Search

BackgroundApproximately 20.8 million people in the United States, or 7% of the population, have diabetes mellitus. Treatment for this disease costs Americans more than $130 billion yearly, and it is the sixth leading cause of death. The prevalence of diabetes has grown substantially in recent decades and is expected to continue to rise. ContextThe medically underserved and poor are at greater risk of developing diabetes and its complications than are other members of the U.S. population. The Health Resources and Services Administration makes health care resources and services available to economically disadvantaged populations through the Health Disparities Collaborative (HDC), a consortium formed to pool resources and services from state- and community-level donors. Since 1999, many of the Centers for Disease Control and Prevention’s Division of Diabetes Translation State Diabetes Prevention and Control Programs (DPCPs) have joined the HDC to leverage resources and services.MethodsThe purpose of a 2004 evaluation was to examine the impact that DPCP involvement with the Collaborative had on aspects of diabetes care at Federally Qualified Health Centers (FQHCs). An electronic survey was administered to DPCP coordinators. They were asked about 1) their roles and experience as participants in the Collaborative; 2) the skills and expertise most useful in developing and maintaining an effective collaboration for improved health care for diabetes; 3) which DPCP contributions were viewed as being routine and which were perceived to be essential; 4) the effects of DPCP contributions on the use of the chronic care model under which FQHCs operate; and 5) which health systems improvements played the greatest role in enhancing components of the chronic care model.ConsequencesMost respondents identified themselves as DPCP coordinators with 3 years of experience in that position. Organizational skills, such as communication, leadership, conflict resolution, negotiation, and meeting management, were cited as necessary to develop and maintain collaborative partnerships. DPCP contributions to FQHCs were perceived to be training, technical assistance with clinical care and patient education, financial resources, linkages to other diabetes partners, educational materials, and improved linkages with community resources.InterpretationDPCPs contribute resources, skills, knowledge, and varied perspectives to the Collaborative that FQHCs may not have otherwise.

Abstract: This work compares three well-known models and simulators in terms of their use in the analysis and design of glucose controllers for patients with Type 1 Diabetes Mellitus (T1DM). The objective is to compare them in practical scenarios which include: model uncertainty, time variance, nonlinearities, glucose measurement noise, delays between subcutaneous and plasma levels, pump saturation, and real-time controller implementation. The pros and cons of all models/simulators are presented. Finally, the simulators are tested with different robust controllers in order to identify the difficulties in the design and implementation phases. To this end, three sources of uncertainty are considered: nonlinearities, time-varying behavior (intra-patient) and inter-patient differences. [Copyright &y& Elsevier]

China has a high burden of drug-resistant tuberculosis (TB) and diabetes mellitus (DM). The objectives of this study were to determine the following in patients with culture-confirmed TB: 1) demographic characteristics and disease patterns in relation to the presence or absence of type 2 diabetes and 2) presence or absence of drug resistance to isoniazid (INH), rifampicin (RMP) or both in relation to duration of diabetes and control of diabetes. This is a cross-sectional and retrospective study involving record reviews. There were 621 patients with culture-positive TB, of whom 187 (30%) had previously known or new type 2 diabetes. In those with diabetes, there was a significantly higher proportion of males, persons aged ≥35 years and patients registered with new TB (p<0.05). Prevalence of multidrug-resistant TB (MDR-TB) was 6.2% in new patients (N=422) and 62.3% in previously treated patients (N=199), with no significant differences between those with and without diabetes. In patients with diabetes, there was no association of drug resistance with diabetes duration or disease control [assessed by fasting blood glucose (FBG) at 1 week]. A high proportion of patients with TB in a tertiary health facility, Beijing, China, had diabetes, but there was no association between type 2 diabetes and drug-resistant TB. Further prospective studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Training and continuous dynamic communication between patients and health professionals in chronic diseases like diabetes, is important. The aim of this study is to evaluate the effects of diabetes self care group education and nurse telephone follow up on glycemic control and compliance with treatment orders in patients with type 2 diabetes attending to diabetes clinic in khomein. Methods: In this clinical trial, 62 patients with type 2 diabetes who attending to the diabetes clinic selected and were randomly assigned to experiment and control groups. Self care group education was applied for case group (n = 31) and they were followed up using telephone calls for 12 weeks by a nurse. The control group (n = 31) received the conventional management. Demographic characteristics, compliance with treatment recommendations (diet, drug use, exercise) and blood glucose control indices were recorded before and after interventions. Data were analyzed by SPSS software version 16 using independent t test, paired t test, Chi square test, non parametric tests, mixed model (ANOVA + repeated measure) and ANCOVA. Results: The mean age of intervention and control groups was 50.9 ± 7.3 and 55.1 ± 10.1 years, respectively. Blood glucose indices (FBS, 2 hpp BS, Hb A1C) were improved in both case and control group after intervention but it was only statistically significant in case group P > 0.0001. During study, percentage of patients with very good compliance in control group decrease from 12.5% to zero (0%), whereas in experiment group these amounts increase from 6.5% to 90.3% P > 0.0001. Conclusions: According to the results of the current study self care group education and 12 weeks follow up by a nurse using telephone causes significant improvement in metabolic parameters and adherence to treatment recommendations in diabetic patients. [ABSTRACT FROM AUTHOR]

