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Patients with type 2 diabetes mellitus (T2DM) are susceptible to mental health issues, impacting medication adherence and diabetes control. This study aimed to evaluate factors associated with depression and anxiety among T2DM patients in Indonesia and Malaysia. A cross-sectional study was conducted in Indonesia and Malaysia from October 2022 to April 2023 among T2DM patients. The study utilised an instrument with patient and disease data and three validated tools to assess depression, anxiety, and medication adherence. Statistical analysis, including binary logistic regression, was performed using SPSS® version 28 software. A study of 606 T2DM patients revealed that 56.5% were at risk of depression, while 41.6% were at risk of anxiety. Older patients with T2DM had lower rates of depression (AOR = 0.41, 0.25–0.68) and anxiety than younger patients. Normal-weight patients were less likely to experience depression and anxiety (AOR = 0.44, 0.27–0.72) than overweight patients. Patients without diabetic foot ulcers had a lower risk of depression (AOR = 0.34, 0.21–0.55) and anxiety than those with foot ulcers. Patients with a shorter duration of diabetes had a higher risk of depression (AOR = 3.27, 1.70–6.30) and anxiety than those with a longer duration. Patients on insulin-based regimens had higher rates of depression and anxiety (AOR = 2.28, 1.20–4.30) than those on metformin-based regimens. Nonadherent patients were more likely to experience depression and anxiety (AOR = 4.30, 2.22–8.32) than patients who adhered to their medication. The prevalence of depression and anxiety is concerning and influenced by factors such as age, diabetes duration, the presence of diabetic foot ulcers, and the prescribed medication regimen. Further efforts are necessary to enhance the mental health of T2DM patients and improve management outcomes. [ABSTRACT FROM AUTHOR]

Background: Diabetes is becoming a worldwide concern. Optimal diabetes control reduces diabetes complications. Objectives: We aimed to measure the principal diabetes care parameters to recognize the main deficits in care for patients with diabetes in the region. Methods: This cross-sectional study is based on the Khuzestan Comprehensive Health Study (KCHS) data. Of all participants, 4673 (15.3%) were identified to have diabetes. We invited the known cases of diabetes to complete a checklist about their diabetes through face-to-face interviews, and we obtained a blood sample to measure their HbA1c. Results: Of all participants of the KCHS study, 312 patients with diabetes who met the inclusion criteria were identified. Mean (± SD) HbA1c was 8.5% (± 1.8), and 225 (72.1%) of the participants had poor glycemic control. About 45.2% had blood pressure less than 130/80 mmHg, and 24% had FBS lower than 130 mg/dl. Nearly 37.8% of the participants had LDL < 100 mg/dl and 40% TG < 150 mg/dl. Of all participants, 38.5% had undergone retinal examination, 13.8% had their foot examined, and 39.4% had done urine micro-albumin /Cr test. HbA1c level had a statistically significant relationship with gender (P = 0.012), occupation (P = 0.007), nephropathy (P = 0.004) and retinopathy (P < 0.001). Conclusions: This study showed that less than half of the participants achieved the optimal ADA goals for diabetes care, therefore it is necessary to revise the basic protocols of diabetes care in the region to improve diabetes management. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus(T2DM) is associated with coagulation abnormalities and a higher risk for blood clots due to changes in the clotting factors and platelet function. This study aimed to assess blood clotting parameters in T2DM patients within a single research center in the UAE. Methods and Results: This retrospective, cross-sectional study was conducted on 158 patients (112 men and 46 women) diagnosed with T2DM in Thumbay Hospital, Ajman, UAE. Blood samples were properly labeled and used for screening tests. The HbA1c and platelet tests were performed using the Beckman Coulter DxC 700 and DxH 900 analyzers. Coagulation profile tests, including D-dimer, activated partial thromboplastin time (APTT), and prothrombin time (PT), were performed using an ACL TOP 300 CTS analyzer. All patients were divided into two groups. Group 1 included 68 patients with controlled diabetes (cT2DM), and Group 2 included 90 patients with uncontrolled diabetes (uT2DM). The assessment of the blood clotting parameters showed a lower level of INR in the uT2DM group than in the cT2DM group (1.06±0.10 and 1.53±1.13, respectively, P=0.0001). Platelet count, PT, APTT, and D-dimer levels did not differ significantly between the two groups. Men had a higher HbA1c than women (7.30±2.07% and 6.52±2.02%, respectively, P=0.0318), indicating poor diabetes control. Higher HbA1c in men was accompanied with a higher D-dimer level (409.1±44.4 ng/mL for men and 388.7±42.1 ng/mL for women, P=0.0086) and a lower level of INR (1.09±0.10 and 1.73±1.13, respectively, P=0.0001). Platelet count, PT and APTT levels did not differ significantly between male and female patients. Evaluation of the studied parameters, considering age groups, showed increased HbA1c with age (P=0.0018), indicating an increase in poor diabetes control. This was accompanied by a significant increase in the D-dimer levels in the age group above 45 (P=0.0000).The levels of other indicators did not differ significantly depending on the age group. Conclusion: Patients with T2DM have a cumulative thrombotic risk. The prothrombotic state in T2DM is primarily mediated by hyperglycemia and insulin resistance. Good glycemic control (HbA1c

ABSTRACT Aims Diabetes mellitus is the most common endocrine disease in childhood which significantly impacts quality of life, morbidity and mortality. This study aimed to investigate the socioeconomic background of children with diabetes and their families and to assess its association with diabetes control. Methods This cross‐sectional study was conducted in Khartoum State, Sudan, in 2018, at three outpatient diabetes clinics, using standardised questionnaires. We included 138 diabetic children (T1D and T2D) aged 2–18 years using systematic random sampling. Descriptive statistics, economic indicator and inferential statistics were applied using SPSS version 20. An HbA1C level of > 7.0% was set as the cut‐point for uncontrolled diabetes. A p‐value of 0.05). Conclusion Neither children' nor parents' characteristics influenced HbA1C level. The high rate of uncontrolled diabetes (78.0%), and other countries showing better profiles of control, suggests the need for exploring other contributing factors. Insulin availability and lack of home glucose monitoring need to be considered. We recommend future prospective studies to consider these factors and use multiple HbA1C measures' average as a better indicator of diabetic control.

Background: Self-efficacy is a popular psychological concept that refers to an individual's perception or belief in his ability to perform specific actions. This study aimed to assess the predictive value of self-efficacy, measured using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEM6S) questionnaire, for diabetes management and overall well-being in patients with diabetes. Subject and methods: An anonymous online cross-sectional study was conducted to evaluate the self-efficacy of diabetic patients in the Asser region of Saudi Arabia. The participants were requested to upload their most recent glycated hemoglobin A1C (HbA1C) measurements taken in the last three months, which helped in the accurate categorization of their diabetes as either controlled or uncontrolled. We used the valid Arabic version of the SEM6S and WHO-5 wellbeing questionnaires to assess patient self-efficacy and well-being. Results: A cohort of 342 patients was enrolled in the study, 67.25% were married, their mean age was 43.17 ± 17.61 years, and 52.69% had university-level or higher education. Among the participants, 46.0% exhibited well-being, while 24.9% reported poor well-being, including 9.4% who were identified as experiencing depression. The mean scores of self-efficacy and well-being were significantly higher among those with controlled diabetes versus uncontrolled diabetes (40.86 ± 13.26 vs. 36.48 ± 13.26) and (67.35 ± 21.22 vs. 60.93 ± 25.05), respectively. The predictors of glycemic control were self-efficacy [Odds ratio (OR)=1.03 (95%CI, 1.01-1.06, P=0.002], having other chronic diseases [OR=3.25 (95%CI), P<0.001], having type 1 diabetes [OR=7.16, 95%CI, P=0.005], being Saudi [OR=7.67, (95%CI, P=0.027], working in a public sector [OR=0.15, (95%CI, 0.05-0.44), P=0.005], being unemployed [OR=0.19, (95%CI, 0.06-0.59), P=0.005], being a smoker [OR=0.44, 95%CI, 0.19-0.98, P=0.048], and duration of diabetes between 6-10 years [OR= 0.33, 95%CI, 0.11-0.95), P=0.043] or more than 10 years OR=0.32, 95%CI, 0.12-0.86), P=0.026]. The main determinants of well-being were having self-efficacy [OR=1.07 (95%CI, 1.04-1.09), P = 0.0001], having public health insurance [OR=4.36 (95%CI, P=0.015], and education level (read and write) [OR=0.13 (95%CI,.02-.70), P=0.021]. Conclusions: The study reveals that non-modifiable and modifiable factors, including self-efficacy, play a crucial role in diabetes control. The study recommends providing targeted educational interventions, using different social media platforms, psychosocial support programs, and inclusive healthcare policies to improve diabetes control and mental well-being among diabetic patients. [ABSTRACT FROM AUTHOR]

