partir dos resultados experimentais, comprovou-se que todos os índices no grupo experimental foram aprimorados, porém as mudanças no grupo de controle não foram evidenciadas. Conclusão: O exercício intermitente de alta intensidade combinado com fármacos apresentaram um efeito positivo no controle da glicose sanguínea em pacientes com diabetes tipo 2. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: Algunos estudios señalan que los ejercicios de entrenamiento intermitente de alta intensidad combinados con fármacos pueden mejorar la resistencia de los pacientes con diabetes de tipo 2. Sin embargo, la información relativa al control de la glucemia sigue siendo escasa. Objetivo: Profundizar en el efecto del ejercicio intermitente de alta intensidad combinado con fármacos sobre el control de la glucemia en pacientes con diabetes tipo 2. Métodos: Mediante un experimento de control, se seleccionaron 100 pacientes voluntarios, divididos equitativamente en dos grupos para este experimento. Al grupo experimental se le añadió un protocolo con ejercicio intermitente de alta intensidad para la intervención asociado al tratamiento farmacológico, mientras que el control recibió el tratamiento farmacológico estándar. Resultados: Los resultados de cada índice en el grupo experimental fueron: TC pre 4,80±1,00, post 4,56±0,78; TG pre 1,77±1,15, post 1,49±1,16; LDL pre 2,94±0,83, post 2,51±0,73. A partir de los resultados experimentales, se comprobó que todos los índices del grupo experimental mejoraron, pero no se evidenciaron cambios en el grupo de control. Conclusión: El ejercicio intermitente de alta intensidad combinado con fármacos tuvo un efecto positivo sobre el control de la glucemia en pacientes con diabetes tipo 2. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.