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Diabetes mellitus (DM) is regarded as one of the most critical public health challenges of the 21st century. It has evolved into a burgeoning epidemic since the last century, and today ranks among the major causes of mortality worldwide. Diabetes specialist nurses (DSNs) are central to good patient care and outcomes including confident self-care management. Evidence shows that DSNs are cost-effective, improve clinical outcomes, and reduce length of stay in hospital. In this brief narrative review, we aim to describe the roles of DSNs and their contribution in the treatment and management of patients with DM. This narrative review describes the importance of DSNs in healthcare practice, in the inpatient and outpatient departments, in the pediatrics department, in managing diabetic foot ulcers, in the treatment and management of gestational diabetes, in prescribing medications for DM and in diabetes self-management education on glycosylated hemoglobin, and cardiovascular risk factors. To conclude, DSNs have a crucial role in the treatment and management of patients with DM and its complications. DSNs have a great impact on diabetes therapy, and hence implementation of DSNs and nurse-led diabetic clinics might be beneficial for the health care system. Finally, having DSNs might significantly contribute to good healthcare practice and support. Even though DSNs are not available in several regions around the globe, and even though this post is still new to several health care institutions, the presence of DSNs recognized and certified by the various healthcare systems would be very useful. [ABSTRACT FROM AUTHOR]

Diabetes mellitus type 1 (T1D) and type 2 (T2D) develop due to dysfunction of the Langerhans islet β-cells in the pancreas, and this dysfunction is mediated by oxidative, endoplasmic reticulum (ER), and mitochondrial stresses. Although the two types of diabetes are significantly different, β-cell failure and death play a key role in the pathogenesis of both diseases, resulting in hyperglycemia due to a reduced ability to produce insulin. In T1D, β-cell apoptosis is the main event leading to hyperglycemia, while in T2D, insulin resistance results in an inability to meet insulin requirements. It has been suggested that autophagy promotes β-cell survival by delaying apoptosis and providing adaptive responses to mitigate the detrimental effects of ER stress and DNA damage, which is directly related to oxidative stress. As people with diabetes are now living longer, they are more susceptible to a different set of complications. There has been a diversification in causes of death, whereby a larger proportion of deaths among individuals with diabetes is attributable to nonvascular conditions; on the other hand, the proportion of cancer-related deaths has remained stable or even increased in some countries. Due to the increasing cases of both T1D and T2D, these diseases become even more socially significant. Hence, we believe that search for any opportunities for control of this disease is an overwhelmingly important target for the modern science. We focus on two differences that are characteristic of the development of diabetes’s last periods. One of them shows that all-cause death rates have declined in several diabetes populations, driven in part by large declines in vascular disease mortality but large increases in oncological diseases. Another hypothesis is that some T2D medications could be repurposed to control glycemia in patients with T1D. [ABSTRACT FROM AUTHOR]

A transdermal patch that delivers insulin at high glucose concentrations can offer tremendous advantages to ease the concern of safety and improve the quality of life for people with diabetes. Herein, a novel self‐crosslinkable and glucose‐responsive polymer‐based microneedle patch (MN) is designed to deliver insulin at hyperglycemia. The microneedle patch is made of hyaluronic acid polymers functionalized with dopamine and 4‐amino‐3‐fluorophenylboronic acid (AFBA) that can be quickly crosslinked upon mixing of the polymer solutions in the absence of any chemicalcrosslinking agents or organic solvents. The catechol groups in the dopamine (DA) units form covalent crosslinkages among themselves by auto‐oxidation and dynamic crosslink with phenylboronic acid (PBA) via complexation. The reversible crosslinkages between catechol and boronate decrease with increasing glucose concentration leading to higher swelling and faster insulin release at hyperglycemia as compared to euglycemia. Such superior glucose‐responsive properties are demonstrated by in vitro analyses and in vivo efficacy studies. The hydrogel polymers also preserve native structure and bioactivity of insulin, attributable to the interaction of hyaluronic acid (HA) with insulin molecules, as revealed by experiments and molecular dynamics simulations. The simplicity in the design and fabrication process, and glucose‐responsiveness in insulin delivery impart the matrix microneedle (mMN) patch great potential for clinical translation. [ABSTRACT FROM AUTHOR]

Background: The management of antidiabetic therapy in people with type 2 diabetes (T2D) has evolved beyond glycemic control. In this context, Brazil and Portugal defined a joint panel of four leading diabetes societies to update the guideline published in 2020. Methods: The panelists searched MEDLINE (via PubMed) for the best evidence from clinical studies on treating T2D and its cardiorenal complications. The panel searched for evidence on antidiabetic therapy in people with T2D without cardiorenal disease and in patients with T2D and atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or diabetic kidney disease (DKD). The degree of recommendation and the level of evidence were determined using predefined criteria. Results and conclusions: All people with T2D need to have their cardiovascular (CV) risk status stratified and HbA1c, BMI, and eGFR assessed before defining therapy. An HbA1c target of less than 7% is adequate for most adults, and a more flexible target (up to 8%) should be considered in frail older people. Non-pharmacological approaches are recommended during all phases of treatment. In treatment naïve T2D individuals without cardiorenal complications, metformin is the agent of choice when HbA1c is 7.5% or below. When HbA1c is above 7.5% to 9%, starting with dual therapy is recommended, and triple therapy may be considered. When HbA1c is above 9%, starting with dual therapyt is recommended, and triple therapy should be considered. Antidiabetic drugs with proven CV benefit (AD1) are recommended to reduce CV events if the patient is at high or very high CV risk, and antidiabetic agents with proven efficacy in weight reduction should be considered when obesity is present. If HbA1c remains above target, intensification is recommended with triple, quadruple therapy, or even insulin-based therapy. In people with T2D and established ASCVD, AD1 agents (SGLT2 inhibitors or GLP-1 RA with proven CV benefit) are initially recommended to reduce CV outcomes, and metformin or a second AD1 may be necessary to improve glycemic control if HbA1c is above the target. In T2D with HF, SGLT2 inhibitors are recommended to reduce HF hospitalizations and mortality and to improve HbA1c. In patients with DKD, SGLT2 inhibitors in combination with metformin are recommended when eGFR is above 30 mL/min/1.73 m2. SGLT2 inhibitors can be continued until end-stage kidney disease. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Hypertriglyceridemia is common in patients with diabetes. Although the fatty acid (FA) composition of triglycerides (TGs) is suggested to be related to the pathology of diabetes and its complications, changes in the fatty acid composition caused by diabetes treatment remain unclear. This study aimed to identify short‐term changes in the fatty acid composition of plasma triglycerides after diabetes treatment. Materials and Methods: This study was a sub‐analysis of a prospective observational study of patients with type 2 diabetes aged between 20 and 75 years who were hospitalized to improve glycemic control (n = 31). A lipidomic analysis of plasma samples on the 2nd and 16th hospital days was conducted by supercritical fluid chromatography coupled with mass spectrometry. Results: In total, 104 types of triglycerides with different compositions were identified. Most of them tended to decrease after treatment. In particular, triglycerides with a lower carbon number and fewer double bonds showed a relatively larger reduction. The inclusion of FA 14:0 (myristic acid), as a constituent of triglyceride, was significantly associated with a more than 50%, and statistically significant, reduction (odds ratio 39.0; P < 0.001). The total amount of FA 14:0 as a constituent of triglycerides also decreased significantly, and its rate of decrease was the greatest of all the fatty acid constituents. Conclusions: A 2 week comprehensive risk management for diabetes resulted in decreased levels of plasma triglycerides and a change in the fatty acid composition of triglycerides, characterized by a relatively large reduction in FA 14:0 as a constituent of triglycerides. [ABSTRACT FROM AUTHOR]

