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Background: Continuous glucose monitoring (CGM) has a beneficial impact on diabetes control; however, its utilization within people with diabetes remains low. The success of CGM requires cluster of...

Aim This study aimed to systematically review the prevalence of diagnosed sleep disorders in people with diabetes and to determine the association between sleep disorders and blood glucose levels and diabetes outcomes. Methods We conducted a literature search in the following databases: MEDLINE (Pubmed), EMBASE, CINAHL, PsychInfo and Web of Science Citation Index. Meta-analysis (random-effects models) was conducted to estimate the prevalence of sleep disorders in people with diabetes. Results Forty-one articles measured the prevalence of sleep disorders in adults with diabetes. The estimated pooled prevalence of sleep disorders in diabetes was estimated to be 52% (95% CI 42–63%). The highest pooled prevalence was observed for unspecified sleep apnea (69%; 95% CI: 59–78%), followed by obstructive sleep apnea (60%; 95% CI 39–80%), and restless leg syndrome (27%; 95% CI 20–34%). Eleven studies examined the association between sleep disorders and diabetes control and complications. The presence of comorbid sleep disorders was associated with increased diabetes outcomes. Conclusions Diagnosed sleep disorders are highly prevalent in people with diabetes. Sleep disorders are associated with diabetes outcomes, though there was considerable heterogeneity across studies.

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

Background: Low health literacy (HL) is associated with an extensive range of health outcomes. Objective: The present study was performed to inquire about the relationship between HL and glycemic control in gestational diabetes in order to design interventional future preventing programs. Methods: This cross-sectional study was performed on 104 Iranian pregnant women with gestational diabetes mellitus (GDM) referred from urban and rural areas to endocrinology clinic of Hamadan Beheshti Hospital, in 2017. Iranian Health Literacy Questionnaire (IHLQ) and a sociodemographic checklist were distributed among women. Correlation between HL and glycemic control was examined using SPSS. The significance level was set at P < 0.05. Results: Among women, 48.1% (50) were affected by uncontrolled diabetes and only 22% (11) had an adequate level of HL. An adequate level of HL were 50% and 22% in glycemic controlled and uncontrolled women, respectively. In univariate analysis, there was a significant relationship between diabetes control and adequate HL. So, problematic HL could increase the chance of uncontrolled diabetes more than three times (odds ratio: 3.5; CI: 1.5–8.3; P value: 0.004). Among all related variables, education and being housewife were considered as protective and risk factors for problematic HL, respectively. Conclusion: In conclusion, this study has provided evidence of limited HL and its relationship with low glycemic control in pregnant women with GDM. The problem was more serious in low educated, rural, housekeepers, and older-aged women. This deficit needs to be addressed by health planners and policymakers who are responsible for promoting the health of people and decreasing health inequalities community.

IN BRIEF This study investigates the combination of diabetes education, telehealth, a wireless enabled meter, and medication algorithms to improve care for a targeted population of employees with type 1 or type 2 diabetes. After more than 2 years of follow-up, mean A1C was reduced by 1.8%, and a reduction was observed in cost of care, along with an increase in visits with the managing physician provider. Thus, this study showed improved diabetes control using new technologies to provide remote monitoring and telehealth augmenting the outreach and education provided in a diabetes self-management program.

Introduction: Middle-aged Hispanic women have the highest prevalence of overweight and lifetime risk for diabetes of all gender/racial groups. This study examines use of alternative medicine for weight loss and diabetes management among overweight and obese Mexican American women with or at risk for diabetes. Method: As part of a diabetes risk-reduction intervention targeting overweight and obese Hispanic women at a federally qualified health center in Hillsboro, Oregon, we administered a survey of different treatment modalities, including alternative medicine, traditional Mexican medicine, and home remedies to 85 Hispanic women. We also asked participants how often they disclosed their use of alternative methods to their providers. Results: Nearly all participants with diabetes (97%) reported using at least one alternative strategy for diabetes control, with home remedies, commercial weight-loss products, and herbal teas being the most endorsed. Most participants with diabetes and half of those without diabetes reported never telling their provider. Conclusion: This group of women reported a high prevalence of use of alternative methods for weight control and diabetes management. Yet most participants with diabetes never reported this use to a health care provider. To ensure patient safety, providers treating Hispanic women need to probe for complementary and alternative medicine practices.