Aims To evaluate the self-perception of diabetes control associated with physical indicators and with practicing exercise and a healthy diet, among rural residents. Background It remains unclear whether a subject's self-perception of diabetes control increases its deleterious effects. Design Cross-sectional, correlational. Methods We recruited 715 participants from 18 primary healthcare centres in the rural regions of Chiayi County, Taiwan. Data were collected between 1 January 2009-30 June 2010. Logistic regression was conducted to identify the determinant factors associated with perceptions of diabetes control. Results A high percentage of participants overestimated their fasting blood glucose and HbA1C status. Total cholesterol, triglyceride, low density lipoprotein cholesterol, blood pressure, and waist circumference exceeded the medical standard in the 'feel good' group, and many did not adopt a healthy diet and undertake physical activity. The final logistic regression model demonstrated that residents with diabetes who exercised frequently had normal fasting glucose, and normal HbA1C tended to perceive 'feel good' control. Conclusion Misperception and unawareness of diabetes control were prevalent among rural residents. Addressing misperceptions among rural residents with diabetes and increasing their knowledge of professional advice could be important steps in improving diabetes control in an elder population. [ABSTRACT FROM AUTHOR]

Continuous glucose monitors (CGM), devices that can measure interstitial glucose in 'real time,' have become widely available particularly for use in patients with diabetes, and their accuracy and ease of use have greatly improved over the last decade. A number of large and well-controlled clinical trials have firmly established their usefulness in improving metabolic control (as measured by HbA1C) and decreasing time spent in hypoglycemia in adults; however, data have been less robust proving benefit in children and adolescents. Benefits are clearly linked to near-continuous wear. Insulin dosing algorithms based on CGM glucose trends have proven useful in dissecting the large volume of data generated daily by these devices, although these are imperfect tools, particularly in children. The technology is likely to be most useful when integrated with insulin pump delivery systems (sensor augmented). In this review, we concentrate on the analysis of published results of the largest trials in adults and children, including the very young, with diabetes. [ABSTRACT FROM AUTHOR]

Continuous glucose monitoring became more common in everyday clinical practice. New parameters have been created as a standard for assessing the degree of control for people with diabetes and can be used more clearly than glycated haemoglobin. The new parameter time in range represents a significant benefit not only for diabetologists, but also an important tool to help the patients in their daily lives with diabetes.

Introduction As the COVID-19 pandemic progressed, multiple barriers arose for patients and providers in the primary care setting. Despite the attempt to utilize telemedicine to overcome barriers, visits remained lower than pre-pandemic levels. This raises concern for preventative medicine and chronic disease management. Methods This study aimed to evaluate the impact of the pandemic in primary care by utilizing two years of data from a family medicine clinic. Data obtained from the electronic medical record for March 2019 through February 2020 and March 2020 through February 2021 were used to evaluate monthly trends from the year before the pandemic and the first year of the pandemic in the following six categories: hypertension control, diabetes control, lipid profile screening, breast cancer screening, colorectal cancer screening, and cervical cancer screening. Results The paired t-tests found a significant difference in the averages between the two years for all categories except hypertension control. The results for chi-square demonstrated a significant difference in four months for cervical cancer screening, five months for hypertension control and colorectal cancer screening, nine months for diabetes control and lipid profile screening, and 10 months for breast cancer screening. Conclusion These results show a profound impact of the pandemic on both preventative medicine and chronic disease management. This study had a large sample size but is not generalizable to the entire population. These results can help guide quality improvement measures going forward. However, further research is necessary to better understand the full extent of COVID-19's impact on primary care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Varandani et al.)

