Glycemic control and its association with sociodemographics,comorbid conditions,and medication adherence among patients with type 2 diabetes in southwestern Nigeria

ObjectiveWe determined the prevalence of poor glycemic control and associations with sociodemographics, comorbid conditions, and medication adherence among patients with type 2 diabetes mellitus (T2DM) at a tertiary hospital in southwestern Nigeria.MethodsWe conducted a retrospective observational study among 300 patients with T2DM using systematic random sampling. We used a semi-structured questionnaire to collect information on respondents’ sociodemographic profile, lifestyle, comorbid conditions, and antidiabetic medications. Adherence was determined using the Morisky Medication Adherence Scale. Fasting blood samples were tested using a glycated hemoglobin marker. Multivariate logistic regression was used to identify factors associated with poor glycemic control.ResultsRespondents’ mean age was 61.9 ± 11.8 years. The prevalence of poor glycemic control was 40.0% (95% confidence interval [CI]: 34.4%–45.8%). The adjusted odds ratio (95% CI) for factors associated with poor glycemic control was 2.522 (1.402–4.647) for older age, 1.882 (1.021–3.467) for low income, 1.734 (1.013–3.401) for obesity, 2.014 (1.269–5.336) for non-initiation of insulin therapy, and 1.830 (1.045–3.206) for poor medication adherence.ConclusionOlder age, lower income, obesity, non-initiation of insulin, and poor medication adherence were associated with poor glycemic control. These variables may help clinicians identify patients at high risk of poor glycemic control.     

Chemotherapy for tuberculosis

Abstract

The prevalence of type 2 diabetes mellitus (T2DM) is rising in association with an increase in obesity rates. Current treatment options for patients with T2DM include lifestyle modifications and numerous antidiabetic medications. Despite the availability of effective and well-tolerated treatments, many patients do not achieve recommended glycemic targets. Lack of efficacy is complicated by the wide range of available agents and little specificity in treatment guidelines, thus challenging clinicians to understand the relative benefits and risks of individual options for each patient. In this article, lifestyle intervention strategies and current antidiabetic agents are evaluated for their efficacy, safety, and weight-loss potential. Because of the heterogeneous and progressive nature of T2DM, physicians should advocate approaches that emphasize weight management, limit the risk of hypoglycemia and adverse events, and focus on the core pathophysiologic defects in patients with T2DM. A healthy, plant-based diet that is low in saturated fat and refined carbohydrates but high in whole grains, vegetables, legumes, and fruits, coupled with resistance and aerobic exercise regimens, are recommended for patients with T2DM. When necessary, drug intervention, described in this article as the MGI (metformin, glucagon-like peptide-1 receptor agonist, and insulin) approach, should begin with metformin and progress to the early addition of glucagon-like peptide-1 receptor agonists because of their weight loss potential and ability to target multiple pathophysiologic defects in patients with T2DM. For most patients, treatments that induce weight gain and hypoglycemia should be avoided. Long-acting insulin should be initiated if glycemic control is not achieved with metformin and glucagon-like peptide-1 receptor agonist combination therapy, focusing on long-acting insulin analogs that induce the least weight gain and have the lowest hypoglycemic risk. Ultimately, a patient-centered treatment approach that addresses the core pathologies of T2DM and obesity will not only increase overall efficacy and the likelihood that a patient adheres to treatment, but may also improve a patient's mental well-being and quality of life.     

Early Detection of Prediabetes and T2DM Using Wearable Sensors and Internet-of-Things-Based Monitoring Applications

Background  Prediabetes and type 2 diabetes mellitus (T2DM) are one of the major long-term health conditions affecting global healthcare delivery. One of the few effective approaches is to actively manage diabetes via a healthy and active lifestyle. Objectives  This research is focused on early detection of prediabetes and T2DM using wearable technology and Internet-of-Things-based monitoring applications. Methods  We developed an artificial intelligence model based on adaptive neuro-fuzzy inference to detect prediabetes and T2DM via individualized monitoring. The key contributing factors to the proposed model include heart rate, heart rate variability, breathing rate, breathing volume, and activity data (steps, cadence, and calories). The data was collected using an advanced wearable body vest and combined with manual recordings of blood glucose, height, weight, age, and sex. The model analyzed the data alongside a clinical knowledgebase. Fuzzy rules were used to establish baseline values via existing interventions, clinical guidelines, and protocols. Results  The proposed model was tested and validated using Kappa analysis and achieved an overall agreement of 91%. Conclusion  We also present a 2-year follow-up observation from the prediction results of the original model. Moreover, the diabetic profile of a participant using M-health applications and a wearable vest (smart shirt) improved when compared to the traditional/routine practice.     