BackgroundSelf-efficacy is a popular psychological concept that refers to an individual’s perception or belief in his ability to perform specific actions. This study aimed to assess the predictive value of self-efficacy, measured using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEM6S) questionnaire, for diabetes management and overall well-being in patients with diabetes.Subject and methodsAn anonymous online cross-sectional study was conducted to evaluate the self-efficacy of diabetic patients in the Asser region of Saudi Arabia. The participants were requested to upload their most recent glycated hemoglobin A1C (HbA1C) measurements taken in the last three months, which helped in the accurate categorization of their diabetes as either controlled or uncontrolled. We used the valid Arabic version of the SEM6S and WHO-5 well-being questionnaires to assess patient self-efficacy and well-being.ResultsA cohort of 342 patients was enrolled in the study, 67.25% were married, their mean age was 43.17 ± 17.61 years, and 52.69% had university-level or higher education. Among the participants, 46.0% exhibited well-being, while 24.9% reported poor well-being, including 9.4% who were identified as experiencing depression. The mean scores of self-efficacy and well-being were significantly higher among those with controlled diabetes versus uncontrolled diabetes (40.86 ± 13.26 vs. 36.48 ± 13.26) and (67.35 ± 21.22 vs. 60.93 ± 25.05), respectively. The predictors of glycemic control were self-efficacy [Odds ratio (OR)=1.03 (95%CI, 1.01-1.06, P=0.002], having other chronic diseases [OR=3.25 (95%CI), P

Objective: The purpose of this study was to investigate the effectiveness of acceptance and commitment based group therapy (ACT) with the Islamic approach to diabetes control, increasing self-care behaviors in patients with type II diabetes mellitus (T2DM) referent to the Yazd Diabetes Research Center. Materials and Methods: The study method was semi experimental with control group. For this purpose, 40 diabetic patients were randomly divided into two experimental and control groups. The study was in Yazd diabetes research center. The purposeful sampling method was done. So, all of the patients did the A1C hemoglobin test, and completed the self-care questionnaire for diabetic patients (SDSCA). Then, the experimental group received ACT with an Islamic approach during 16 weeks. The population of both groups performed the A1C Hemoglobin test and completed the self-care questionnaire again after performing the instructional plan. In this research, the covariance analysis test was done to analyze the results. Results: The findings of the research showed that ACT group therapy with an Islamic approach effects on HbA1c decreasing (P: 0.001) and self-care behaviors improvement (P: 0.001) in T2DM patients. Conclusion: This study showed that the treatment group based on commitment resulted in a significant reduction of HbA1 and a significant increase in self-care activities in patients with T2DM.

Abstract Background Our aim was to determine whether child attachment to parents, parent attachment style, and morning cortisol levels were related to diabetes outcomes measured by average glycated hemoglobin (HbA1c), HbA1c variability over 4 years and time in range (TIR) in children with type 1 diabetes (T1D). Research design and methods 101 children with T1D and one of their parents were assessed at baseline for child attachment (Child Attachment Interview; CAI) and parent attachment (Relationship Structures Questionnaire; ECR-RS). Serum samples were collected for cortisol measurements before the interviews. HbA1c levels were measured during a 4-year follow-up period at regular 3-monthly visits, and data for TIR were exported from blood glucose measuring devices. Multivariate linear regression models were constructed to identify independent predictors of glycemic outcomes. Results More girls than boys exhibited secure attachment to their mothers. The results of the regression models showed that securely attached girls (CAI) had higher average HbA1c than did insecurely attached girls (B = −0.64, p = 0.03). In boys, the more insecure the parent's attachment style, the worse the child's glycemic outcome: the higher the average Hb1Ac (B = 0.51, p = 0.005), the higher the HbA1c variability (B = 0.017, p = 0.011), and the lower the TIR (B = −8.543, p = 0.002). Conclusions Attachment in close relationships is associated with glycemic outcomes in children with T1D, and we observed significant differences between sexes. A sex- and attachment-specific approach is recommended when treating children with less favorable glycemic outcomes. Special attention and tailored support should be offered to securely attached girls in transferring responsibility for diabetes care and at least to male children of insecurely attached parents to prevent suboptimal glycemic control. Further studies in larger samples and more daily cortisol measurements may help us better understand the links between stress response, attachment and T1D.

Objectives: A self-care approach is very important in diabetes management. In this study, it was aimed to make the Turkish validity and reliability of the Comprehensive Diabetes Self-Management Scale (CDSMS), which examines the behaviors of diabetes patients. Methods: The study is of methodological type. CDSMS, which was translated into Turkish from its original version and tested for language validity, was first included in the pilot application and then in the main study. The validity of the scale was evaluated by the Cronbach's alpha coefficient. Then, a Receiver Operating Characteristic (ROC) analysis was performed to determine the cut off score. Results: The mean age of the study participants was 57.10 ± 11.20 years and the mean disease duration was 9.96 ± 7.79 years. The internal consistency of CDSMS was 0.73, which was measured using Cronbach's alpha. After the ROC analysis, the optimal cut-point score of CDSMS to predict good glycemic control was determined as 21.17 points. Conclusion: With this study, it was found that the Turkish version of CDSMS is valid and reliable for use in the Turkish population. It is thought that CDSMS will be beneficial to physicians working in the clinic in terms of showing the disease management skills of diabetic patients. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this study were to investigate associations between micronutrient levels and diabetes and to explore the association in individuals with controlled and uncontrolled diabetes. Methods: A case–control study, matched on age and gender, was performed on participants with (cases) and without diabetes (controls), who were Qatari or long-term residents (≥15 years of residence). Participants with diabetes were divided into those with controlled and uncontrolled diabetes using an HbA1c cutoff of 7%. Levels of micronutrients were measured from serum and categorized into normal and abnormal levels. Results: A total of 1118 participants (374 cases and 744 controls) were included with a mean age of 41.7 years (SD 9.9), of whom 53.9% were female. Of those with diabetes, 229 had controlled diabetes and 145 had uncontrolled diabetes. Compared to those without diabetes, participants with diabetes had significantly lower mean magnesium (0.80 mmol/L (SD 0.07) vs. 0.84 mmol/L (SD 0.06), respectively, p < 0.001). Lower magnesium and iron were observed in participants with uncontrolled compared to participants with controlled diabetes. After multivariable logistic regression, diabetes was associated with hypomagnesemia (OR 3.2, 95% CI 3.4–213.9) and low iron (OR 1.49, 95% CI 1.03–2.15). Uncontrolled diabetes showed stronger odds of association with hypomagnesemia (OR 5.57, 95% CI 3.65–8.52). Conclusion: In an affluent setting in the MENA region, diabetes was associated with low magnesium and low iron, and this association was stronger in individuals with uncontrolled diabetes. [ABSTRACT FROM AUTHOR]

Background: Our aim was to determine whether child attachment to parents, parent attachment style, and morning cortisol levels were related to diabetes outcomes measured by average glycated hemoglobin (HbA1c), HbA1c variability over 4 years and time in range (TIR) in children with type 1 diabetes (T1D). Research design and methods: 101 children with T1D and one of their parents were assessed at baseline for child attachment (Child Attachment Interview; CAI) and parent attachment (Relationship Structures Questionnaire; ECR-RS). Serum samples were collected for cortisol measurements before the interviews. HbA1c levels were measured during a 4-year follow-up period at regular 3-monthly visits, and data for TIR were exported from blood glucose measuring devices. Multivariate linear regression models were constructed to identify independent predictors of glycemic outcomes. Results: More girls than boys exhibited secure attachment to their mothers. The results of the regression models showed that securely attached girls (CAI) had higher average HbA1c than did insecurely attached girls (B = −0.64, p = 0.03). In boys, the more insecure the parent's attachment style, the worse the child's glycemic outcome: the higher the average Hb1Ac (B = 0.51, p = 0.005), the higher the HbA1c variability (B = 0.017, p = 0.011), and the lower the TIR (B = −8.543, p = 0.002). Conclusions: Attachment in close relationships is associated with glycemic outcomes in children with T1D, and we observed significant differences between sexes. A sex- and attachment-specific approach is recommended when treating children with less favorable glycemic outcomes. Special attention and tailored support should be offered to securely attached girls in transferring responsibility for diabetes care and at least to male children of insecurely attached parents to prevent suboptimal glycemic control. Further studies in larger samples and more daily cortisol measurements may help us better understand the links between stress response, attachment and T1D. [ABSTRACT FROM AUTHOR]

