Los efectos del ayuno intermitente en pacientes con Diabetes Mellitus tipo 2. Revisión sistemática / The effects of intermittent fasting in patients with type 2 Diabetes Mellitus. Systematic review

Introducción: La enfermedad de Diabetes Mellitus (DM)es considerada una de las enfermedades no transmisibles quecausa mayor morbimortalidad a nivel mundial y requiere deun elevado volumen de recursos y costes. Puesto que laforma de presentación más común es la diabetes mellitus tipo2 (DM2), se plantean nuevas estratégicas terapéuticas, comoes el uso de la dieta de ayuno intermitente como forma deafrontamiento de la enfermedad. Objetivo: Determinar los efectos del ayuno intermitenteen los pacientes con DM2, así como identificar los riesgos ybeneficios de la práctica de dicha dieta. Material y métodos: Se ha realizado una búsqueda bibliográfica en 6 bases de datos (Pubmed, Dialnet, Cochrane,Cinahl, Embase y Scopus), sobre los efectos que produce lapráctica del ayuno intermitente en personas con DM2. Se seleccionaron 16 artículos, que han sido analizados mediante lalectura crítica con el programa FLC 3.0. Resultados: Sedestacaron cambios positivos y estadísticamente significativos en los niveles de hemoglobina glicosilada (HbA1c), disminución de peso, disminución de los niveles de la glucosa en ayunas, así como los niveles de lípidosplasmáticos, el índice de masa corporal (IMC) y la circunferencia de la cintura. Como efectos adversos se observaron loseventos de hipoglucemia, pero no se vieron vinculados a lapráctica del ayuno, sino a las características personales decada paciente. Conclusiones: La dieta del ayuno intermitente en los pacientes con DM2 puede ser una herramienta eficaz que aportabeneficios a la salud de las personas siempre y cuando éstossean controlados y asesorados por profesionales adecuados. No obstante, se necesitan más estudios en humanos, con unamayor muestra de personas y más prolongados en el tiempopara obtener unos resultados más sólidos y concluyentes.(AU)

Introduction: The disease known as diabetes mellitus(DM) is generally considered one of the non communicablediseases worldwide and requires a high number of resourcesand costs for its treatment. Given that the most common formof diabetes mellitus type 2 (DM2), new therapeutical strategies are to be implemented, for instance the intermittent fasting as a way to deal with it.Objective: Determine the effects of the intermittent fasting on diagnosed DM2 patients as well as to identify the risksand benefits of carrying out this diet. Material and methods: Pubmed, Dialnet, Cochrane,Cinahl, Embase and Scopus were all used in the bibliographical research and documentation in regard with the effects produced by the implementation of the intermittentfasting on diagnosed DM2 patients. In addition, sixteen articles have been thoroughly analysed and examined throughthe FLC 3.0 Platform. Results: Positive and statistically significant changes stoodout on the levels of glycosylated haemoglobin (HbA1c),weight loss, lowering of the glucose and plasma lipids levelsduring the fasting period, a reduction of the body mass index(BMI) and the circumference of the waistline. On the contrary,hypoglycaemic events appeared as an adverse effect,nonetheless they were not associated with the practice of thefasting, but for the individual characteristics of the patients. Conclusions: The intermittent fasting on diagnosed DM2patients may suppose an efficient tool which brings healthbenefits as long as the patients are being under an adequate professional control and assessment. However, there is aneed of more longterm investigation and research on humans on a bigger scale with a larger sample in order to obtain more solid and conclusive results.(AU)

Clinical Profile of Elderly Patients (Over 90 Years) with Type 2 Diabetes Seen at a Diabetes Center in South India.