Microneedles (MN) technology is an emerging technology for the transdermal delivery of therapeutics. When combined with photoresponsive (PR) materials, MNs can deliver therapeutics precisely and effectively with enhanced efficacy or synergistic effects. This review systematically summarizes the therapeutic applications of PRMNs in cancer therapy, wound healing, diabetes treatment, and diagnostics. Different PR approaches to activate and control the release of therapeutic agents from MNs are also discussed. Overall, PRMNs are a powerful tool for stimuli-responsive controlled-release therapeutic delivery to treat various diseases. [Display omitted] [ABSTRACT FROM AUTHOR]

Diabetes mellitus is one of the most serious public health problems in the world. Repeated daily injections of subcutaneous insulin is the standard treatment for patients with type 1 diabetes mellitus; however, subcutaneous insulin injections can potentially cause local discomfort, patient noncompliance, hypoglycemia, failure to regulate glucose homeostasis, infections, and fat deposits at the injection sites. In recent years, numerous attempts have been made to produce safe and efficient nanoparticles for oral insulin delivery. Oral administration is considered the most effective alternative route to insulin injection, but it is accompanied by several challenges related to enzymatic proteolysis, digestive breakdown, and absorption barriers. A number of natural and synthetic polymeric, lipid‐based, and inorganic nanoparticles have been investigated for use. Although improvements have recently been made in potential oral insulin delivery systems, these require further investigation before clinical trials are conducted. In this review, new approaches to oral insulin delivery for diabetes treatment are discussed, including polymeric, lipid‐based, and inorganic nanoparticles, as well as the clinical trials performed for this purpose. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Diabetes patients develop a variety of metabolic abnormalities in addition to hyperglycemia. However, details regarding change in various metabolites after comprehensive diabetes treatment remain unknown. This study aimed to identify the short‐term change in metabolome in inpatients who were subject to comprehensive diabetes treatment, using gas chromatography/mass spectrometry‐based non‐target metabolomics techniques. Materials and Methods: Participants of the present study were randomly recruited from the patients with type 2 diabetes hospitalized due to problems with glycemic control (n = 31) and volunteers without diabetes (n = 30), both of whom were aged between 20 and 75 years. A metabolomic analysis of fasting plasma samples on the 2nd (pre‐treatment) and 16th hospital (post‐treatment) day with gas chromatography/mass spectrometry using a multiple reaction monitoring mode was carried out. Results: A principal component analysis showed that metabolome of fasting plasma was different between individuals with and without diabetes. The metabolome of fasting plasma in diabetes patients after treatment was different from that of pre‐treatment, as well as individuals without diabetes. Many amino acids (proline, glycine, serine, threonine, methionine, pyroglutamic acid, glutamine and lysine) were significantly increased by >10% after administering the inpatient diabetes treatment. A hierarchical clustering analysis showed that in the case of patients with markedly decreased monosaccharide levels and increased 1,5‐anhydroglucitol, the levels of amino acids increased more significantly. Conclusions: After a 2‐week comprehensive treatment, the plasma levels of various amino acids increased in conjunction with the reduction in monosaccharide levels in poorly controlled type 2 diabetes patients. [ABSTRACT FROM AUTHOR]

Aims: COVID-19 has and still is sweeping away the national health systems worldwide. In this review, we sought to determine the evidence base proofs on the antidiabetic treatment capable to reduce the risk of COVID-19-related mortality. Methods: We have performed a systematic search of published articles using PubMed, and EMBASE from March 2020 to March 31st, 2021. We excluded editorials, commentary, letters to the editor, reviews, and studies that did not have mortality as an outcome. For metformin and insulin only, we performed a meta-analysis using Cochrane RevMan 5.2. Results: Among antidiabetic drugs, metformin was the only drug associated with a reduced risk of mortality. Conversely, insulin appears associated with an increased risk. The other classes of drugs were neutral. Conclusions: The totality of articles reports retrospective data strongly affected by "channeling bias" so that most of the existing results on each class of drugs are driven by the phenotype of patients likely to receive that specific drug by prescription. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is one of the oldest characterized diseases in the world. By today diabetes has become a worldwide epidemic that is associated with the modern lifestyle, increased stress, improper nutrition or eating behaviours and lack of physical activity. Material And Methods: 330 patients aged 30-76 years were administered to the study. All the metabolic marker analyses were conducted using an automated clinical chemistry analyzer (Dimension Xpand Plus, Siemens Healthcare, Germany). Random Plasma glucose levels (RPG) was taken 2-4 hours post meal. Sujok treatments were carried out by certified Sujok Therapists according to the Diabetes treatment protocol (ISA R&D center, Nagpur, India). Result: A major decrease in plasma glucose levels was recorded 30 minutes after the initial Sujok treatment. Following 5 treatments, 70% of the patients responded in decrease in glucose levels (52.45±10.49 mg/dl) while 24% increase in glucose levels (22.2±7.4 mg/dl), 6% of the patients did not show any change in glucose plasma levels. HbA1c was monitored in the patients that undergone 3 months of Sujok treatment. A considerable decrease in the percent of HbA1c was observed in the plasma of treated patients (5.53±0.98%), in comparison to the initial level measured prior to the treatment procedure (8.13±1.29%). Conclusion: This study is a pilot study to evaluate possible effect of Sujok therapy for the treatment of diabetes. Overall, it seems that Sujok therapy may decrease glucose levels and HbA1c levels. These results can support the efforts to develop improved therapeutic and preventive strategies for diabetes. A following research regarding the treatment of diabetes complications by Sujok therapy is currently running with promising results. [ABSTRACT FROM AUTHOR]

Metabolic surgery has been studied in the last decades as an effective and safe treatment for type 2 diabetes (T2D), and randomized controlled trials generally found surgery superior when compared with medical treatment. In 2016, the DSS-II Joint Statement recognized the importance of metabolic surgery in the treatment of T2D and urged clinicians to discuss, recommend, or at least consider this procedure for their patients. Diabetes societies also cogitate metabolic surgery as an option for T2D patients in their guidelines. However, there are some differences in recommendations that could lead a careful reader to some confusion. This was potentialized in a recent document published by the same DSS-II group concerning prioritization for surgery after the COVID-19 pandemic, in which the criteria suggested for an expedited recommendation that is not exactly evidence-based, and collided substantially with several clinical guidelines worldwide, especially with regard to secondary prevention of cardiovascular disease. A more harmonious discussion and unified guidelines between clinicians and surgeons are needed in order to provide the same message for those who read different articles. [ABSTRACT FROM AUTHOR]

Individuals with type 1 and advanced type 2 diabetes require daily insulin therapy to maintain blood glucose levels in normoglycemic ranges to prevent associated morbidity and mortality. Optimal insulin delivery should offer both precise dosing in response to real-time blood glucose levels as well as a feasible and low-burden administration route to promote long-term adherence. A series of glucose-responsive insulin delivery mechanisms and devices have been reported to increase patient compliance while mitigating the risk of hypoglycemia. This review discusses currently available insulin delivery devices, overviews recent developments towards the generation of glucose-responsive delivery systems, and provides commentary on the opportunities and barriers ahead regarding the integration and translation of current glucose-responsive insulin delivery designs. Understanding the mechanisms, advantages, and limitations of various insulin delivery routes is imperative for the future design and optimization of innovative delivery devices. Incorporating glucose-responsive modules with drug delivery devices could promote self-regulated insulin delivery in response to the real-time metabolic needs of patients, thereby mitigating exposure to both hyperglycemia and hypoglycemia. There have been major advances in the development of glucose-responsive insulin delivery devices, including efforts to design artificial pancreas devices, synthetic system-based glucose-responsive mechanisms, and engineered molecular glucose-responsive insulin. Integration of minimally invasive delivery strategies is essential for reducing the day-to-day burden of insulin therapy to improve patient adherence and glycemic outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the impact of diabetes status on presenteeism in companies in Japan. Methods: A cross-sectional study was conducted among workers aged 40 years or older. Using medical examination results and health insurance claims data, participants were classified as normal, borderline, or diabetic. The diabetic group was further classified as untreated or treated. The Quantity and Quality (QQ) method was used as an evaluation index of presenteeism. Logistic regression analysis was performed to predict presenteeism loss. Results: Data on 13,292 people were analyzed. Presenteeism loss was significantly higher in the diabetic group versus the normal group. The untreated group did not differ from the normal group, but presenteeism loss was significantly higher in the treated group. Conclusions: Presenteeism loss may occur among diabetic workers in Japan and can be caused by diabetes treatment. [ABSTRACT FROM AUTHOR]