BACKGROUND: Hispanics in the United States represent diverse racial, ethnic, and socioeconomic groups, and manifest heterogeneous cardiovascular risks including diabetes. It is not known if there are residual differences in the control of diabetes among Hispanic groups given uniform access to diabetes care. OBJECTIVE: To evaluate glucose control differences among Mexicans, Puerto Ricans, and Dominicans receiving substantial diabetes care and support in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. DESIGN: Secondary analysis of data from a randomized trial comparing two treatment strategies: intensive, targeting glycated hemoglobin below 6.0 %, and standard, targeting glycated hemoglobin between 7.0 % and 7.9 %. PARTICIPANTS: Seven hundred and sixteen Hispanic and 6066 non-Hispanic white participants were recruited from 77 clinical sites across the United States and Canada. There were 243 Mexicans, 199 Puerto Ricans, and 150 Dominicans; and 135 of these Hispanic groups were born in the United States. MAIN MEASURE: Glycated hemoglobin RESULTS: Compared to Puerto Ricans, Mexicans were more likely (HR = 1.38, CI:0.90-2.10) and Dominicans as likely (HR = 1.01, CI:0.66-1.54) to achieve glycated hemoglobin goal in the intensive arm. Participants born in the United States achieved glycated hemoglobin goal at a higher rate than those born elsewhere (HR = 1.57, CI:0.99-2.51 in the intensive arm, HR = 1.51, CI:0.95-2.43 in the standard arm). These differences were not statistically significant. In the intensive arm, Puerto Ricans (OR = 0.47, CI:0.31-0.71), and Dominicans (OR = 0.41, CI:0.26-0.66) were less likely than non-Hispanic whites to achieve glycated hemoglobin goal, whereas the difference between non-Hispanic whites and Mexicans was not statistically significant, (OR = 0.66, CI:0.43-1.02). CONCLUSIONS: Hispanic groups, given access to comprehensive diabetes care, differed from each other non-significantly and had a variable divergence from non-Hispanic whites in achieving intensive glycated hemoglobin goal. These differences, if confirmed, could be due to such factors as variable acculturation and functional health literacy levels that were not measured in the ACCORD trial, but should be further explored in future studies. [ABSTRACT FROM AUTHOR]

Objectives: This study aims at investigating the effects of maintaining blood glucose levels between 120-150 mg/dl on diabetic patients undergoing myocardial revascularization. Methodology: The glucose control management in two groups of diabetic patients undergoing myocardial revascularization was compared; group (1) using insulin infusion to achieve a serum glucose level between 120-150 mg/dl, and group (2) a historical group of 145 patients with glucose control achieved by interval insulin dosing. Rates of wound infection (superficial and deep), Length of stay (ICU and hospital) and mortality were investigated. Results: There were four patients with superficial wound infection in the strict group (3.3%); whilst there were nine patients in the control group (6.2%) giving a significant p value. None of the study patients had deep seated wound infection compared with two patients in the control group (1.3%). ICU stay was 20±2 hours in the study group compared to 22±3 in the control group (p value > 0.05). In terms of hospital stay the study group had mean of 5.7±1.5 days compared to 6.8±2.5 days in the control group giving a P value < 0.05. Both groups had similar mortality rates. Group I had 5 hypoglycemic episodes occurring in three patients whilst only one patient in group II had a single hypoglycemic episode but the difference was not statistically significant. Conclusion: Strict glycemic control decreases rates of wound infection and duration of hospitalization but had no effect on ICU stay or mortality. [ABSTRACT FROM AUTHOR]