OBJECTIVE To examine the association between dietary behavior, social engagement and participation, and diabetes control among Cypriot adults with diabetes mellitus (DM). METHOD Adults aged between 18 and 75 years, diagnosed with DM, type 1 or type 2, were eligible for inclusion in the study. A questionnaire on general sociodemographic data, and health, nutritional and social factors was administered. The primary outcome was diabetes control as assessed by the mean fasting glucose (FG) levels of the last 3 months. RESULTS The sample consisted of 297 adults (59% men and 41% women), with an average age of 60.9 years (range 19-73 years), most of whom were married with children. More than half of the participants (61.6%) had mean FG levels above the normal levels (i.e. >126 mg/dL). Increased age was associated with a 0.8% lower risk of uncontrolled DM (p<0.05). Higher income was associated with a 3.8% lower risk (p<0.05), and increased exercise with a 3% lower risk (p<0.05) of uncontrolled DM. Higher frequency of going out for food was associated with a 5.5% higher risk of uncontrolled DM (p<0.05). With regard to personal beliefs, believing that DM affects social participation was associated with a 5.8% higher risk (p<0.05) of uncontrolled DM. CONCLUSIONS Going out for food and personal social perceptions that DM affects social participation are associated with poor control of DM in Cypriot adults. [ABSTRACT FROM AUTHOR]

Abelmoschus esculentus (L.) Moench, commonly known as okra, is one of the most widely used vegetable crops currently used for diabetes treatment as well. It is thought that the large amount of soluble dietary fibers present in okra is responsible for the slowing of the absorption of glucose from the gut. However, its role in concomitant administration with commonly prescribed medications, including metformin (MET) and acarbose (ACR) for diabetes, is unclear. Therefore, this study assessed the effect of A. esculentus pod extract (AEE) administered concomitantly with MET and ACR in the glucose-induced hyperglycemic mice model. The AEE was prepared using green okra pods. In this experiment, each male Swiss Webster mouse was administered a 2.5 gm/kg/BW dose of glucose via gastric lavage to induce hyperglycemia. The experimental animals were divided into five groups: (i) negative control, (ii) positive control, (iii) MET only, (iv) MET and ACR, and (v) MET, ACR, and AEE. The orally administered doses of the MET, ACR, and the extract were 150 mg/kg/BW, 15 mg/kg/BW, and 0.2 mL/kg/BW, respectively. We found that MET only and a combination of MET and ACR reduced glucose levels significantly (p < 0.01) compared to the positive control. On the other hand, when MET, ACR, and AEE were administered simultaneously, the synergistic antihyperglycemic action of the MET and ACR was diminished. After 150 min, the blood glucose level was 4.50 ± 0.189 mmol/L (iv) and 6.58 ± 0.172 mmol/L (v). This study suggests that taking AEE concurrently with MET and ACR would reduce the effectiveness of antidiabetic drugs; thereby, concomitant administration of these antidiabetic agents is not recommended. This study provides an essential basis for decision-making about the consumption of AEE with conventional medicine. Further study is required to find the molecular insight of drug interactions in combination therapy of medicinal plants for diabetes.

Objective: The objectives of this study were to investigate associations between micronutrient levels and diabetes and to explore the association in individuals with controlled and uncontrolled diabetes. Methods: A case–control study, matched on age and gender, was performed on participants with (cases) and without diabetes (controls), who were Qatari or long-term residents (≥15 years of residence). Participants with diabetes were divided into those with controlled and uncontrolled diabetes using an HbA1c cutoff of 7%. Levels of micronutrients were measured from serum and categorized into normal and abnormal levels. Results: A total of 1118 participants (374 cases and 744 controls) were included with a mean age of 41.7 years (SD 9.9), of whom 53.9% were female. Of those with diabetes, 229 had controlled diabetes and 145 had uncontrolled diabetes. Compared to those without diabetes, participants with diabetes had significantly lower mean magnesium (0.80 mmol/L (SD 0.07) vs. 0.84 mmol/L (SD 0.06), respectively, p < 0.001). Lower magnesium and iron were observed in participants with uncontrolled compared to participants with controlled diabetes. After multivariable logistic regression, diabetes was associated with hypomagnesemia (OR 3.2, 95% CI 3.4–213.9) and low iron (OR 1.49, 95% CI 1.03–2.15). Uncontrolled diabetes showed stronger odds of association with hypomagnesemia (OR 5.57, 95% CI 3.65–8.52). Conclusion: In an affluent setting in the MENA region, diabetes was associated with low magnesium and low iron, and this association was stronger in individuals with uncontrolled diabetes.

Purpose: To examine the effectiveness of a culturally and linguistically appropriate, patient-centered, target-driven lifestyle intervention with video education training in improving clinical outcomes, health literacy, and diabetic self-care practices in newly diagnosed patients in Nepal. Methods: A total of 110 participants with newly and consequently diagnosed Type 2 were randomly allocated into intervention (mean age = 45 ± 9.7 years) and control (mean age = 47 ± 12.5 years) groups. Intervention group participants were trained on a culturally and linguistically appropriate diabetic video education program and were given a customized dietary and physical activity plan with specific targets to practice at home. Participants' compliance was monitored weekly via telephone calls. Both groups received the usual treatment from their doctor and were followed up after three months. Outcome measures included changes in: i. diabetic health literacy, diet, and physical activity measured using self-reported questionnaires; and ii. blood glucose (glycated hemoglobin, HbA1c), cholesterol, blood pressure, body mass index, and visual acuity. Clinical outcome measures were blinded from randomization and intervention allocation. Results: After three months, HbA1c decreased to 6.1% from the baseline value of 7.2% in the intervention group compared to 6.6% in the control group from the baseline value of 7.1% (p <0.05). The intervention group had mean total cholesterol and low-density lipoprotein of 174 and 95.5 mg/dL, which were significantly lower than 186 and 107.5 mg/dL in the control group. Daily white rice consumption decreased by 36.5% in the intervention vs. 4% in the control group (p <0.05). After three months, the intervention group participants exercised more than the control group (p <0.05). All intervention group participants self-initiated retinal screening checks since the baseline visit among which 13% showed early diabetic retinopathy signs compared to 0% in the control group. Health literacy improvement in the intervention group was found to be sustained after three months too. Conclusions: A culturally appropriate, target-driven lifestyle intervention with video education training is effective in improving clinical outcomes, health literacy, and self-care practice in newly diagnosed diabetic patients in Nepal, i.e., at a time period when effective diabetes control is vital to prevent further complications. The training intervention could be rolled out nationwide in order to reduce the risk of diabetic-related complications and improve people's quality of life and productivity. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the prevalence and impact of various predictive factors including diabetes control in malignant external otitis (MEO) treatment response. Methods: In a cross-sectional study on MEO patients, we defined treatment response with three indices; ESR level decrease, hospitalization period, and systemic antifungal drug usage. The impact of diabetes control and other predictive factors on these indices have been evaluated. Results: Overall, 164 patients with a mean age of 67.8 ± 9.7 years were included. Cranial nerve involvement was present in 56 patients. Nine patients had immunodeficiency. 19.5% of cases had leukocytosis. Diabetes mellitus was present in 156 patients, suffering for an average of 13.9 ± 8.6 years. The overall mean hemoglobin A1C (HbA1c) level was 8.3% (4.4–12.8%), and the mean fasting blood sugar was 146.4 mg/dl (63–292 mg/dl). 29.3% of patients had good diabetes control before admission (HbA1c < 7%), 54.9% had poor control (7% < HbA1c < 10%) and 15.9% had very poor glycemic control (HbA1c > 10%). The predictive role for the following factors were not statistically significant: age, gender, comorbidities, diabetes, diabetes management method used before and during hospitalization, diabetes duration, leukocytosis, immunodeficiency, fasting blood sugar level, HbA1c level, glycemic control index, and insulin amount. However, CRP level with a mean value of 34.3 mg/L showed a significant correlation with ESR decrease, hospitalization period, and antifungal drug usage. Conclusion: CRP level could be used as a predictor for the hospitalization period, the need for systemic antifungal and ESR level decrease. It would be helpful to check the CRP level at the time of diagnosis to predict the hospitalization period and the necessity of systemic antifungal management to adjust the treatment strategy. [ABSTRACT FROM AUTHOR]

