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Introduction and Aim: Diabetes mellitus is one of the commonest metabolic causes associated with hypomagnesaemia. Magnesium is said to be one of the chief neuroprotective and vasodilatory mineral of the body. The main aim of this study was to establish the potential correlation between the serum magnesium levels and the auditory acuity in type II Diabetes mellitus patients. Materials and Methods: It is a cross-sectional study done at Sree balaji medical college & hospital, Chrome pet, Chennai. In this study we evaluated a total of 200 type II DM cases consisting of 100 cases with poor glycaemic control, and 100 cases under glycaemic control, all are recently diagnosed cases of type II Diabetes mellitus, in the age groups of 40-55 years who had come to the hospital for their regular annual master check-ups. Their serum magnesium levels were measured using the xylidyl blue dye binding method and pure tone audiometry was also done. Results: Results showed that of the 100 poorly controlled type II DM subjects(i.e. HbA1c >/= 7),65 patients with hypomagnesaemia had sensory neural type of hearing loss & of the 100 type II DM subjects with controlled HbA1c levels(i.e. HbA1c

To compare healthcare resource use (HRU) and annual costs in type 2 diabetes mellitus (T2DM) patients with poor glycaemic control and obesity versus good glycaemic control without obesity.Observational retrospective study based on the analysis of electronic medical records from the BIG-PAC database, with one year of follow-up. T2DM patients aged ≥30 years who requested medical care during 2013 were included. Annual HRU and costs per patient were compared between a reference group (HbA1c ≥ 8%, BMI ≥30 kg/mDuring the follow-up, patients in the reference group (Poor glycaemic control and obesity in T2DM patients were associated with increased HRU and costs in routine clinical practice.

We aimed to evaluate the effects of hypogonadism on metabolic and chronic complications in type 2 diabetic males. 261 nonobese males with type 2 diabetes aged 18-70 were involved in the study. Hypononadal males were divided into 2 groups as overt hypogonadism (total testosterone≤230 ng/dl) and borderline hypogonadism (230-345 ng/dl). The control group involved eugonadal diabetic males. Micro-macrovascular complications were recorded. 101 patients had hypogonadism (38.7%), and 160 patients were eugonadal (61.3%). Microvascular complication rate was not different, but macrovascular complication rate was significantly higher in hypogonadal males (42.6%/31.3%, p = 0.042). Optimal glycosylated haemoglobin (HbA1c) achievement(

Aim To evaluate the economic and clinical burden associated with poor glycaemic control in Sweden, in people with type 2 diabetes (T2D) initiating first‐line glucose‐lowering therapy. Materials and Methods Population data were obtained from Swedish national registers. Immediate glycaemic control was compared with delays in achieving control of 1 and 3 years, with outcomes projected over 3, 10 and 50 years in the validated IQVIA CORE Diabetes Model. Glycaemic control was defined as glycated haemoglobin (HbA1c) targets of 52, 48 and 42 mmol/mol, as recommended in Swedish guidelines, according to age and disease duration. Costs (expressed in 2019 Swedish krona [SEK]) were accounted from a Swedish societal perspective. Results Immediate glycaemic control was associated with population‐level cost savings of up to SEK 279 million and SEK 673 million versus delays of 1 and 3 years, respectively, as well as small population‐level life expectancy benefits of up to 1305 and 2590 life years gained. Reduced levels of burden were a result of lower incidence and delayed time to onset of diabetes‐related complications. Conclusions Even in people with T2D initiating first‐line glucose‐lowering therapy, the economic burden of poor glycaemic control in Sweden is substantial, but could be reduced by early and effective treatment to achieve glycaemic targets.

Introduction: Prevalence rates for diabetes mellitus continue to rise, which, coupled with increasing costs of complications, has appreciably increased expenditure in recent years. Poor glycaemic control including hypoglycaemia enhances complication rates and associated morbidity, mortality and costs. Consequently, this needs to be addressed. Whilst the majority of patients with diabetes have type-2 diabetes, a considerable number of patients with diabetes require insulin to help control their diabetes. Long-acting insulin analogues were developed to reduce hypoglycaemia associated with insulin and help improve adherence, which can be a concern. However, their considerably higher costs have impacted on their funding and use, especially in countries with affordability issues. Biosimilars can help reduce the costs of long-acting insulin analogues thereby increasing available choices. However, the availability and use of long-acting insulin analogues can be affected by limited price reductions versus originators and limited demand-side initiatives to encourage their use. Consequently, we wanted to assess current utilisation rates for long-acting insulin analogues, especially biosimilars, and the rationale for patterns seen, across multiple Asian countries ranging from Japan (high-income) to Pakistan (lower-income) to inform future strategies. Methodology: Multiple approaches including assessing utilization and prices of insulins including biosimilars among six Asian countries and comparing the findings especially with other middle-income countries. Results: Typically, there was increasing use of long-acting insulin analogues among the selected Asian countries. This was especially the case enhanced by biosimilars in Bangladesh, India, and Malaysia reflecting their perceived benefits. However, there was limited use in Pakistan due to issues of affordability similar to a number of African countries. The high use of biosimilars in Bangladesh, India and Malaysia was helped by issues of affordability and local production. The limited use of biosimilars in Japan and Korea reflects limited price reductions and demand-side initiatives similar to a number of European countries. Conclusions: Increasing use of long-acting insulin analogues across countries is welcomed, adding to the range of insulins available, which increasingly includes biosimilars. A number of activities are needed to enhance the use of long-acting insulin analogue biosimilars in Japan, Korea and Pakistan.

Introduction: Poor adherence of patients to the polypharmacy approach is a crucial challenge in the management of Type 2 Diabetes Mellitus (T2DM) and use of triple Fixed-Dose Combination (FDC) of metformin, glimepiride, and voglibose is effective in achieving glycaemic control and would aid in improved drug adherence. Aim: To analyse clinical profile and treatment patterns of FDC of glimepiride, metformin, and voglibose with or without other antidiabetic therapy in patients with T2DM. Materials and Methods: A retrospective, observational, multi- centric study conducted during August 2019 to March 2020. Included patients of either sex, ≥18 years of age with T2DM and who had received treatment with FDC of glimepiride, metformin, and voglibose of varying strengths with or without other antidiabetic therapy. Data extracted from medical records included demographic characteristics, duration of disease, co- morbidities, concomitant medications and dosage pattern. Data were analysed using Chi-square test and Mann-Whitney U test. Results: A total of 2650 patients with T2DM were included, of which 1689 (63.7%) were males. The mean (standard deviation {SD}) age was 54.2 (11.4) years. The average Body Mass Index (BMI) was 27.2 (4.3) kg/m2 and hypertension 1656 (62.5%) and dyslipidaemia 1109 (41.9%) were the most common co-morbidities. Dipeptidyl peptidase-4 inhibitors 908 (34.3%) and antihypertensives 1601 (60.4%) were the most common concomitant diabetic and non diabetic medications received, respectively. Glimepiride (2 mg)+metformin (500 mg)+voglibose (0.2 mg) FDC twice-a-day 878 (33.1%) was a common triple FDC. A total of 2449 (92.4%) patients were compliant and 2585 (97.9%) achieved glycaemic goal with triple FDC treatment. During the therapy, the majority of patients had decreased weight 1106 (67.2%). The mean Haemoglobin A1c (HbA1c) levels significantly decreased post-treatment (mean change 1.45%; p-value