We performed a literature review of composite metrics for describing the quality of glycemic control, as measured by continuous glucose monitors (CGMs). Nine composite metrics that describe CGM data were identified. They are described in detail along with their advantages and disadvantages. The primary benefit to using composite metrics in clinical practice is to be able to quickly evaluate a patient's glycemic control in the form of a single number that accounts for multiple dimensions of glycemic control. Very little data exist about (1) how to select the optimal components of composite metrics for CGM; (2) how to best score individual components of composite metrics; and (3) how to correlate composite metric scores with empiric outcomes. Nevertheless, composite metrics are an attractive type of scoring system to present clinicians with a single number that accounts for many dimensions of their patients' glycemia. If a busy health care professional is looking for a single-number summary statistic to describe glucose levels monitored by a CGM, then a composite metric has many attractive features. [ABSTRACT FROM AUTHOR]

Background: In current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM. Methods: MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria. Results and conclusions: In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA1c is 6.5–7.5%. When HbA1c is 7.5–9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA1c remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction (< 40%) and glomerular filtration rate (eGFR) > 30 mL/min/1.73 m2, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30–60 mL/min/1.73 m2 or eGFR 30–90 mL/min/1.73 m2 with albuminuria > 30 mg/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-1RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM. [ABSTRACT FROM AUTHOR]

Background: In the current era of modern technology, the development of smart devices such as the flash glucose monitoring (FGM) systems helps patients with diabetes to effortlessly monitor their glucose levels more frequently. In this study, we determine the user acceptability of FGM among young patients with type 1 diabetes (T1D). Methods: A cross-sectional study was performed among 67 young patients with T1D in the age group of 13 to 19 years and who were managed on the FGM method for self-testing the glucose levels for a minimum of 6 months. The participants acceptability measures that were collected with a standard questionnaire and where they rated their experience with the system on a scale of 1 (strongly agree/painless) to 5 (strongly disagree/severe pain). In addition to the demographic and clinical parameters, a closed/structured questionnaire was administered, in order to record the prior and present skin issues, over a 6-month period. Results: From the patient statements regarding sensor application, 95.5% of the study population strongly agreed that the sensor application caused less pain than the routine finger-stick. Similarly, 85% of the users strongly agreed that using the sensor was comfortable, while 94% strongly agreed that they found the small size of the FGM made it easy to wear, 47.8% strongly agreed that wearing the sensor did not attract attention, 70.1% reported no discomfort under the skin, 80.6% stated that the sensor could be scanned without anyone noticing it, 89.6% felt that the sensor did not affect their daily activities, 91% strongly agreed that the sensor was very compatible with their lifestyle, 79.1% reported ease with taking a glucose reading with the scan, 89.6% reported that taking glucose readings with this system would not disrupt their daily activities, and 76.1% participants were excited to share with other individuals their experiences with this system. A comparison of the self-monitoring of blood glucose and freestyle techniques demonstrated that 83.6% participants strongly agreed that it was less painful to get glucose readings from the freestyle sensor, and that it was a more discreet (83.6%), more comfortable (85.1%), easier (95.5%), faster (82.1%), simpler (79.1%), more private (88.1%), and less stressful (77.6%) method, with minimal hassle (74.6%). It is notable here that 86.6% of the participants reported absolutely no pain when the freestyle sensor was applied; also, the majority of the participants (91%) reported no pain symptoms when scanning the sensor. Conclusion: The findings of this study clearly showed that the study population had a high level of acceptability of the FGM. [ABSTRACT FROM AUTHOR]

To clarify the necessity of exercise therapy for continuation care in patients with type 2 diabetes, and to continue the continuation of nursing services from hospital to community or family to improve self-management ability, self-efficacy and quality of life of type 2 diabetes patients. The purpose of this paper is to analyze the effects of exercise therapy on patients with type 2 diabetes mellitus complicated with peripheral vascular disease by comparing the changes of type 2 diabetes patients after different nursing interventions with exercise therapy, and to understand the occurrence and development of diabetes and different exercise therapy for diabetes. The effects of blood lipids, and the comparison after nursing intervention, studied the mechanism of exercise therapy on patients with type 2 diabetes complicated with peripheral vascular disease, and explored the corresponding mechanism of action. Using the method of this paper, through the experimental data analysis, we learned the mechanism of exercise therapy on patients with type 2 diabetes complicated with peripheral vascular disease, and found that yoga has a greater effect on patients with type 2 diabetes mellitus and peripheral vascular disease, up to 80%. Combined with the experimental data, it is analyzed that the two kinds of exercise therapy, yoga and walking, are relatively good, and the use of yoga exercise therapy is as high as 53%. The results show that exercise therapy is important for patients with type 2 diabetes and peripheral vascular disease. Role, nursing intervention plays a corresponding auxiliary role. To provide a reference for further effective treatment of patients with type 2 diabetes and peripheral vascular disease. [ABSTRACT FROM AUTHOR]

Background: In the current era of modern technology, the development of smart devices such as the flash glucose monitoring (FGM) systems helps patients with diabetes to effortlessly monitor their glucose levels more frequently. In this study, we determine the user acceptability of FGM among young patients with type 1 diabetes (T1D). Methods: A cross-sectional study was performed among 67 young patients with T1D in the age group of 13 to 19 years and who were managed on the FGM method for self-testing the glucose levels for a minimum of 6 months. The participants acceptability measures that were collected with a standard questionnaire and where they rated their experience with the system on a scale of 1 (strongly agree/painless) to 5 (strongly disagree/severe pain). In addition to the demographic and clinical parameters, a closed/structured questionnaire was administered, in order to record the prior and present skin issues, over a 6-month period. Results: From the patient statements regarding sensor application, 95.5% of the study population strongly agreed that the sensor application caused less pain than the routine finger-stick. Similarly, 85% of the users strongly agreed that using the sensor was comfortable, while 94% strongly agreed that they found the small size of the FGM made it easy to wear, 47.8% strongly agreed that wearing the sensor did not attract attention, 70.1% reported no discomfort under the skin, 80.6% stated that the sensor could be scanned without anyone noticing it, 89.6% felt that the sensor did not affect their daily activities, 91% strongly agreed that the sensor was very compatible with their lifestyle, 79.1% reported ease with taking a glucose reading with the scan, 89.6% reported that taking glucose readings with this system would not disrupt their daily activities, and 76.1% participants were excited to share with other individuals their experiences with this system. A comparison of the self-monitoring of blood glucose and freestyle techniques demonstrated that 83.6% participants strongly agreed that it was less painful to get glucose readings from the freestyle sensor, and that it was a more discreet (83.6%), more comfortable (85.1%), easier (95.5%), faster (82.1%), simpler (79.1%), more private (88.1%), and less stressful (77.6%) method, with minimal hassle (74.6%). It is notable here that 86.6% of the participants reported absolutely no pain when the freestyle sensor was applied; also, the majority of the participants (91%) reported no pain symptoms when scanning the sensor. Conclusion: The findings of this study clearly showed that the study population had a high level of acceptability of the FGM. [ABSTRACT FROM AUTHOR]