Behavior and biology: the prevention of type 2 diabetes

Type 2 diabetes mellitus (DM), characterized by insulin resistance and a beta-cell secretory defect, appears to result from a number of gene and environmental interactions. There are marked differences in the phenotypic expression of type 2 DM with individuals exhibiting varying levels of insulin resistance and impairments in insulin secretion. Study results indicate that a number of healthy lifestyle behaviors, such as increased physical activity and reduced intake of dietary fat, are associated with decreased development of type 2 DM. This article explores the genetic and environmental factors associated with the development of type 2 DM along with the role of lifestyle modifications in the prevention of this disease.     

Is acanthosis nigricans a reliable indicator for risk of type 2 diabetes in obese children and adolescents? A systematic review

Obesity and type 2 diabetes is becoming a major health problem affecting children and adolescents in the United States. This article reviews the current literature examining the association between the presence of acanthosis nigricans (AN) and risk for developing type 2 diabetes mellitus (T2DM) in obese children and adolescents. Ethnicity, family history of diabetes, and emergence of obesity are contributing factors for development of hyperinsulinemia, and insulin resistance, and ensuing visible changes on skin which is known as the AN. The purpose of this review was to assess the validity of AN as an early indicator of T2DM. Nineteen articles that were published from 1994 to 2010 were included for this review and reported an association between AN, hyperinsulinemia, and hyperglycemia. Nurses and advanced nurse practitioners working with children and adolescents have a tremendous role in identifying the risk factors, counseling, role modeling, and referring them to available community resources to promote healthy living. Early initiatives focusing on lifestyle changes may halt the progress, chronicity, and burden of T2DM in children and adolescents.     

Identification of independent risk factors for diabetic neuropathy progression in patients with type 2 diabetes mellitus

ObjectiveTo identify independent risk factors for diabetic neuropathy (DN) in patients with type 2 diabetes mellitus (T2DM).MethodsWe retrospectively analyzed 376 patients with T2DM at the First Affiliated Hospital of Fujian Medical University, China between January 2013 and October 2016. Multivariate logistic regression was used to explore potential risk factors for progression of DN in patients with T2DM. Effect sizes were estimated using odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe prevalence of DN in patients with T2DM was 43.1%. Multivariate logistic regression indicated that retinopathy (OR: 2.755, 95% CI: 1.599–4.746); diabetic nephropathy (OR: 2.196, 95% CI: 1.279–3.772); longer duration of T2DM (OR: 1.081, 95% CI: 1.045–1.120); use of insulin (OR: 1.091, 95% CI: 1.018–1.170); longer history of alcohol consumption (OR: 1.034, 95% CI: 1.010–1.059); and higher blood urea nitrogen (OR: 1.081, 95% CI: 1.009–1.159) were associated with increased risk of DN in patients with T2DM.ConclusionsRetinopathy, diabetic nephropathy, longer duration of T2DM, use of insulin, longer history of alcohol consumption, and higher blood urea nitrogen were independent risk factors for DN. These findings should be verified in large-scale prospective studies.     

