Effect of yoga on cardiac autonomic dysfunction and insulin resistance in non-diabetic offspring of type-2-diabetes parents: A randomized controlled study

ObjectiveThe present study was aimed to determine the effect of yoga program on cardiac autonomic dysfunction and insulin resistance in non-diabetic offspring of diabetes parents.MethodsA randomized passive-controlled study was conducted on 64 non-diabetic offspring of type-2-diabetes parents (mean-age:25.17years). Yoga group participants received yoga training for 8 weeks. Heart-rate variability (HRV) indices: low frequency (LF), high frequency (HF) and LF/HF ratio; fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and insulin resistance (IR) were estimated at baseline and after 8-weeks of intervention.ResultsWe found a significant decrease in LF (p = 0.005), LF/HF ratio (p = 0.004), IR (p < 0.001), OGTT (p = 0.003) and increase in HF (p = 0.022) in yoga group participants. Control group participants did not show any significant change in any variables.ConclusionsImprovement in cardiac autonomic function and insulin resistance by yoga training implies that yoga can reduce the risk of development of diabetes in offspring of diabetes parents.     

Fetal pancreatic Langerhans islets size in pregnancies with metabolic disorders

Objective: Metabolic disorders are a pandemic and increasing health problem. Women of childbearing age may also be affected, thus an abnormal metabolism may interfere with pregnancy short- and long-term outcomes, harming both mother and child. In the context of an abnormal maternal and intrauterine metabolic milieu the development of fetal organs, including pancreas, may be affected.

Aim: To investigate the effects of pregnancy metabolic disorders on the morphology of pancreatic Langerhans islets in human late-third trimester stillborn fetuses.

Methods: Samples from fetal pancreas underwent a quantitative histological evaluation to detect differences between pregnancy with (cases, n?=?9) or without (controls, n?=?6) abnormal metabolism.

Results: Results show that the islets size increases in fetuses from dysmetabolic pregnancies and that this increment is related to both beta-cell hyperplasia and hypertrophy. Moreover, according to pregnancy and fetal metabolic disorders, a threshold of abnormal size of the islets has been identified. Above this threshold the size of fetal pancreatic Langerhans islets should be considered excessively increased.

Conclusion: The study suggests that an accurate fetal pancreas analysis supplies an important tool in stillborn fetus, to discover metabolic disturbances that should be kept in mind and managed in future pregnancies.     

Hipertiroidismo como manifestación de la enfermedad trofoblástica gestacional: a propósito de un caso

Gestational trophoblastic disease (GTD) is a group of tumours caused by the hyperproliferation of trophoblast cells and is noted for its overproduction of hCG. Among its manifestations, there may be hyperthyroidism, due to the stimulating activity of hCG on TSH receptors. In most cases it is only a biochemical hyperthyroidism, with its presentation as symptomatic hyperthyroidism being much less frequent. We report the case of a patient with GTD, who at diagnosis presented with symptomatic hyperthyroidism. Treatment included surgical evacuation of the hydatidiform mole, as well as a beta-blocker and antithyroid drug treatment to relieve the symptoms.     

Evaluation of the metformin initiation rate in veterans with newly identified type 2 diabetes

BackgroundAn estimated 35 million individuals in the United States have diabetes. The American Diabetes Association recommends metformin as first-line pharmacologic treatment. The primary objective of this study was to evaluate the metformin initiation rate in veterans with recently identified type 2 diabetes.MethodsVeterans with new onset type 2 diabetes were identified using National Veterans Health Administration Data. Retrospective information was obtained from those with a first A1C ≥ 6.5% (48 mmol/mol) between 2013 and 2018. Veterans with at least one additional A1C < 6.5% (48 mmol/mol) documented in the three years prior to the A1C diagnostic for diabetes were included in the analysis.ResultsA total of 144,180 veterans were included. Of those, 45,776 (31.7%) were started on metformin within one year of diabetes diagnosis. The median time to metformin initiation was 12 days and median time to initiation of any anti-hyperglycemic was 11 days. Approximately 16,000 veterans were referred for lifestyle interventions within 90 days.ConclusionMetformin initiation occurred in fewer patients than expected given metformin is a generic, well-tolerated medication recommended as first-line pharmacologic treatment option regardless of A1C. Further studies are needed to assess the barriers of initiating metformin at time of diabetes diagnosis.     

Novel Risk Factors for Progression of Diabetic and Nondiabetic CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

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Improving compliance with diabetes care using a novel mnemonic: A quality improvement project in an urban primary care clinic

AimThe aim of this quality improvement project was to improve compliance with the delivery of multidimensional patient-centered diabetes care using a streamlined mnemonic based on established diabetes guidelines.MethodsUsing the Institute for Healthcare Improvement (IHI) model for improvement, four rapid plan-do-study-act cycles primarily implemented different tests of change over eight weeks using a streamlined mnemonic – the LLaVES (lifestyle, laboratory tests, vaccination, examination, social/psychosocial) bundle for screening and case management of patients with diabetes. Secondary to the LLaVES bundle, tests of change were also conducted for clinic team members and patients. Team member engagement utilized a best-practice toolkit for effective communication. Patient engagement implemented validated models to evaluate knowledge of diabetes and stage of change. Data were analyzed using run charts to evaluate the impact of interventions on outcomes. Overall compliance was measured as the diabetes management compliance rate (DMCR), composed of LLaVES implementation, team engagement, and patient engagement scores.ResultsThe diabetes management compliance rate increased by 72.2%, from a baseline of 49% to 84.4% in eight weeks. Team engagement increased from 76.6% to 92% while patient engagement increased from 70.4% to 87.4%.ConclusionsDiabetes management is complex and requires team and patient engagement to implement a structured and multidimensional process. Composed of established, high-level evidence interventions, the LLaVES bundle is one approach to systematize complex care while taking into account the specific and unique challenges of a health care organization.     