Background: The current life expectancy in India is <70 years. Type 2 diabetes mellitus (T2DM) is known to reduce life expectancy by 6-8 years. Hence elderly people with T2DM in India would be rare. We report on the clinical profile of Asian Indian patients with T2DM who lived beyond 90 years of age and compared them with T2DM patients aged 50 to 60 years. Methods: From the diabetes electronic medical records of >470,000 diabetes patients, we identified T2DM patients who had lived ≥90 years and compared them with those in the 50-60 years age group, matched for gender and duration of diabetes. Clinical data included age at last visit, age at diagnosis, duration of diabetes, family history, smoking and alcohol, details of medications, body mass index (BMI), and blood pressure. Biochemical data included fasting and postprandial plasma glucose, glycated hemoglobin, fasting and stimulated C-peptide levels, lipid profile, and renal function studies. Assessment of retinopathy, nephropathy, neuropathy, coronary artery disease (CAD), and peripheral vascular disease (PVD) was also done. Results: A total of 325 T2DM patients aged ≥90 years and 278 T2DM patients aged between 50 and 60 years were selected for the study. Patients aged ≥90 years had higher systolic blood pressure (P < 0.001) and lower BMI (P < 0.001) than those between 50 and 60 years. Prevalence of retinopathy (29.7% vs. 53.5%) and macroalbuminuria (3.7% vs. 16.0%) was lower in the ≥90 years T2DM patients than in the 50-60 years age group. However, prevalence of neuropathy (89.8% vs. 50.8%), PVD (13.5% vs. 2.0%), and CAD (60.3% vs. 32.0%) was higher among the ≥90 years patients. Eighty-five percent of the T2DM aged ≥90 years were on oral hypoglycemic agents (OHAs), (of whom 64.9% were on sulfonylurea), 12% were on insulin, and 3% on diet alone. Among the 50-60 years old, 87.8% were on OHAs and 12.2% on insulin. Conclusions: This is the first report on the clinical profile of Asian Indians with T2DM aged ≥90 years, and significant differences are seen in their clinical profile compared with younger T2DM patients.

Variation of carbohydrate intake in diabetic children on carbohydrate counting.

AIMS: Carbohydrate counting (CC) is a technique for managing diabetes particularly based on the counting of carbohydrates. It allows diabetic patients to vary their amount of carbohydrates from one meal to another by adjusting their insulin dose. The primary objective was to determine the variation of carbohydrate intake (CI) in children on CC. METHOD: This was a prospective study conducted between 2014 and 2016. We collected the amount of carbohydrates eaten at each meal by 77 diabetic over a period of 28 days (i.e. 8068 data). We analyzed the number and percentage of significant CI variation rates from one day to another, both for the whole day and for each meal. The CI variation rate was deemed significant if it was greater than or equal to 30%. RESULTS: The percentage of significant CI variation rates was 30% at the daily level, 34% for breakfast, 44% for lunch and dinner, and 53% for snack. The percentage of significant variation rates varied according to age, treatment and occurrence of events. CONCLUSION: Children varied their CI significantly from one meal to another more than one in three times. CC offers flexibility and a better quality of life for children using this method.

Adherence to special diets and its association with meeting the nutrient recommendations in individuals with type 1 diabetes.

AIMS: Not much is known about adherence to special diets in type 1 diabetes, characteristics of individuals with special diets, and whether such practices should raise concerns with respect to meeting the dietary recommendations. In this study, we assessed the frequencies of adherence to special diets, in a population of individuals with type 1 diabetes, and investigated the association between special diet adherence and dietary intake, measured as dietary patterns and nutrient intakes. METHODS: During the Finnish Diabetic Nephropathy Study visit, participants with type 1 diabetes (n = 1429) were instructed to complete a diet questionnaire inquiring about the adherence to special diets. The participants also completed a food record, from which energy and nutrient intakes were calculated. RESULTS: In all, 36.6% participants reported adhering to some special diet. Most commonly reported special diets were lactose-free (17.1%), protein restriction (10.0%), vegetarian (7.0%), and gluten-free (5.6%) diet. Special diet adherents were more frequently women, older, had longer diabetes duration, and more frequently had various diabetes complications. Mean carbohydrate intakes were close to the lower levels of the recommendation in all diet groups, which was reflected in low mean fibre intakes but high frequencies of meeting the sucrose recommendations. The recommendation for saturated fatty acid intake was frequently unmet, with the highest frequencies observed in vegetarians. Of the micronutrients, vitamin D, folate, and iron recommendations were most frequently unmet, with some differences between the diet groups. CONCLUSIONS: Special diets are frequently followed by individuals with type 1 diabetes. The adherents are more frequently women, and have longer diabetes duration and more diabetes complications. Achieving the dietary recommendations differed between diets, and depended on the nutrient in question. Overall, intakes of fibre, vitamin D, folate, and iron fell short of the recommendations.