2型糖尿病口服降糖药治疗

2型糖尿病（T2DM）是一种以胰岛素抵抗及胰岛β细胞功能缺陷为基本特征的慢性进行性疾病,其患病率迅速增加。近年来,随着对T2DM发病机制理解的深入,如肠促胰素效应减弱、神经递质功能紊乱、肾脏重吸收葡萄糖增加等,基于特定机制研发的新型口服降糖陆续运用于T2DM的治疗。本文将简要介绍几种新型降糖药的有效性和安全性。     

Intensification of insulin therapy in patients with type 2 diabetes mellitus: An algorithm for basal-bolus therapy

Abstract

The incidence of diabetes mellitus is projected to continue to increase worldwide over the next 20 years leading to increased costs in the management of the disease and its associated co-morbidities. Insulin replacement is one of many treatment options that can help to bring about near normoglycemia in the patient with type 2 diabetes mellitus (T2DM). Glycemic control as close to normoglycemia as possible can help to reduce the risk of microvascular and macrovascular complications, yet less than one-half of patients with T2DM achieve glycemic targets as recommended by practice guidelines. The purpose of this review is to provide guidance to primary care physicians for the initiation and intensification of basal-bolus insulin therapy in patients with T2DM. Two treatment algorithms that can be both patient- and physician-driven are proposed: a stepwise approach and a multiple daily injections approach. Evidence shaping the two approaches will be discussed alongside management issues that surround the patient treated with insulin: hypoglycemia, weight gain, patient education, and quality of life.     

Effects of incretin-based therapies on β-cell function in type 1 diabetes mellitus: a systematic review and meta-analysis

AimTo assess the effects of incretin-based therapies on β-cell function in patients with type 1 diabetes mellitus (T1DM).MethodsWe searched the PubMed, Cochrane Library, Embase, and Web of Knowledge databases for eligible randomized clinical trials published up to July 2021. The inclusion criteria were patients with T1DM or latent autoimmune diabetes in adults, patients treated with dipeptidyl peptidase-4 inhibitors or glucagon like peptide-1 receptor agonists, and outcomes included one of the following: fasting plasma glucose, fasting C-peptide, postprandial C-peptide, C-peptide area under the curve (AUC), homeostasis model assessment for β cell function, and insulin resistance. The effects were analyzed using a random effect model with STATA 11.0.ResultsEight trials including 427 participants were included in the final analysis. A pooled analysis found no significant difference in fasting plasma glucose, fasting C-peptide, postprandial C-peptide, or C-peptide AUC between patients treated with incretin-based therapies and placebo. The two trials that reported changes in 2-hour postprandial C-peptide and two of the four trials that reported changes in C-peptide AUC reported increases after incretin-based therapies.ConclusionThis meta-analysis showed that incretin-based therapies did not preserve β-cell function in patients with T1DM.     

初诊2型糖尿病患者胰腺脂肪沉积程度与胰岛素抵抗的关系

目的研究初诊2型糖尿病(T2DM)患者胰腺脂肪沉积程度以及与胰岛素抵抗(IR)的关系。方法收集对照组(30例),T2DM非肥胖患者(20例),T2DM肥胖患者(30例),均接受上腹部CT检查,计算脾胰CT差值,评估胰腺脂肪沉积的程度。结果胰腺脂肪沉积程度在对照组[(4.29±3.39)Hu],T2DM患者[(8.56±6.15)Hu],T2DM肥胖患者[(8.10±5.82)Hu]内呈递增趋势(P<0.01),胰腺脂肪沉积是胰岛素抵抗指数(HOMA-IR)的独立相关因素(P<0.01)。结论胰腺脂肪沉积与IR相关,可能参与T2DM的发展。     

Choice of early treatment regimen and impact on β‐cell preservation in type 2 diabetes

The progressive deterioration of glycaemic control in individuals with type 2 diabetes mellitus (T2DM) results from insulin resistance combined with the ongoing loss of β‐cell function. Although it had been suggested that most β‐cell dysfunction occurs after the development of T2DM, studies have documented a substantial early loss of β‐cell function, particularly during the prediabetic state. In patients diagnosed with T2DM, β‐cell function continues to decline despite treatment with commonly prescribed antihyperglycaemic medications, and ultimately exogenous insulin administration is required to maintain optimal glycaemic control. Thus, interventions to address the early decline in β‐cell function could potentially alter the course of T2DM, preventing or delaying its onset and decreasing the incidence of complications. Original research and review articles on this topic were identified in a PubMed search from January 2000 through August 2012. Data from prospective studies and clinical trials suggest that lifestyle modifications and certain antihyperglycaemic medications, including thiazolidinediones (TZDs), glucagon‐like peptide‐1 (GLP‐1) agonists, dipeptidyl peptidase‐4 (DPP‐4) inhibitors and insulin, may preserve or enhance β‐cell function. The implication of current data is that early initiation of lifestyle modifications and antihyperglycaemic agents that preserve β‐cell function might reverse or delay progression to T2DM in those with prediabetes. Moreover, improved β‐cell function may confer more durable glucose control and perhaps reduce/delay the incidence of diabetic complications. Long‐term studies are needed to validate this hypothesis.     