Over half of patients with type 2 diabetes (T2D) are unable to achieve blood glucose targets despite therapeutic compliance, significantly increasing their risk of long-term complications. Discovering ways to identify and properly treat these individuals is a critical problem in the field. The arachidonic acid metabolite, prostaglandin E2 (PGE2), has shown great promise as a biomarker of β-cell dysfunction in T2D. PGE2 synthesis, secretion, and downstream signaling are all upregulated in pancreatic islets isolated from T2D mice and human organ donors. In these islets, preventing β-cell PGE2 signaling via a prostaglandin EP3 receptor antagonist significantly improves their glucose-stimulated and hormone-potentiated insulin secretion response. In this clinical cohort study, 167 participants, 35 non-diabetic, and 132 with T2D, were recruited from the University of Wisconsin Hospital and Clinics. At enrollment, a standard set of demographic, biometric, and clinical measurements were performed to quantify obesity status and glucose control. C reactive protein was measured to exclude acute inflammation/illness, and white cell count (WBC), erythrocyte sedimentation rate (ESR), and fasting triglycerides were used as markers of systemic inflammation. Finally, a plasma sample for research was used to determine circulating PGE2 metabolite (PGEM) levels. At baseline, PGEM levels were not correlated with WBC and triglycerides, only weakly correlated with ESR, and were the strongest predictor of T2D disease status. One year after enrollment, blood glucose management was assessed by chart review, with a clinically-relevant change in hemoglobin A1c (HbA1c) defined as ≥0.5%. PGEM levels were strongly predictive of therapeutic response, independent of age, obesity, glucose control, and systemic inflammation at enrollment. Our results provide strong support for future research in this area. [ABSTRACT FROM AUTHOR]

Background: It has been hypothesized that insulin resistance is pivotal in mediating amyloid and tau dysregulations in Alzheimer's disease (AD)., Objective: To investigate the impact of different antidiabetic agents, their daily dosage intake, and treatment duration on cerebrospinal fluid (CSF) AD biomarkers among patients with type 2 diabetes., Methods: This cross-sectional study selected patients between 50 and 80 years with diabetes and CSF AD biomarkers screened between 2017 and 2023 in the VALCODIS Cohort. CSF biomarkers were total tau (t-tau), phosphorylated tau 181 (p-tau), and amyloid-β 42 (Aβ 42 ). Analytical variables were obtained. Antidiabetic prescriptions were recorded in defined daily doses (DDD), according to the ATC/DDD 2021 system, and years of drug exposure duration before lumbar puncture. Logistic regressions were performed to establish the correlations between drug usage and AD biomarker alteration., Results: Among patients with diabetes, Insulin consumption was associated with lower odds of abnormal Aβ 42 levels (OR 0.36 [95% CI 0.15, 0.76]) and tau pathology (OR 0.49 [95% CI 0.24-0.98]). Metformin was related to lower odds of pathological p-tau when diabetes was uncontrolled, acting on t-tau and t-tau/Aβ 42 ratio when it was concomitant with insulin, and patients had controlled diabetes. Lower odds of pathological levels of tau were observed when additional oral antidiabetic drugs were added among metformin users. iSGLT2 was associated with tau pathology., Conclusions: The impact of antidiabetics on AD-related pathological biomarkers may depend on diabetes management., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

PurposeTo examine the effectiveness of a culturally and linguistically appropriate, patient-centered, target-driven lifestyle intervention with video education training in improving clinical outcomes, health literacy, and diabetic self-care practices in newly diagnosed patients in Nepal.MethodsA total of 110 participants with newly and consequently diagnosed Type 2 were randomly allocated into intervention (mean age = 45 ± 9.7 years) and control (mean age = 47 ± 12.5 years) groups. Intervention group participants were trained on a culturally and linguistically appropriate diabetic video education program and were given a customized dietary and physical activity plan with specific targets to practice at home. Participants’ compliance was monitored weekly via telephone calls. Both groups received the usual treatment from their doctor and were followed up after three months. Outcome measures included changes in: i. diabetic health literacy, diet, and physical activity measured using self-reported questionnaires; and ii. blood glucose (glycated hemoglobin, HbA1c), cholesterol, blood pressure, body mass index, and visual acuity. Clinical outcome measures were blinded from randomization and intervention allocation.ResultsAfter three months, HbA1c decreased to 6.1% from the baseline value of 7.2% in the intervention group compared to 6.6% in the control group from the baseline value of 7.1% (p

Purpose: To assess and summarize the effects of internet-based interventions on diabetes control and self-management of older adults with diabetes.Methods: PubMed, Web of Science and three Chinese databases were searched to identified articles published in until December 2021. Clinical trials if they covered the effects of internet-based interventions on diabetes control and self-management of older adults with diabetes were included. All data analysis were performed by Review Manager 5.3.Results: Sixteen studies with a total of 5604 participants met the inclusion criteria. Our primary outcomes included HbA1c control and self-management. (1) HbA1c control: results indicated statistically difference and high heterogeneity [Q = 112.9, df = 8, p < 0.001, I2 = 93%], in the subgroup analysis of studies in China, results showed a significant influence of internet-based interventions on HbA1c control [Q = 21.31, df = 5, p = 0.03, I2 = 77%]; (2) self-management: in the subgroup analysis of study duration ≤ 6 months [Q = 84.62, df = 2, p < 0.001, I2 = 98%].Conclusion: Internet-based interventions are promising on diabetes control and self-management of older adults with diabetes, but still preliminary due to the heterogeneity of intervention components and the limited number of higher methodological quality trials.Availability Of Data and Material: Applicable. [ABSTRACT FROM AUTHOR]

Environmental parameters, including built and sociodemographic environments, can impact diabetes control (DC). Epidemiological studies have associated specific environmental factors with DC; however, the impact of multidimensional environmental status has not been assessed. The Environmental Quality Index (EQI), a comprehensive quantitative metric capturing five environmental domains, was co nsidered as an exposure. Age-adjusted rates of DC prevalence for each county in the United States were used as an outcome. DC was defined as the proportion of adults aged 20+ years with a previous diabetes diagnosis who currently do not have high fasting blood glucose (≥126 mg/dL) or elevated HbA1c (≥6.5). We conducted county-level analyses of DC prevalence rates for the years 2004–2012 in association with EQI for 2006–2010 a nd domain-specific indices using random intercept multilevel linear regression models clustered by state and controlled for county-level rates of obesity and physical inact ivity. Analyses were stratified by rural–urban strata, and results are reported as prevalence r ate differences (PRD) with 95% CIs comparing highest quintile/worst environmental quality to lowest quintile/best environmental quality. The association of DC with cumulative environmental quality was negative after control for all counties (PRD −0.32, 95% CI: −0.38, −0.27); suggesting that rates of DC worsen as environmental quality declines. While overall environmental quality exerts effects on DC that vary across the rural–urban spectrum, poor sociodemographic, and built environmental factors are associated with decreased DC nationally. These data suggest improvements in environmental quality mediated by larger-scale policy and practice interventions may improve glycemic control and reduce the morbidity and mortality arising from hyperglycemia.