Background and Aims: Diabetes mellitus (DM), poor glycaemic control and raised body mass index (BMI) have been associated with postoperative complications in arthroplasty, although the relative importance of these factors is unclear. We describe the prevalence of DM in elective hip arthroplasty in a UK centre, and evaluate the impact of these factors. Methods: We analysed retrospective data for DM patients undergoing arthroplasty over a 6-year period and compared with non-diabetic matched controls (1 DM patient: 5 controls). DM was present in 5.7% of hip arthroplasty patients (82/1443). Results: Postoperative complications occurred in 12.2% of DM patients versus 12.9% of controls ( p = 1.000); surgical complications were present in 6.1% of those with DM and 2.4% of controls ( p = 0.087), while medical complications occurred in 8.5% of DM patients versus 10.7% of controls ( p = 0.692). Complications developed in 23.1% of DM patients with poor glycaemic control (HbA1c > 53 mmol/mol) versus 9.8% with good control ( p = 0.169). In DM patients and controls combined, complications occurred in 16.3% of obese patients versus 10.0% of non-obese patients ( p = 0.043). In the DM cohort, 13.7% of overweight patients had complications versus 0% with a normal or low BMI ( p = 0.587). Conclusions: DM rates were lower than expected, and glycaemic control was good. Overall complication rates were unrelated to the presence of DM or to glycaemic control, although surgical complications were observed more frequently in those with DM and poor glycaemic control was uncommon within our cohort. Complications were more frequent in those with a higher BMI. Whether some patients with DM but without an increased risk of complications are currently being excluded from surgery requires exploration.

Background: Despite the fact that there is an increasingly effective armoury of medications to treat diabetes many patients continue to have substantially elevated blood glucose levels. The purpose of this study was to explore what the barriers to diabetes management are in a cohort of people with diabetes and poor glycaemic control.Methods: Qualitative semi-structured interviews were carried out with 10 people with diabetes who had known diabetes and a recent HbA1c of > 11.3% (100 mmol/mol) to explore their experiences of barriers to diabetes self-management and glycaemic control. Results: Barriers to diabetes management were based around two key themes: biopsychosocial factors and disease awareness / information delivery. Specifically, financial concerns, social stigma, medication side effects and cognitive impairment due to hyperglycaemia were commonly reported as barriers to medication use. Other barriers included a lack of knowledge about their own disease, poor relationships with health care professionals and a lack of relevant resources to support diet and weight loss.Conclusion: people with diabetes with poor glycaemic control experience many of the same barriers as those reported elsewhere, but also experience issues specifically related to their severe hyperglycaemia. Management of diabetes could be improved via the increased use of patient education and availability of locally relevant resources.

Background: Living with diabetes is challenging, especially for adolescents at risk of poor glycaemic control. Understanding the illness perceptions of this group is important to be able to develop interventions for this growing population in need. Aim: This study explored the illness perception amongst adolescents living with type 1 diabetes (T1D) and how these perceptions interacted with the management of T1D. Setting: This study was conducted at a medical centre providing care for adolescents living with T1D in Parktown, South Africa. Methods: A qualitative, explorative design with semi-structured interviews was followed. A non-random purposive sampling method was utilised. The illness perception amongst eight adolescents, aged 12–18 years, at risk of poor glycaemic control, was analysed through thematic analysis. Results: Two subthemes related to illness perception were generated, namely (1) illness perception of T1D is negative and (2) living with T1D leads to a sense of being different. Furthermore, two subthemes were generated in relation to how illness perceptions interacted with diabetes management, namely (3) management of T1D is challenging and (4) management of T1D is motivated by fear. Conclusion: This group of adolescents with at-risk glycaemic control believed that T1D is difficult to manage, leading to a largely negative perception of the disease. This study contributes to the body of literature on adolescents where illness perception may play a role in adhering to diabetes care plans. This research may give additional insights into the awareness of illness perception in designing successful interventions.

Introduction The prevalence of diabetes is increasing around the world, especially in populations with limited health service resources. Diabetes is associated with increased mortality and cost. Therefore, we investigated the impact of increasing access to diabetes care through telemedicine. Methods Five rural communities were connected via videoconference. Patients received diabetes consultation (DC) or diabetes self-management education (DSME). DC was performed by an endocrinologist, while DSME was delivered by a certified diabetes educator. Haemoglobin A1c (HbA1c), blood pressure (BP) and lipid profile were evaluated as outcome measures. Results Sixty-nine subjects (70% females, 91% Caucasians) were studied, with 33 receiving DC and 36 receiving DSME. Patients were aged 56.7 ± 9.4 and 56.5 ± 6.7 years, respectively ( p > 0.5), and had had diabetes for 11.4 ± 10.1 and 11.7 ± 9.2 years, respectively ( p > 0.5). Both DC and DSME reduced HbA1c equally: DC at baseline 9.3 ± 1.3% compared to at 12 months 7.2 ± 0.9% ( p = 0.0002), and DSME at baseline 9.8 ± 1.6% compared to at 12 months 8.3 ± 1.9% ( p = 0.009). There was no difference in HbA1c between DC and DSME at baseline and at 12 months ( p > 0.1). On the average, BP and lipids were equally controlled in DC and DSME at six months: total cholesterol 178.3 ± 50.5 mg/dL versus 185.9 ± 57.3 mg/dL, low-density lipoprotein cholesterol 91.4 ± 36.1 mg/dL versus 91.5 ± 50.2 mg/dL, high-density lipoprotein cholesterol 46.2 ± 11.0 mg/dL versus 43.5 ± 10.8 mg/dL, systolic BP 136.8 ± 23.6 mmHg versus 131.9 ± 22.3 mmHg, diastolic BP 72.0 ± 13.2 mmHg versus 77.7 ± 11.3 mmHg ( p > 0.1). All subjects found DC and DSME cost effective, while 97% reported better diabetes control. Discussion In patients with long-standing uncontrolled diabetes who lived in rural communities with high diabetes-related mortality rates, DC or DSME delivered by videoconference improved glycemic control. No difference was found between the two interventions.

