Continuation of Oral Antidiabetic Medications Was Associated With Better Early Postoperative Blood Glucose Control Compared to Sliding Scale Insulin After Total Knee Arthroplasty

BACKGROUND

This study evaluated blood glucose (BG), creatinine levels, metabolic issues, length of stay (LOS), and early postoperative complications in diabetic primary total knee arthroplasty (TKA) patients. It examined those who continued home oral antidiabetic medications and those who switched to insulin postoperatively. The hypothesis was that continuing home medications would lead to lower BG levels without metabolic abnormalities.

METHODS

Patients who had diabetes who underwent primary TKA from 2013 to 2022 were evaluated retrospectively. Diabetic patients who were not on home oral antidiabetic medications or who were not managed as an inpatient postoperatively were excluded. Patient demographics and laboratory tests collected preoperatively and postoperatively as well as 90-day emergency department visits and 90-day readmissions, were pulled from electronic records. Patients were grouped based on inpatient diabetes management: continuation of home medications versus new insulin coverage. Acute postoperative BG control, creatinine levels, metabolic abnormalities, LOS, and early postoperative complications were compared between groups. Multivariable regression analyses were performed to measure associations.

RESULTS

A total of 867 primary TKAs were assessed; 703 (81.1%) patients continued their home oral antidiabetic medications. Continuing home antidiabetic medications demonstrated lower median maximum inpatient BG (180.0 mg/dL versus 250.0 mg/dL; P < .001) and median average inpatient BG (136.7 mg/dL versus 173.7 mg/dL; P < .001). Logistic regression analyses supported the presence of an association (odds ratio = 17.88 [8.66, 43.43]; P < .001). Proportions of acute kidney injury (13.5 versus 26.7%; P < .001) were also lower. There was no difference in relative proportions of metabolic acidosis (4.4 versus 3.7%; P = .831), LOS (2.0 versus 2.0 days; P = .259), or early postoperative complications.

CONCLUSIONS

Continuing home oral antidiabetic medications after primary TKA was associated with lower BG levels without an associated worsening creatinine or increase in metabolic acidosis.

LEVEL III EVIDENCE

Retrospective Cohort Study.

Benefits and risks of drug combination therapy for diabetes mellitus and its complications: a comprehensive review

Diabetes is a chronic metabolic disease, and its therapeutic goals focus on the effective management of blood glucose and various complications. Drug combination therapy has emerged as a comprehensive treatment approach for diabetes. An increasing number of studies have shown that, compared with monotherapy, combination therapy can bring significant clinical benefits while controlling blood glucose, weight, and blood pressure, as well as mitigating damage from certain complications and delaying their progression in diabetes, including both type 1 diabetes (T1D), type 2 diabetes (T2D) and related complications. This evidence provides strong support for the recommendation of combination therapy for diabetes and highlights the importance of combined treatment. In this review, we first provided a brief overview of the phenotype and pathogenesis of diabetes and discussed several conventional anti-diabetic medications currently used for the treatment of diabetes. We then reviewed several clinical trials and pre-clinical animal experiments on T1D, T2D, and their common complications to evaluate the efficacy and safety of different classes of drug combinations. In general, combination therapy plays a pivotal role in the management of diabetes. Integrating the effectiveness of multiple drugs enables more comprehensive and effective control of blood glucose without increasing the risk of hypoglycemia or other serious adverse events. However, specific treatment regimens should be tailored to individual patients and implemented under the guidance of healthcare professionals.

Analysis of risk factors of neonatal hypoglycemia and its correlation with blood glucose control of gestational diabetes mellitus: A retrospective study

This study aimed to investigate the risk factors associated with neonatal hypoglycemia and its correlation with blood glucose control in patients with gestational diabetes mellitus (GDM). This study was a retrospective study. 880 pregnant women with GDM and their newborns were hospitalized from January 2018 to December 2022 in our hospital. The clinical information of GDM pregnant women and their newborns were reviewed and the hemoglobin A1c (HbA1c) values measured within 1 week before delivery were collected. According to the occurrence of neonatal hypoglycemia, which was divided into the control and observation groups. Logistic regression model was used to estimate the potential factors associated with neonatal hypoglycemia. The association between HbA1c of pregnant women before delivery and abnormal glucose metabolism in newborns was examined using spearman correlation analysis. A total of 104 cases of hypoglycemia occurred in neonates delivered by 880 GDM women and the incidence of neonatal hypoglycemia was 11.82%. There were significant differences in pre-pregnancy overweight or obesity, delivery mode, maternal blood sugar control effect and neonatal feeding standard between the 2 groups of GDM women (P < .05). Pre-pregnancy overweight or obesity, poor blood sugar control in GDM women, and improper neonatal feeding were risk factors for neonatal hypoglycemia. The results of logistic regression analysis showed that abnormal glucose metabolism in newborn (odds ratio [OR]: 2.43, 95% confidence interval [CI]: 1.12-4.73) and neonatal hypoglycemia (OR: 3.04, 95% CI: 1.33-5.79) were a risk factor. We also conducted the logistic analysis to evaluate the correlation between HbA1c before delivery and abnormal glucose metabolism in newborns of pregnant women with GDM through adjusting some potential factors. The results were still significant in the abnormal glucose metabolism in newborn (OR: 2.84, 95% CI: 1.23-6.63) and neonatal hypoglycemia (OR: 3.64, 95% CI: 1.46-8.18). Overweight or obesity of GDM parturient before pregnancy, poor blood glucose control of GDM parturient and improper feeding of newborns are all risk factors for neonatal hypoglycemia. HbA1c before delivery has a certain predictive value for abnormal glucose metabolism in newborns.

The Effects of Elexacaftor, Tezacaftor, and Ivacaftor (ETI) on Blood Glucose in Patients With Cystic Fibrosis: A Systematic Review

Cystic fibrosis (CF) is an autosomal recessive genetic disorder resulting from defects in the cystic fibrosis transmembrane conductance regulator (CFTR) protein, which in turn results in a multi-systemic disorder. There are numerous known CF alleles associated with different mutations of the CFTR gene, with the most common CF allele being a three-base-pair deletion known as ΔF508. One common manifestation of CF is glycemic dysregulation associated with decreased insulin secretion, often progressing into a distinct form of diabetes known as cystic fibrosis-related diabetes (CFRD). In the past decade, a class of drugs known as CFTR modulators has entered clinical practice. These drugs interact with the CFTR protein to restore its function, with different modulators (or combinations of modulators) suitable for patients with different CFTR mutations. Previous research has established that the modulator ivacaftor is effective in decreasing blood glucose and sometimes resolving CFRD in patients with certain CFTR mutations (class III mutations). However, early modulator therapies for individuals with the common ΔF508 mutation (e.g., a combination of the modulators lumacaftor and ivacaftor) have largely proven ineffective in improving glucose regulation. More recently, a combination therapy of three modulators, namely elexacaftor, tezacaftor, and ivacaftor (ETI), has entered clinical practice for patients with the ΔF508 mutation. However, it is not clear whether this therapy is effective in treating dysglycemia. We searched for studies of any design that examined the effects of ETI on measures of blood glucose. All available studies were observational studies comparing patients before and after initiating ETI therapy. Measures of daily-life blood glucose (those obtained with continuous glucose monitoring systems or by measuring glycated hemoglobin (HbA1c)) and post-prandial glucose spikes from oral glucose tolerance tests showed significant improvements in at least some studies. The majority of studies showed significant improvements from pre- to post-ETI in one or more blood glucose measures. While the interpretation of this evidence is complicated by the lack of randomized controlled trials, it appears that ETI therapy is associated with improved glucose regulation for at least some patients with the ΔF508 mutation.