Objectives: The Czech National Childhood Diabetes Register (ČENDA) is a web-based nationwide database that collects treatment and outcome data in children and adolescents with diabetes. Here we present data from the first five years of ČENDA (2013-2017). Methods: Data include characteristics of disease onset and annual summaries of key clinical care parameters from every patient treated by participating pediatric diabetes outpatient clinics. Results: The database contains data from 4361 children (aged 0 to 19 years) from 52 centers, which is estimated to be 85% of all Czech pediatric patients. Of these, 94% had type 1 diabetes (T1D), 4.5% had genetically proven monogenic or secondary, and 1.5% had type 2 diabetes. In children with T1D, median HbA1c decreased throughout the observed period from 66.3 to 61.0 mmol/mol (p < 0.0001, 95% confidence interval for change -6 to -5). Consequently, the proportion of children reaching the ADA target therapeutic goal of 58.5 mmol/mol increased from 28% in 2013 to 40% in 2017. This improvement was significant for all categories of age and diabetes duration and was independent of gender. The overall proportion of children treated with continuous subcutaneous insulin infusion (CSII) remained stable over the observed period (25%). The main predictors associated with lower HbA1c were treatment with CSII, male sex and care provided at a large diabetes center (with >100 patients in regular care). Conclusions: A significant continuous decrease in HbA1c was observed in Czech children over the past five years. As this improvement was not accompanied by appreciable changes in the mode of therapy, we assume that the establishment of our nationwide register has itself constituted a stimulus towards improvement in the care process. Disclosure Z. Sumnik: None. M. Pavlíková: None. O. Cinek: None. Funding Ministry of Health of the Czech Republic

Source Citation Jovanovski E, Khayyat R, Zurbau A, et al. Should viscous fiber supplements be considered in diabetes control? Results from a systematic review and meta-analysis of randomized contro...

Over the past ten years, technology has been developed to the point, where it can enable continuous and efficient monitoring of blood glucose levels for patients with diabetes mellitus. The biggest step forward was demonstrated by biosensors, which, with a non-invasive approach, provide healthcare workers with the information required for good titration of insulin doses. We looked at the benefits of using biosensors in diabetes monitoring in terms of medical aspect and economic justification of replacing traditional test strips with biosensors. In this paper, we have shown potential benefits in terms of improving diabetes control, patient benefits, and how the medical benefit is collerating with the economic viability of biosensors use. On the territory of Bosnia and Herzegovina test strips for glucose control are still in use. This paper includes an analysis of the costs of traditional monitoring and monitoring using biosensors. We also reviewed the monitoring of diabetes in neighboring countries such as Croatia, Slovenia, Montenegro, and Serbia in order to compare them with the current situation in Bosnia and Herzegovina.

Aims To assess the impact of a structured transition tool for young people (YP) with type 1 diabetes in the transition from paediatric to adult services. Methods In a retrospective observational study, the case notes were reviewed for young people with Type 1 diabetes that transitioned between children’s and adults services at a single tertiary centre between 2011 and 2014. YP were categorised as to whether they had experienced the ‘Ready Steady Go’ (RSG) structured transition programme during routine clinical care (RSG versus non-RSG). Comparisons were made between the groups evaluating changes in HbA1c, cholesterol, BMI, non-elective, diabetes-related hospital admissions and documentation of advice. Results Of 106 reviewed case notes, 71 YP underwent structured transition utilising the RSG transition programme. In evaluation pre and post-transfer of care, undergoing the RSG programme was associated with a lowering of non-elective diabetes-related hospital admissions (RSG p=0.008 versus non-RSG p=1.000) and non-HDL cholesterol (RSG p=0.049 versus non-RSG p=0.921). The widely observed rise in HbA1c post transition was not observed in YP undergoing the RSG programme (RSG p=0.629 versus non-RSG p=0.023). No differences were observed in total cholesterol or BMI. Additionally, those who underwent structured transition had higher rates of documentation surrounding key topics; including contraception and pregnancy (p=0.005). Conclusion This study supports the role of a structured transition tool for YP with type 1 diabetes transitioning from paediatric to adult services. Improvements in markers of metabolic and diabetes control were observed in YP utilising the Ready Steady Go Programme.

