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Background: Worldwide, one in ten pregnancies is related with diabetes; 87.6% of which are gestational diabetes mellitus (GDM). Maternal hyperglycaemia affects the successful progression of pregnancy. Objectives: To determine the proportion and the factors associated with poor glycaemic control among women with gestational diabetes. Methods: This hospital-based cross-sectional study was conducted in a tertiary care hospital, Puducherry, South India from September to October 2019. Pregnant women diagnosed as GDM and on treatment for at least one month were approached consecutively for the study. A fasting blood sugar (FBS) ≥92 mg/dl and postprandial blood sugar (PPBS) 1 hour ≥180 mg/dl or PPBS 2 hour ≥153 mg/dl were considered as poor glycaemic control. Results: A total of 301 women with GDM were included and the mean (SD) age was 27 (5) years. Of total, 29 (10%) reported GDM during their previous pregnancy and 95 (32%) got diagnosed before reaching the tertiary care hospital. Lifestyle modifications (77%) were the most common mode of management for GDM. Of total, 116 (38.5%; 95% CI 33%-44.3%) had poor glycaemic control. Multigravida women (46.9%) and those on pharmacological treatment for GDM had poor glycaemic control. Conclusion: One-third of women with GDM at a tertiary care centre had poor glycaemic control. Therefore, a novel approach to improve awareness about GDM control both among pregnant women and the medical fraternity is needed.

BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is increasing quickly all over the world. In spite of effective treatment guidelines for type 2 diabetes, in majority of the people, the disease is poorly controlled with existing therapies. Glycaemic control is considered as the most important step for prevention of organ damage and other complications of diabetes. A study on the prevalence and determinants of poor glycaemic control can assist in understanding the expanse of this problems and the ways to address it. We wanted to study the prevalence and determinants of poor glycaemic control among adult patients with type II diabetes mellitus attending a primary health care setting. METHODS The cross-sectional study was conducted in the outpatient department of NCD clinic in a Primary health centre of Kerala for a period of six months. Two hundred and fifty individuals diagnosed with Type II DM for a year were recruited as study participants. The study participants were interviewed using a semi-structured questionnaire. Adherence to medication was assessed using The Morisky Medication Adherence Scale. Anthropometric measurements and blood pressures were recorded. HbA1c and RBS was measured using semi quantitative technique. Any patient with an HbA1c of more than 7 was defined as having poor glycaemic control. RESULTS 64.4 % of the participants had poor glycaemic control. Poor adherence to medication, fewer visits to doctor, lack of diet modification, frequent junk food consumption, higher body mass index and lack of exercise were found to be significantly associated with poor glycaemic control. CONCLUSIONS A focused approach targeting these modifiable risk factors, especially in primary care setting, has the potential to bring about better glycaemic control which can prevent and minimize the occurrence of diabetes complications. KEYWORDS Poor Glycaemic Control, Uncontrolled Diabetes, Diabetes Mellitus, HbA1c, Diabetes Complications

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.

Background. Diabetes mellitus rates and associated costs continue to rise across Europe enhancing health authority focus on its management. The risk of complications is enhanced by poor glycaemic control, with long-acting insulin analogues developed to reduce hypoglycaemia and improve patient convenience. There are concerns though with their considerably higher costs, but moderated by reductions in complications and associated costs. Biosimilars can help further reduce costs. However, to date, price reductions for biosimilar insulin glargine appear limited. In addition, the originator company has switched promotional efforts to more concentrated patented formulations to reduce the impact of biosimilars. There are also concerns with different devices between the manufacturers. As a result, there is a need to assess current utilisation rates for insulins, especially long-acting insulin analogues and biosimilars, and the rationale for patterns seen, among multiple European countries to provide future direction. Methodology. Health authority databases are examined to assess utilisation and expenditure patterns for insulins, including biosimilar insulin glargine. Explanations for patterns seen were provided by senior-level personnel. Results. Typically increasing use of long-acting insulin analogues across Europe including both Western and Central and Eastern European countries reflects perceived patient benefits despite higher prices. However, activities by the originator company to switch patients to more concentrated insulin glargine coupled with lowering prices towards biosimilars have limited biosimilar uptake, with biosimilars not currently launched in a minority of European countries. A number of activities were identified to address this. Enhancing the attractiveness of the biosimilar insulin market is essential to encourage other biosimilar manufacturers to enter the market as more long-acting insulin analogues lose their patents to benefit all key stakeholder groups. Conclusions. There are concerns with the availability and use of insulin glargine biosimilars among European countries despite lower costs. This can be addressed., peer-reviewed

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.

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.