Influence of one-day diabetes mellitus clinic management on blood glucose control and prognosis in patients with gestational diabetes mellitus

OBJECTIVE

To explore the influence of the one-day diabetes mellitus (DM) clinic management model on blood glucose control and prognosis in patients with gestational diabetes mellitus (GDM).

METHODS

A total of 930 patients diagnosed with GDM by oral glucose tolerance test screening at 24-28 weeks of gestation were selected from those who underwent outpatient prenatal checkups at our hospital and were randomly divided into one-day DM clinic group (n = 509) and control group (n = 421). A one-day DM clinic intervention was conducted in the one-day DM clinic group, and individualized dietary interventions and exercise instruction were given in the control group.

RESULTS

The compliance rates of fasting blood glucose and two-hour postprandial blood glucose (2-h PPBG) were higher in the one-day DM clinic group than in the control group (p < .05). The compliance rates of the oral glucose tolerance test and insulin release test were higher in the one-day DM clinic group than in the control group (p < .05). There existed statistically significant differences in fasting blood glucose before delivery, together with the difference between fasting blood glucose at enrollment and before delivery and the difference between glycated hemoglobin at enrollment and before delivery (p < .05).

CONCLUSION

The one-day diabetes mellitus clinic management model is more conducive to blood glucose control in patients with GDM and more conducive to the recovery of blood glucose and islet function in patients with GDM after delivery and to reduce the occurrence of adverse pregnancy outcomes.

Application of starch-based nanoparticles and cyclodextrin for prebiotics delivery and controlled glucose release in the human gut: a review

Starches are a major constituent of staple foods and are the main source of energy in the human diet (55-70%). In the gastrointestinal tract, starches are hydrolyzed into glucose by α-amylase and α-glucosidase, which leads to a postprandial glucose elevation. High levels of blood glucose levels over sustained periods may promote type 2 diabetes mellitus (T2DM) and obesity. Increasing consumption of starchy foods with a lower glycemic index may therefore contribute to improved health. In this paper, the preparation and properties of several starch-based nanoparticles (SNPs) and cyclodextrins (CDs) derivatives are reviewed. In particular, we focus on the various mechanisms responsible for the ability of these edible nanomaterials to modulate glucose release and the gut microbiome in the gastrointestinal tract. The probiotic functions are achieved through encapsulation and protection of prebiotics or bioactive components in foods or the human gut. This review therefore provides valuable information that could be used to design functional foods for improving human health and wellbeing.

Far-red light-activated human islet-like designer cells enable sustained fine-tuned secretion of insulin for glucose control

Diabetes affects almost half a billion people, and all individuals with type 1 diabetes (T1D) and a large portion of individuals with type 2 diabetes rely on self-administration of the peptide hormone insulin to achieve glucose control. However, this treatment modality has cumbersome storage and equipment requirements and is susceptible to fatal user error. Here, reasoning that a cell-based therapy could be coupled to an external induction circuit for blood glucose control, as a proof of concept we developed far-red light (FRL)-activated human islet-like designer (FAID) cells and demonstrated how FAID cell implants achieved safe and sustained glucose control in diabetic model mice. Specifically, by introducing a FRL-triggered optogenetic device into human mesenchymal stem cells (hMSCs), which we encapsulated in poly-(l-lysine)-alginate and implanted subcutaneously under the dorsum of T1D model mice, we achieved FRL illumination-inducible secretion of insulin that yielded improvements in glucose tolerance and sustained blood glucose control over traditional insulin glargine treatment. Moreover, the FAID cell implants attenuated both oxidative stress and development of multiple diabetes-related complications in kidneys. This optogenetics-controlled "living cell factory" platform could be harnessed to develop multiple synthetic designer therapeutic cells to achieve long-term yet precisely controllable drug delivery.

Real-World Application of Insulin Pump Therapy Among Patients With Type 1 Diabetes in China: A Cross-Sectional Study

BACKGROUND

Although insulin pump therapy is an important treatment modality for patients with type 1 diabetes, rates of pump use appear to vary broadly internationally. This study aimed to investigate the application of insulin pump therapy among patients with type 1 diabetes in China.

METHODS

Data were collected from the Type 1 Diabetes Mellitus in China: Coverage, Costs and Care Study (3C Study). A total of 779 participants from this cross-sectional study were included. Multivariable logistic regression was used for data analysis.

RESULTS

The median (interquartile range) age at diagnosis of diabetes was 17 (10-28) years and the duration of diabetes was 4 (1-8) years. Among 779 patients, only 89 patients (11.4%) used an insulin pump to control blood glucose. A statistically significant difference was found in HbA1c favoring insulin pump therapy (8.3 ± 1.7% vs. 9.2 ± 2.6%) without obvious differences for severe hypoglycaemia. There were higher proportions of patients with no smoking, frequent daily intake of fruits and vegetables, and adequate self-blood glucose monitoring among patients with insulin pump therapy as compared to those using multiple daily insulin injections. Logistic regression analysis showed that younger age at diagnosis, longer duration of diabetes, higher education level of family members, and higher household income were associated with the use of an insulin pump.

CONCLUSIONS

Data from 3C Study demonstrated that only a minority of patients with type 1 diabetes in China utilize insulin pump therapy. Insulin pump therapy was associated with better blood glucose control and self-management. Patients with younger age at diagnosis and longer duration of diabetes, and patients with better socioeconomic status were more likely to use an insulin pump.

A New Meal Absorption Model for Artificial Pancreas Systems

BACKGROUND

Artificial pancreas (AP) systems reduce the treatment burden of Type 1 Diabetes by automatically regulating blood glucose (BG) levels. While many disturbances stand in the way of fully closed-loop (automated) control, unannounced meals remain the greatest challenge. Furthermore, different types of meals can have significantly different glucose responses, further increasing the uncertainty surrounding the meal.

METHODS

Effective attenuation of a meal requires quick and accurate insulin delivery because of slow insulin action relative to meal effects on BG. The proposed Variable Hump (VH) model adapts to meals of varying compositions by inferring both meal size and shape. To appropriately address the uncertainty of meal size, the model divides meal absorption into two disjoint regions: a region with coarse meal size predictions followed by a fine-grain region where predictions are fine-tuned by adapting to the meal shape.