Rice is one of the most cultivated and consumed cereals worldwide. It is composed of starch, which is an important source of diet energy, hypoallergenic proteins, and other bioactive compounds with known nutritional functionalities. Noteworthy is that the rice bran (outer layer of rice grains), a side-stream product of the rice milling process, has a higher content of bioactive compounds than white rice (polished rice grains). Bran functional ingredients such as γ-oryzanol, phytic acid, ferulic acid, γ-aminobutyric acid, tocopherols, and tocotrienols (vitamin E) have been linked to several health benefits. In this study, we reviewed the effects of rice glycemic index, macronutrients, and bioactive compounds on the pathological mechanisms associated with diabetes, identifying the rice compounds potentially exerting protective activities towards disease control. The effects of starch, proteins, and bran bioactive compounds for diabetic control were reviewed and provide important insights about the nutritional quality of rice-based foods.

Introduction: Treatment-induced neuropathy of diabetes (TIND) presenting as a new-onset peripheral neuropathy usually associated with autonomic dysfunction has been documented in literature. It can occur when there is a drop of more than 2% in HbA1C in a three month period. Worsening of existing peripheral neuropathy and retinopathy has also been observed suggesting a common pathophysiological mechanism. However, the onset of a cranial neuropathy temporally linked to intensified glycemic control has not been well reported. Case Report: A 32-year-old male patient presented to the emergency department with double vision, preceded by headache, and increased burning in his feet. No other neurologic symptoms were reported. Past medical history was significant for poorly controlled, labile type 1 diabetes mellitus. His home medications included gabapentin for peripheral neuropathy, long-acting and short-acting meal time insulin regimen. Physical examination was unremarkable except for a neurological exam which showed pupil-sparing third cranial nerve palsy. CT angiography of the head and neck revealed no acute ischemia, hemodynamically significant stenosis, aneurysm or dissection. MRI of the brain also showed no abnormality. Review of his prior HbA1c values showed a decrease of 3.6 % (14% to 10.4%) over 3 months. The patient was diagnosed with TIND presenting with simultaneous worsening of peripheral neuropathy and new onset right oculomotor nerve palsy. He was discharged on reduced doses of insulin, targeting a gradual decline in HbA1c after initial stabilization. The patient was also asked to liberalize his diet and was given an eye patch. While his peripheral neuropathy improved, there was not much improvement in his diplopia at a two week follow-up visit. Discussion: Our patient presented with worsening of peripheral neuropathy and pupil sparing oculomotor palsy. Secondary causes including CVA and aneurysm were excluded with brain imaging. Diabetes related microvascular disease presenting with pupil sparing oculomotor palsy is commonly seen in patients older than 50 years of age with uncontrolled diabetes and other vascular risk factors like hypertension and dyslipidemia. Absence of hypertension and hyperlipidemia, sudden onset of presentation and an intense control of DM as evidenced by rapid decline of A1C make TIND the likely cause for his presentation. The paradoxical worsening of his peripheral neuropathy also supports the diagnosis of TIND. Through this case, we highlight the importance of recognizing this entity as management differs significantly. Quality improvement metrics for practitioners in various institutions often include HbA1c target ranges in diabetic patients. Our case highlights the issues associated with rapid corrections of HbA1c and thus we advocate for a gradual decrease of 2 % every 3 months till target goals are reached.