To characterize the risk of falls among males and females by joint glycemic, blood pressure (BP) and cholesterol control among older adults (≥65 years) with diagnosed diabetes in USA. Using longitudinal data from the Health and Retirement Study (2006–2019), we studied the association of joint glycemic (HbA1c < 7.5 %), BP (systolic <140 and diastolic <90 mmHg) and cholesterol (total < 200 mg/dL) control with two-year risk of falls. We estimated risk ratios (RR) to describe the associations for joint ABC control and independent biomarker control by sex, using modified Poisson regressions after adjusting for known individual and household risk factors. The analytic sample consisted of 4509 observations from 2829 older adults (54.7 % female) with a mean age of 72.2 (SD: 6.6) years and duration of diabetes of 9.9 years. Joint ABC control was not associated with risk of falls among females but was associated with lower risk among males (0.91 [95%CI: 0.81–1.02]). Furthermore, achievement of glycemic control (0.85 [95%CI: 0.73–0.98]) and BP control (0.89 [95%CI: 0.79–1.01]) were associated with lower risk but cholesterol control (1.15 [95%CI: 0.99, 1.34]) was associated with higher risk of falls among males. Joint achievement of glycemic, BP and cholesterol targets may prevent falls among older males. Future studies among people with diabetes should consider biomarker control as a preventive factor for falls. • Previous studies report sex-specific differences in risk factors for falls but did not explore diabetes control • Majority of previous studies were in small, cross-sectional and regional samples • Achievement of joint ABC control was associated with lower risk of falls among older males with diabetes, but not among older females. • Known determinants, namely a history of falls, polypharmacy, functional impairment and older age were associated with higher risk of falls. [ABSTRACT FROM AUTHOR]

Background: To evaluate the impact of COVID‐19 lockdown on glycaemic control and diabetes follow‐up in a Spanish metropolitan area with a total general population of 340,000. Methods: A retrospective real‐world study comparing HbA1c testing, an indicator of diabetes control, and mean HbA1c during different COVID‐19 restriction periods in 2020 (full lockdown, post‐lockdown, partial lockdown) with the same periods in 2019. HbA1c testing was analysed per study period and according to gender, age and clinical setting. Associations between HbA1c testing and different covariables were investigated using logistic regression analysis. Changes in HbA1c were evaluated by repeated measures multivariate analysis of variance (ANOVA). Results: During full lockdown, 6847 individuals, of which 56.7% were over 65 and 6.5% below 40, were tested for HbA1c compared to 14,180 in 2019 (OR 0.47, 95% CI:0.46–0.49). Reduction in HbA1c testing was greater among older individuals (OR 0.44, 95% CI:0.42–0.45). No differences were observed for post‐lockdown (OR 1.01, 95% CI:0.99–1.04). During partial lockdown, 10,816 individuals had at least one HbA1c measured compared to 12,749 in 2019 (OR 0.84, 95% CI:0.82‐0.87). Mean HbA1c during full lockdown was 7.26% (±1.06) compared to 7.50% (±1.14) in 2019 (p <.0001). For gender and across all age groups, HbA1c levels were lower during full lockdown. HbA1c changes were not significantly different during post‐lockdown and partial lockdown. Conclusions: COVID‐19 restriction measures affected HbA1c testing. During complete lockdown, HbA1c testing decreased by half across all gender and age groups. No deleterious effect on glycaemic control was observed during lockdown and post‐lockdown among those tested. [ABSTRACT FROM AUTHOR]

Abelmoschus esculentus (L.) Moench, commonly known as okra, is one of the most widely used vegetable crops currently used for diabetes treatment as well. It is thought that the large amount of soluble dietary fibers present in okra is responsible for the slowing of the absorption of glucose from the gut. However, its role in concomitant administration with commonly prescribed medications, including metformin (MET) and acarbose (ACR) for diabetes, is unclear. Therefore, this study assessed the effect of A. esculentus pod extract (AEE) administered concomitantly with MET and ACR in the glucose-induced hyperglycemic mice model. The AEE was prepared using green okra pods. In this experiment, each male Swiss Webster mouse was administered a 2.5 gm/kg/BW dose of glucose via gastric lavage to induce hyperglycemia. The experimental animals were divided into five groups: (i) negative control, (ii) positive control, (iii) MET only, (iv) MET and ACR, and (v) MET, ACR, and AEE. The orally administered doses of the MET, ACR, and the extract were 150 mg/kg/BW, 15 mg/kg/BW, and 0.2 mL/kg/BW, respectively. We found that MET only and a combination of MET and ACR reduced glucose levels significantly (p < 0.01) compared to the positive control. On the other hand, when MET, ACR, and AEE were administered simultaneously, the synergistic antihyperglycemic action of the MET and ACR was diminished. After 150 min, the blood glucose level was 4.50 ± 0.189 mmol/L (iv) and 6.58 ± 0.172 mmol/L (v). This study suggests that taking AEE concurrently with MET and ACR would reduce the effectiveness of antidiabetic drugs; thereby, concomitant administration of these antidiabetic agents is not recommended. This study provides an essential basis for decision-making about the consumption of AEE with conventional medicine. Further study is required to find the molecular insight of drug interactions in combination therapy of medicinal plants for diabetes. [ABSTRACT FROM AUTHOR]

Purpose: The aim the study was to assess the impact of the lockdown due to COVID-19 on diabetes control. Methods: The HbA1c value from a pre-lockdown visit (V1) from patients with diabetes was compared to the lockdown visit one (V2) after 3–5 months of its duration. Additional information on how the HbA1c changed and which variables can modify HbA1c during lockdown was also studied. Results: Records from 65 patients (type 2 diabetes −96,9%) were eligible and revealed that: HbA1c was at the target in 60% of the patients at V2 compared to 40% at V1; HbA1c decreased and normalized in 19, but worsened in 4 participants during the lockdown. No impact on HbA1c of: sex, age, diabetes duration, therapy type and modification before the pandemic, abandonment of the treatment, previous problems with glycemic control, or change in body weight and physical activity during the lockdown, was found. The previous macrovascular complications were the only variable that affected the increase in HbA1c (p = 0.0072), OR = 5.33. Conclusions: The COVID-19 pandemic has not revealed worsened glycemic control in patients with type 2 diabetes, in general. The patients with macrovascular complications turned out to be at risk of the harmful impact of the restrictions on the HbA1c. [ABSTRACT FROM AUTHOR]

In this work, the adaptive regulation of blood glucose (BG) in type I diabetic (T1D) patients is considered by developing a Multiple Model Adaptive Control (MMAC), where its estimation is based on Magdelaine's long-term glucose-insulin Model. The (MMAC) is built using a bank of Kalman- Bucy Filters (KBFs)with optimal state feedback controllers. Each KBF is based on a particular value of the equilibrium point for which, the optimal Linear Quadratic Servo (LQ-Servo) controller is designed. The total state estimation is resolved by the probabilistic weighted sum of the produced outputs of all filters based on measured glucose signal. Simulation results show that MMAC is capable of providing reliable estimation and regulation of insulin delivery. Moreover, the performance of the controlled glucose/insulin is improved by 99% compared with that when using a single KBF. The MMAC has accurately identified the glucose signal corresponding to the hypothesis models with an average accuracy of 96.4% for 5 tested patients. Robust performance has been tested with different initial conditions and disturbance.

Background: Gestational diabetes mellitus (GDM) can be managed with blood glucose control management, which includes a healthy lifestyle, insulin therapy, and oral anti-diabetic drug (OAD) medications when needed. Sub-optimally or poorly managed GD Mmay lead to arisk of complications, one of which is an abnormal growth in the fetus. This study aimed to compare the effect of blood glucose control management on the incidence of fetal macrosomia and large for gestational age (LGA) births in patients with GDM. Methods: This systematic review study obtained data from formerly published studies from the Science Direct database. The article search method used the characteristics of PICO (Population, Intervention, Comparison, Outcome) and compiled using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) method. Conclusion: The use of medical nutrition therapy (MNT) and exercise in the therapeutic regimen, as well as routine monitoring of glycemic levels are very important to control the patient's glycemic level. The use of metformin can increase the success of therapy due to reduced levels of LGA and macrosomia in GDM patients. [ABSTRACT FROM AUTHOR]

Objective. Mutations of the KCNJ11 gene are the most common cause of the permanent neonatal diabetes mellitus (PNDM). Majority of people with KNCJ11-PNDM have a de-novo mutation. We aimed to compare diabetes phenotype in two children and their mothers with PNDM carrying the same sulfonylurea-sensitive KCNJ11 variants.