RESULTS

Using gold-standard triple tracer meal data, the proposed VH model is compared to three simpler second-order response models. The proposed VH model increased model fit capacity by 22% and prediction accuracy by 12% relative to the next best models. A 47% increase in the accuracy of uncertainty predictions was also found. In a simple control scenario, the controller governed by the proposed VH model provided insulin just as fast or faster than the controller governed by the other models in four out of the six meals. While the controllers governed by the other models all delivered at least a 25% excess of insulin at their worst, the VH model controller only delivered 9% excess at its worst.

CONCLUSIONS

The VH Model performed best in accuracy metrics and succeeded over the other models in providing insulin quickly and accurately in a simple implementation. Use in an AP system may improve prediction accuracy and lead to better control around mealtimes.

Patient-Reported Outcomes Following the Use of Jiang Tang San Huang Tablets in Type 2 Diabetes Mellitus: A Retrospective Cohort Study in a Chinese Population

PURPOSE

We aimed to assess the efficacy of the Jiang Tang San Huang (JTSH) tablet for the treatment of patients with type 2 diabetes mellitus (T2DM).

METHODS

All data for this retrospective cohort study were acquired from the outpatient clinic database of our institution, and all enrolled patients received JTSH tablet for at least two months. Overall, 147 patients were included in the analysis. The primary outcome was patient-reported outcomes on the efficacy of the JTSH tablets using a questionnaire survey. Correlation analysis evaluated the duration of JTSH tablet administration and glycemic control in patients with T2DM. The secondary outcome measures included: changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), 2-hour postprandial blood glucose, homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of β-cell function (HOMA-β) after 2 months of treatment with JTSH tablets.

RESULTS

Overall,120 patients (81.63%) reported a JTSH tablet treatment satisfaction score of ≥60 points, and believed that JTSH tablets had satisfactory hypoglycemic effects and could improve symptoms. The average duration of JTSH tablet treatment was 2.57±1.45 years. Overall, 111 patients achieved good blood glucose control, while 36 patients had poor glycemic control. Multivariate logistic regression model analysis showed that taking JTSH tablets for 1 year might reduce the risk of poor hypoglycemic effect by 17.00% (Risk ratio=0.830, 95% confidence interval:0.578, 1.021, P=0.066). Compared with the baseline data, the levels of HbA1c, FPG and HOMA-IR decreased significantly and HOMA-β levels increased significantly (P<0.05).

CONCLUSION

Good blood glucose control may be positively correlated with the duration of JTSH tablets administration. Patients with T2DM were satisfied with the anti-diabetic effects of JTSH tablets, which can significantly reduce blood glucose and insulin resistance, and improve the function of islet cells.

Hyperglycemia and blood glucose deterioration are risk factors for severe COVID-19 with diabetes: a two-center cohort study

We aimed to assess whether blood glucose control can be used as predictors for the severity of 2019 coronavirus disease (COVID‐19) and to improve the management of diabetic patients with COVID‐19. A two‐center cohort with a total of 241 confirmed cases of COVID‐19 with definite outcomes was studied. After the diagnosis of COVID‐19, the clinical data and laboratory results were collected, the fasting blood glucose levels were followed up at initial, middle stage of admission and discharge, the severity of the COVID‐19 was assessed at any time from admission to discharge. Hyperglycemia patients with COVID‐19 were divided into three groups: good blood glucose control, fair blood glucose control, and blood glucose deterioration. The relationship of blood glucose levels, blood glucose control status, and severe COVID‐19 were analyzed by univariate and multivariable regression analysis. In our cohort, 21.16% were severe cases and 78.84% were nonsevere cases. Admission hyperglycemia (adjusted odds ratio [aOR], 1.938; 95% confidence interval [95% CI], 1.387–2.707), mid‐term hyperglycemia (aOR, 1.758; 95% CI, 1.325–2.332), and blood glucose deterioration (aOR, 22.783; 95% CI, 2.661–195.071) were identified as the risk factors of severe COVID‐19. Receiver operating characteristic (ROC) curve analysis, reaching an area under ROC curve of 0.806, and a sensitivity and specificity of 80.40% and 68.40%, respectively, revealed that hyperglycemia on admission and blood glucose deterioration of diabetic patients are potential predictive factors for severe COVID‐19. Our results indicated that admission hyperglycemia and blood glucose deterioration were positively correlated with the risk factor for severe COVID‐19, and deterioration of blood glucose may be more likely to the occurrence of severe illness in COVID‐19.

High fasting blood glucose level, especially the initial level at admission was an important risk factor for severe cases.

Deterioration of blood glucose may be more likely to the occurrence of severe 2019 coronavirus disease.

A Comprehensive Review of Neuronal Changes in Diabetics

There has been an exponential rise in diabetes mellitus (DM) cases on a global scale. Diabetes affects almost every system of the body, and the nervous system is no exception. Although the brain is dependent on glucose, providing it with the energy required for optimal functionality, glucose also plays a key role in the regulation of oxidative stress, cell death, among others, which furthermore contribute to the pathophysiology of neurological disorders. The variety of biochemical processes engaged in this process is only matched by the multitude of clinical consequences resulting from it. The wide-ranging effects on the central and peripheral nervous system include, but are not limited to axonopathies, neurodegenerative diseases, neurovascular diseases, and general cognitive impairment. All language search was conducted on MEDLINE, COCHRANE, EMBASE, and GOOGLE SCHOLAR till September 2021. The following search strings and Medical Subject Headings (MeSH terms) were used: "Diabetes Mellitus," "CNS," "Diabetic Neuropathy," and "Insulin." We explored the literature on diabetic neuropathy, covering its epidemiology, pathophysiology with the respective molecular pathways, clinical consequences with a special focus on the central nervous system and finally, measures to prevent and treat neuronal changes. Diabetes is slowly becoming an epidemic, rapidly increasing the clinical burden on account of its wide-ranging complications. This review focuses on the neuronal changes occurring in diabetes such as the impact of hyperglycemia on brain function and structure, its association with various neurological disorders, and a few diabetes-induced peripheral neuropathic changes. It is an attempt to summarize the relevant literature about neuronal consequences of DM as treatment options available today are mostly focused on achieving better glycemic control; further research on novel treatment options to prevent or delay the progression of neuronal changes is still needed.