Temporal changes in glycaemic thresholds for treatment intensification in type 2 diabetes in an urban Australian setting: the Fremantle Diabetes Study.

BACKGROUND: Pharmacotherapy and supportive care for diabetes in Australia are improving, with potential beneficial effects on therapeutic procrastination. AIM: To determine whether glycaemic thresholds for therapeutic intensification in type 2 diabetes changed over the 15 years between phases of the community-based Fremantle Diabetes Study (FDS). METHODS: We studied 531 Phase 1 participants (mean age 62.4 years, 54.2% males, median diabetes duration 3.0 years) with valid data from baseline assessment and five subsequent annual reviews between 1993 and 2001 and 930 Phase 2 participants (mean age 65.3 years, 53.8% males, median diabetes duration 8.0 years) with valid data from baseline and two subsequent biennial reviews between 2008 and 2015. The main outcome measure was HbA1c at assessments before and after change in blood glucose-lowering therapy (average 6 months in Phase 1, 12 months in Phase 2). RESULTS: Ninety-seven participants in Phase 1 and 84 in Phase 2 progressed from diet-based management to oral hypoglycaemic agents (OHA) and 45 and 85 participants, respectively, progressed from diet/OHA to insulin. The median HbA1c was 7.5% (58 mmol/mol) and 6.9% (52 mmol/mol) before OHA initiation in Phases 1 and 2, respectively, and 9.1% (76 mmol/mol) and 7.8% (62 mmol/mol), respectively, before insulin initiation. There were median HbA1c falls of 0.3% (3 mmol/mol) and 1.5% (16 mmol/mol) after OHA and insulin initiation in Phase 1, but no statistically significant changes in Phase 2. CONCLUSIONS: HbA1c thresholds triggering treatment intensification fell between FDS phases, suggesting a more proactive approach to management of glycaemia over time.

Evaluation of glycemic control in patients with type 2 diabetes mellitus in Chinese communities: a cross-sectional study.

This study aimed to evaluate the glycemic levels in Chinese patients with type 2 diabetes mellitus (T2DM) and to explore the factors related to the results of glycemic control. A total of 2454 T2DM patients from 11 communities were examined for glycosylated hemoglobin levels and glycemic control options. Potential factors related to the results of glycemic control were analyzed using logistic regression. Of all the patients, 55.3 % achieved the glycemic control target of HbA1c < 7 %. Multivariate analysis showed that male sex (OR 1.345, 95 % CI 1.022-1.769; P = 0.034), higher levels of fasting blood glucose (OR 1.954, 95 % CI 1.778-2.147; P < 0.001), and low-density lipoprotein cholesterol (OR 1.181, 95 % CI 1.020-1.367; P = 0.026) were significantly associated with poor glycemic control. The complexity of antidiabetics was also associated with poor glycemic control (P < 0.05). Compared to diet and exercise, insulin injection was most strongly associated with poor glycemic control (OR 6.210, 95 % CI 4.054-9.514; P < 0.001). Male patients with higher levels of total cholesterol, lower levels of high-density lipoprotein cholesterol, or longer diabetic durations showed poor glycemic control, which was not found in female patients. Glycemic control was not satisfactory in T2DM patients of Nanjing communities. Various factors are associated with poor results of glycemic control.