Background: Youth with type 1 diabetes (T1D) (16–18 y.o.) present worst disease control of all age groups and need structured interventions. Those should be based on unbiased, national‐scale outcomes, which have not yet been successfully assessed in Poland. Objective: To evaluate the glycemic control in young patients with T1D in Poland. Method: All pediatric diabetes care centers and the nine largest centers for adults with T1D were invited to this cross‐sectional study, conducted in March 2018. Eligibility was defined as age ≤ 30 years and diabetes duration ≥1 year. Blinded samples of capillary blood and clinical questionnaires were sent to coordinating center, where HbA1c was measured by high‐pressure liquid chromatography. Results: Nine adult and 25/28 pediatric centers participated, providing data for 1255 patients (50.8% males), mean age 12.3 years (95%CI:12.1–12.6) for children and 23.2 years (22.9–23.6) for adults; mean diabetes duration 7.1 years (6.8–7.3). This covered ~8% of pediatric population and 2% of 18–30‐years‐olds with T1D. Mean HbA1c was comparable between children and adults (57 mmol/mol [7.4%], 95%CI:56‐57 mmol/mol [7.3–7.4%] vs. 57 mmol/mol [7.4%], 95%CI:56–60 mmol/mol [7.3–7.6%], p = 0.1870). Overall, 45.2% of patients achieved ISPAD target (<53 mmol/mol [<7.0%]). During the month preceding the study, 0.9% of patients experienced severe hypoglycemia and 0.4% suffered ketoacidosis. HbA1c was related to the method of insulin therapy, continuous glucose monitoring use and body weight (p < 0.0001). Conclusions: In Polish children and young adults with T1D glycemic control expressed as HbA1c is promising in the light of ISPAD guidelines. Our results confirm the known associations between better glycemic control and the use of new technologies and maintaining optimal body weight. [ABSTRACT FROM AUTHOR]

Over half of patients with type 2 diabetes (T2D) are unable to achieve blood glucose targets despite therapeutic compliance, significantly increasing their risk of long-term complications. Discovering ways to identify and properly treat these individuals is a critical problem in the field. The arachidonic acid metabolite, prostaglandin E2 (PGE2), has shown great promise as a biomarker of β-cell dysfunction in T2D. PGE2 synthesis, secretion, and downstream signaling are all upregulated in pancreatic islets isolated from T2D mice and human organ donors. In these islets, preventing β-cell PGE2 signaling via a prostaglandin EP3 receptor antagonist significantly improves their glucose-stimulated and hormone-potentiated insulin secretion response. In this clinical cohort study, 167 participants, 35 non-diabetic, and 132 with T2D, were recruited from the University of Wisconsin Hospital and Clinics. At enrollment, a standard set of demographic, biometric, and clinical measurements were performed to quantify obesity status and glucose control. C reactive protein was measured to exclude acute inflammation/illness, and white cell count (WBC), erythrocyte sedimentation rate (ESR), and fasting triglycerides were used as markers of systemic inflammation. Finally, a plasma sample for research was used to determine circulating PGE2 metabolite (PGEM) levels. At baseline, PGEM levels were not correlated with WBC and triglycerides, only weakly correlated with ESR, and were the strongest predictor of T2D disease status. One year after enrollment, blood glucose management was assessed by chart review, with a clinically-relevant change in hemoglobin A1c (HbA1c) defined as ≥0.5%. PGEM levels were strongly predictive of therapeutic response, independent of age, obesity, glucose control, and systemic inflammation at enrollment. Our results provide strong support for future research in this area.

Aims: Type 2 Diabetes Mellitus (T2DM) is a prevalent chronic condition that can lead to significant complications if not well controlled. The COVID-19 pandemic created disruptions in daily life; however, it is unknown whether the pandemic's disruptions affected the ability for adults with T2DM to control their condition. This study aims to fill the knowledge gap with the experiences of adults with T2DM in Arkansas, U.S. during the COVID-19 pandemic.Methods: This study analyzed cross-sectional, observational survey data collected from adults (≥18 years) who live, work, or receive healthcare in Arkansas; self-reported a diagnosis of T2DM; and completed the diabetes module of the Impact of COVID-19 online survey (n = 131) fielded in July-August 2020. Descriptive statistics were used to characterize the sample and survey responses, and multivariate regression was used to identify demographics, self-care behaviors, and access issues associated with uncontrolled T2DM (HbA1c ≥ 9% or 74.9 mmol/mol) or with an increase in HbA1c.Results: 28.2% reported an increase in their HbA1c since the pandemic began, and 18.2% had uncontrolled T2DM. Educational level, eating healthily, and weight gain were negatively associated with uncontrolled T2DM. Eating less healthily and having difficulty accessing diabetes related medication were positively associated with an increase in HbA1c.Conclusions: Adults with T2DM in Arkansas were reasonably able to maintain control of their T2DM during the five months post the first case of COVD-19 diagnosed in the state. However, T2DM self-management interventions targeting those with lower educational levels that are focused on eating habits and/or that improve access to diabetes medication should be considered for future public health emergencies. [ABSTRACT FROM AUTHOR]

Unmet basic needs (eg, food insecurity, inadequate housing) are major barriers to diabetes self-management. The purpose of this study was to identify the prevalence of unmet basic needs and examine the association with diabetes control and care utilization among insured persons with diabetes. A total of 4043 adult patients with diabetes were screened for unmet basic needs using Your Current Life Situation, a screener for unmet basic needs, during a clinical encounter or as an online survey, during the study period (January 1, 2016–August 31, 2017). Hemoglobin A1c and care utilization (outpatient, emergency department [ED], hospitalization, diabetes-related prescription refills) were extracted from the electronic health record 12 months prior to screening. The authors compared patients with unmet basic needs to those with no needs on poor diabetes control (ie, A1c ≥8%) and care utilization using multivariable regression models. Of the 4043 patients screened, 25% endorsed ≥1 unmet basic need. In adjusted analyses, the presence of unmet basic needs was associated with an increased likelihood of having an A1c ≥8% (OR = 1.77; 95% CI 1.47, 2.13), more outpatient visits (incidence rate ratio [IRR] = 1.3; 1.2, 1.4), more ED visits (IRR = 2.3; 2.0, 2.6), more hospitalizations (IRR = 1.8; 1.5, 2.2), and more delays in refilling diabetes medication (IRR = 1.21; 1.13, 1.30). Findings indicate that unmet basic needs are highly prevalent, even among an insured patient population, and are associated with poor diabetes-related clinical outcomes and excess utilization. Future studies to determine best strategies to integrate this information into treatment planning are warranted. [ABSTRACT FROM AUTHOR]

Asian Americans (AA) are disproportionately affected by diabetes (DM) and its complications than non-Hispanic whites (whites). We examined white-AA disparities in glycemic, cholesterol and blood pressure control, known as 'ABCs of DM', and evaluated if acculturation plays a role in DM control in AA with DM. Using data from NHANES 2011-2016, we found AA patients were significantly less likely to meet glycemic, cholesterol and the collective 'ABCs' goals than their white counterparts. Acculturation was positively associated with glycemic goal achievement in AA patients. This study identified disparities and pointed to strategies related to acculturation to improve DM control for AA. [ABSTRACT FROM AUTHOR]

Introduction: Obstructive sleep apnea syndrome (OSAS) is a severe condition that is characterized by recurrent partial or complete breathing interruptions during sleep, leading to insulin resistance, microvascular complications, and cardiovascular complications. It is of great importance to know the impact of type 2 diabetes mellitus (DM), which is prevalent in the world and in our country, Turkey, leads to significant mortality and morbidity, significantly affects the quality of life, and requires continuous follow-up, on sleep in patients with OSAS and to raise awareness on this issue. In this study, we aimed to determine the effects of diabetes on sleep duration and sleep architecture in patients with OSAS and to investigate the relationship between OSAS severity and DM control., Methods: Fifty diabetic and 42 non-diabetic patients diagnosed with OSAS at the Sleep Disorders Center of Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, between October 2022 and March 2023 were included in the study. Polysomnographic and biochemical parameters of the two groups were compared. The effect of OSAS severity and sleep architecture on diabetes control was investigated., Results: No significant difference was found between diabetic and non-diabetic patients in terms of total sleep duration, sleep efficiency, and sleep latency, whereas REM (rapid eye movement) latency was prolonged and REM sleep duration and percentage were significantly lower in diabetic patients. The severity of OSAS was found to be greater in diabetic patients and they spent significantly more time below 90% saturation during sleep. No correlation was found between the groups in the glycated hemoglobin (HbA1c) parameter, which we examined in terms of diabetes control, sleep architecture, and OSAS severity., Conclusion: The presence of diabetes aggravates the severity of OSAS, prolongs the transition to REM sleep, and leads to a decrease in REM duration. Sleep is essential for both mental and physical well-being. In this regard, it is of utmost importance to examine diabetic patients for OSAS and to perform polysomnography in appropriate patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Durak et al.)