A 44-year-old woman, known case of type 2 diabetes mellitus with poor glycaemic control (glycated haemoglobin 10.8%), was hospitalised for continuous glucose monitoring (CGM). On enquiring retrospectively during her hospital stay, she also reported a history of effort intolerance, palpitation and

Background Diabetes is a powerful but modifiable vascular risk factor, and it is well-established that effective glycaemic control improves cardiovascular outcomes. Current international guidelines do not recommend routine measurement of HbA1c in patients with acute coronary syndrome (ACS). We hypothesise that measuring HbA1c levels in all patients during admission to hospital with ACS would allow: Identification of patients with known diabetes and poor glycaemic control Increased diagnoses in patients with previously undiagnosed diabetes Aims To identify how often HbA1c was measured in patients admitted with ACS, and when measured whether HbA1c identified poor glycaemic control in patients with known diabetes and/or led to new diagnoses of diabetes. Methods Measurement of HbA1c was audited among patients admitted with ACS to two large acute NHS Trusts. Electronic records of patients admitted with ACS during a two-month period at Trust 1 and a three-month period at Trust 2 were analysed. Results 218 patients were admitted with ACS (122/218 Trust 1, 96/218 Trust 2). Mean age was 71 (range 34-97), 70% male. 77/218 (35%) had known diabetes. HbA1c was measured during admission (or 64mmol/mol) was identified in 16/36 (44%) patients with known diabetes. 15/51 patients did not have known diabetes; in this population mean HbA1c was 40mmol/mol (range 31-50). HbA1c testing led to 1 new diagnosis of diabetes being confirmed. Among patients with known diabetes, 33/36 who had an HbA1c test underwent invasive angiography; 15/33 had an HbA1c >64mmol/mol and 18/33 HbA1c 64mmol/mol population were more likely to undergo CABG than be managed with PCI or medical therapy alone than the HbA1c 64mmol/mol (n=16) and HbA1c Conclusion In this study of patients admitted with ACS, HbA1c testing identified poor glycaemic control in a large number of patients with known diabetes. Only 1 new diagnosis of diabetes was made, likely due to established screening programs in primary care being effective in prior identification. Among patients with known diabetes, revascularisation with CABG was more common in those with poor glycaemic control in keeping with current revascularisation guidelines. HbA1c testing therefore identified a higher risk group within the ACS population, as well as identifying poor glycaemic control. These results, taken together with the recent development of novel therapies for diabetes, suggest that HbA1c testing should be considered routinely in all patients admitted with ACS. Conflict of Interest None

Introduction: Current ISPAD guidelines recommend biennial diabetic retinopathy (DR) screening starting at age 11 yrs with type 1 diabetes (T1D) duration 2-5 yrs. Growing evidence suggesting less frequent screening. Methods: DR was ETDRS graded and progress assed by Markov chain model analysis. Retinal photos were from 2,169 patients (baseline (mean±SD): age 13.1±2.1 yrs, HbA1c 8.5±1.4%, 5.4±2.9 yrs T1D, follow-up 5.3±3.6 yrs) who attended the T1D clinic at least twice in 1990-2018. Results: In 11/2,169 patients DR progressed to severe non-proliferative (SNP) DR or above. See tables 1 and 2 below for detailed results. Conclusions: Our data support less frequent DR screening in T1D youth without any DR. Although DR progression is generally slow, poor glycaemic control greatly accelerates it. Disclosure A.S. Januszewski: None. V. Velayutham: None. P.Z. Benitez-Aguirre: None. M.E. Craig: None. G. Liew: None. Y. Cho: None. A. Jenkins: Advisory Panel; Self; Abbott, Medtronic. Research Support; Self; Abbott, GlySens Incorporated, Medtronic, Sanofi-Aventis. K.C. Donaghue: None.

Background: Results of previous studies on the effect on glycaemic control of anthropometric measures of obesity, some economic status variables and the presence of metabolic syndrome are not consistent and appear to differ among health institutions. The status of glycaemic control and some of its determinants was investigated among adult black patients with type-2 diabetes mellitus (T2DM) at Dr George Mukhari Academic Hospital (DGMAH).Method: A random sample of 176 adult black South African patients with T2DM attending the diabetic clinic at DGMAH was investigated in the current study. Fasting blood glucose, glycated haemoglobin (HbA1c), lipid profile components levels as well as anthropometric measures of obesity were measured using standard measuring procedures for these variables. The presence of metabolic syndrome was assessed according to the International Diabetic Federation criteria. Information related to patients’ socioeconomic status was collected by means of a structured questionnaire. Associations between these factors and poor glycaemic control were assessed by means of binary and multivariate logistic analysis.Results: Glycaemic control was found to be very poor at DGMAH. As low as 16.6% of the study subjects achieved SEMDSA’s 2012 recommended target HbA1c value of less than 7.0%. Whereas binary logistic analysis revealed that marital status, matriculation, increase waist circumference and duration of diabetes 5 years may lead to poor glycaemic control, multivariate logistic regression analysis indicated that only increased waist circumference was independently associated with poor glycaemic control at DGMAH.Conclusions: Central obesity appears to be an independent risk factor for poor glycaemic control among T2DM patients at DGMAH.

The aim of this study was to test the serum concentrations of fatty acid-binding protein 4(FABP4) in children with type 1 diabetes mellitus (T1DM) and to determine the relationship between patients with good and poor glycaemic control who were classified according to their glycated hemoglobin A1c (HbA1c) levels.Children with T1DM were selected consecutively from our department from May 2016 to May 2017. For comparison, the same non-diabetic, age, sex, BMI and pubertal stage-matched healthy children were selected consecutively among non-diabetic children. Serum levels of FABP4 were batch analyzed using a commercially available ELISA assay. Patients were categorized into two groups according to their glycaemic control (Poor glycaemic control is HbA1c7.0% and good is ≤7.0%).In this study, 118 children with T1DM and 118 control cases were included. The mean serum FABP4 concentrations were significantly (P.001) higher in T1DM as compared to controls. There was a modest correlation between serum concentrations of FABP4 and duration of diabetes (r=0.484, P.001). Fifty-two patients were defined as poor glycaemic control (HbA1c7.0%). The mean serum FABP4 concentrations were significantly (P=.002) higher in the poor glycaemic control as compared to the good glycaemic control. After adjusting for all other predictors, FABP4 remained an independent poor glycaemic control indictor with an adjusted OR of 1.07 (95% CI, 1.01-1.13; P=.03).The present results indicated that FABP4 concentrations were increased and independently associated with the poor glycaemic control in Chinese children with T1DM.