A Cross-Sectional Study of the Effects of Physical Activity and Nutrient Intakes on Blood Glucose Control Rates in Middle-Aged and Elderly Diabetes Patients: Korean National Health and Nutrition Examination Survey 2015-2017

This study aimed to investigate factors affecting blood glucose control among middle-aged and older diabetic patients taking medications or receiving insulin therapy. In 2015–2017 data obtained from the Korean National Health and Nutrition Examination Survey (KNHANES), 1257 patients with diabetes were divided into a controlled group and an uncontrolled group based on blood glucose levels (cutoff ≥126 mg/dL). After adjusting for confounding factors, the BMI, total cholesterol level, and triglycerides level of the uncontrolled group were significantly higher than the controlled group. The total amount of moderate-intensity activity in controlled patients was significantly higher than that of the controlled group. Total energy, fat, saturated fatty acids, and cholesterol intakes were found to be significantly higher in the uncontrolled than controlled group. Intakes of calcium, phosphorus, potassium, riboflavin, niacin, and vitamin C were significantly lower in the uncontrolled than controlled group. Adequate nutrition intake and physical activity of patients undergoing diabetes therapy are required for effective blood glucose management for both diabetic drug and insulin therapies.

Low Carbohydrate Dietary Approaches for People With Type 2 Diabetes-A Narrative Review

Although carbohydrate restriction is not a new approach for the management of Type 2 diabetes, interest in its safety and efficacy has increased significantly in recent years. The purpose of the current narrative review is to summarise the key relevant research and practical considerations in this area, as well as to explore some of the common concerns expressed in relation to the use of such approaches. There is a strong physiological rationale supporting the role of carbohydrate restriction for the management of Type 2 diabetes, and available evidence suggests that low carbohydrate dietary approaches (LCDs) are as effective as, or superior to, other dietary approaches for its management. Importantly, LCDs appear to be more effective than other dietary approaches for facilitating a reduction in the requirement for certain medications, which leads to their effects on other health markers being underestimated. LCDs have also been demonstrated to be an effective method for achieving remission of Type 2 diabetes for some people. The available evidence does not support concerns that LCDs increase the risk of cardiovascular disease, that such approaches increase the risk of nutrient deficiencies, or that they are more difficult to adhere to than other dietary approaches. A growing number of organisations support the use of LCDs as a suitable choice for individuals with Type 2 diabetes.

Therapeutic Potential of Metformin in COVID-19: Reasoning for Its Protective Role

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections present with increased disease severity and poor clinical outcomes in diabetic patients compared with their nondiabetic counterparts. Diabetes/hyperglycemia-triggered endothelial dysfunction and hyperactive inflammatory and immune responses are correlated to twofold to threefold higher intensive care hospitalizations and more than twice the mortality among diabetic coronavirus disease 2019 (COVID-19) patients. While comorbidities such as obesity, cardiovascular disease, and hypertension worsen the prognosis of diabetic COVID-19 patients, COVID-19 infections are also associated with new-onset diabetes, severe metabolic complications, and increased thrombotic events in the backdrop of aberrant endothelial function. While several antidiabetic medications are used to manage blood glucose levels, we discuss the multifaceted ability of metformin to control blood glucose levels and possibly attenuate endothelial dysfunction, inhibit viral entry and infection, and modify inflammatory and immune responses during SARS-CoV-2 infections. These actions make metformin a viable candidate drug to be considered for repurposing and gaining ground against the SARS-CoV-2-induced tsunami in diabetic COVID-19 patients.

Association of Glycated Albumin/Glycosylated Hemoglobin Ratio with Blood Glucose Fluctuation and Long-Term Blood Glucose Control in Patients with Type 2 Diabetes Mellitus

OBJECTIVE

This study aimed to investigate the association of the glycated albumin (GA)/glycosylated hemoglobin (HbA1c) ratio with the mean amplitude of glycemic excursion (MAGE) in type 2 diabetes mellitus (T2DM).

METHODS

A total of 102 patients with T2DM who were first treated in Jinjiang Hospital of Fujian Province were enrolled in this study. The patients' general clinical data, including HbA1c, GA, fasting blood glucose, and fasting and peak C-peptide values upon diagnosis and after one year of follow-up, were collected, and their MAGE was calculated.

RESULTS

With the increase of the GA/HbA1c ratio at baseline, the patients' fasting and peak C-peptide values decreased gradually from baseline to follow-up, while their MAGE, HbA1c, and fasting blood glucose increased gradually. A regression analysis demonstrated that the baseline MAGE was independently positively correlated with the GA/HbA1c ratio. A Cox regression analysis demonstrated that a baseline GA/HbA1c ratio of >2.78 was an independent risk factor for poor fasting blood glucose and HbA1c.

CONCLUSION

The GA/HbA1c ratio is closely related to the MAGE and islet function in patients with T2DM.

An adaptive technique based blood glucose control in type-1 diabetes mellitus patients

This study proposes Grasshopper Optimization Algorithm (GOA) based type 1 diabetes mellitus system utilizing the nonlinear Bergman minimal model with proportional integral derivative (PID) controller. GOA is the optimization algorithm, which is utilized for selecting the optimized tuning parameters of the PID controller also solves the nonlinear system parameter identification problem. The novelty of the proposed study is to stabilize the glucose level in blood for type 1 diabetic patients by infusion of insulin in reduced time with optimal quantity. Without any intervention to the normal activities of patients, the supply of insulin injection and glucose monitoring is performed automatically for type 1 diabetic patients using this controller. In between the measured variable and set point, the difference is calculated by the PID controller to evaluate an error values. In realistic patient oriented conditions, the control performance evaluation, control optimization, and advanced patient modelling should be highly concentrated during the research/analysis on blood glucose control. Evaluation is performed to analyze control performances and implementation is done on Simulink/MATLAB environment. The performance analysis of the type 1 diabetes mellitus system with GOA technique is also discussed and to improve the control performance, to optimize the controller parameters. The simulation results have proved the substantial improvement in the performance of proposed algorithm with the better results achieved than the other conventional controllers such as PSO-PID and EHO-PID.

Effects of L-Phenylalanine on Energy Intake and Glycaemia-Impacts on Appetite Perceptions, Gastrointestinal Hormones and Gastric Emptying in Healthy Males

In humans, phenylalanine stimulates plasma cholecystokinin (CCK) and pyloric pressures, both of which are important in the regulation of energy intake and gastric emptying. Gastric emptying is a key determinant of postprandial blood glucose. We evaluated the effects of intragastric phenylalanine on appetite perceptions and subsequent energy intake, and the glycaemic response to, and gastric emptying of, a mixed-nutrient drink. The study consisted of two parts, each including 16 healthy, lean males (age: 23 ± 1 years). In each part, participants received on three separate occasions, in randomised, double-blind fashion, 5 g (Phe-5 g) or 10g ('Phe-10 g) L-phenylalanine, or control, intragastrically, 30 min before a standardised buffet-meal (part A), or a standardised mixed-nutrient drink (part B). In part A, plasma CCK and peptide-YY (PYY), and appetite perceptions, were measured at baseline, after phenylalanine alone, and following the buffet-meal, from which energy intake was assessed. In part B, plasma glucose, glucagon-like peptide-1 (GLP-1), insulin and glucagon were measured at baseline, after phenylalanine alone, and for 2 h following the drink. Gastric emptying of the drink was also measured by ¹³C-acetate breath-test. Phe-10 g, but not Phe-5 g, stimulated plasma CCK (p = 0.01) and suppressed energy intake (p = 0.012); energy intake was correlated with stimulation of CCK (r = -0.4, p = 0.027), and tended to be associated with stimulation of PYY (r = -0.31, p = 0.082). Both Phe-10 g and Phe-5 g stimulated insulin and glucagon (all p < 0.05), but not GLP-1. Phe-10 g, but not Phe-5 g, reduced overall plasma glucose (p = 0.043) and peak plasma glucose (p = 0.017) in response to the mixed-nutrient drink. Phenylalanine had no effect on gastric emptying of the drink. In conclusion, our observations indicate that the energy intake-suppressant effect of phenylalanine is related to the stimulation of CCK and PYY, while the glucoregulatory effect may be independent of stimulation of plasma GLP-1 or slowing of gastric emptying.

Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes

Type 2 diabetes (T2D) is a major comorbidity of COVID-19. However, the impact of blood glucose (BG) control on the degree of required medical interventions and on mortality in patients with COVID-19 and T2D remains uncertain. Thus, we performed a retrospective, multi-centered study of 7,337 cases of COVID-19 in Hubei Province, China, among which 952 had pre-existing T2D. We found that subjects with T2D required more medical interventions and had a significantly higher mortality (7.8% versus 2.7%; adjusted hazard ratio [HR], 1.49) and multiple organ injury than the non-diabetic individuals. Further, we found that well-controlled BG (glycemic variability within 3.9 to 10.0 mmol/L) was associated with markedly lower mortality compared to individuals with poorly controlled BG (upper limit of glycemic variability exceeding 10.0 mmol/L) (adjusted HR, 0.14) during hospitalization. These findings provide clinical evidence correlating improved glycemic control with better outcomes in patients with COVID-19 and pre-existing T2D.

Accuracy of Blood Glucose Measurement and Blood Glucose Targets

BACKGROUND

To summarize new evidence regarding the methodological aspects of blood glucose control in the intensive care unit (ICU).

METHODS

We reviewed the literature on blood glucose control in the ICU up to August 2019 through Ovid Medline and Pubmed.

RESULTS

Since the publication of the Leuven studies, the benefits of glycemic control have been recognized. However, the methodology of blood glucose control, notably the blood glucose measurement accuracy and the insulin titration protocol, plays an important but underestimated role. This may partially explain the negative results of the large, pragmatic multicenter trials and made everyone realize that tight glycemic control with less-frequent glucose measurements on less accurate blood glucose meters is neither feasible nor advisable in daily practice. Blood gas analyzers remain the gold standard. New generation point-of-care blood glucose meters may be an alternative when using whole blood of critically ill patients in combination with a clinically validated insulin dosing algorithm.

CONCLUSION

When implementing blood glucose management in an ICU one needs to take into account the interaction between aimed glycemic target and blood glucose measurement methodology.

The Impact of Sprint Interval Training Frequency on Blood Glucose Control and Physical Function of Older Adults

Exercise is a powerful tool for improving health in older adults, but the minimum frequency required is not known. This study sought to determine the effect of training frequency of sprint interval training (SIT) on health and physical function in older adults. Thirty-four (13 males and 21 females) older adults (age 65 ± 4 years) were recruited. Participants were allocated to a control group (CON n = 12) or a once- (n = 11) or twice- (n = 11) weekly sprint interval training (SIT) groups. The control group maintained daily activities; the SIT groups performed 8 weeks of once- or twice-weekly training sessions consisting of 6 s sprints. Metabolic health (oral glucose tolerance test), aerobic capacity (walk test) and physical function (get up and go test, sit to stand test) were determined before and after training. Following training, there were significant improvements in blood glucose control, physical function and aerobic capacity in both training groups compared to control, with changes larger than the smallest worthwhile change. There was a small to moderate effect for blood glucose (d = 0.43–0.80) and physical function (d = 0.43–0.69) and a trivial effect for aerobic capacity (d = 0.01) between the two training frequencies. Once a week training SIT is sufficient to produce health benefits. Therefore, the minimum time and frequency of exercise required is much lower than currently recommended.

Efficacy and safety of a needle-free injector in Chinese patients with type 2 diabetes mellitus treated with basal insulin: a multicentre, prospective, randomised, crossover study

Objective: To evaluate the efficacy and safety of a needle-free injector in Chinese patients with type 2 diabetes mellitus treated with basal insulin. Methods: 62 patients with type 2 diabetes were enrolled in a multicenter, randomised, prospective, open-label, crossover study. All patients received subcutaneous insulin glargine administered by a needle-free injector or a glargine pen for 7 ~ 14 days, and were then crossed over after wash out. Results: Patients in the insulin needle-free injector (NFI) and glargine pen (GP) groups achieved similar fasting blood glucose control . However, the dosage of insulin required to achieve the target FBG level in the NFI group was lower than in the GP group (16.14 ± 5.13 U/day vs 19.25 ± 6.20 U/day, respectively; p = 0.0046). This difference was more significant in patients who received higher insulin dosages compared with those receiving lower dosages. Use of the needle-free injector was also associated with significantly less pain (p < 0.001) and less fear of injection (p < 0.001) than glargine pens. Conclusion: The use of a needle-free injector can significantly lower the dosage of insulin required to achieve good glycemic control and reduce topical adverse reactions and the fear of injections as well, which help to improve patient compliance. Clinical Trial Registration Number KY20172077-1; NCT03420040.

Effect of simulation education and case management on glycemic control in type 2 diabetes

BACKGROUND

The aim of the study was to investigate whether simulation education (SE) and case management had any effect on glycemic control in type 2 diabetes (T2DM) patients.

METHODS

In this single center pilot trial, 100 T2DM patients who received medication and basic diabetes self-management education (DSME) were randomly divided into a control group (n = 50) and an experimental group (n = 50), who received SE and a case management program. Evaluation of biochemical indices was conducted at baseline and after 6 months. DSME consisted of 2-hour group trainings weekly for 2 consecutive weeks followed by 2 × 30 minute education sessions after 3 and 6 months. The SE program comprised additional 50-minute video sessions 3 times in the first week and twice in the second week. The experimental group was supervised by a nurse case manager, who followed up participants at least once a month, and who conducted group sessions once every 3 months, focusing on realistic aspects of physical activity and nutrition, with open discussions about setting goals and strategies to overcome barriers.

RESULTS

After 6 months, HbA1c, fasting plasma glucose, and postprandial blood glucose level improvements were superior in the experimental group compared with the control group (P < 0.05). Self-care behavior adherence scores of healthy diet (P = 0.001), physical activity (P = 0.043), self-monitoring of blood glucose (P < 0.001), and reducing risks (P < 0.001) were significantly increased in the experimental group compared with the control group.

CONCLUSIONS

Simulation education and case management added to routine DSME effectively improved glycemic control in T2DM patients.