Abstract: Oral d-tagatose (d-tag) attenuates the rise in plasma glucose during an oral glucose tolerance test in subjects with type 2 diabetes mellitus (DM) and reduces food intake in healthy human subjects. A reduction in food consumption and less weight gain occur in rats fed tagatose. This pilot study explored the metabolic effects of d-tag given daily to 8 human subjects with type 2 DM for 1 year. We hypothesized that this treatment period would lead to weight loss and improvements in glycated hemoglobin and the lipid profile. A 2-month run-in period was followed by a 12-month treatment period when 15 g of oral d-tag was taken 3 times daily with food. No serious adverse effects were seen during the 12-month treatment period. Ten of the initially12 recruited subjects experienced gastrointestinal side effects that tended to be mild and transient. When 3 subjects were excluded who had oral diabetes, medications added and/or dosages increased during the study and mean (SD) body weight declined from 108.4 (9.0) to 103.3 (7.3) kg (P = .001). Glycated hemoglobin fell nonsignificantly from 10.6% ± 1.9% to 9.6% ± 2.3% (P = .08). High-density lipoprotein cholesterol progressively rose from a baseline level of 30.5 ± 15.8 to 41.7 ± 12.1 mg/dL at month 12 in the 6 subjects who did not have lipid-modifying medications added during the study (P < .001). Significant improvements in body weight and high-density lipoprotein cholesterol in this pilot study suggest that d-tag may be a potentially useful adjunct in the management of patients with type 2 DM. [ABSTRACT FROM AUTHOR]

Abstract: Background: Ramadan, the ninth month of the Islamic lunar calendar, is the holy month of fasting for adolescent and adult Muslims. Observance of Ramadan is considered obligatory for every healthy adult Muslim. During this time, Muslims refrain from eating, drinking, smoking, and administering oral or parenteral medications from sunrise to sunset daily for 28 to 30 days. Case summary: We evaluated the need for changes in basal insulin regimen in 5 patients (4 males and 1 female; age range, 15-19 years) with type 1 diabetes mellitus (T1DM) who fasted during Ramadan. The patients were receiving insulin pump therapy with regular human insulin and maintained weekly visits with their endocrinologist at The Chronic Care Center (Beirut, Lebanon). They were instructed to break the fast after any episode of hypoglycemia (finger stick glucose <70 mg/dL) or severe hyperglycemia (finger stick glucose ≥300 mg/dL or any hyperglycemia associated with presence of urine ketone bodies on urinary dipstick). Blood glucose concentrations did not change significantly with fasting. Finger stick blood glucose taken at 4-hour intervals decreased in the afternoon (at 4 pm) and increased in the evening and morning (10 pm and 8 am, respectively) during this month in 4 of 5 patients, while no significant change in circadian rhythm of finger stick blood glucose was observed in 1 patient. Based on the investigators'' findings, the basal insulin requirement decreased by 5.5% to 25.0% (4 patients) or did not change (1 patient) during the fast. Changes in regimens, based on collaboration between the endocrinologist and diabetes educational nurse, were determined by blood glucose self-monitoring done at 4-hour intervals during the fasting period, pre-Suhur (predawn breakfast), and ≥2 hours after Iftar (evening fast-breaking meal). No cases of keto-acidosis or severe hypoglycemia were reported. Conclusion: These 5 adolescent and adult patients with T1DM who were using an insulin pump were able to fast during Ramadan without incidences of severe hypoglycemia or ketoacidosis by using close blood glucose self-monitoring and weekly follow-up with their endocrine team, which consisted of an endocrinologist, a registered nutritionist, and a diabetes educational nurse. [Copyright &y& Elsevier]