Case report of chloroquine therapy and hypoglycaemia in type 1 diabetes: What should we have in mind during the COVID-19 pandemic?

A type 1 diabetes patient experienced remission associated with chloroquine therapy while travelling to a malaria-endemic area. Chloroquine has immunomodulatory and hypoglycaemic effects and may become more frequently used due to the COVID-19 pandemic. Patients with type 1 diabetes treated with chloroquine should be monitored for hypoglycaemia, even after recovery.     

The impact of dusk phenomenon on total glucose exposure in Chinese people with type 2 diabetes

This study was aimed at assessing the impact of the dusk phenomenon on the total glucose exposure in Chinese people with type 2 diabetes.A total of 380 type 2 diabetes who received a retrospective continuous glucose monitoring system (CGMs) for 72 hours were enrolled in our study, 32 of them failed in CGMs. The patients were first divided into 2 groups: dusk phenomenon (n = 95) and non dusk phenomenon group (n = 253). The magnitude of the dusk phenomenon (δDusk) was quantified by pre-dinner glucose minus post-lunch 2 hours glucose. A persistent δDusk ≥ 0 or a once only δDusk < 0 can be diagnosed with the dusk phenomenon. The participants were secondarily matched for the post-lunch 2 hours glucose to assess the impact of the dusk phenomenon on the overall glucose exposure. The impact of the dusk phenomenon was assessed on high-performance liquid chromatography assay (HbA1c) and 24-hour mean glucose.There were 95 of 348 (27.3%) participants with the dusk phenomenon in the overall population, and the median of δDusk level was –0.8 (–1.8, 0.2) mmol/L. The median of glucose differences between the 2 paired groups were 0.4 (–0.4, 1.0)% for HbA_1c, 0.9 (0.2, 1.4) mmol/L for 24 hours mean glucose. The correlation analysis showed no relationship between the magnitude of dawn phenomenon and the dusk phenomenon (r = 0.052, P = .472).The incidence of dusk phenomenon is about 27.3% in people with type 2 diabetes. The impacts of dusk phenomenon on HbA1c and 24-hour mean glucose were about 0.4% and 0.9 mmol/L and the dusk phenomenon was not related with the dawn phenomenon.     

Preclinical relevance of probiotics in type 2 diabetes: A systematic review

Type 2 diabetes (T2DM) is among the most prevalent metabolic diseases in the world and may result in several long‐term complications. The crosstalk between gut microbiota and host metabolism is closely related to T2DM. Currently, fragmented data hamper defining the relationship between probiotics and T2DM. This systematic review aimed at investigating the effects of probiotics on T2DM in animal models. We systematically reviewed preclinical evidences using PubMed/MEDLINE and Scopus databases, recovering 24 original articles published until September 27th, 2019. This systematic review was performed according to PRISMA guidelines. We included experimental studies with animal models reporting the effects of probiotics on T2DM. Studies were sorted by characteristics of publications, animal models, performed analyses, probiotic used and interventions. Bias analysis and methodological quality assessments were examined through the SYRCLE's Risk of Bias tool. Probiotics improved T2DM in 96% of the studies. Most studies (96%) used Lactobacillus strains, and all of them led to improved glycaemia. All studies used rodents as models, and male animals were preferred over females. Results suggest that probiotics have a beneficial effect in T2DM animals and could be used as a supporting alternative in the disease treatment. Considering a detailed evaluation of the reporting and methodological quality, the current preclinical evidence is at high risk of bias. We hope that our critical analysis will be useful in mitigating the sources of bias in further studies.     

Effect of maternal perceived stress during pregnancy on gestational diabetes mellitus risk: A prospective case-control study

Background and aimsA variety of risk factors have been reported for the development of gestational diabetes mellitus (GDM). But limited review on the role of antenatal perceived stress necessitated the design of the present study to evaluate the association between GDM and perceived stress during pregnancy.MethodsA prospective case-control study was carried out among 100 GDM cases and 273 matched controls, attending regular antenatal clinic at two private hospitals of Karnataka. Data was collected by personal interviews using a standard questionnaire. Perceived stress was assessed using the Cohen 10-item Perceived Stress Scale. Score of ≥20 was identified as high stress. Statistical Package for the Social Sciences version 15 was used for analysis.ResultsExposure rates for high maternal perceived stress among cases during pregnancy were noted. The odds of GDM were 13 folds higher among those with high antenatal stress (≥20) compared to those with low (<20) (p < 0.001) perceived stress. No correlation between maternal antenatal stress and blood glucose following OGTT was noted.ConclusionsThe study identified high perceived stress during pregnancy as a potential risk factor for GDM.