Sources of Inter-individual Variability in the Therapeutic Response of Blood Glucose Control to Exercise in Type 2 Diabetes: Going Beyond Exercise Dose

In the context of type 2 diabetes, inter-individual variability in the therapeutic response of blood glucose control to exercise exists to the extent that some individuals, occasionally referred to as “non-responders,” may not experience therapeutic benefit to their blood glucose control. This narrative review examines the evidence and, more importantly, identifies the sources of such inter-individual variability. In doing so, this review highlights that no randomized controlled trial of exercise has yet prospectively measured inter-individual variability in blood glucose control in individuals with prediabetes or type 2 diabetes. Of the identified sources of inter-individual variability, neither has a prospective randomized controlled trial yet quantified the impact of exercise dose, exercise frequency, exercise type, behavioral/environmental barriers, exercise-meal timing, or anti-hyperglycemic drugs on changes in blood glucose control, in individuals with prediabetes or type 2 diabetes. In addition, there is also an urgent need for prospective trials to identify molecular or physiological predictors of inter-individual variability in the changes in blood glucose control following exercise. Therefore, the narrative identifies critical science gaps that must be filled if exercise scientists are to succeed in optimizing health care policy recommendations for type 2 diabetes, so that the therapeutic benefit of exercise may be maximized for all individuals with, or at risk of, diabetes.

Optimizing Glycemic Control in Adults With Type 1 or Type 2 Diabetes Attending a Multidisciplinary Foot Clinic

OBJECTIVES

To determine the impact of a diabetes nurse educator (DNE) on glycemic control in a multidisciplinary diabetes foot (MDF) clinic.

METHODS

A prospective cohort trial to measure the impact of a DNE on glycemic control was conducted in an MDF clinic. Change in glycated hemoglobin (A1C) levels over time was measured against the percentage of patient visits (PPVs) accompanied by a glucose meter and/or diary.

RESULTS

Increasing PPVs were significantly associated with decline in A1C levels in females. Every 10% increase in PPVs resulted in a 0.18% decrease in A1C levels (p<0.0001). To achieve a clinically important decrease of 1% in A1C levels, a 56% increase in PPVs was required. Increased A1C levels were significantly associated with higher baseline A1C levels (p<0.001) and increased hospital days for foot complications (p<0.0052).

CONCLUSIONS

Regular, face-to-face contact with a DNE in an MDF clinic has a positive impact on glycemic control in females.

Services aimed at achieving desirable clinical outcomes in patients with chronic kidney disease and diabetes mellitus: A narrative review

There is a large number of patients with chronic kidney disease (CKD), diabetes mellitus (DM), and hypertension (HT) but whether the targets on blood pressure (BP) control in patients with DM and/or CKD are met is not clear. This narrative review therefore investigated evidence on services aimed at achieving desirable clinical results in patients with CKD and DM, and HT in Australia. Literature pertaining to pathology diagnosis and management of these patients as well as the complexities in management were considered. This involved evidence from PubMed-listed articles published between 1993 and 2016 including original research studies, focusing on randomised controlled trials and prospective studies where possible, systematic and other review articles, meta- analyses, expert consensus documents and specialist society guidelines, such as those from the National Heart Foundation of Australia, American Diabetes Association, the Department of Health, The Royal College of Pathologists of Australasia, and The Australasian College of Emergency Medicine. Based on the literature reviewed, it is yet unknown as to how effective programs, such as diabetes inpatient services, endocrine out-patient services, and cardiac rehabilitation services, are at achieving guideline recommendations. It is also not clear how or whether clinicians are encumbered by complexities in their efforts of adhering to DM, HT, and glucose control recommendations, and the potential reasons for clinical inertia. Future studies are needed to ascertain the extent to which required BP and glucose control in patients is achieved, and whether clinical inertia is a barrier.

Effect of different types of anesthesia on intraoperative blood glucose of diabetic patients: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND

Systematic review which analyzes the impact of different anesthesia on intraoperative blood glucose levels of diabetes patients.

METHODS

We searched Medline (via PubMed), Embase, Cochrane Library, Web of Science, Wangfang, CNKI, and CBM database through June 2016, included in randomized controlled trial (RCT), about different anesthesia on intraoperative blood glucose levels in patients with diabetes. Two researchers in 1 group independently screened literatures with eligibility criteria, extracted information, and used RevMan5.3 software to perform meta-analysis.

RESULTS

We included 11 trials and performed the meta-analysis with 10 trials. The meta-analysis results suggested that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels (WMD -1.26, 95% confidence interval [CI] -1.77 to 0.76), the epidural anesthesia had no significant effects compared with general anesthesia (WMD -0.74, 95% CI 4.41-2.92), and the combined spinal-epidural anesthesia had no significant effects compared with epidural anesthesia (WMD -0.28, 95% CI -1.02 to 0.46). One study suggested that compared with epidural anesthesia, the combined general-epidural anesthesia can lower blood glucose levels CONCLUSION:: Existing evidence showed that compared with general anesthesia, the combined general-epidural anesthesia has a better glycemic control in intraoperative blood glucose levels.

Glycated albumin is associated with body mass index in euglycemic adults but is not predictive of postprandial blood glucose response

BACKGROUND

The level of glycated albumin in circulation is an indicator of blood glucose control over the preceding 2 weeks. It is not known if the level of glycated albumin in circulation relates to an individual's postprandial blood glucose response.

METHODS

Eighty-four euglycemic young adults (21.1 [3.9] years, BMI 23.9 [4.0] kg/m² ) primarily of European descent underwent a fasted meal test of 50 g carbohydrate from white bread. Capillary blood was then sampled at regular intervals over 2 hours. Correlations were sought between glycated albumin, fasted and 2-hour post-load blood glucose measurements, incremental area under the blood glucose curve, glycemic range, body mass index (BMI), and C-reactive protein (CRP).

RESULTS

When adjusted for age and sex, glycated albumin was inversely correlated with BMI (r=-.25, P=.027). No significant correlations existed for glycated albumin and postprandial markers of blood glucose control. BMI and CRP values correlate in this population (r=.30, P=.009).

CONCLUSIONS

Glycated albumin in circulation is not related to postprandial blood glucose response in young euglycemic adults. Glycated albumin is lower in euglycemic adults with higher BMI values. Contrary to research with older adults or those with impaired glucose control, glycated albumin did not correlate to CRP.