T2D is a well-established risk factor for development and progression of CKD. KDIGO recommends categorization of risk by likelihood of progression to ESKD. Compared to placebo, empagliflozin decreases likelihood of worsening (OR 0.70, 95 % CI 0.62–0.78) and increases likelihood of improvement (OR 1.56, 95 % CI 1.30–1.86) in KDIGO risk category. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the safety of insulin degludec (degludec) in relation to age and risk of hypoglycaemia post hoc in individuals with type 2 diabetes (T2D) (SWITCH 2 trial). Methods: In this crossover study, individuals with T2D who were at risk of hypoglycaemia were randomized to double‐blind treatment with degludec or insulin glargine 100 units/mL (glargine U100) ± oral antidiabetic drugs. After 32 weeks, patients crossed over to the other treatment. Primary endpoint was number of overall severe (positively adjudicated) or glucose‐confirmed (plasma glucose <56 mg/dL; 3.1 mmol/L) symptomatic hypoglycaemia events during the two 16‐week maintenance periods. Results: For individuals ≤65 (n = 450) and >65 (n = 270) years, baseline median (range) duration of diabetes was 12 (1–40) vs 15 (1–54) years, mean HbA1c was 7.7% vs 7.4% and mean estimated glomerular filtration rate was 87.0 vs 63.7 mL/min/1.73 m2, respectively. No significant differences in HbA1c reduction were seen in individuals ≤65 or >65 years. During both maintenance periods, treatment with degludec lowered rates of hypoglycaemia (overall/nocturnal symptomatic) vs those with glargine U100 in individuals ≤65 (31% vs 43%) and >65 (30% vs 41%) years. With degludec and glargine U100, respectively, six vs nine severe hypoglycaemic events occurred in individuals ≤65 years and four vs eight events occurred in those >65 years. Adverse event rates were 3.2 and 3.3 events/patient‐year for individuals ≤65 years and were 3.5 and 4.1 events/patient‐year for individuals >65 years with degludec and glargine U100, respectively. Conclusion: Treatment with degludec was safe and effective, with a frequency of hypoglycaemia lower than that with glargine U100 in both younger and older individuals (>65 years) with T2D. [ABSTRACT FROM AUTHOR]

Background: Mobile health (MH) technologies including clinical decision support systems (CDSS) provide an efficient method for patient monitoring and treatment. A mobile CDSS is based on real-time sensor data and historical electronic health record (EHR) data. Raw sensor data have no semantics of their own; therefore, a computer system cannot interpret these data automatically. In addition, the interoperability of sensor data and EHR medical data is a challenge. EHR data collected from distributed systems have different structures, semantics, and coding mechanisms. As a result, building a transparent CDSS that can work as a portable plug-and-play component in any existing EHR ecosystem requires a careful design process. Ontology and medical standards support the construction of semantically intelligent CDSSs.Methods: This paper proposes a comprehensive MH framework with an integrated CDSS capability. This cloud-based system monitors and manages type 1 diabetes mellitus. The efficiency of any CDSS depends mainly on the quality of its knowledge and its semantic interoperability with different data sources. To this end, this paper concentrates on constructing a semantic CDSS based on proposed FASTO ontology.Results: This realistic ontology is able to collect, formalize, integrate, analyze, and manipulate all types of patient data. It provides patients with complete, personalized, and medically intuitive care plans, including insulin regimens, diets, exercises, and education sub-plans. These plans are based on the complete patient profile. In addition, the proposed CDSS provides real-time patient monitoring based on vital signs collected from patients' wireless body area networks. These monitoring include real-time insulin adjustments, mealtime carbohydrate calculations, and exercise recommendations. FASTO integrates the well-known standards of HL7 fast healthcare interoperability resources (FHIR), semantic sensor network (SSN) ontology, basic formal ontology (BFO) 2.0, and clinical practice guidelines. The current version of FASTO includes 9577 classes, 658 object properties, 164 data properties, 460 individuals, and 140 SWRL rules. FASTO is publicly available through the National Center for Biomedical Ontology BioPortal at https://bioportal.bioontology.org/ontologies/FASTO .Conclusions: The resulting CDSS system can help physicians to monitor more patients efficiently and accurately. In addition, patients in rural areas can depend on the system to manage their diabetes and emergencies. [ABSTRACT FROM AUTHOR]

Abstract Recent work, Goodwin et al. (2015, 2018), has established that, subject to an assumption regarding the relative blood glucose response times of meal and insulin, it is optimal for the minimisation of the peak blood glucose excursion to apply a bolus of insulin at the time of (or slightly prior to) meal ingestion. A key assumption underlying this result is that the impact of an impulse of insulin "lasts longer" than the impact of an impulse of food. The result is consistent with clinical trials reported in Lopez et al. (2014). In the current paper we consider the converse situation where the response of the meal lasts longer than the response of an insulin impulse. The latter situation is known to arise in certain circumstances e.g., when low glycaemic index and/or hi-fat/hi-protein meals are consumed (Bell et al., 2015; Lodefalk et al., 2008; van der Hoogt et al., 2017). We consider the same set-up as in Goodwin et al. (2015). However, here we show that, when the response of the meal lasts longer than the response of an insulin impulse, it is optimal to use an open-loop policy combining an insulin bolus (applied with the meal) and a specific form of decaying insulin flow thereafter. This gives support to results for clinical trials, reported in Lopez et al. (2017). However, as far as we are aware, no earlier work has given a methodology to quantify the best insulin flow after the initial bolus nor the best split between bolus and post-bolus insulin flow. In support of the theory, we apply the results to a model obtained from clinical trials on a real subject with Type 1 diabetes and include a discussion of open-loop versus closed-loop policies. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Generation of free radicals and oxidative stress are a major contributor to diabetes. These factors lead to the development of diabetic testicles disorders. Objective: In this study, the protective effect of vitamin E on functional disorders associated with diabetes induced oxidative stress in male reproductive systems has been investigated. Materials and Methods: Thirty-three adult male Mice were divided into control, diabetic, and untreated diabetic groups. Streptozotocin was used to induce diabetes. In the treated group, vitamin E was given to the Mice intraperitoneally for 30 days. Then, animals were anesthetized and sacrificed. Animal testicles were isolated and homogenized in phosphate buffer and used for measuring sperm count, motility and survival of sperm, MDA concentration and antioxidant capacity (TAC). Apoptosis was also performed with the TUNEL test. Results: The results of reduction (12.03±98.11) TAC, MDA concentration (-28.5±2.58), sperm motility (unstable sperma= 86.4±7.48), sperm count (171.51), Sperm morphology (natural morphology= 49.69±31.93) and abnormal morphology (9.77±49.7) with increased oxidative damage. These changes were statistically significant in comparison with the control group for all variables other than MDA (p= 0.05). Treatment of vitamin E diabetic Mice improved the ability of antioxidants to prevent oxidative damage in the testicles, restore the sperm movement, and increase the number of normal sperm as well as TAC. The level of apoptosis in the treated group has decreased compared to the untreated group. Conclusion: Vitamin E protects the reproductive system against diabetes mellitus. Therefore, it was concluded that vitamin E may be a suitable agent for protecting the sperm and testicular parameters against undesirable effects of diabetes. [ABSTRACT FROM AUTHOR]

Background and aims: PREDATORR Study estimated diabetes mellitus (DM) prevalence in Romania at 11.7%. MENTOR is the first national major study trying to determine the quality of the metabolic control in patients with type 2 diabetes (T2DM), the therapeutic options used, and the microvascular and macrovascular complications prevalence in order to achieve a better management for Romanian patients with T2DM. Material and methods: The study was designed as an observational analytical, multicenter, prospective study. Study population was selected from T2DM patients stratified by: age, diabetes duration and gender. Data was collected in an eCRF: demographics, physical examination, cardiovascular evaluation, blood tests, known pathology, treatment. Results: There were 54.80% women, mean age was 60.53±7.39 years. The average BMI is over 30 kg/m2 with a decreasing trend over the age. 60% had their HbA1c over the threshold of 7%. Average blood pressure was less than 140/80 mmHg. 76,66% of T2DM subjects have at least one chronic complication. On oral therapy we have 55.44% of patients, on insulin only therapy 12.99% and on a combination of oral and insulin therapy 22.51%. Conclusions: This study showed a high prevalence of diabetes complications and metabolic alterations (obesity, hypertension, dyslipidemia, etc.). Age, male gender and diabetes duration were associated with a higher risk for poor metabolic control and complications. Further data will be collected over a 3 years period to obtain a better image over T2DM evolution in Romanian population. [ABSTRACT FROM AUTHOR]