Evaluation of information retention and adherence to treatment in patients with gestational diabetes mellitus after multidisciplinary group.

OBJECTIVE: To evaluate the retention of information after participation in multidisciplinary group in patients with gestational diabetes mellitus (GDM) through a phone contact. METHOD: 122 pregnant women diagnosed with gestational diabetes were included. After diagnosis of gestational diabetes, the patients were referred to the multidisciplinary group where they received medical, nutrition and nursing guidelines related to the disease. After three days these patients received one telephone call from a nurse, who made the same questions regarding the information received. In the statistical analysis, results were presented as absolute and relative frequencies. RESULTS: Most patients 119/122 patients (97.5%) were managing to do self glucose monitoring. Twenty-one patients (17.2%) reported having difficulty performing the blood glucose, especially finger pricking. When questioning whether the woman was following the proposed diet, 24/122 (19.7%) patients said they did not; the meal frequency was not reached by 23/122 (18.9%) of the women, and forty-seven (38.5%) of the women reported having ingested sugar in the days following the guidance in multidisciplinary group. CONCLUSION: Regarding the proposed treatment, there was good adherence of patients, especially in relation to blood glucose monitoring. As for nutritional control, we observed greater difficulty in following the guidelines demonstrating the need for long-term monitoring, as well as further clarification to the patients about the importance of nutrition in diabetes management.

Evaluation of information retention and adherence to treatment in patients with gestational diabetes mellitus after multidisciplinary group / Avaliação da retenção de informações e da adesão ao tratamento em pacientes com diabetes mellitus gestacional após grupo multiprofissional

SUMMARY Objective: To evaluate the retention of information after participation in multidisciplinary group in patients with gestational diabetes mellitus (GDM) through a phone contact. Method: 122 pregnant women diagnosed with gestational diabetes were included. After diagnosis of gestational diabetes, the patients were referred to the multidisciplinary group where they received medical, nutrition and nursing guidelines related to the disease. After three days these patients received one telephone call from a nurse, who made the same questions regarding the information received. In the statistical analysis, results were presented as absolute and relative frequencies. Results: Most patients 119/122 patients (97.5%) were managing to do self glucose monitoring. Twenty-one patients (17.2%) reported having difficulty performing the blood glucose, especially finger pricking. When questioning whether the woman was following the proposed diet, 24/122 (19.7%) patients said they did not; the meal frequency was not reached by 23/122 (18.9%) of the women, and forty-seven (38.5%) of the women reported having ingested sugar in the days following the guidance in multidisciplinary group. Conclusion: Regarding the proposed treatment, there was good adherence of patients, especially in relation to blood glucose monitoring. As for nutritional control, we observed greater difficulty in following the guidelines demonstrating the need for long-term monitoring, as well as further clarification to the patients about the importance of nutrition in diabetes management.

RESUMO Objetivo: avaliar a retenção de informações, após participação em grupo multiprofissional, em pacientes com diabetes mellitus gestacional (DMG), por meio de contato telefônico. Método: foram incluídas 122 gestantes com diagnóstico de DMG. Após o diagnóstico, as pacientes eram encaminhadas ao grupo multiprofissional para receber orientações médicas, nutricionais e de enfermagem relacionadas à doença. Após três dias, as pacientes receberam um contato telefônico de um enfermeiro, que realizou perguntas relacionadas às informações recebidas. Na análise estatística, os resultados foram apresentados em frequências absolutas e relativas. Resultados: a maioria das pacientes, 119/122 (97,5%), estava conseguindo fazer a automonitorização glicêmica. Vinte e uma pacientes (17,2%) referiram ter dificuldades para realizar a glicemia capilar, sendo a principal relacionada às lancetas. Quanto à dieta proposta, 24/122 (19,7%) referiram que não estavam conseguindo cumprir; o fracionamento da dieta não foi alcançado por 23/122 (18,9%) das gestantes e 47 (38,5%) relataram ter ingerido açúcar nos dias seguintes à orientação do grupo multiprofissional. Conclusão: em relação ao tratamento proposto, houve boa adesão das pacientes, especialmente quanto à automonitorização glicêmica. Em relação aos controles nutricionais, observamos maior dificuldade no seguimento das orientações, mostrando haver necessidade de seguimento em longo prazo e de fornecer melhor esclarecimento às pacientes sobre a importância da nutrição no controle do diabetes.