Background Therapy with sulfonylurea is preferable to insulin in the majority of individuals with KCNJ11 mutations, but not all of these people achieve target levels of HbA1c in long-term follow-up. We aimed to compare sulfonylurea therapy with insulin treatment in two sulfonylurea-sensitive individuals with a KCNJ11 mutation who had poorly controlled permanent neonatal diabetes mellitus. Case report We report on two individuals with a KCNJ11 mutation (p.R201H) who are currently aged 35 (SVK1) and 21 years (SVK2). These individuals were switched from insulin to sulfonylurea in 2005. Data from the first 4 (SVK2) and 8 years (SVK1) of the follow-up showed improved diabetes control and increased quality of life for both individuals. During the following years, however, both individuals failed to retain good diabetes control (HbA1c ≤ 53 mmol/mol; 7.0%). We therefore changed the therapy to a combination of insulin and sulfonylurea in both individuals, or to insulin monotherapy in SVK1, and compared the effects on HbA1c with those of sulfonylurea monotherapy. HbA1c levels in both individuals worsened after adding insulin to sulfonylurea [67 mmol/mol (8.3%) vs 77 mmol/mol (9.2%) in SVK1 and 106 mmol/mol (11.8%) vs 110±19 mmol/mol (12.2±1.7%) in SVK2], and after switching to only insulin therapy in SVK1 [57 mmol/mol (7.4%) vs 62 mmol/mol (7.8%)] when compared with sulfonylurea monotherapy. Discussion Our data show that sulfonylurea monotherapy might be preferable to insulin in people with permanent neonatal diabetes mellitus sensitive to sulfonylurea even when HbA1c is above target.

Adolescents with type 1 diabetes mellitus (T1DM) are at increased risk for poor treatment adherence and glycaemic lability. Parental involvement in a youth's diabetes regimen is associated with better outcomes, yet supported treatments may be inaccessible due to limited community resources and financial constraints. Furthermore, existing interventions emphasise a collaborative effort between family members, which may not be effective with youth with particular vulnerabilities. Similarities between T1DM and anorexia nervosa prompted our use of modified family-based therapy (FBT) with a 16-year-old male with poor glycaemic control. FBT-guided strategies were brief and implemented by a family medicine physician at routine visits. Medical symptoms dramatically improved over a four-month period, demonstrating that FBT tailored to T1DM warrants further investigation for youth with poor treatment adherence. Copyright © 2017 John Wiley & Sons.

Introduction: Diabetes Mellitus (DM) is a global health problem, characterised by high levels of glucose in blood with impairment of carbohydrate, fat and protein metabolism. Patients with DM have a high risk of developing atherothrombotic events. This leads to initiation and progression of microvascular and macrovascular complications. Aim: To compare the coagulation profile parameters in patients with Type 2 DM with good glycaemic control (Glycated Haemoglobin (HbA1c)

Introduction and objectives Erectile dysfunction (ED) is one of the main threats in diabetic patients. This research aimed to assess the relationship between glycated hemoglobin (HbA1c) level and pharmacopenile duplex ultrasonography (PPDU) indices in diabetic patients with ED. Materials and methods A total of 130 males with ED were recruited (100 had diabetes mellitus (DM) and 30 did not as control). The International Index of Erectile Function (IIEF) was used to evaluate patients for ED. Measurement of HbA1c, lipid profile and assessment of erectile function using PPDU were performed. All participants were assessed to take the medical history. Results The mean age ± SD was 53.8 ± 8.9 and 53.6 ± 2.8 years for patients and controls, respectively. Patients had variable grades of ED: mild in 20%, mild to moderate in 32.3%, moderate in 35.3%, and severe in 12.3%. A significant association was found between the existence of DM and a deprived response to intracorporeal injection (ICI), rising end-diastolic velocity (EDV), and reducing resistance index (RI) values. Comparing all diabetic groups according to HbA1c with controls, a significant relationship was found in; severity of IIEF-5 score, poor response to ICI, decreased peak systolic velocity (PSV) at 10 min, increased EDV at 10, 20 min and decreased RI at 10, 20 min. A significant relationship was found between smoking, dyslipidaemia, and decreased PSV at 10, 20 min and decreased increment ratio. However, a non-significant relationship was observed between age, type of DM and PPDU parameters. Conclusion Poor glycaemic control of DM is associated with an increase in EDV and decrease in RI, and PSV of PPDU.

Poor glycaemic control elevates the risk for vascular complications. Biomarkers for predicting susceptibility to glycaemic worsening are lacking. This 3-year prospective analysis assessed the utility of several circulating diabetes-related biomarkers for predicting loss of glycaemic control, and their contribution to albuminuria progression in type 2 diabetes mellitus (T2DM).T2DM subjects with adequately-controlled diabetes (HbA1c 8%) at initial recruitment were analysed (N = 859). Baseline plasma levels of osteoprotegerin (OPG), C-reactive protein (CRP), adiponectin, intercellular-cell adhesion molecule-1, and vascular-cell adhesion molecule-1 were quantified using immunoassay. Definitions for development of uncontrolled diabetes and albuminuria progression were HbA1c ≥ 8.0% and increase in albuminuria category at follow-up, respectively.At follow-up, 185 subjects developed uncontrolled diabetes. Higher baseline CRP and OPG levels were observed in the high-risk individuals, and predicted increased risk for developing uncontrolled diabetes. OPG, but not CRP, was associated with albuminuria progression after multivariable adjustment. The relationship was attenuated following adjustment for development of uncontrolled diabetes, which emerged as a significant associate. Mediation analysis revealed that loss of glycaemic control explained 64.5% of the relationship between OPG and albuminuria progression.OPG outperformed other diabetes-related biomarkers to be a potentially useful biomarker for predicting loss of glycaemic control and its associated albuminuria deterioration.

Background and objectives Poorly controlled type 2 diabetes mellitus (T2DM) is the number one cause of premature deaths, hospital admissions and disability in Fiji. The purpose of this qualitative study was to determine healthcare providers' perceptions of factors associated with glycaemic control. Method Three focus group discussions were conducted with 19 healthcare providers selected through purposive variation sampling in three selected diabetes clinics in Suva, Fiji, in August 2017 and analysed using thematic analysis. Results Five themes on factors associated with poor glycaemic control emerged: patients' adherence to treatment and management plans, attitudes, knowledge about diabetes, culture/beliefs and support. Other factors that play a pivotal part in achieving good glycaemic control are healthcare providers' behaviour and addressing patient's caregiver issues DISCUSSION: Knowing how to empower patients with T2DM to manage the different patient-related factors associated with poor glycaemic control at first encounter will assist healthcare providers to deliver high-quality patient-centred diabetic care services and achieve better health outcomes in patients.