Importance Choroidal thickness changes in diabetic retinopathy improve the understanding of the pathophysiology and managements of this disease. Background: To examine the choroidal layer thickness in diabetes mellitus (DM) patients and normal individuals, and to compare the findings based on medical history of systemic DM treatments, and stage of diabetic retinopathy (DR). Design Case control study. Participants: Two hundred and sixty‐eight eyes of 134 DM patients and age‐matched 72 healthy controls of 92 eyes. Methods: Central choroidal layer thickness (total, inner and outer layers) was measured using enhanced depth imaging OCT. DM patients were divided into two groups; the DM‐treated group (88 cases), and the untreated group (46 cases). These two groups were further classified into four groups; no DR (NDR), mild/moderate non‐proliferative DR (mNPDR), severe NPDR and PDR. Main Outcome Measures: Comparison of subfoveal choroid layer thickness in control and diabetic patient groups. Results: Choroidal thickness measurements of diabetic eyes had strong correlation between masked raters in choroidal layers, proving high reproducibility. The total and outer choroid thicknesses in mNPDR in the DM‐untreated group were significantly thinner than normal controls (each P < 0.05). Choroidal outer layer thickness of the severe NPDR in the DM‐untreated group was significantly thicker than normal controls (P < 0.05). In the DM treatment group, there were no significant differences from the control group regarding choroidal layer thicknesses and all stages of DR. Conclusions and Relevance: The choroidal thickness significantly changed in the DM‐untreated group, and the main anatomical changes might result from the outer layer. [ABSTRACT FROM AUTHOR]

A niosomal formulation for simultaneous encapsulation and release of hydrophobic and hydrophilic anti-diabetic drugs is reported. The niosomes were prepared by thin film hydration method which involved self assembly of Tween 80 and cholesterol. Confocal laser scanning microscopy (CLSM) investigations revealed that nile red (the hydrophobic molecule) preferentially accumulated in the shell while FITC-dextran (the hydrophilic molecule) loaded in the aqueous core of the niosome. Fourier transform infra-red (FTIR) spectroscopy investigation of niosomes revealed hydrogen bond formation between tween 80 and cholesterol. The encapsulation efficiencies for glipizide and metformin hydrochloride (metformin HCl) were found to be 67.64% and 58.72%, respectively. The drug release experiments performed in buffers at different pH values (mimicking the blood plasma pH, cellular endosomal and gastric environments) revealed that the drug release followed a linear profile up to 8–10 h, slowed down, and lasted for 12–14 h. Thus, this formulation offers a promising drug delivery system for combinatorial sustained release of anti-diabetic drugs. [ABSTRACT FROM AUTHOR]

Patients with diabetes are sometimes overwhelmed with the burden of self-care associated with the disease. Although it may seem appropriate to diagnose patients experiencing such emotional burdens with depression, the literature over the past 20 years has matured the concept of diabetes distress, which may more accurately describe the phenomenon. [ABSTRACT FROM AUTHOR]

We studied demographic, metabolic, and clinical characteristics of patients with diabetes and autoimmune hepatitis (AIH) from the German/Austrian DPV registry. A total of 139 patients with diabetes and AIH were analyzed and compared to 437 728 patients with diabetes without AIH. The prevalence of AIH in patients with T1DM (44.8/100 000) seems higher than in the general population, the prevalence of AIH in patients with T2DM (23.6/100 000) does not seem to be increased. Patients with T2DM and AIH had a shorter duration of diabetes (p = 0.007) and a higher proportion of females (p < 0.001) compared to T2DM without AIH. Patients with diabetes (T1DM or T2DM) and AIH required higher insulin doses (p < 0.001 and p = 0.03, respectively) and showed increased liver enzymes (aspartate transaminase, alanine transaminase, gamma-glutamyltransferase) compared to diabetes patients without (all p < 0.001). We detected a lower percentage of patients treated with oral antidiabetic drugs (p = 0.01) and a higher percentage of patients treated by insulin in patients with T2DM and AIH (p < 0.001) compared to patients with T2DM alone. We observed a higher incidence of autoimmune thyroid disease (AIT) in patients with diabetes (T1DM or T2DM) and AIH (p < 0.001) compared to diabetes patients without AIH. AIH seems more frequent in patients with T1DM. Patients with diabetes and AIH require intensification of antidiabetic therapy and seem to have a higher prevalence of AIT. [ABSTRACT FROM AUTHOR]

The study aims for development of an efficient polymeric carrier for evaluating pharmaceutical potentialities in modulating the drug profile of quercetin (QUE) in anti-diabetic research. Alginate and succinyl chitosan are focused in this investigation for encapsulating quercetin into core-shell nanoparticles through ionic cross linking. The FT-IR, XRD, NMR, SEM, TEM, drug entrapment and loading efficiency are commenced to examine the efficacy of the prepared nanoparticles in successful quercetin delivery. Obtained results showed the minimum particle size of ∼91.58 nm and ∼95% quercetin encapsulation efficiently of the particles with significant pH sensitivity. Kinetics of drug release suggested self-sustained QUE release following the non-fickian trend. A pronounced hypoglycaemic effect and efficient maintenance of glucose homeostasis was evident in diabetic rat after peroral delivery of these quercetin nanoparticles in comparison to free oral quercetin. This suggests the fabrication of an efficient carrier of oral quercetin for diabetes treatment. [ABSTRACT FROM AUTHOR]

Background: Aim of this study was to compare cancer incidence in populations with and without diabetes by cancer site. Furthermore, we aimed at comparing excess risk of cancer according to diabetes type, diabetes duration and treatment, the latter as regards Type 2 diabetes.Methods: By use of the Reggio Emilia diabetes registry we classified the resident population aged 20-84 at December 31st 2009 into two groups: with and without diabetes. By linking with the cancer registry we calculated the 2010-2013 cancer incidence in both groups. The incidence rate ratios (IRR) by cancer site, type of diabetes, diabetes duration, and as concerns Type 2 diabetes, by treatment regimen were computed using Poisson regression model and non-diabetic group as reference.Results: The cohort included 383,799 subjects without diabetes and 23,358 with diabetes. During follow-up, we identified 1464 cancer cases in subjects with diabetes and 9858 in the remaining population. Overall cancer incidence was higher in subjects with diabetes than in those without diabetes (IRR = 1.22, 95%CI 1.15-1.29), with similar results focusing on subjects with at least 2-year diabetes duration. Cancer sites driving overall increased risk were liver, pancreas, Colon rectum, and bladder in both sexes, corpus uteri for females. There was also suggestion of an increased risk for kidney cancer in females and a decreased risk for prostate cancer. Excess risk was found in patients with Type 2 diabetes, more marked among insulin users, especially with combined therapy. We observed an increasing risk for diabetes duration up to 10 years from diagnosis (IRR = 1.44, 95%CI 1.29-1.61) and a subsequent decrease to moderate-higher risk (IRR = 1.15, 95%CI 1.04-1.30).Conclusions: Our study indicates that the strength of association depends on specific cancer site. Insulin, monotherapy or combined therapy, per se or as an indication of poor blood glucose control, in addition to diabetes duration, may play a role in the association of diabetes and cancer. [ABSTRACT FROM AUTHOR]