Knowledge and perceptions about diet and physical activity among Sri Lankan adults with diabetes mellitus: a qualitative study.

BACKGROUND: Diabetes mellitus (DM) is a rapidly growing health concern in Sri Lanka. Diet and physical activity are important modifiable risk factors affecting the incidence, severity and management of DM. The present study aims to evaluate the knowledge and perceptions about dietary patterns and physical activity among a group of adults with DM in Sri Lanka using qualitative research methods. METHODS: Fifty adults from a cohort of diabetic patients attending the medical clinics at the National Hospital of Sri Lanka were invited for the study. Data were collected via 10 Focus Group Discussions. Verbatim recording and documenting emotional responses were conducted by two independent observers. Directed content analysis of qualitative data was done with the help of NVIVO v10.0. RESULTS: Mean age was 61.2 ± 9.9 years and 46 % were males. Mean duration of diabetes was 10.4 ± 7.5 years. All were aware of the importance of diet in the management of DM. But most had difficulty in incorporating this knowledge into their lives mostly due to social circumstances. The majority described a list of 'good foods' and 'bad foods' for DM. They believed that 'good' foods can be consumed at all times, irrespective of quantity and 'bad' foods should be completely avoided. Many believed that fruits were bad for diabetes, while vegetables were considered as a healthy food choice. The majority thought that there were 'special' foods that help to control blood glucose, the most common being curry leaves and bitter-gourd. Most study participants were aware of the importance of being physical active. However, there was lack of consensus and clarity with regards to type, duration, timing and frequency of physical activity. CONCLUSIONS: Despite understanding the importance of dietary control and physical activity in the management of diabetes, adherence to practices were poor, mainly due to lack of clarity of information provided. There were many myths with regards to diet, some of which have originated from health care professionals. More evidence is needed to support or refute the claims about 'special' foods that the participants believe as being good for diabetes.

Effect of a low glycaemic index diet in gestational diabetes mellitus on post-natal outcomes after 3 months of birth: a pilot follow-up study.

A low glycaemic index (LGI) diet during pregnancy complicated by gestational diabetes mellitus (GDM) may offer benefits to the mother and infant pair beyond those during pregnancy. We aimed to investigate the effect of an LGI diet during pregnancy complicated with GDM on early post-natal outcomes. Fifty-eight women (age: 23-41 years; mean ± SD pre-pregnancy body mass index: 24.5 ± 5.6 kg m(-2) ) who had GDM and followed either an LGI diet (n = 33) or a conventional high-fibre diet (HF; n = 25) during pregnancy had a 75-g oral glucose tolerance test and blood lipid tests at 3 months post-partum. Anthropometric assessments were conducted for 55 mother-infant pairs. The glycaemic index of the antenatal diets differed modestly (mean ± SD: 46.8 ± 5.4 vs. 52.4 ± 4.4; P < 0.001), but there were no significant differences in any of the post-natal outcomes. In conclusion, an LGI diet during pregnancy complicated by GDM has outcomes similar to those of a conventional healthy diet. Adequately powered studies should explore the potential beneficial effects of LGI diet on risk factors for chronic disease.

Predictors of self-management in pediatric type 1 diabetes: individual, family, systemic, and technologic influences.

Type 1 diabetes (T1D) is a complex chronic disease that has many facets for successful management. The burden of this management falls largely on the individual and their family members. Self-management has a major influence on T1D health outcomes, and with successful management, children and adolescents with T1D can lead long and healthy lives. We discuss how various individual, family, and systemic/technologic factors influence T1D self-management, providing research that supports interventions targeting each of these factors. With this information, health care practitioners and researchers can better understand the role of T1D self-management and bolster this important aspect of T1D care.