Abstract: Objectives: (1) To measure the proportion of participants who used hypoglycaemic agents provided by CDAP only, for at least 6 months, and attained an HbA1c of ≤7% (a measure of glycaemic control) and (2) to determine the attitudes and practices of patients and pharmacist in this new programme. Design and methods: The attainment of a glycosylated haemoglobin (HbA1c) concentration of ≤7% in patients with type 2 diabetes mellitus was used as a measure of good glycaemic control. Consequently we measured the HbA1c in 208 subjects who satisfied the entry criteria. Two questionnaires were designed, pre-tested and administered to both patients and pharmacist in the programme to determine their attitudes and practices. Results: Of the 208 eligible participants, 128 (61.5%) were well controlled, 94% of all participants were satisfied with CDAP and only 23.3% of participants experienced one or more minor side effect with the drugs used from CDAP. There were no significant differences between patients who were well controlled and poorly controlled with respect to gender, physical activity and diet. Conclusion: The study demonstrated that CDAP has impacted favorably on the control of type 2 diabetes mellitus in Trinidad, most participants were satisfied with the programme and there were no major adverse effects from the drugs used. [Copyright &y& Elsevier]

Aims To determine if a transition support programme for young adults with diabetes could maintain attendance at a specialist clinic, improve diabetes control and reduce acute hospital admissions with diabetic ketoacidosis (DKA) in 15–25-year-olds with Type 1 diabetes. Methods A transition coordinator/diabetes educator arranged booking and rebooking of appointments for a young adult diabetes clinic based in an adult hospital between July 2001 and March 2006. An after-hours phone support service was initiated. Data collected included source of referral, frequency of clinic attendance and HbA1c at each visit. Numbers of admissions and readmissions with DKA, length of stay and HbA1c on admission were recorded. Results One hundred and ninety-one young adults were referred. HbA1c at initial referral was 9.3 ± 2.17%. HbA1c significantly improved to 8.8 ± 1.9% ( P < 0.001) after a median of five visits with a statistically significant fall in HbA1c of 0.13% per visit ( P = 0.01). The greatest improvements were seen in those with starting HbA1c > 11% (−2.5 ± 2.3%, P < 0.001). Eighty-two percent had attended appointments in the last 6 months. There was a significant reduction in DKA admissions falling by 1/3 ( P = 0.05), and in readmissions a significant reduction in length of stay (−3.6 days, P = 0.02), over 3.5 years. Conclusions If young adults are appropriately supported in adult services, clinic attendance is maintained, diabetes control is improved and hospital admission rates with DKA are reduced. The cost savings from reduced admissions covered the costs of the programme. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hypoglycemia is a risk factor common to all insulin therapy. The hypothesis is that efforts to reduce or prevent this adverse side effect may fail because providers generally lack the resources to predict not only future blood glucose levels but also future risks of hypoglycemia. This lack has been remedied. A controlled study was undertaken to test the hypothesis. Methods: Twenty-two insulin dependent subjects suffering more than one (1) episode/week of hypoglycemia with similar insulin regimens, similar diabetes education and similar self-management training participated in this study. For all subjects, a remote monitoring resource (registry and database) was used to capture daily SMBG and afford a return path for provider interventions and decision support. Identical telemedical methods were used which differed only for the provider either by the presence (prediction group) or by the absence (control group) of an on-screen, visual display of predicted glycemia and predicted risks of hypoglycemia. The study lasted 2 months. Results: Over an average of 41 days from baseline to follow up and while using the glycemic prediction resource, providers intervened more effectively in the prediction group reducing rates of hypoglycemia nine-fold (P <0.0001) and insulin therapy by just −9U/day (P <0.01). Mean pre-meal glycemia was not compromised. Over 61 days from baseline to final follow up but without glycemic predictions in the control group, providers’ interventions were less effective and resulted in no net changes in rates of hypoglycemia, daily insulin therapy, or mean pre-meal glycemia. Conclusions: Given knowledge of future glycemia and future risks of hypoglycemia, providers in clinical practice can now avert iatrogenic hypoglycemia in less than 2 months. A shared diabetes data center furnishing remote data capture and decision support is fundamental to the implementation of this as a new clinical procedure in diabetes. [Copyright &y& Elsevier]