Sarcopenia is defined as an age-related loss of skeletal muscle mass and strength, and is a major cause of disability and mobility limitations. Recent studies have demonstrated that type 2 diabetes and insulin signaling deficiencies contribute to the progression of sarcopenia, suggesting that a sufficient supply of insulin to the skeletal muscles may be important for the maintenance of muscle function; however, little has been reported regarding whether insulin treatment can protect against sarcopenia. We conducted a retrospective observational study to examine the impact of insulin treatment on the muscle mass of patients with type 2 diabetes. A total of 312 patients (mean age: 64 ± 11 years; 40.8% female; 27.6% treated with insulin) were studied in this retrospective observational study. Skeletal muscle index (SMI) and grip strength (kg) were used to assess sarcopenia. The prevalence of sarcopenia was 18.0%. Insulin treatment was shown to be protective against the annual decline of SMI (standardized β 0.195; p = 0.025) even after adjusting for covariates, including age, gender, duration of diabetes, and body mass index. In a cohort matched by propensity scores, insulin treatment significantly increased the 1-year change in SMI (mean ± SE) compared with non-insulin-treated group (2.40 ± 0.98% vs. -0.43 ± 0.98%; p = 0.050). Our data suggest that insulin treatment could attenuate the progression of sarcopenia in patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients’ journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more effectively, if they and their family have money, useful social relations, and knowledge, together with the capacity to communicate with health staff. Patients coming from households with high socio-economic status (SES) are more likely to have all of these resources, while for patients with low or medium SES, lack of economic resources increases the importance of connections within the health system. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this paper is to propose a framework to detect adverse drug reactions (ADRs) using internet user search data, so that ADR events can be identified early. Empirical investigation of Avandia, a type II diabetes treatment, is conducted to illustrate how to implement the proposed framework. Design/methodology/approach: Typical ADR identification measures and time series processing techniques are used in the proposed framework. Google Trends Data are employed to represent user searches. The baseline model is a disproportionality analysis using official drug reaction reporting data from the US Food and Drug Administration's Adverse Event Reporting System. Findings: Results show that Google Trends series of Avandia side effects search reveal a significant early warning signal for the side effect emergence of Avandia. The proposed approach of using user search data to detect ADRs is proved to have a longer leading time than traditional drug reaction discovery methods. Three more drugs with known adverse reactions are investigated using the selected approach, and two are successfully identified. Research limitations/implications: Validation of Google Trends data's representativeness of user search is yet to be explored. In future research, user search in other search engines and in healthcare web forums can be incorporated to obtain a more comprehensive ADR early warning mechanism. Practical implications: Using internet data in drug safety management with a proper early warning mechanism may serve as an earlier signal than traditional drug adverse reaction. This has great potential in public health emergency management. Originality/value: The research work proposes a novel framework of using user search data in ADR identification. User search is a voluntary drug adverse reaction exploration behavior. Furthermore, user search data series are more concise and accurate than text mining in forums. The proposed methods as well as the empirical results will shed some light on incorporating user search data as a new source in pharmacovigilance. [ABSTRACT FROM AUTHOR]

Aims: Characterize adult patients with diabetes on intensive insulin therapy in terms of: (a) practices and perceived difficulties relative to carbohydrate counting (CC) and diabetes treatment, and (b) their perceptions and expectations relative to CC.Methods: Participants completed a 30-question web-based questionnaire.Results: Participants with type 1 diabetes (T1D) and using CC as part of their treatment plan (n=180) were included in this analysis. Participants were predominantly women (64%), aged 42±13years old and had diabetes for 22±13years. A large proportion of participants reported being confident in applying CC (78%) and considered precise CC as being important for glycemic control (91%), while only 17% reported finding CC difficult. Despite the low perceived difficulty associated with CC, many specific difficulties were encountered by patients such as the perception that glycemia fluctuates even with appropriate CC and that CC complicates the management of diabetes. A larger proportion of participants with a lower level of education (Conclusions: Although a majority of participant reported being confident in applying CC, many difficulties and constraints associated with CC have been identified. These results highlight that patients with a lower level of education and with a history or current depression could benefit from specific CC education strategies. Future studies should examine the efficacy of technology tools to facilitate CC. [ABSTRACT FROM AUTHOR]

We aimed to characterize the effect of insulin resistance and plasma glucose on all-cause and cardiovascular disease (CVD) death. A total of 462 individuals without diabetes in the original Da Qing Diabetes and IGT Study were enrolled in the present analysis, and further divided into G1 (low insulin low glucose), G2 (high insulin low glucose), G3 (low insulin high glucose) and G4 (high insulin high glucose) groups according to medians of glucose and insulin level at baseline. The all-cause and CVD death were assessed from 1986 to 2016. During the 30-year follow-up, compared with G1, G2, G3, and G4 groups were all at increased death risk after adjusting covariates. G2 and G3 were associated with similar risks in both all-cause (G2: HR 1.65, 95%CI 1.02–2.67; G3: HR 1.76, 95%CI 1.11–2.81) and CVD death (G2: HR 2.03, 95%CI 1.01–4.05; G3: HR 1.85, 95%CI 0.93–3.68). The highest risk was observed in G4 (all-cause death: HR 2.32, 95%CI 1.45–3.69; CVD death: HR 2.68, 95%CI 1.35–5.29). In this post-hoc study, participants with either high glucose or high insulin were related to increased risk of mortality, implying that strategies targeting eliminating both hyperglycemia and hyperinsulinemia may favor the long-term outcomes. [ABSTRACT FROM AUTHOR]

The different forms of diabetes mellitus differ in their pathogenesis but, ultimately, they are all characterized by progressive islet β-cell loss. Restoring the β-cell mass is therefore a major goal for future therapeutic approaches. The number of β-cells found at birth is determined by proliferation and differentiation of pancreatic progenitor cells, and it has been considered to remain mostly unchanged throughout adult life. Recent studies in mice have revealed an unexpected plasticity in islet endocrine cells in response to stress; under certain conditions, islet non-β-cells have the potential to reprogram into insulin producers, thus contributing to restore the β-cell mass. Here, we discuss the latest findings on pancreas and islet cell plasticity upon physiological, pathological and experimental conditions of stress. Understanding the mechanisms involved in cell reprogramming in these models will allow the development of new strategies for the treatment of diabetes, by exploiting the intrinsic regeneration capacity of the pancreas. [ABSTRACT FROM AUTHOR]

Aims: Several instruments evaluate patient-reported outcomes in diabetes mellitus (DM), but almost none are validated for use in Arabic language. The aim of this study is to test the psychometric properties and responsiveness of the Arabic version of the Diabetes Treatment Satisfaction Questionnaire (DTSQs) in Qatar.Methods: Ambulatory Arabic speaking DM patients were interviewed at two consecutive time points in Doha, Qatar. The 8-item DTSQs was administered in conjunction with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the World Health Organization Quality of Life Measure (WHOQOL-Bref) to assess convergent validity. Reliability was evaluated by internal consistency and item analysis. Construct validity was evaluated using "known groups" comparisons (including gender, insulin use, and HbA1c). Sensitivity of DTSQs scores to the subject's metabolic conditions was determined.Results: One hundred subjects (mean age 50.7) participated. Half (54%) were female. The majority (93%) had Type 2 DM, but 39 (42%) were using insulin. Results revealed satisfactory internal consistency. Metabolic measures (fasting blood glucose and AIC) had significant inverse correlations with DTSQs scores (interview 1, Pearson's r=-0.333 and r=-0.401, respectively, p<0.01). Scale criterion and construct validity were found to be satisfactory. Most sub-dimensions of the SF-36 and WHOQOL-Bref were correlated with the DTSQ, indicating a good concurrent validity. As in prior studies, women demonstrated poorer treatment satisfaction.Conclusions: The Qatar Arabic DTSQs version was found to be a reliable and valid instrument for the assessment of treatment satisfaction in Arabic diabetes mellitus patients in the country. [ABSTRACT FROM AUTHOR]