Vinegar Functions on Health: Constituents, Sources, and Formation Mechanisms

Vinegars are one of only a few acidic condiments throughout the world. Vinegars can mainly be considered grain vinegars and fruit vinegars, according to the raw materials used. Both grain vinegars and fruit vinegars, which are fermented by traditional methods, possess a variety of physiological functions, such as antibacteria, anti-infection, antioxidation, blood glucose control, lipid metabolism regulation, weight loss, and anticancer activities. The antibacteria and anti-infection abilities of vinegars are mainly due to the presence of organic acids, polyphenols, and melanoidins. The polyphenols and melanoidins also provide the antioxidant abilities of vinegars, which are produced from the raw materials and fermentation processes, respectively. The blood glucose control, lipid metabolism regulation, and weight loss capabilities from vinegars are mainly due to acetic acid. Besides caffeoylsophorose (inhibits disaccharidase) and ligustrazine (improves blood circulation), other functional ingredients present in vinegars provide certain health benefits as well. Regarding anticancer activities, several grain vinegars strongly inhibit the growth of some cancer cells in vivo or in vitro, but related functional ingredients remain largely unknown, except tryptophol in Japanese black soybean vinegar. Considering the discovering of various functional ingredients and clarifying their mechanisms, some vinegars could be functional foods or even medicines, depending on a number of proofs that demonstrate these constituents can cure chronic diseases such as diabetes or cardiovascular problems.

Diabulimia: how eating disorders can affect adolescents with diabetes

Adherence to self-management and medication regimens is required to achieve optimal blood glucose control in adolescents with type 1 diabetes mellitus. Non-adherence places adolescents at serious risk of short and long-term health complications. Adherence difficulties may be exacerbated by concurrent eating disorders. Diabulimia is a term used to describe the deliberate administration of insufficient insulin to maintain glycaemic control for the purpose of causing weight loss. This article explores the concept of diabulimia and the compounding complications of an eating disorder on maintaining self-management regimens in adolescents with diabetes.

Peer-Led, Empowerment-Based Approach to Self-Management Efforts in Diabetes (PLEASED): A Randomized Controlled Trial in an African American Community

PURPOSE

We compared a 3-month diabetes self-management education (DSME) program followed by a 12-month peer support intervention with a 3-month DSME program alone in terms of initial and sustained improvements in glycated hemoglobin (HbA1c). Secondary outcomes were risk factors for cardiovascular disease (CVD), diabetes distress, and social support.

METHODS

We randomized 106 community-dwelling African American adults with type 2 diabetes to a 3-month DSME program followed by 12 months of weekly group sessions and supplementary telephone support delivered by peer leaders or to a 3-month DSME program with no follow-up peer support. Assessments were conducted at baseline, 3, 9, and 15 months.

RESULTS

No changes in HbA1c were observed at 3 months or at 15 months for either group. The peer support group either sustained improvement in key CVD risk factors or stayed the same while the control group worsened at 15 months. At 15 months, the peer-support group had significantly lower low-density lipoprotein cholesterol levels (-15 mg/dL, P = .03), systolic blood pressure (-10 mm Hg, P = .01), diastolic blood pressure (-8.3 mm Hg, P = .001), and body mass index (-0.8 kg/m(2), P = .032) than the DSME-alone group.

CONCLUSIONS

In this population of African American adults, an initial DSME program, whether or not followed by 12 months of peer support, had no effect on glycemic control. Participants in the peer-support arm of the trial did, however, experience significant improvements in some CVD risk factors or stay approximately the same while the control group declined.

Resistance exercise in type 1 diabetes

It is relatively well known that moderate-intensity aerobic exercise increases the risk of hypoglycemia in individuals with type 1 diabetes. Conversely, brief high-intensity (anaerobic) activity can cause post-exercise hyperglycemia. Recent evidence has indicated that including small amounts of anaerobic activity, either in the form of short sprints or as resistance exercise (weight lifting), during aerobic exercise sessions may decrease the drop in blood glucose levels associated with moderate-intensity aerobic exercise. This review discusses the recent developments in the area of exercise and type 1 diabetes, with a particular focus on the effects of resistance exercise. Practical exercise recommendations, as well as suggestions for the future direction of research in this area, are also provided.

The "ups" and "downs" of a bike race in people with type 1 diabetes: dramatic differences in strategies and blood glucose responses in the Paris-to-Ancaster Spring Classic

OBJECTIVE

Recommendations for insulin adjustments and carbohydrate intake exist for individuals with type 1 diabetes who are undertaking moderate exercise. Very few guidelines exist for athletes with type 1 diabetes who are competing in events of higher intensity or longer duration. This observational study reports the strategies adopted by 6 habitually active men with type 1 diabetes (glycated hemoglobin = 8.3%±2.0%) undertaking a relatively intense endurance cycling event.

METHODS

Participants wore continuous glucose monitoring (CGM) sensors for 24 hours before competition, while racing and overnight postrace. They were asked to eat their regular meals and snacks and make their usual insulin adjustments before, during and after competition. All food intake and insulin adjustments were recorded in detail.

RESULTS

Participants used a variety of adjustments for exercise. Of 6 participants, 4 decreased their insulin dosages and all participants consumed carbohydrates during the race (mean = 87±57 g). In spite of these strategies, 3 of the 6 participants experienced mild to moderate hypoglycemia (not requiring assistance) during the event. Hyperglycemia was seen in all participants 3 hours postexercise. There were no incidents of nocturnal hypoglycemia.

CONCLUSIONS

Individuals with type 1 diabetes can compete in intensive long-distance athletic events using a variety of nutrition- and insulin-adjustment strategies. In addition to finely tuned insulin adjustments and increased carbohydrate intake, vigilance will always be required to maintain some semblance of glycemic control during events of extended duration.

Motivational interviewing delivered by diabetes educators: does it improve blood glucose control among poorly controlled type 2 diabetes patients?

AIM

To determine whether glycemic control is improved when motivational interviewing (MI), a patient-centered behavior change strategy, is used with diabetes self management education (DSME) as compared to DSME alone.

METHODS

poorly controlled type 2 diabetes (T2DM) patients (n=234) were randomized into 4 groups: MI+DSME or DSME alone, with or without use of a computerized summary of patient self management barriers. We compared HbA1c changes between groups at 6 months and investigated mediators of HbA1c change.

RESULTS

study patients attended the majority of the four intervention visits (mean 3.4), but drop-out rate was high at follow-up research visits (35%). Multiple regression showed that groups receiving MI had a mean change in HbA1c that was significantly lower (less improved) than those not receiving MI (t=2.10; p=0.037). Mediators of HbA1c change for the total group were diabetes self-care behaviors and diabetes distress; no between-group differences were found.

CONCLUSIONS

DSME improved blood glucose control, underlining its benefit for T2DM management. However, MI+DSME was less effective than DSME alone. Overall, weak support was found for the clinical utility of MI in the management of T2DM delivered by diabetes educators.

Combining basal-bolus insulin infusion for tight postprandial glucose control: an in silico evaluation in adults, children, and adolescents

BACKGROUND

Achieving good postprandial glycemic control, without triggering hypoglycemia events, is a challenge of treatment strategies for type 1 diabetes subjects. Continuous subcutaneous insulin infusion, the gold standard of therapy, is based on heuristic adjustments of both basal and prandial insulin. Some tools, such as bolus calculators, are available to aid patients in selecting a meal-related insulin dose. However, they are still based on empiric parameters such as the insulin-to-carbohydrate ratio and on the physicians' and patients' ability to fit bolus mode to meal composition.