Self-care activities and control of blood sugar levels among children with type I diabetes have a positive impact on the quality of their lives. The aim of this study was to assess the quality of life, self-care activities, and diabetes control among school age children. A descriptive design was used in the conduction of this study. Setting: The study was carried out at the Health Insurance at El-Arab El-Shamla clinic at Port Said City. A random sample of 223 children was recruited from diabetes clinic. Tools of Data Collection, two tools were used to collect the necessary data to achieve the aim of the study in six months period. The study revealed that there were statistical positive correlation between children`s quality of life, diabetes control, and their self-care activities regarding diabetes. The study was concluded that there is a clear relationship between children's high quality of life, control of diabetes and self-care activities. This study recommended that education and counseling for diabetic children are required to minimize the complications emergence and improve their quality of life.

Aim To assess associations between HbA1c and progression of coronary artery calcification (CAC) in persons with and without diabetes. Methods In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany (N=3453, aged 45–74years), CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. At baseline, participants were divided into five groups: poorly (HbA1c≥7.0%) and well (HbA1c 5 (factor by which CAC after 5-year follow-up is larger than baseline CAC), and categories of CAC change, respectively. Results Relative to group V, adjusted percentage increase of the geometric mean of PF 5 (95% CI) was: 69.1% (33.9%;113.6%), 15.4% (−5.6%;41.1%), −4.1% (−22.2%;18.2%), 4.2% (−5.4%;14.8%) for groups I–IV, respectively. The corresponding odds ratios for annual CAC increase ≥100 Agatston units (reference: Conclusions In known diabetes, CAC progression was stronger in poor diabetes control. For newly detected diabetes diagnosed by HbA1c ≥6.5%, associations with CAC progression were weak.

For diabetic patients, fasting during Ramadan, the ninth month of the Islamic calendar, can cause wide fluctuations in blood sugar levels, posing a medical challenge for patients and physicians and increasing the risk of acute metabolic complications including hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, and thrombosis. Proper patient education, risk stratification, and modification of antidiabetic medications can reduce the risk of complications.

Background: Diabetes is a lifelong disease and reduces the victim’s lifespan and quality of life. Diabetes management is a continuing life-long endeavor requiring cognitive, attitudinal and behavioral changes. The purpose of the study: To evaluate the effectiveness of home based diabetes management programme on diabetes control conducted by health team. Methods: This study which was designed as a one-group pretest-posttest pattern. Home visits were carried out once a week for nine weeks for 52 patients. The obtained data were evaluated by using percentages, t-test and the McNemar significance test. Results: At the completion of the intervention, life-style changes, such as the frequency of controlling blood glucose, glycemic control, exercise, and increasing vegetable and fruit consumption all produced changes which proved statistically significant and positive. Similarly, in comparison to before the intervention, the results after completion of the intervention showed that the values of patients’ weight (86.28 ± 13.50, 80.40 ± 23:13), systolic blood pressure (139.75 ± 17.53, 135.31 ± 17.91), and postprandial blood glucose (265.63 ± 128.63, 215.48 ± 69.71) had all statistically and significantly decreased (p

Background Most people with diabetes are not attaining desirable levels of HbA1c (glycated haemoglobin), or of blood pressure and cholesterol, leaving them at risk of developing complications. Aim To identify ways of improving diabetes control by gaining insight into patients’ attitudes/beliefs. Design and setting Questionnaires were offered to patients attending for a diabetes review in the 24 GP practices of North East Hampshire and Farnham Clinical Commissioning Group. Method Infrequent attenders were contacted by post. Volunteers then participated in focus groups. Results Self-reported medication adherence was good with 83% (98/118) of responders recording ≥9 on a 10-point scale. Patients generally accepted they ‘needed’ and ‘could take’ medication. A substantial minority reported ‘not liking’ taking tablets. Focus groups confirmed this and revealed a reluctance to change lifestyle, with medication reported as a way to evade it. A total of 68 out of 112 responders (60.7%) knew their HbA1c value. However, focus groups identified little understanding of HbA1c, with responders perceiving it as medical jargon. Phrases such as ‘stuck-on-sugar’ or ‘sugarload’ were suggested as being semantically easier to understand. The questionnaire revealed trust in clinicians. This was confirmed in focus groups but confounded by frequent reports of healthcare providers giving inadequate/incorrect advice. Conclusion Investment in lifestyle change is needed. Participants were reluctant to change and saw medication as a way of avoiding it. HbA1c needs to be better explained. Intuitive phrases such as ‘stuck-on-sugar’ or ‘sugarload’ could be adopted into common parlance. Inadequate/ incorrect advice seems to be hampering diabetes management and there appears to be a need for more diabetes-trained clinicians.