Background Diabetes mellitus is associated with an increased risk of fractures, which is not explained by bone mineral density. Other markers as bone turnover markers (BTMs) may be useful. Aim To assess the relationship between BTMs, diabetes, and fractures. Methods A systematic literature search was conducted in August 2014. The databases searched were Medline at Pubmed and Embase. Medline at Pubmed was searched by “Diabetes Mellitus” (MESH) and “bone turnover markers” and Embase was searched using the Emtree by “Diabetes Mellitus” and “bone turnover”, resulting in 611 studies. The eligibility criteria for the studies were to assess BTM in either type 1 diabetes (T1D) or type 2 diabetes (T2D) patients. Results Of the 611 eligible studies, removal of duplicates and screening by title and abstract lead to 114 potential studies for full-text review. All these studies were full-text screened for eligibility and 45 studies were included. Two additional studies were added from other sources. Among the 47 studies included there were 1 meta-analysis, 29 cross-sectional studies, 13 randomized controlled trials, and 4 longitudinal studies. Both T1D and T2D were studied. Most studies reported fasting BTM and excluded renal disease. Conclusion Markers of bone resorption and formation seem to be lower in diabetes patients. Bone specific alkaline phosphatase is normal or increased, which suggests that the matrix becomes hypermineralized in diabetes patients. The BTMs: C-terminal cross-link of collagen, insulin-like growth factor-1, and sclerostin may potentially predict fractures, but longitudinal trials are needed. This article is part of a Special Issue entitled Bone and diabetes. [ABSTRACT FROM AUTHOR]

Aims: Treatment strategies for obese patients with type 2 diabetes mellitus aim to increase physical activity, reduce body weight, and improve glucose control using weight-beneficial antidiabetic drugs. The objective of this study was to determine whether these strategies are implemented, and to identify factors predictive of glucose control and body weight management in a large, real-world patient population. Methods: The prospective DiaRegis cohort study included 3807 patients with type 2 diabetes in whom the treating physician decided to intensify and optimize treatment because of insufficient glucose control. Results: Antidiabetic treatment of overweight and obese patients was compared with that of normal-weight patients over a 2-years follow-up period, and multivariate analyses were performed to identify predictors of body weight loss. Among the 3807 participants, 92.5 % were overweight or obese. Normal-weight participants were more often treated with sulfonylureas or insulin, and overweight and obese patients with metformin or glucagon-like peptide (GLP)-1 analogues. Predictors of weight loss were body mass index (BMI) ≥30 kg/m and any reported physical activity. Conclusions: DiaRegis study shows that under real-world conditions, antidiabetic drug therapy is performed dependent on body weight. This strategy results in adequate glucose control and moderate weight reductions in overweight and obese patients. Weight loss is affected by treatment with weight-beneficial drugs, but also by any reported physical activity. However, only a small subgroup of patients perform physical activity. Initiation and maintenance of a physically active lifestyle remains a significant challenge for physicians, and patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background The goal of this research was to measure the age-sex standardized prevalence of pre-diabetes (pre- DM) and diabetes ( DM), and the effectiveness of diabetes management (using HbA1C as the indicator) in an urban area in Iran. Methods Using a randomized cluster household survey, we recruited 5900 individuals whose age ranged from 15 to 75 from Kerman for assessing coronary artery disease risk factors ( KERCADRS) including diabetes. In 2010 and 2011, all of the participants were interviewed by trained staff for medical history and physical activities, and were then examined for blood pressure and anthropometric measures. Venus blood sample was also collected for fasting plasma glucose and HbA1c. Results The age-sex standardized prevalence of pre-diabetes, diagnosed and undiagnosed was 18.7%, 6.3% and 2.7%, respectively. Diabetes increased by age (from 14.7% in the 15-24 years old group to 28.4% in the 65-75 years old group), particularly after 40 years. Occasional opium users had the highest prevalence of Pre- DM (34.6%). Seventy-nine percent of the depressed and 75.5% of the anxious participants with diagnosed- DM were identified as uncontrolled- DM. More than 60% of diagnosed diabetic cases had impaired HbA1c. Overweight and obesity (adjusted odds ratio ( AOR) 1.6) and low physical activity ( AOR 1.5) were the most preventable risk factors associated with diabetes. Conclusion Considerable prevalence of diabetes, susceptibility in progressing to diabetes and uncontrolled diabetes among individuals living in Kerman, suggested ineffective prevention and treatment of diabetes in urban areas in Iran. Successful experience regarding primary health-care in rural areas should be expanded to urban settings. [ABSTRACT FROM AUTHOR]

The prevalence of type 2 diabetes mellitus ( T2DM) among elderly people is increasing. Often associated with disabilities/comorbidities, T2DM lowers the chances of successful aging and is independently associated with frailty and an increased risk of hypoglycaemia, which can be further exacerbated by antihyperglycaemic treatment. From this perspective, the clinical management of T2DM in the elderly is challenging and requires individualization of optimum glycaemic targets depending on comorbidities, cognitive functioning and ability to recognize and self-manage the disease. The lack of solid evidence-based medicine supporting treatment guidelines for older people with diabetes further complicates the matter. Several classes of medicine for the treatment of T2DM are currently available and different drug combinations are often required to achieve individualized glycaemic goals. Many of these drugs, however, carry disadvantages such as the propensity to cause weight gain or hypoglycaemia. Dipeptidyl peptidase-4 ( DPP-4) inhibitors, a recent addition to the pharmacological armamentarium, have become widely accepted in clinical practice because of their efficacy, low risk of hypoglycaemia, neutral effect on body weight, and apparently greater safety in patients with kidney failure. Although more information is needed to reach definitive conclusions, growing evidence suggests that DPP-4 inhibitors may become a valuable component in the pharmacological management of elderly people with T2DM. The present review aims to delineate the potential advantages of this pharmacological approach in the treatment of elderly people with T2DM. [ABSTRACT FROM AUTHOR]

Background: Suboptimal blood glucose control among patients with type 2 diabetes continues to support the need for new pharmacologic approaches. Objective: The purpose of this commentary was to highlight newly available and soon-to-be available agents that are promising tools for targeting specific pathophysiologic pathways in the management of diabetes. Methods: Published evidence to support the application of novel incretin-based therapies, dipeptidyl peptidase (DPP)-4 inhibitors, sodium-glucose cotransporter (SGLT)-2 inhibitors, other oral agents and insulins for managing specific aspects of type 2 diabetes, as well as disadvantages associated with those novel medications, are discussed. Results: Several new glucagon-like peptide (GLP)-1 receptor agonists with different time frames of action, although each has unique advantages and disadvantages, have been through clinical trials. Examples of these are lixisenatide and albiglutide. Currently available DPP-4 inhibitor agents, important for inhibiting the breakdown of endogenous GLP-1, have not been associated with weight gain or hypoglycemia. SGLT-2 inhibitors, which do not depend on insulin secretion or insulin action, may be advantageous in that they appear to be broadly efficacious at all stages of diabetes. New insulin analogues, such as degludec and U-500, improve glycemic control without contributing to hypoglycemia. Conclusions: Advances in pharmacologic options offer the promise of improving glycemic control for longer periods, with limited glycemic fluctuations, hypoglycemia, and weight gain. However, the effectiveness of these agents ultimately depends on their availability to providers managing the health care of patients at high risk for poor diabetes outcomes and patients' use of them as directed. Long-term effectiveness and safety trials are ongoing. [ABSTRACT FROM AUTHOR]

Diabetes and cancer are both heterogeneous and multifactorial diseases with tremendous impact on health worldwide. Epidemiologic evidence suggests that certain malignancies may be associated with diabetes, as well as with diabetes risk factors and, perhaps, with certain diabetes treatments. Numerous biological mechanisms could account for these relationships. Insulin-like growth factor ( IGF)-1, IGF-2, IGF-1 receptors, insulin, and the insulin receptor play roles in the development and progression of cancers. Although evidence from randomized controlled trials does not support or refute associations of diabetes and its treatments with either increased or reduced risk of cancer incidence or prognosis, consideration of malignancy incidence rates and the magnitude of the trials that would be required to address these issues explains why such studies may not be readily undertaken. [ABSTRACT FROM AUTHOR]