Considerations affecting dietary behaviour of immigrants with type 2 diabetes: a qualitative study among Surinamese in the Netherlands.

PURPOSE: The purpose of this study was to explore the sociocultural factors affecting the dietary behaviour of Dutch Surinamese patients with type 2 diabetes. METHODS: In this qualitative study, 32 Surinamese primary care patients with type 2 diabetes mellitus participated in semi-structured interviews (16 African Surinamese and 16 Hindustani Surinamese). Interviews were recorded and transcripts were analysed and coded into themes using principles of grounded theory and MAXQDA software. RESULTS: Surinamese food was eaten regularly by all respondents. Most participants were aware of the need to change their diet but reported difficulty with changing their dietary behaviour to meet dietary guidelines. Many perceived these guidelines to be based on Dutch eating habits, making it difficult to reconcile them with Surinamese cooking and eating practices. Firstly, respondents indicated that they did not choose foods based on their nutritional qualities. Instead, choices were based on Surinamese beliefs regarding 'good' (e.g., bitter vegetables) or 'bad' (e.g., spicy dishes) foods for diabetes. Secondly, respondents often perceived recommendations such as eating at fixed times as interfering with traditional values, for example hospitality. Above all, the maintenance of Surinamese cooking and eating practices was regarded as extremely important since the respondents perceived these to be a core element of their identity as Surinamese. CONCLUSIONS: For Surinamese diabetes patients, cooking and eating practices are related to deeply rooted cultural beliefs and values. The wish to maintain one's Surinamese identity may pose difficulty for patients' adherence to dietary guidelines, as these are perceived as being based on 'Dutch' habits. This suggests that immigrants with a long duration of residence in the host country like the Surinamese, who are seen as well integrated might benefit from culturally sensitive diabetes education that is adapted at surface and deep structure.

[Consumption of sweeteners and dietetic foods by individuals with type 2 diabetes mellitus, assisted by the National Health System in Ribeirão Preto, SP]. / Consumo de adoçantes e produtos dietéticos por indivíduos com diabetes melito tipo 2, atendidos pelo Sistema Unico de Saúde em Ribeirão Preto, SP.

OBJECTIVE: To analyze the consumption of sweeteners and dietetic foods by individuals with type 2 diabetes, assisted by the Brazilian National Health System, in the city of Ribeirão Preto, SP. SUBJECTS AND METHODS: Through a questionnaire were interviewed 120 patients were interviewed, stratified by sex, age and level of health care. RESULTS: The use of sweeteners is very frequent by the population in study, with predominance of the liquid type, and the use of dietetic foods is less common, with predominance of soft drinks. The diagnosis of diabetes was determinant for starting the use of both and the used criterion for selection of the sweetener is its flavor. The percentage of the population that knows the difference between diet and light products, that has the habit to read labels, and that is worried with the amount used of sweetener, is small. CONCLUSION: There is a need to include information about the adequate use of these products in the health care activities for patients with diabetes in the different levels of the Brazilian National Health System.

Consumo de adoçantes e produtos dietéticos por indivíduos com diabetes melito tipo 2, atendidos pelo Sistema Único de Saúde em Ribeirão Preto, SP / Consumption of sweeteners and dietetic foods by individuals with type 2 diabetes mellitus, assisted by the National Health System in Ribeirão Preto, SP

OBJETIVO: Analisar o consumo de adoçantes e produtos dietéticos por indivíduos com diabetes melito tipo 2, atendidos pelo Sistema Único de Saúde (SUS) em Ribeirão Preto, SP. SUJEITOS E MÉTODOS: Por meio de questionário, foram entrevistados 120 pacientes, estratificados por sexo, faixa etária e nível de atendimento. RESULTADOS: Os resultados mostram que o uso de adoçantes é frequente na população em estudo, com predomínio do tipo líquido, e o uso de produtos dietéticos é menor, com predomínio dos refrigerantes. O diagnóstico do DM foi determinante para o uso dos produtos e o critério de seleção mais utilizado foi o sabor. É pequena a porcentagem da amostra que sabe a diferença entre diet e light, que tem o hábito de ler o rótulo dos alimentos e que se preocupa com a quantidade utilizada de adoçante. CONCLUSÃO: É uma necessidade a inclusão de informações sobre o uso adequado desses produtos nas atividades assistenciais aos pacientes com DM nos diversos níveis do SUS.