METHODS

In this article, a nonheuristic method for assessment of prandial insulin administration is presented and evaluated. An algorithm based on set inversion via interval analysis is used to coordinate basal and bolus insulin infusions to deal with postprandial glucose excursions. The evaluation is carried out through an in silico study using the 30 virtual patients available in the educational version of the Food and Drug Administration-accepted University of Virginia simulator. Results obtained using the standard bolus strategy and different coordinated basal-bolus solutions provided by the algorithm are compared.

RESULTS

Coordinated basal-bolus solutions improve postprandial glucose performance in most cases, mainly in terms of reducing hypoglycemia risk, but also increasing the percentage of time in normoglycemia. Moreover, glycemic variability is reduced considerably by using these innovative solutions.

CONCLUSIONS

The algorithm presented here is a robust nonheuristic alternative to deal with postprandial glycemic control. It is shown as a powerful tool that could be integrated in future smart insulin pumps.

Relationships of family support, diet therapy practice and blood glucose control in typeII diabetic patients

The purpose of this study was to investigate the degree of family support for diabetic patients and the diet therapy practice of patients themselves, and to analyze the relationship between family support and diet therapy practice and blood glucose control, and thus to prepare basic data for the development of effective education programs to improve blood glucose control in diabetic patients. The study subjects were 82 patients with type II diabetes, aged over 20 in the Chungbuk area. The gender distribution of subjects was 52.4% males and 47.6% females, and BMI showed 29.3% overweight and 35.3% obesity. Among the 82 study subjects, the relationship between diet therapy related family support and blood glucose control was examined in 67 subjects who answered practicing diet therapy, and the results showed that the family support score of a group with excellent blood glucose control was significantly higher than those of groups with fair or poor control (p<0.001) and the correlation between the two factors was very high (r=0.341, p<0.001). For the relationship between diet therapy practice by patients themselves and blood glucose control, diet therapy practice of a group with excellent blood glucose control was significantly higher than those of other groups (fair or poor control groups) (p<0.001) and the correlation between two factors was very high (r=0.304, p<0.001). For other factors influencing blood glucose control, a group with diabetes education showed significantly better blood glucose control compared to other groups without education (p<0.05). From the above results, diet therapy practice by patients, family support, and the necessity of diabetes education were confirmed to control blood glucose of diabetic patients. In conclusion, development and operation of education program should include not only patients but also their family members.

Prescription checking device promises to resolve intractable hypoglycemia

BACKGROUND

Satisfactory glycemic control, meeting American Diabetes Association recommendations, is often accompanied by unsatisfactory hypoglycemia. The converse is also true. We hypothesize that this diabetes treatment dilemma may be resolved by repeated, objective, prescription checks. To do this, a new, two-part device has been developed. It includes a personal diabetes database for the patient and a built-in diabetes prescription checker for the provider. Its goals are to enhance diabetes education and improve patient care.

RESEARCH DESIGN AND METHODS

The device includes a database and supporting software, all contained in a standard USB flash drive. Using the medical prescription, body weight, and recent self-monitored blood glucose (SMBG) data, prescription checks can be done at any time. To demonstrate the device's capabilities, an observational study was performed using data from 11 patients with type 1 diabetes mellitus, on intensified therapy, with a mean glycated hemoglobin A1c <7%, and who all suffered intractable hypoglycemia. Patients had performed SMBG contours on successive days at monthly intervals. Each contour included pre- and postmeal as well as bedtime measurements. The replicated contours were used to predict the patient's glycemic profile each month. Applying a built-in simulator to each profile, changes in the prescription were explored that were consistent with reducing the recalcitrant hypoglycemia.

RESULTS

A total of 110 glycemic profiles containing 822 profile points were explored. Of these profile points, 351 (43%) showed risks of hypoglycemia, whereas 385 (47%) fell outside desired ranges. With the simulated changes in the prescription, the predicted risks of hypoglycemia were reduced 2.5-fold with insignificant increases predicted in hemoglobin A1c levels of +0.6 +/- 0.9%.

CONCLUSIONS

A novel support tool for diabetes promises to resolve the diabetes treatment dilemma. Supporting the patient, it improves self-management. Supporting the provider, it reviews the medical prescription in light of objective outcomes and formalizes interventions for maximum safety and efficacy.

Closing the circle of care with new firmware for diabetes: MyDiaBase+RxChecker

BACKGROUND

Satisfactory glycemic control, meeting American Diabetes Association recommendations, is difficult to achieve. Technologically, this is most likely because the circle of care is incomplete. Many have suggested that the introduction of information technology may remedy the situation. However, previous attempts have not succeeded. Recognizing this, we evolved firmware that supports and links both the patient at home and their care providers in the clinic.

FIRMWARE DESIGN AND METHODS

The device includes software and a database, all contained in a standard USB flash drive. At home, patients use the database portion of the device (MyDiaBase). It fully complements their diabetes education while capturing pertinent self-management information by tracking self-monitored blood glucose data, body weight, medication dosing, physical activity, diet, lifestyle, and stress. In the clinic, providers use the RxChecker program to perform prescription checks that are based on their patients' outcomes data, thereby effectively closing the circle of care.

Diabetes and exercise: the role of the athletic trainer

OBJECTIVE

To identify the role that exercise plays in the management of diabetes mellitus and to provide the reader with guidelines for preventing and treating exercise-related complications.

DATA SOURCES

MEDLINE was searched from 1985 to 1996 using the key words "diabetes," "exercise," "Type I diabetes," and "athlete."

DATA SYNTHESIS

Diabetes mellitus is a chronic metabolic disorder characterized by an abnormally elevated blood glucose level. It is a disease that has long-term ramifications for the body's organ systems. The primary goal of diabetes management is to normalize the blood glucose level. Exercise, along with dietary modifications and insulin, is an important component of the management scheme. While exercise is not consistently associated with improvements in long-term blood glucose control, it does lead to other benefits that may reduce the severity and number of diabetes-related complications.

CONCLUSIONS/RECOMMENDATIONS

The athletic trainer can help athletes with diabetes to compete safely by understanding their unique physiologic responses to exercise, as well as the risks and benefits of exercise.

Controlling blood sugars

Management of the diabetic patient has undergone a minor revolution in the past decade. Better understanding of insulin's physiology, its interaction with glucose and other aspects of metabolism, and knowledge of hyperglycemia's detrimental effects, have contributed to a drive to keep blood glucose levels as close to non-diabetic norms as possible. One of the most important therapeutic advances has been the realization that patients must become their own chief therapists. They therefore must be adequately and intensively educated to understand the interrelationships of diet, insulin, and activity in controlling blood glucose levels. Self blood glucose monitoring is essential to gauge these interrelationships and allows the educated patient to make daily therapeutic decisions.