The study investigates the quality of diabetes control and its economic implications in Bulgaria for the years 2012–2016. It is a retrospective study of the national diabetes register. Patients were categorized according to type of diabetes, gender, newly diagnosed cases per year, body-mass index (BMI) and achieved disease control. The relative risks for reducing the diabetes-related complications achieved through a 1% reduction of HbA1c were taken from literature data, and macrocosting was used to calculate the saved cost for diabetes complications. The new cases of type 1 diabetes decreased (10% lower in 2016 than in 2012) but the number of new cases with type 2 diabetes increased (12%). In 2012, the average percentage of glycosylated hemoglobin in the second recording at the end of the year was 7.59% (SD 1.85), whereas the second recording of values for 2016 revealed an average value of 7.3% (SD 1.32). The mean yearly reduction in 2012 was 0.05% (SD 1.1) with a slow increase to 0.07% (SD 0.46) in 2016. The absolute risk reduction for all diabetes-related complications was 20.6. The total prevented costs for all complications in the entire population were 20 million BGN. The results for the period 2012–2016 showed improved control of diabetes. The proportion of patients who achieved control increased over the period, reaching over 40% of the afflicted population. The achieved adequate control led to a reduced risk of developing diabetes-related complications, thereby saving costs of 20 million BGN associated with them, and decreasing the burden on the healthcare system.

Objective: To study the impact of educational level on the control of type 2 diabetes mellitus and subsequent development of its complications. Methods: Epidemiological Cross-sectional study conducted with 200 patients with Type 2 diabetes mellitus. The data were obtained from patients attending a Tertiary care hospital in Eastern India. Results: Glycemic control is better in more educated persons and level of education has an inverse relationship to the complication score. Percentage of patients with complication score more than 10 gradually decreases as the literacy level increases from 5th standard class onwards. Conclusion: Our study thus showed a positive impact of education on diabetes control and an inverse relationship with development of complications i.e. the more the education, the less the Diabetic complications.

Abstract Background To investigate the potential barriers to optimal diabetes control by evaluating the different perspectives of physicians and patients on such matters in China. Methods This multi-center survey was conducted from December 2015 to March 2016. A multi-stage stratified random sampling method was used to sample representative diabetes physicians and patients in 18 hospitals in Shaanxi province, China. A self-designed questionnaire was used. The questionnaire mainly consisted of 2 questions for physicians and 1 question for patients of which the participants were required to rank in priority of 3 (for physicians) and 2 (for patients) choices from a list of barriers. The strategies to improve diabetes control were only in the questionnaire for physicians. Results A total of 85 physicians and 584 patients completed the questionnaire. Physicians and patients differed regarding the patients’ awareness of the risk of diabetes: over 70% of the physicians believed that the patients had no sufficient understanding of the harm and risk of diabetes, whereas the patients believed otherwise. Both physicians and patients considered self-monitoring of blood glucose to be an important link of glucose control; unfortunately, most of the patients failed to do so in practice. In addition, physicians considered “improving health insurance coverage for diabetes” as the first important measure and “providing more and easy-to-use diabetes brochures or educational materials for patients” as the second important measure to improve diabetes control. Conclusion The survey revealed differences between the perspectives of physicians and patients on the potential barriers to optimal diabetes control. The main potential barriers to optimal diabetes control were patient’s poor lifestyle interventions, limited understanding of the danger of diabetes, and poor self-monitoring of blood glucose. From the physicians’ perspective, China’s primary focus about diabetes control in the future should still be put on diabetes education, particular the importance of lifestyle interventions.

Backround. Diabetes is an important public health problem, one of four priority noncommunicable diseases targeted for action by world leaders. The aim of this study was to investigate the factors affecting diabetes control in patients with type 2 diabetes in the rural areas of northern Iran. Methods. This study was conducted following a descriptive-analytical cross-sectional study design based on the data of 308 patients with type 2 diabetes in the rural areas of golestan province. The samples were selected through two-stage stratified random sampling. Data were collected using a questionnaire (completed by the interviewer) and by measuring the blood glucose, blood pressure, and lipid profile of patients and also using data from patients' records. Data were analyzed using descriptive and analytical statistics and SPSS version 19. results. The mean age of patients was 57 ± 15 years and 220 patients (71%) were female. Fifty-five percent of patients had a family history of diabetes and 69% had comorbidity. The mean vegetable intake in patients was 3 days a week with 1.5 servings per day and only 20% had exercise at least three times a week. The proportion of patients with adequately controlled glycated hemoglobin (hBA1c), blood pressure (BP), triglyceride (Tg), low-density lipoprotein (lDl), and high-density lipoprotein (hDl) were 27, 91, 31, 41 and 55.5%, respectively. There was also a significant relationship between the controlled blood glucose with increasing age, absence of comorbidity, the number of nutrition counseling, and lowering blood triglycerides. Conclusion. The results of this study showed poor blood glucose control in the studied geography. Therefore, considering these data, it seems necessary to review the national plan for the prevention and control of diabetes. [ABSTRACT FROM AUTHOR]

Background and Aims: Diabetes is a suitable model to evaluate intervention programmes aimed at chronic diseases, because of its well-defined and measurable process and outcome indicators. In this study, we aimed at investigating the effects of group based self-management education on clinical and psychological variables in type 2 diabetes.Methods and Results: Four-year randomized controlled clinical trial (ISRCTN14558376) comparing Group Care and traditional one-to-one care. Clinical and psychological variables were monitored at baseline, 2 and 4 years. Although differences between groups appear to be non-significant at univariate analysis, body weight, BMI and HbA1c, systolic and diastolic blood pressure improved in the patients followed by Group Care but not among Controls. Prescription of lipid-lowering and anti-hypertensive agents did not change among the patients on Group Care, whereas anti-hypertensives were stepped up among Controls without improving their blood pressure. Multivariable analysis suggests that blood pressure improvement among patients on Group Care was independent of BMI, duration of diabetes and antihypertensive medication, suggesting a direct effect of education, presumably by increasing adherence. The "Powerful Others" dimension of the Locus of Control worsened and fear of complications decreased among Controls.Conclusions: The results confirm that a multidisciplinary structured group educational approach improves blood pressure, presumably through better adherence to healthy lifestyle and medication, in people with type 2 diabetes.Clinical Trial Registration Number: ISRCTN14558376. [ABSTRACT FROM AUTHOR]

Featured Application: Mobile application for iterative simulation of a diabetic model. This paper presents an educational mobile assistant application for type 1 diabetes patients. The proposed application is based on four mathematical models that describe the glucose-insulin-glucagon dynamics using a compartmental model, with additional equations to reproduce aerobic exercise, gastric glucose absorption by the gut, and subcutaneous insulin absorption. The medical assistant was implemented in Java and deployed and validated on several smartphones with Android OS. Multiple daily doses can be simulated to perform intensive insulin therapy. As a result, the proposed application shows the influence of exercise periods, food intakes, and insulin treatments on the glucose concentrations. Four parameter variations are studied, and their corresponding glucose concentration plots are obtained, which show agreement with simulators of the state of the art. The developed application is focused on type-1 diabetes, but this can be extended to consider type-2 diabetes by modifying the current mathematical models. [ABSTRACT FROM AUTHOR]

Summary: Dealing with the interpatient and the intrapatient variability in type 1 diabetes mellitus (T1DM) patient are the prominent control challenges in the development of the artificial pancreas system (APS). An APS consider a nonlinear patient model that has many state variables, but the reality is that out of the many states only glucose concentration is measurable till date without any complication and undue high cost. In the present work, the philosophy is to evolve a control technique that can address the above‐cited challenges or issues. In the sequel, a robust observer is first designed based on the attractive ellipsoid method (AEM) for norm‐bounded uncertainty structure. The information of the estimated states is then used to design a guaranteed‐cost robust output feedback control. The design methodology approximates the nonlinearity present in the model as quasi‐one‐sided Lipschitz thus including more information of nonlinearity in the design as well as the control problem is recast into a linear matrix inequality (LMI) framework. Numerical simulations of 200 virtual T1DM patients are carried out which reveal that there are no cases of hypoglycemia and postprandial hyperglycemia in the presence of bounded parametric variability and high uncertainty in exogenous meal disturbance. The proposed method is simple, efficient and optimal closed‐loop solution for blood glucose regulation in T1DM patients in a robust nonlinear framework. [ABSTRACT FROM AUTHOR]