Increased adiposity confers elevated risk for diabetic kidney disease (DKD) progression in type 2 diabetes mellitus (T2DM). This 3-year prospective study examined whether worsening of metabolic control e.g. development of uncontrolled diabetes mediated the relationship between increased adiposity and DKD deterioration.T2DM subjects who had adequately controlled diabetes (HbA1c 8%) at initial recruitment were analysed (N = 853). HbA1c ≥ 8% at follow-up was classified as development of uncontrolled T2DM. Absolute changes in body weight (ΔWeight), body mass index (ΔBMI), and body fat mass (ΔBFM) were calculated by subtracting baseline from follow-up values. DKD deterioration (outcome) was defined as an increase in the composite ranking of relative risk by glomerular filtration rate and albuminuria levels (Kidney Disease: Improving Global Outcomes 2009).Subjects with deteriorated DKD displayed lower reduction in body composition at follow-up than those who remained stable or/improved (all P 0.05). In separate regression models, ΔWeight (risk ratio (RR):1.04, 95% CI:1.01-1.06), ΔBMI (RR:1.07, 95% CI:1.01-1.13), and ΔBFM (RR:1.03, 95% CI:1.01-1.06) were independently associated with worsened DKD. The associations were attenuated after accounting for the loss of glycaemic control. Binary mediation analysis revealed that the development of uncontrolled diabetes explained 41.7%, 45.4% and 39.7%, respectively, of the effects of ΔWeight, ΔBMI and ΔBFM on the outcome.Among T2DM individuals who had adequately-controlled T2DM at initial recruitment, the relationship between gain in adiposity and DKD deterioration is mediated by the development of poor glycaemic control over time. Therefore, preventing worsening adiposity and hyperglycaemia is pivotal to impede DKD progression.

Diabetes in older adults has shown an increase in prevalence, especially in urban areas of Indonesia. This study aimed to assess the relationship between self-efficacy in physical activity and glycemic control in older adults' population with diabetes mellitus in Indonesia. This research used cross sectional design that involved 52 adults with diabetes, aged between 55-90 years old who regularly attended the older adult's health post (Posyandu Lansia) at Jagir Sub-district, Surabaya. Those who had physical disabilities were excluded from the study. Questionnaires were used to measure the physical activity and two types of self-efficacy whilst the glycemic control was measured using HbA1c in basal condition. The relationship between the variables was tested using Pearson and partial correlation test. Results show that the level of physical activity was insufficient (216.4 ± 343.5 MET) with only 32.7% (N = 17) of the participants was categorized as being physically active. The mean of the HbA1c indicated poor glycaemic control (8.63 ± 2.34%) with majority of them (76.9%, N = 40) was in the poor glycaemic control group (HbA1c ≥ 6.5%). Their self-efficacy was at the average level (Against the barriers:52.65 ± 13.23; Engage in physical activity: 59.06 ± 26.2). The self-efficacy in performing the physical activity was found significantly related to the duration of physical activity (r = 0.278, p = 0.046). Other relationships, however, were not significant (p > 0.05). In conclusion, self-efficacy to engage in physical activity is paramount to increase the physical activity among the older adults. Nevertheless, further longitudinal research on self-efficacy in physical activity management is needed., Glycemic control, HbA1c, Self-efficacy, Physical activity, Health and wellbeing.

The choice of type and quantity of food is vital to achieving glycaemic control in diabetes, more so in type 1 diabetes mellitus. The attention to detail could however reach a level of obsession of an eating disorder and thereby have a negative impact on glycaemic control. We conducted a study to see if there was a risk of developing eating disorders among adolescent, young and middle-aged adults with type 1 diabetes mellitus and whether it has an association with HbA1C levels. A cross-sectional study was conducted on 113 type 1 diabetes mellitus patients and age-gender-matched healthy controls. The two groups were screened using the Eating Attitude Test-26 (EAT-26) questionnaire. EAT-26 identified type 1 diabetes as having a high risk for developing eating disorder when compared to those without diabetes (OR = 38.5 with 95% CI 8.7, 170.7; p < 0.001). The risk of developing eating disorder increased with the duration of diabetes. There was no significant difference in the risk between males and females. The risk of developing eating disorder did not correlate with glycaemic control. EAT-26 identified subjects with type 1 diabetes as high risk for developing eating disorder in comparison to those without diabetes. In our setting, this did not reflect on poor glycaemic control.

Pooled participant-level data from 16 RCTs (≥ 24 weeks) were used to explore the association of demographic and clinical markers with different levels of HbA1c achieved at Week 24 in insulin-naive people with T2DM on oral agents after starting insulin glargine 100 U/mL (Gla-100). A stepwise logistic regression analysis was performed to identify potential predictive and exploratory factors for attaining an HbA1c < 7.0%. In total, 46%, 37%, and 17% of 3,415 participants (53% male) included in the analysis achieved Week 24 HbA1c < 7.0%, 7.0-8.0%, and > 8.0%, respectively. Key clinical findings and multivariate analysis results are shown in the Table. Sex, diabetes duration, baseline BMI, HbA1c, FPG, and overall 2h-PPG were significant predictors of attaining HbA1c < 7.0% at Week 24, whereas change in FPG or 2h-PPG were not. FPG and 2h-PPG levels in the HbA1c > 8.0% group remained highest despite a higher Gla-100 dose (0.52 U/kg) and lower overall hypoglycaemia (PG < 3.9 mmol/L) rate at Week 24. In people with T2DM, high baseline HbA1c, FPG, and PPG levels are important predictors of failure of basal insulin/OAD therapy to achieve desired glycaemic goals. A more active treatment strategy targeting both fasting and postprandial hyperglycaemia appears to be indicated for people with poor glycaemic control after starting basal insulin therapy. Disclosure D.R. Owens: Consultant; Self; Boehringer Ingelheim GmbH, Roche Diagnostics Corporation, Eli Lilly and Company, Sanofi, Takeda Development Centre Europe Ltd.. Speaker's Bureau; Self; Boehringer Ingelheim GmbH, Roche Diagnostics Corporation, Eli Lilly and Company, Sanofi, Takeda Development Centre Europe Ltd. W. Landgraf: Employee; Self; Sanofi-Aventis Deutschland GmbH. Stock/Shareholder; Self; Sanofi. M. Zhang: Employee; Self; Sanofi US. Stock/Shareholder; Self; Sanofi US. B.M. Frier: Advisory Panel; Self; Novo Nordisk A/S, Eli Lilly and Company. Consultant; Self; Locemia Solutions, Zucara Therapeutics. Speaker's Bureau; Self; Novo Nordisk A/S, Eli Lilly and Company, Roche Pharma, AstraZeneca. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Sanofi US, Novo Nordisk Inc.. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; American Diabetes Association. P. Home: Consultant; Self; AstraZeneca. Other Relationship; Self; Biocon, Boehringer Ingelheim GmbH. Research Support; Self; GlaxoSmithKline plc.. Consultant; Self; Hanmi Pharmaceutical. Other Relationship; Self; Janssen Research & Development. Consultant; Self; Janssen Research & Development, Merck & Co., Inc.. Other Relationship; Self; Merck & Co., Inc.. Research Support; Self; Merck & Co., Inc.. Other Relationship; Self; Novo Nordisk A/S. Consultant; Self; AntriaBio, Inc., Earlysign, Roche Diabetes Care Health and Digital Solutions. Research Support; Self; Sanofi. Consultant; Self; Sanofi. G.B. Bolli: Speaker's Bureau; Self; Menarini Group, Sanofi. Research Support; Self; Sanofi.