Objective To compare the use of guideline-recommended prescription medications for diabetes among Medicare beneficiaries enrolled in stand-alone prescription drug plans ( PDPs) with Medicare Advantage prescription drug plans ( MAPDs) in the presence of potential selection bias. Data Sources/Study Setting Centers for Medicare and Medicaid Services' Chronic Condition Data Warehouse (2006, 2007). Study Design Retrospective cross-sectional comparison of drug use and proportion of days covered ( PDC) for oral-antidiabetics, ACE-inhibitors/ ARBs, and antihyperlipidemics among PDP and MAPD enrollees with diabetes. We estimated 'naïve' regression models assuming exogenous plan choice and two-stage residual inclusion (2 SRI) models to study endogeneity in choice of Part D plan type. Data Collection/Extraction Methods We identified 111,290 diabetics based on ICD-9 codes in Medicare claims from a random 5 percent sample of Medicare beneficiaries in 2005 excluding dual eligibles. Principal Findings The naïve regression models indicated lower probability of drug use for oral-antidiabetics (−4 percent; p < .001) and ACE-inhibitors/ ARBS (−2 percent; p = .004) among PDP enrollees, but their PDC was higher (3-5 percent) for all drug classes ( p < .001). 2 SRI models produced no significant differences in any-use equations, but significantly higher PDC values for PDP enrollees for oral-antidiabetics and ACE-inhibitors/ ARBs. Conclusions We found similar overall use of recommended drugs in diabetes treatment and no consistent evidence of favorable or adverse selection into PDPs and MAPDs. [ABSTRACT FROM AUTHOR]

Aims Inhibition of diacylglycerol acyltransferase 1 ( DGAT1), which catalyses the final step in triacylglycerol ( TAG) assembly, is suggested as a treatment for type 2 diabetes and obesity based on animal data indicating insulin sensitization and weight reduction. This first-time-in-human single ascending dose study explored the safety, tolerability, pharmacokinetics and pharmacodynamics of the selective DGAT1 inhibitor AZD7687. Methods Eighty healthy male subjects were enrolled. In each of 10 cohorts, six subjects received the same dose of AZD7687 orally (range across cohorts 1-60 mg) and two placebo. Plasma AZD7687 exposure was measured repeatedly. Postprandial serum TAG excursion was measured during 8 h after a standardized mixed meal with fat energy content of 60% ( SMM 60%; five cohorts, 1-20 mg), before (baseline) and after dosing, to assess effects on gut DGAT1 activity. Results AZD7687 markedly reduced postprandial TAG excursion with a steep concentration-effect relationship. Incremental TAG AUC (area under the serum concentration vs. time curve) following SMM 60% was decreased >75% from baseline at doses ≥5 mg (p < 0.0001 vs. placebo). Serum levels of diacylglycerol, specifically measured with mass spectrometry, did not increase after AZD7687 administration. Nausea, vomiting and diarrhoea were reported with increasing doses and they limited dose escalation. Lowering of SMM fat content to 45 or 30% in five cohorts gradually reduced the frequency of gastrointestinal symptoms at a given dose of AZD7687. Conclusions The attenuating effect of AZD7687 on postprandial TAG excursion provides proof of mechanism with respect to gut DGAT1 inhibition. However, dose and diet-related gastrointestinal side effects may impact further development of DGAT1 inhibitors. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Prescription rates for diabetic drugs vary considerably across the United States for Medicare beneficiaries. The goal of this study was to determine if non-clinical factors (patient race, ethnicity, gender, income) are associated with regional variation in pharmacotherapy decisions for diabetic patients enrolled in Medicare. Methods: We performed a spatially-weighted, linear regression analysis of the entire diabetic population enrolled in Medicare Parts A, B, and D for the years 2006 through 2009. Our outcomes of interest were the percentage of diabetic patients being treated with metformin, a sulfonylurea, a thiazolidinedione, or insulin within a hospital referral region (HRR). Results: Prescription rates for metformin, sulfonylureas, thiazolidinediones, and insulin varied more than two-fold between hospital referral region. Metformin prescription rates were increased in western states while prescription rates for sulfonylureas and insulins were highest in the South and Midwest. In contrast with these other diabetic drug classes, members of the thiazolidinedione drug class were prescribed more frequently in the Central United States (Great Plains, Colorado Rockies, Northern Texas, Oklahoma). Prescription rates for each drug class were increased in hospital referral regions with a lower household income. Referral regions with larger African American populations were associated with higher prescription rates for insulin (p<0.001) and lower prescription rates for metformin (p<0.001). Gender and Hispanic ethnicity were not associated with regional variation in prescription rates for the four major diabetic drug classes. Conclusions: Geographic differences exist in the management of type 2 diabetes for Medicare enrollees. Prescription patterns were associated with household income and African American race. Further studies are necessary to identify local, unidentified factors that might be influencing provider management styles. [Copyright &y& Elsevier]

Large clinical trials have shown that improving glycaemic control significantly reduces the risk of long-term microvascular complications in type 1 (T1DM) and type 2 (T2DM) diabetes. Achieving optimal glycaemic control often requires the use of multiple daily insulin injections. Current approaches to insulin administration are less than optimal; many T2DM patients view insulin therapy as inconvenient and uncomfortable and may delay starting insulin therapy because of this. A new oral insulin spray formulation and delivery system provides an alternative to injectable and inhaled insulin. The system allows a liquid oral spray insulin formulation to be delivered into the mouth via an aerosolized spray. The oral insulin spray is a tasteless liquid aerosol mist formulation that is administered to the buccal mucosa using a proprietary delivery system. The active pharmaceutical ingredient is recombinant human insulin; however, the formulation behaves in a fashion more similar to the synthetic fast-acting insulin analogues. In clinical studies of healthy subjects and subjects with T1DM and T2DM, investigators have shown that the oral insulin spray was absorbed in direct relation to the amount given and had a faster onset and a shorter duration of action when compared with regular insulin given subcutaneously. In all of the studies conducted, the oral insulin spray was generally well tolerated. Some healthy individuals and subjects with T1DM experienced transient (1–2 min) mild dizziness during dosing; these symptoms were mild and self-limited. No changes in vital signs, laboratory values or physical examination results were noted. The ease of use of the insulin spray formulation may increase patient acceptance and treatment compliance, thereby potentially reducing complications and improving quality of life for patients with insulin-dependent diabetes. This article provides an overview of the safety profile and proposed mechanism of action of this insulin formulation and presents findings from trials which studied its effects in subjects with T1DM and T2DM. [ABSTRACT FROM AUTHOR]

Aim: Continuous intraperitoneal insulin infusion (CIPII) with the DiaPort system using regular insulin was compared to continuous subcutaneous insulin infusion (CSII) using insulin Lispro, to investigate the frequency of hypoglycemia, blood glucose control, quality of life, and safety. Methods: In this open, randomized, controlled, cross-over, multinational, 12-month study, 60 type 1 diabetic patients with frequent hypoglycemia and/or HbA1c > 7.0% with CSII were randomized to CIPII or CSII. The aim was to obtain the best possible blood glucose while avoiding hypoglycemia. Results: The frequency of any hypoglycemia was similar (CIPII 118.2 (SD 82.6) events / patient year, CSII 115.8 (SD 75.7) p = 0.910). The incidence of severe hypoglycemia with CSII was more than twice the one with CIPII (CIPII 34.8 events / 100 patient years, CSII 86.1, p = 0.013). HbA1c, mean blood glucose, and glucose fluctuations were not statistically different. Treatment-related severe complications occurred mainly during CIPII: port infections (0.47 events / patient year), abdominal pain (0.21 events / patient year), insulin underdelivery (0.14 events / patient year). Weight gain was greater with CSII (+ 1.5 kg vs. − 0.1 kg, p = 0.013), quality of life better with CIPII. Conclusions: In type 1 diabetes CIPII with DiaPort reduces the number of severe episodes of hypoglycemia and improves quality of life with no weight gain. Because of complications, indications for CIPII must be strictly controlled. CIPII with DiaPort is an alternative therapy when CSII is not fully successful and provides an easy method of intraperitoneal therapy. [ABSTRACT FROM AUTHOR]