We aimed to investigate the association between working hours and poor glycemic control using a cross-sectional data from the Korea National Health and Nutrition Examination Survey (KNHANES). The participants who were medically diagnosed with diabetes mellitus by a physician were defined as diabetic patients, and patients with hemoglobin A1c (HbA1c) levels >9.0% were considered as "poorly controlled". The association of HbA1c level with working hours was examined by linear regression plot, using local regression line and logistic regression analyses. The local regression plot showed a smooth increasing pattern: the longer were the working hours, the higher were the HbA1c levels, even though it was not statistically significant. Odds ratios of working hours over 52 h per week were higher with the criterion of poor diabetic control (HbA1c >9.0%). The results were significant in elderly female workers (odds ratio 3.30, 95% confidence interval 1.19-9.18). Long working hours were associated with poor glycemic control, specifically among elderly female workers with diabetes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of type-2 diabetes on implant survival and complication rate. Materials and Methods: Prospective study enrolling type-2 diabetic patients suffering from edentulism, having a mean perioperative HbA1c level of 7.2%, and compliant with a maintenance program. All the patients underwent dental and periodontal examinations and had laboratory testing for HbA1c, fasting plasma glucose, blood lipids, and microalbuminuria. Nondiabetic patients matched for implant treatment indication served as controls. The influence of clinical diabetes-related factors and periodontal parameters (Plaque Index, bleeding on probing, probing depth) on implant survival were assessed via univariate then multivariate methods. Results: Forty-five diabetic patients, followed for 1 to 12 years, mean age 64.7 years, received 255 implants: 143 following a classical protocol and 112 in cases of sinus floor elevation, immediate loading, and guided bone regeneration. Forty-five nondiabetic control patients received 244 implants: 142 following a classical protocol and 102 in cases of advanced surgery. Implant survival following conventional or advanced implant therapy was not statistically different between the well-controlled (HbA1c < 7%, P = .33) and the fairly well-controlled group (HbA1c 7% to 9%, P =.37). The overall survival rate for the diabetic group was 97.2% (control 98.8%) and was not significantly different for age, gender, diabetes duration, smoking, or type of hypoglycemic therapy. The mean peri-implant bone loss was 0.41 ± 0.58 mm (control, 0.49 ± 0.64 mm). PI and BOP fairly correlated with postoperative complications. HbA1c was the only multivariate independent factor affecting the complication rate (P = .04). No statistically significant difference was found for patients (P = .81) or for implants (P = .66) for the advanced surgery cases or the conventional approach in diabetic patients compared to nondiabetic patients. [ABSTRACT FROM AUTHOR]

Abstract Background The rates of diabetes and prediabetes in the USA are growing, significantly impacting the quality and length of life of those diagnosed and financially burdening society. Premature death and disability can be prevented through implementation of evidence-based programs and policies (EBPPs). Local health departments (LHDs) are uniquely positioned to implement diabetes control EBPPs because of their knowledge of, and focus on, community-level needs, contexts, and resources. There is a significant gap, however, between known diabetes control EBPPs and actual diabetes control activities conducted by LHDs. The purpose of this study is to determine how best to support the use of evidence-based public health for diabetes (and related chronic diseases) control among local-level public health practitioners. Methods/design This paper describes the methods for a two-phase study with a stepped-wedge cluster randomized trial that will evaluate dissemination strategies to increase the uptake of public health knowledge and EBPPs for diabetes control among LHDs. Phase 1 includes development of measures to assess practitioner views on and organizational supports for evidence-based public health, data collection using a national online survey of LHD chronic disease practitioners, and a needs assessment of factors influencing the uptake of diabetes control EBPPs among LHDs within one state in the USA. Phase 2 involves conducting a stepped-wedge cluster randomized trial to assess effectiveness of dissemination strategies with local-level practitioners at LHDs to enhance capacity and organizational support for evidence-based diabetes prevention and control. Twelve LHDs will be selected and randomly assigned to one of the three groups that cross over from usual practice to receive the intervention (dissemination) strategies at 8-month intervals; the intervention duration for groups ranges from 8 to 24 months. Intervention (dissemination) strategies may include multi-day in-person workshops, electronic information exchange methods, technical assistance through a knowledge broker, and organizational changes to support evidence-based public health approaches. Evaluation methods comprise surveys at baseline and the three crossover time points, abstraction of local-level diabetes and chronic disease control program plans and progress reports, and social network analysis to understand the relationships and contextual issues that influence EBPP adoption. Trial registration ClinicalTrial.gov, NCT03211832

Introduction: A strategy of a diabetes group education session as a diabetes camp without staying overnight is commonly practiced in Thailand for type 2 diabetes patients. Aim: To compare the effectiveness of diabetes control between a group education session and non-intervention in type 2 diabetes. Materials and Methods: A randomised controlled trial was conducted between May 2015 and January 2016 at the Diabetes Clinic, Naresuan University Hospital, and 6 Health Promotion Hospitals. Type 2 diabetes patients with Glycosylated Haemoglobin Level (A1C) levels of more than 8% who received insulin with or without oral hypoglycaemic treatment were randomly assigned to join or not to join a 1-day diabetes group education session or a so-called Diabetes Day Camp. The primary outcomes were glycaemic control determined by fructosamine value and A1C level, 2 weeks and 3 months after finishing the intervention, respectively. Chi-square test and independent t-test were used for comparison of demographic data and final outcomes between the experimental group and the control. Before and after outcome analysis within group was determined by paired t-test. The p-value

Objectives: A self-care approach is very important in diabetes management. In this study, it was aimed to make the Turkish validity and reliability of the Comprehensive Diabetes Self-Management Scale (CDSMS), which examines the behaviors of diabetes patients., Methods: The study is of methodological type. CDSMS, which was translated into Turkish from its original version and tested for language validity, was first included in the pilot application and then in the main study. The validity of the scale was evaluated by the Cronbach's alpha coefficient. Then, a Receiver Operating Characteristic (ROC) analysis was performed to determine the cut off score., Results: The mean age of the study participants was 57.10 ± 11.20 years and the mean disease duration was 9.96 ± 7.79 years. The internal consistency of CDSMS was 0.73, which was measured using Cronbach's alpha. After the ROC analysis, the optimal cut-point score of CDSMS to predict good glycemic control was determined as 21.17 points., Conclusion: With this study, it was found that the Turkish version of CDSMS is valid and reliable for use in the Turkish population. It is thought that CDSMS will be beneficial to physicians working in the clinic in terms of showing the disease management skills of diabetic patients., Competing Interests: None declared., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Background: Strict adherence to multiple daily insulin (MDI) therapy is a cornerstone for the achievement of good glucose control in people with advanced type 2 diabetes (T2D). Here, we aim to in silico assess glucose control in T2D subjects with poor adherence to MDI therapy., Methods: We tuned the Padova T2D Simulator, originally describing early-stage T2D physiology, around advanced T2D people. One hundred in silico advanced T2D subjects were generated and equipped with optimal MDI therapy: specifically, basal and bolus insulin amounts and injection times were individualized for each subject by applying titration algorithms that iteratively update insulin dose based on glucose deviation from its target. Then, the effect of nonadhering to MDI therapy was assessed using standard glucose control metrics calculated in two 6-month 3-meal/day in silico scenarios: in Scenario 1 , subjects received the optimal basal and prandial insulin bolus at each meal; in Scenario 2 , subjects received optimal basal insulin and randomly delayed or skipped the prandial insulin bolus in 3 lunches during working days and 1 dinner during weekends., Results: A statistically significant degradation was found in all glucose control outcome metrics in Scenario 2 versus Scenario 1 : e.g., percent time above 180 mg/dL increased by 22.2% and glucose management index by 0.2%., Conclusions: Impaired adherence to MDI therapy in T2D leads to glucose control deteriorations in both short and long terms. Interestingly, short-term hyperglycemia seems being contrasted by residual endogenous insulin secretion, which statistically increased by 3-fold after delayed/skipped insulin boluses compared with optimal ones., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.