AIMS AND OBJECTIVES To determine the views of nurses and physicians working in intensive care units (ICU) about the aims of glycaemic control and use of their protocols. BACKGROUND Evidence about the optimal aims and methods for glycaemic control in ICU is controversial, and current local protocols guiding practice differ between ICUs, both nationally and internationally. The views of professionals on glycaemic control can influence their practice. DESIGN Cross-sectional, multicentre, survey-based study. METHODS An online short survey was sent to all physicians and nurses of seven ICUs, including questions on effective glycaemic control, treatment of hypoglycaemia and deviations from protocols' instructions. STROBE reporting guidelines were followed. RESULTS Over half of the 40 respondents opined that a patient spending

BACKGROUND Diabetic patients are commonly hyperglycaemic on presentation. Admission hyperglycaemia is associated with adverse outcomes, particularly prolonged hospitalisation. Improving inpatient glycaemia may reduce length of hospital stay (LOS) in diabetic patients. AIMS To determine whether in-hospital recognition and treatment of admission hyperglycaemia in diabetic patients is associated with reduced LOS. METHODS Medical records were reviewed from 1 November 2011 to 31 May 2012 for 162 diabetic patients admitted with a blood glucose level (BGL) ≥11.1mmol/L. In-hospital outcomes were compared. Stepwise multiple regression was used to evaluate factors contributing to LOS. RESULTS Compared to the untreated individuals (n=67), hyperglycaemia treatment (n=95) was associated with a longer LOS (median eight vs. four days, p

Objective. To identify the number of haemodialysis patients with diabetes in a large NHS Trust, their current glycaemic control, and the impact on other renal specific outcomes.Design. Retrospective, observational, cross-sectional study.Methods. Data was collected from an electronic patient management system. Glycaemic control was assessed from HbA1c results that were then further adjusted for albumin (Alb) and haemoglobin (Hb). Interdialytic weight gains were analysed from weights recorded before and after dialysis, 2 weeks before and after the most recent HbA1c date. Amputations were identified from electronic records.Results. 39% of patients had poor glycaemic control (HbA1c > 8%). Adjusted HbA1c resulted in a greater number of patients with poor control (55%). Significant correlations were found with interdialytic weight gains (P<0.02,r=0.14), predialysis sodium (P<0.0001,r=-1.9), and predialysis bicarbonate (P<0.02,r=0.12). Trends were observed with albumin and C-reactive protein. Patients with diabetes had more amputations (24 versus 2).Conclusion. Large number of diabetic patients on haemdialysis have poor glycaemic control. This may lead to higher interdialytic weight gains, larger sodium and bicarbonate shifts, increased number of amputations, and possibly increased inflammation and decreased nutritional status. Comprehensive guidelines and more accurate long-term tests for glycaemic control are needed.

The lack of population-based evidence on the risk factors for poor glycaemic control in diabetics, particularly in resource-poor settings, is a challenge for the prevention of long-term complications. This study aimed to identify the metabolic and demographic risk factors for poor glycaemic control among diabetics in a rural community in Malaysia. A total of 1844 (780 males and 1064 females) known diabetics aged ≥ 35 years were identified from the South East Asia Community Observatory (SEACO) health and demographic surveillance site database. 41.3% of the sample had poor glycaemic control. Poor glycaemic control was associated with age and ethnicity, with older participants (65+) better controlled than younger adults (45–54), and Malaysian Indians most poorly controlled, followed by Malay and then Chinese participants. Metabolic risk factors were also highly associated with poor glycaemic control. There is a critical need for evidence for a better understanding of the mechanisms of the associations between risk factors and glycaemic control.

Background: Glycaemic control is suboptimal in a large proportion of people with type 2 diabetes who are consequently at an increased and avoidable risk of potentially severe complications. We sought to explore attitudes and practices among healthcare professionals that may contribute to suboptimal glycaemic control through a review of recent relevant publications in the scientific literature. Methods: An electronic search of the PubMed database was performed to identify relevant publications from January 2011 to July 2015. The electronic search was complemented by a manual search of abstracts from key diabetes conferences in 2014/2015 available online. Results: Recently published data indicate that glycaemic control is suboptimal in a substantial proportion (typically 40%–60%) of people with diabetes. This is the case across geographic regions and in both low- and higher-income countries. Therapeutic inertia appears to be an important contributor to poor glycaemic control in up to half of people with type 2 diabetes. In particular, prescribers are often willing to tolerate extended periods of ‘mild’ hyperglycaemia as well as having low expectations for their patients. There are often delays of 3 years or longer in initiating or intensifying glucose-lowering therapy when needed. Conclusion: Many people with type 2 diabetes are failed by current management, with approximately half not achieving or maintaining appropriate target blood glucose levels, leaving these patients at increased and avoidable risk of serious complications. Review criteria: The methodology of this review article is detailed in the ‘Methods’ section.

Children and young people who manage diabetes with injection therapy are at risk of using a poor technique. This may have serious consequences, including poor glycaemic control, leading to the longer term complications of diabetes. The Forum for Injection Technique (FIT) is an international body that promotes best practice in injection technique. This article summarises the forum's UK-specific guidance, with particular reference to the nursing care of children and young people with diabetes. The FIT UK board, of which the author is a member, consists of experienced diabetes specialist nurses.

The aim of this study was to investigate the reasons for patients with type 2 diabetes continuing to attend a specialist clinic with an active discharge policy. Clinic letters of 526 patients with type 2 diabetes who attended annual review over one year were audited to identify the major reasons for them remaining in the clinic. The majority of patients (97.3%) fulfilled current specialist clinic criteria for remaining in the clinic. Poor glycaemic control, nephropathy, ongoing changes to management and diabetes foot problems were common reasons found. In 9% of cases, patient choice was identified as a factor. For 2.7% of patients no clear reason could be identified. It was concluded that while most patients fulfilled the criteria to continue attending the clinic at that time, some patients chose to remain even though they were fit for discharge. The reasons why patients choose to remain under secondary care need to be investigated as they could guide how primary and secondary care should work together. Copyright © 2013 John Wiley & Sons.