OBJECTIVE: To analyze the consumption of sweeteners and dietetic foods by individuals with type 2 diabetes, assisted by the Brazilian National Health System, in the city of Ribeirão Preto, SP. SUBJECTS AND METHODS: Through a questionnaire were interviewed 120 patients were interviewed, stratified by sex, age and level of health care. RESULTS: The use of sweeteners is very frequent by the population in study, with predominance of the liquid type, and the use of dietetic foods is less common, with predominance of soft drinks. The diagnosis of diabetes was determinant for starting the use of both and the used criterion for selection of the sweetener is its flavor. The percentage of the population that knows the difference between diet and light products, that has the habit to read labels, and that is worried with the amount used of sweetener, is small. CONCLUSION: There is a need to include information about the adequate use of these products in the health care activities for patients with diabetes in the different levels of the Brazilian National Health System.

Gender risk of nonfatal stroke in type 2 diabetic patients differs depending on the type of treatment.

BACKGROUND: The gender differences in stroke risk among diabetic patients with different treatments have not been studied previously. We aim to determine if there is a gender difference in nonfatal stroke risk in diabetic patients receiving different types of glucose-lowering treatments. METHODS: In December 2005, data of type 2 diabetic patients were extracted from a nationwide population-based diabetes registry covering 11 Ukrainian regions. Male/female odds ratios (OR) for nonfatal stroke were calculated in three treatment groups: diet only 7,273/15,901, oral glucose-lowering drugs 15,109/33,913, and insulin 5,529/12,462 male/female. Male/female ORs of stroke were estimated using a logistic regression model. RESULTS: The age-adjusted ORs of stroke were higher among diabetic men compared with diabetic women with oral glucose-lowering drug treatment (OR 1.37, 95% CI 1.22-1.54) and diet treatment only (OR 1.53, 95% CI 1.35-1.73). No differences were found among patients who used insulin (OR 0.97, 95% CI 0.84-1.11). Further adjustment for duration of type 2 diabetes, body mass index (BMI), systolic blood pressure, total cholesterol, and smoking affected the results only slightly. CONCLUSIONS: The gender risks of nonfatal stroke in patients with type 2 diabetes appear to differ considerably depending on treatment types.

Antenatal factors predicting subsequent need for insulin treatment in women with gestational diabetes.

OBJECTIVE: To identify characteristics indicative of subsequent requirement of insulin in patients with gestational diabetes (GDM). METHODS: Identified from a database were patients with GDM not receiving insulin or oral hypoglycemic agents at enrollment for outpatient education and surveillance. Maternal characteristics were compared between patients achieving glycemic control with diet and those requiring insulin. Cox proportional hazards regression was used to assess multiple effects of significant univariate factors. RESULTS: Data from 2365 patients were analyzed. Patients requiring insulin were more likely to be multiparous, obese, have a history of GDM, be diagnosed at <28 weeks of gestation, and have a fasting blood glucose of >95 mg/dL, a glucose tolerance test 3-hour blood glucose of >140 mg/dL, and a glycosylated hemoglobin (A1c) of >or=6% at diagnosis of GDM. CONCLUSIONS: Laboratory values at diagnosis of GDM were the strongest indicators of subsequent need for insulin treatment. Patients with fasting blood glucose of >95 mg/dL and A1c values >or=6% at diagnosis of GDM should receive close surveillance of daily blood glucose.