Abstract: Increased monocyte recruitment into subendothelial space in atherosclerotic lesions is one of the hallmarks of diabetic angiopathy. The aim of this study was to determine the state of peripheral blood monocytes in diabetes associated with atherosclerosis. Diabetic patients treated with/without an oral hypoglycemic agent and/or insulin for at least 1 year were recruited (n =106). We also included 24 non-diabetic control subjects. We measured serum levels of monocyte chemoattractant protein (MCP)-1, fasting plasma glucose (FPG), HbA1c, total cholesterol, triglyceride, body mass index (BMI), high sensitivity CRP (hs-CRP) and evaluated CCR2, CD36, CD68 expression on the surface of monocytes. Serum MCP-1 levels were significantly (p <0.05) higher in diabetic patients than in normal subjects. In diabetic patients, serum MCP-1 levels correlated significantly with FPG, HbA1c, triglyceride, BMI, and hs-CRP. The expression levels of CCR2, CD36, and CD68 on monocytes were significantly increased in diabetic patients and were more upregulated by MCP-1 stimulation. Our data suggest that elevated serum MCP-1 levels and increased monocyte CCR2, CD36, CD68 expression correlate with poor blood glucose control and potentially contribute to increased recruitment of monocytes to the vessel wall in diabetes mellitus. [Copyright &y& Elsevier]

Aims/hypothesis: Diabetic subjects do home monitoring to substantiate their success (or failure) in meeting blood glucose targets set by their providers. To succeed, patients require decision support, which, until now, has not included knowledge of future blood glucose levels or of hypoglycaemia. To remedy this, we devised a glucose prediction engine. This study validates its predictions. Methods: The prediction engine is a computer program that accesses a central database in which daily records of self-monitored blood glucose data and life-style parameters are stored. New data are captured by an interactive voice response server on-line 24 h a day, 7 days a week. Study subjects included 24 patients with debilitating hypoglycaemia (unawareness), which qualified them for islet cell transplantation. Comparison of each prediction with the actually observed data was done using a Clarke Error Grid (CEG). Patients and providers were blinded as to the predictions. Results: Prior to transplantation, a total of 31,878 blood glucose levels were reported by the study subjects. Some 31,353 blood glucose predictions were made by the engine on a total of 8,733 days-used. Of these, 79.4% were in the clinically acceptable Zones of the CEG. Of 728 observed episodes of hypoglycaemia, 384 were predicted. After transplantation, a total of 45,529 glucose measurements were reported on a total of 12,906 days-used. Some 42,316 glucose predictions were made, of which 97.5% were in the acceptable CEG Zones A and B. Successful transplantation eliminated hypoglycaemia, improved glycaemic control, lowered HbA1c and freed 10 of 24 patients from daily insulin therapy. Conclusions/ interpretation: It is clinically feasible to generate valid predictions of future blood glucose levels. Prediction accuracy is related to glycaemic stability. Risk of hypogly-caemia can be predicted. Such knowledge may be useful in self-management. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between ethnicity, depression, quality of life, and diabetic control in Malaysian adolescents and young adults with type I diabetes mellitus. Methods: Fifty-two outpatients with type I diabetes (mean age 15.5 years) who attended a Diabetes Clinic were included. The level of HbAlc was the measure of diabetes control used (better control defined as HbAlc < 10%). Other variables were measured through questionnaires (e.g., depressive symptoms, quality of life), computerized diagnostic interviews (major depression), and medical records (e.g., demographic, family circumstances, compliance with treatment). Results: Ethnic Chinese youth showed better diabetic control than Malays and Indians (mean HbAlc 9.1%, 10.3%, and 11.0% respectively). Young people with better diabetic control (HbAlc < 10%) were more likely to have better quality of life and less likely to live in problematic families. When the cut-off for diabetic control was stricter (HbAlc ≤ 8%), the young person's compliance was the main predictor of poor control. Family problems were also associated with poor control but to a lesser extent. The initial association between poorer diabetes control and depression became non-significant when quality of life was taken into account. Conclusions: There are ethnic differences in juvenile diabetic control in this Malaysian sample which need to be understood further. Previous findings of an association between quality of life and glycemic control were verified but different definitions of good control showed different associations with individual and environmental variables. Clinicians' awareness and early intervention for psychosocial problems (for example, inadequate family support) could improve diabetes control. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study is to assess the association of psychological, as well as physical and sociodemographic, indicators with patients'' ratings of personal health status and diabetes control and to investigate the association of mental health and depression with errors in the perception of diabetes control. Method: A sociodemographically diverse sample of 623 diabetes patients was recruited from the general medicine clinics of a county health care system and a Veterans Affairs health care system. We examined three types of determinants of patients'' health perceptions: physical health indicators (symptoms, comorbid diagnoses, and glycosylated hemoglobin or HbA1c levels), psychological health indicators (general mental health and diabetes-related worry), and sociodemographic factors (age, race, gender, income, and education). Results: After controlling for patient'' sociodemographic characteristics, perceived general health was associated with patients'' symptom burden and emotional distress (but not with patients'' HbA1c levels). Perceived diabetes control additionally was associated with HbA1c and diabetes-related worries. Further analyses showed that both mental health and diagnosed depression were associated with errors in personal appraisals of diabetes control, with depressed patients more often inaccurately assessing their glycemic control as poor (false-positive error) and nondepressed patients more often missing poor HbA1c levels (false-negative error). Conclusions: Findings indicate that patients use a comprehensive model for assessing their general health and that depression may lead to more accurate assessments of poor glucose control. [Copyright &y& Elsevier]