Although there is strong evidence that supports the appropriate control of intraoperative glycaemic levels, there is little literature we are aware of that assesses how well perioperative physicians manage it. This project describes an audit of intraoperative glycaemic control at Victoria General Hospital in Victoria, British Columbia, Canada. There were 51 surgical patients included in the audit that took place over 19 days. The results showed that 25.5% of patients included in the audit had a blood glucose level outside the ideal range. Due to the association between poor glycaemic control and increased morbidity and mortality, we found this percentage left considerable room for improvement. We make several recommendations, including the introduction of an evidence-based protocol that guides anaesthetists when to measure and, if clinically indicated, correct intraoperative glycaemic levels.

Background Inpatient hyperglycaemia and diabetes mellitus (DM) are common and are associated with an increased risk of complications and mortality. The severity of hyperglycaemia determines the rate of complications in patients treated in the emergency department (ED). Our aim was to examine whether determination of the capillary haemoglobin A1c (HbA1c) is a reliable method for detecting unknown diabetes and poor glycaemic control in the ED. Methods A prospective observational study was conducted in adult (>18 years) patients treated in a single-centre ED. We compared the results of HbA1c levels measured by Bio-Rad in2it point-of-care device on a capillary blood sample and by the hospital laboratory. Results A total of 187 ED patients with an average age of 57.1 ± 19.2 years were studied. The mean HbA1c value was 5.78 ± 1.26 % by capillary POC testing and 6.10 ± 1.12 % by the hospital laboratory (correlation = 0.712, P 126 mg/dL and/or HbA1c > 6.5 %) was made in ten (5.4 %) additional cases (prior undiagnosed DM) for a total prior DM prevalence of 22.5 % (95 % CI 16.4–28.5 %). Capillary HbA1c detected 11 additional cases of unknown DM (5.9 %). A capillary HbA1c value greater than 6 % has a sensitivity of 85.7 % and specificity of 85.3 % for the screening of DM. Conclusions Determination of the capillary HbA1c in the ED is a reliable, fast, and simple system for the screening of unknown or uncontrolled DM.

Recreational drug use during 'rave' parties is increasingly popular, but the impact of recreational drug use in type 1 diabetes (T1D) is not known. We determined the self-reported pattern and effects of recreational/illicit drug use in Australians with T1D people by inviting people with T1D to participate in an anonymous online/paper survey of drug use, through national radio broadcast and online/hospital advertising. Of the people with T1D who responded to our survey, more than three quarters reported having used recreational/illicit drug, but few people had informed health professionals about drug use. Drug use was associated with worse glycaemic control and higher risk of diabetic ketoacidosis. Medical awareness of common, currently underreported, drug use in young people with T1D is essential. It offers the possibility of helping such patients improve related suboptimal metabolic control.

SUMMARY With appropriate multi-disciplinary team care, most women with diabetic nephropathy will have successful pregnancy outcomes; however, pregnancy complications are increased compared to non-diabetic individuals, particularly in those with poor glycaemic control. Women with more severe renal impairment, especially those with hypertension and proteinuria at are highest risk of worse pregnancy outcomes and deterioration in pre-existing renal function. Pre-pregnancy counselling should be offered to all women with diabetes in order to optimise diabetic care, and inform women of potential complications. Pregnancy is an indicator of long-term health, and may indicate important issues for the future management of women with diabetic nephropathy.

Background Adolescence is a period associated with poor glycaemic control. The key developmental concerns of young people are in conflict with the requirements of diabetes self-management. This study explores the relative influence of adolescents' and caregivers' illness representations and how any difference/similarity in their representations may be related to adolescents' diabetes self-management. Methods Fifty-five adolescents between 12 and 16 years of age were asked to complete the Diabetes Illness Representation Questionnaire and Summary of Diabetes Self-Care Activities Questionnaire. Their primary caregivers were asked to complete a caregivers' version of the Diabetes Illness Representation Questionnaire. Results Caregivers believed diabetes to be more chronic, to have a more negative impact, pose more of a threat to adolescents' health and believed more strongly in the effectiveness of treatment than did adolescents. Caregivers' representations about the impact of diabetes and the ability of treatment to prevent future complications were related to adolescents' dietary self-management. Conclusions This study emphasizes the important role of significant others illness representations in adolescent self-management of diabetes.

AIM: To evaluate the correlation between metabolic control and the presence and severity level of diabetic retinopathy (DR) in patients with diabetes type 2. METHODS: This cross-sectional study included 80 patients divided into four groups according to the duration of the disease: de novo; up to 10 years; from 11 to 20 years; and over 20 years. In order to evaluate the metabolic control each patient was tested for: glycosylated hemoglobin (HbA1c), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG). According to eye fundus changes patients were classified following the American Academy of Ophthalmology classification. RESULTS: The patients with DR had significantly increased values of HbA1c. (9.5 ± 1.83%) and decreased values of HDL-C (1.1 ± 0.21 mmol/L) compared to patients without DR (6.9 ± 1.29%, t = 5.088; p < 0,001) and (1.3 ± 0.25 mmol/L, t = 3.022; p < 0.01) respectively. The presence and severity level of DR correlated positively with HbA1c values (p < 0.001) and poor glycaemic control (p < 0.001) while HDL-C values correlated inversely with the presence (p < 0.01) and severity level of DR (p < 0.05). CONCLUSION: Poor metabolic control determined by the increased values of HbA1c and decreased values of HDL-C correlates with the presence and severity of DR.

Background: Diabetic patients develop systolic and diastolic dysfunction without even associated coronary artery disease. But diastolic dysfunction is more prevalent in diabetic patients than systolic dysfunction and usually occurs before onset of symptoms. Recognition of early diastolic dysfunction is likely to make management better and avoids progression of cardiac dysfunction. This study was conducted in patients of Diabetes mellitus without other comorbidities.Methods: The present study which is cross sectional and was carried out among outpatients and inpatients of tertiary care hospital of Armed forces and involved army personnel and their dependents and sample size was 100 patients.Results: The prevalence of diastolic dysfunction among our study participants was found to be 36%. Diastolic dysfunction was found to be significantly higher among elderly individuals (60%) when compared to young study participants. (p

The number of people with diabetes worldwide is projected to reach 380 million by 2025, with 90% of these cases attributed to type 2 diabetes. Diabetes can cause a range of long-term complications, including heart disease, stroke and blindness. Studies have shown that poor glycaemic control can increase the risk of developing these complications and guidelines have been developed that provide recommendations on how best to manage diabetes and encourage good glycaemic control. However, a number of barriers to achieving good glycaemic control remain and in many parts of the world treatment is suboptimal. It is generally agreed that glycosylated haemoglobin (HbA1c) testing represents the best way to monitor blood glucose levels. Yet many doctors lack the time and resources required to implement recommended guidelines on HbA1c monitoring. Consequently, patients have a lack of understanding of HbA1c testing and do not achieve target levels. Nurses have an important role to play in treating diabetes. Ev...