Uncontrolled diabetes, unlike controlled diabetes, is associated with an impaired immune response. However, little is known about the impact of the status of diabetes control on clinical features and treatment outcomes in patients with pulmonary TB (PTB). We conducted this study to evaluate whether the status of diabetes control influences clinical manifestations and treatment responses in PTB.A multicentre prospective study was performed between September 2012 and September 2014. The patients were categorised into three groups according to the glycated haemoglobin (HbA1C) level: PTB without diabetes mellitus (non-DM), PTB with controlled diabetes (controlled-DM) and PTB with uncontrolled diabetes (uncontrolled-DM). The primary outcome was the sputum culture conversion rate after 2 months of intensive treatment.Among 661 patients with PTB, 157 (23.8%) had diabetes and 108 (68.8%) had uncontrolled diabetes (HbA1C≥7.0%). The uncontrolled-DM group exhibited more symptoms, positive sputum smears (p0.001) and presence of cavities (p0.001) than the non-DM group. Regarding treatment responses, patients with uncontrolled-DM were more likely to have a positive culture after 2 months (p=0.009) and either treatment failure (p=0.015) or death (p=0.027) compared with the non-DM group. In contrast, those with controlled-DM showed similar treatment responses to the non-DM group. In multivariable analysis, uncontrolled diabetes was an independent risk factor for a positive sputum culture after 2 months of treatment (adjusted OR, 2.11; p=0.042) and either treatment failure or death (adjusted OR, 4.11; p=0.022).Uncontrolled diabetes is an independent risk factor for poor treatment response in PTB.

Introduction: Despite the numerous advances achieved in diabetes control and evaluation, the management of this complex disease remains challenging. This study was conducted with the aim of determining the level of glycaemic control among adult patients with type 2 Diabetes mellitus. Method: The cross-sectional study was conducted in the diabetes care centers of the outpatient departments in Bangladesh. Adult patients with at least 2 years documented history of type 2 diabetes mellitus (T2DM) were recruited and data regarding the demographics, treatment they received and the level of glycaemic control was assessed. Result: A total of 5140 diabetic patients fulfilling the inclusions criteria were recruited for the study. 9.90% of the patients were below 40 years of age and the majority (64.05%) of the respondents were from urban communities. Based on HbA1c levels, only 18.8% of the patients had good glycaemic control. Gender, educational level and the income seem to have a relationship with the level of glycaemic control. Conclusion: Despite the medical advances in the management of diabetes, the glycaemic control of the majority (81.2%) of the T2DM patients are still very poor.

Diabetes disproportionately affects disadvantaged populations. Eighty percent of deaths directly caused by diabetes occurred in low- and middle-income countries. In high-income countries, there are marked disparities in diabetes control among racial/ethnic minorities and those with low socio-economic status. Innovative, effective and cost-effective strategies are needed to improve diabetes outcomes in these populations. Technological advances, peer educators and community health workers have expanded methodologies to reach, educate and monitor individuals with diabetes. In the present manuscript we review the outcomes of these strategies, and describe the barriers to and facilitators of these approaches for improving diabetes outcomes.