In this paper, H∞ control is applied to obtain a robust controller for the automatic insulin delivery rate. The control action permits to prevent the hyperglycaemic levels in a type I diabetic patient. From a control theory point of view, the blood glucose regulation problem is reformulated as a tracking one. For this purpose, the Glucose Tolerance Curve (GTC) of healthy patients is validated as reference model. A nonlinear compartmental model is linearized around a nominal condition, and then reduced for synthesis design. A measure of robust performance is given by accounting parametric uncertainty to the nonlinear model. Two designs were tested to obtain the H∞ controller: (i) the classic Riccati equation based and (ii) the Linear Matrix Inequalities approach. The performance of the resulting controllers was verified in simulations by using the original nonlinear model. Sensitivity and complementary sensitivity functions show the nominal and robust performance of the linear closed-loop system. The maximum blood glucose tracking error for the nominal and the worst case condition was 15 mg/dL. Thus, the control scheme can successfully regulate the blood glucose level and reproduce the glucose absorption of a healthy subject in a type I diabetic patient. [Copyright &y& Elsevier]

Objective: Accurate assessment of blood glucose control is essential to prevent chronic complications in diabetes. Hemoglobin Glycosylation Index (HGI) quantifies the degree to which individuals demonstrate a HbA1C higher or lower than average for the population. This study has aimed to assess the relationship between HGI and blood glucose. Methods: 25 type 1 diabetes subjects (12 men and 13 women), 22.0±5.2 (17–34) years old, were instructed to self-monitor glucose with the One Touch Profile capillary glucose meter. HbA1C was determined and self-monitored blood glucose levels were studied every 3 months. Diabetic patients were monitored for 3–9 months and 62 measurements of HbA1C were included. HbA1C was measured by HPLC. Mean blood glucose (MBG) was calculated from self-monitored blood glucose records. A linear regression was calculated between HbA1C and MBG during the 60 days before sampling to determine HbA1C. For each diabetic patient''s MBG, a predicted HbA1C was calculated from the population regression equation. HGI was then calculated as HGI=observed HbA1C−predicted HbA1C. Blood glucose was analyzed within target range (WTR), below target range (BTR) and above target range (ATR) according to The European Diabetes Policy Group Consensus for type 1 diabetes. Results: A good linear regression between HbA1C and MBG was observed (r=.71, r2=.497, P=.000). No correlation was found between HGI and the percentage of WTR, BTR or ATR values. Moreover, the percentage of self-monitored blood glucose ATR and BTR was the same for high glycosylators (HGI<0 and ATR: 56.2±20.9%; HGI<0 and BTR: 34.5±17.5%) as for low glycosylators (HGI>0 and ATR: 52.8±25.5%; HGI>0 and BTR: 25.1±15.0%). Conclusions: HGI is determined for both physiological factors and blood glucose. A prospective study is necessary to assess whether HGI, together with HbA1C, can predict the incidence and severity of chronic complications in diabetic patients. [Copyright &y& Elsevier]