Background Hospitalised patients with diabetes often have poor glycaemic control. To improve the management of hospitalised patients with diabetes, a new insulin chart incorporating documentation of blood glucose levels was developed and introduced at St Vincent's Hospital, Sydney. Aim To evaluate the impact of a new insulin chart on the management of hospitalised patients with diabetes. Method A retrospective study comparing the management of three groups of hospitalised diabetic patients. The use of insulin and management of hypoglycaemic events before and after the introduction of the new insulin chart were compared. Clinical data were collected from medical records from April 2004 to April 2005. Chi-square tests were performed to analyse the data for significant differences. Results Post-implementation of the new insulin chart, patients seen by the endocrine team were more frequently ordered regular insulin (p < 0.017) than patients not managed by the endocrinologists. The number of omitted doses of regular insulin remained unchanged. Poor cross-referencing of the insulin and standard medication charts may have been a contributing factor. Post-implementation, significantly more hypoglycaemic events were treated according to the hospital's protocol (p < 0.001). Staff satisfaction with the new insulin chart was high except for some doctors' dissatisfaction with the chart when ordering regular insulin. Conclusion Introduction of the new insulin chart had a positive impact on the management of hypoglycaemic events. Other aspects of diabetes management, such as the number of patients on regular insulin and insulin dose omissions were suboptimal.

We studied a new teamwork-based teleconsultation model for treating patients with diabetes, where a specialist in diabetes care, a diabetes nurse and a patient attended by videoconference. The study series consisted of all the patients ( n = 101) at three health centres in northern Finland whose care was provided by a single physician at a remote diabetes clinic. A total of 101 patients with diabetes (19 of type 1 and 82 of type 2) were studied at baseline and at 10–14 months after the first consultation. Mean HbA1c was 8.0% at baseline and 7.6% at follow-up ( P = 0.007). The proportion of patients with poor glycaemic control decreased from 32% to 13%. Mean LDL cholesterol was 3.3 mmol/L at baseline and 2.7 mmol/L at follow-up ( P < 0.001). The percentage of patients with optimum lipid levels increased from 20% to 50%. Mean systolic blood pressure was 146 mmHg at baseline and had decreased by 6 mmHg at follow-up ( P = 0.004). The percentage of patients with poor blood pressure control decreased from 19% to 8%. The most common changes in medication were the introduction or modification of insulin treatment and the introduction of statin and antihypertensive drugs and acetylsalicylic acid. Although the study was uncontrolled, there were improvements in glucose and LDL cholesterol levels and blood pressure in patients who were managed by teleconsultation.

Background Recent recommendation advocates the reporting of HbA1c in terms of mean plasma glucose. We examined the impact of improving patients' interpretation of a given HbA1c value on glycaemic control. Methods We conducted a questionnaire survey among 111 patients attending a hospital diabetes clinic. Patients were provided with information relating to the association between HbA1c and mean plasma glucose levels. Glycaemic control among 80 patients with poor glycaemic control was assessed before and approximately seven months after such intervention. Results Of the respondents, 40.5% (45/111) were familiar (F) (31 type 1, 14 type 2) and 59.5% (66/111) were unfamiliar (U) (23 type 1, 43 type 2) with the term HbA1c. Following information about the interpretation of HbA1c, patients with poorly controlled diabetes (HbA1c >9%) showed a significant reduction in HbA1c levels if they were from group U (10.7% vs. 9.5%, P = 0.04) but not from group F (10.5 vs. 9.8, P = 0.28). Patients with moderately poor glycaemic control (HbA1c 7.5–9%) showed no significant change in HbA1c levels following intervention (8.3% vs. 8.2%, P = 0.57 group U; 8.3% vs. 8.2%, P = 0.79 group F). Conclusion Patients' knowledge of HbA1c is poor, especially among persons with type 2 diabetes. Improvement in patients' understanding of HbA1c, particularly among those with very poorly controlled diabetes with no prior knowledge of HbA1c is associated with improvement in their glycaemic control. Strategies to engage patients to know and interpret their HbA1c values should be encouraged within routine clinical practice.

Diabetes mellitus has become an onerous disease to developing countries such as Nigeria. Rapid acceptance of urbanisation and sedentary life styles pose an encumbrance to its prevention and management. Increased oxidative stress in diabetes mellitus has been implicated as a culprit in perpetuating antioxidant depletion and diabetic complications in diabetes mellitus individuals. This study aims to evaluate the level of antioxidant status in type 2 diabetes mellitus (DM) female participants visiting the out-patient diabetic clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria. A total of 86 participants aged 51±10 years were recruited for this study. The test group consists of 43 already confirmed type 2 diabetes mellitus females, while the control group consists of 43 apparently healthy females. The test subjects were further subgrouped into good and poor glycaemic control groups, using a cut-off of7% for HbA1c. Whole blood was collected from participants and aliquoted into specified sample containers for analysis of the following parameters: random blood glucose (RBG; mg/dL), glycosylated haemoglobin (HbA1c; %), glutathione reductase (GR; U/L) and total antioxidant status (TAS; mmol/L). Results from this study showed that the mean differences in RBG (197.74±49.29 mg/dL) and HbA1c (9.86±1.44%) were significantly higher in the test group compared to the control group RBG (104.79±11.33 mg/dL) and HbA1c (5.21±1.23%) (P0.05). The mean differences of GR (45.81±20.45 U/L) and TAS (1.81±1.04 mmol/L) were significantly lower in the test group compared to the control group GR (61.21±14.34 U/L) and TAS (2.73±2.08 mmol/L) (P0.05). The poor glycaemic test group was observed to have the highest RBG (200.34±50.4 mg/dL) and HbA1c (10.23±1.33%) compared both to good glycaemic test group RBG (186.38±45.39 mg/dL), HbA1c (6.54±0.45%) and non-diabetic group RBG (104.79±11.33 mg/dL) and HbA1c (5.21±1.23%) (P0.05). Glutathione reductase (40.66±15.48 U/L) and TAS (1.80±1.08 mmol/L) were significantly more depleted in the poor glycaemic test group compared to the non-diabetic group GR (61.21±14.34 U/L), TAS (2.73±2.08 mmol/L) and good glycaemic test group GR (68.38±25.09 U/L), TAS (1.86±0.92 mmol/L) (P0.05). Out of the 43 participants in the test group, only 18.6% had good glycaemic control and 81.4% had poor glycaemic control. There were significant negative correlations between RBG and TAS (r=-0.260; P=0.015); RBG and GR (r=-0.403; P=0.000) and HbA1c and GR (r=-0.471; P=0.000) (P0.05). However, HbA1c and TAS showed no significant correlation (r=-0.170; P=0.119) (P0.05). This study concludes that there is antioxidant depletion in females with type 2 diabetes.