Aim: The aim of this study was to evaluate the relationship between hemoglobin A1c (HbA1c) and 25-hydroxyvitamin D levels and to investigate the difference in this relationship between genders. Methods: In this study, we retrospectively evaluated fasting blood glucose, HbA1c, 25-hydroxyvitamin D and parathyroid hormone levels in 3675 subjects (660 male, 3015 female). The subjects were divided into two groups according to sex and into three groups according to HbA1c levels as pre-diabetics (5.7-6.4%), diabetics (6.5-8.0%) and uncontrolled diabetics (>8.1%). Individuals with an HbA1c value between 4.0% and 5.6% who had no history of diabetes mellitus constituted the control group. Results: Significantly low levels of 25-hydroxyvitamin D were detected in female uncontrolled diabetics (p

En nombre de la Sociedad Argentina de Diabetes es para mí un gran placer darles la bienvenida al XX Congreso Argentino de Diabetes.Con trabajo fecundo y no libre de escollos e inconvenientes, el Comité Organizador y el Comité Científico de este Congreso han llegado a concretar este programa.El lema elegido en esta ocasión fue: “Control de la diabetes centrado en el paciente” y esto es un claro reflejo de la tendencia del tratamiento de esta patología en los últimos años.

There is a Type 2 diabetes epidemic; however, unfortunately, even though insulin is an effective therapy, it is mostly used late and as a last resort. Type 1 diabetics find it difficult to administer extra insulin injections when needed owing to the inconvenience and, although most cope well, many dislike injecting themselves so frequently. The newly approved EXUBERA® inhaled insulin should help counteract the resistance of patients and physicians in instituting insulin in the Type 2 diabetic, and the Type 1 diabetic can take more than 1000 fewer injections per year, making their diabetes easier to live with. Pulmonary function tests have demonstrated clinically insignificant changes after years of monitoring. The increases of insulin antibodies found in those who use inhaled insulin have not affected diabetes control. Side effects of inhaled insulin are insignificantly different from injectable insulin except for a couple of mild coughs after an inhalation, which decrease quickly with time. The two dosag...

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

Introduction:Type 2 diabetes (T2D) has tremendous morbidity burden owing to disease management and complication prevention. Behavior modification identified as a key to management includes healthy diet and regular physical activity (PA). This study aims to identify patterns and preferences of PA of T2D patients and explore perceived enablers and barriers for diabetes control in Bhubaneswar.Methods:Cross-sectional, facility-based study conducted in the private sector from June to August 2014 recruited 321 T2D patients using semi-structured questionnaires. Descriptive statistics and associations of PA were computed.Results:Almost two-thirds of patients (59%) were reported performing PA frequently. Majority patients cited walking as the most preferred mode of PA (79%) with 41% performing PA daily. Actual versus perceived weight was a complete mismatch with most patients misjudging their weight. Reasons for enabling PA included ‘controlling diabetes’ and ‘doctor’s advice’ as key factors, while ‘lack of time’ and ‘unwillingness’ were main barriers among inactive patients.Conclusion:Counseling on PA by physicians during routine visits, along with tailored or patient-specific interventions should be considered. Focus on social support for positive behavioral changes and motivation play a central role in diabetes control.

Introduction: Type 2 diabetes (T2D) has tremendous morbidity burden owing to disease management and complication prevention. Behavior modification identified as a key to management includes healthy diet and regular physical activity (PA). This study aims to identify patterns and preferences of PA of T2D patients and explore perceived enablers and barriers for diabetes control in Bhubaneswar. Methods: Cross-sectional, facility-based study conducted in the private sector from June to August 2014 recruited 321 T2D patients using semi-structured questionnaires. Descriptive statistics and associations of PA were computed. Results: Almost two-thirds of patients (59%) were reported performing PA frequently. Majority patients cited walking as the most preferred mode of PA (79%) with 41% performing PA daily. Actual versus perceived weight was a complete mismatch with most patients misjudging their weight. Reasons for enabling PA included ‘controlling diabetes’ and ‘doctor’s advice’ as key factors, while ‘lack of time’ and ‘unwillingness’ were main barriers among inactive patients. Conclusion: Counseling on PA by physicians during routine visits, along with tailored or patient-specific interventions should be considered. Focus on social support for positive behavioral changes and motivation play a central role in diabetes control.