Managing older adults with diabetes

PURPOSE: To review special considerations in the management of adults 65 years of age and older with diabetes mellitus (DM) with particular attention to initiation of insulin in the management of type 2 DM (DM2), Medicare eligibility for insulin pump therapy, and intensive insulin therapy in both type 1 DM (DM1) and DM2 in older adults. DATA SOURCES: American Diabetes Association Standards of Medical Care in Diabetes, selected research articles, textbooks, and Internet sources. CONCLUSIONS: American Diabetes Association, American Association of Diabetes Educators, and American Association of Clinical Endocrinologist acknowledge that no long-term studies have been conducted in older adults with DM. Furthermore, these groups as well as the American Geriatric Society conclude that a person's functional capacity and not age should determine the treatment modality most beneficial in each situation. IMPLICATIONS FOR PRACTICE: Management of diabetes in the older adult is a common clinical scenario for primary care providers (PCPs). Treatment strategies follow a continuum over time from lifestyle modification to intensive management. Intensive insulin therapy, through the use of either multiple daily injections or continuous subcutaneous insulin infusion using insulin pumps, has demonstrated benefit in both DM1 and DM2; however, there is evidence that PCPs are reluctant to initiate insulin. Moreover, in the management of older adults with diabetes, evidence-based outcomes regarding intensive management are lacking. Further studies are needed.     

A Rice Bran Oil Diet Improves Lipid Abnormalities and Suppress Hyperinsulinemic Responses in Rats with Streptozotocin/Nicotinamide-Induced Type 2 Diabetes

The aim of this study was to determine the effects of rice bran oil (RBO) on lipid metabolism and insulin resistance in rats with streptozotocin/nicotinamide-induced type 2 diabetes mellitus (T2DM). Rats were divided into two groups: the control group (15% soybean oil, contains 0 g γ-oryzanol and 0 g γ-tocotrienol/150 g oil for 5 weeks) and the RBO group (15% RBO, contains 5.25 g γ-oryzanol and 0.9 g γ-tocotrienol/150 g oil for 5 weeks). Compared with the control group, the RBO group had a lower plasma nonesterified fatty acid concentration, ratio of total to high-density-lipoprotein cholesterol, hepatic cholesterol concentration, and area under the curve for insulin. The RBO group had a higher high-density-lipoprotein cholesterol concentration and greater excretion of fecal neutral sterols and bile acid than did the control group. RBO may improve lipid abnormalities, reduce the atherogenic index, and suppress the hyperinsulinemic response in rats with streptozotocin/nicotinamide-induced T2DM. In addition, RBO can lead to increased fecal neutral sterol and bile acid excretion.     

The importance of postprandial glycemic control: optimizing add-on therapy to basal insulin

Diabetes, mainly type 2 diabetes mellitus (T2DM), is associated with a growing clinical and economic burden in the United States, which is expected to increase in association with an aging population. Sufficient glycemic control in patients with T2DM, in order to reduce the risk of micro- and macrovascular complications associated with diabetes, is mediated by lifestyle modifications and a regimen of increasingly intensive antidiabetes drugs. Several treatments and strategies are available for primary care physicians to select from when choosing the most appropriate therapy for their individual patients with T2DM, but, ultimately, due to the progressive nature of the disease, most of these patients will require insulin therapy to maintain glycemic control. Regimens containing basal and postprandial insulins are widely used, but there is still widespread reluctance to initiate insulin treatment due to fear of weight gain and hypoglycemia. Furthermore, as patients approach recommended glycated hemoglobin targets, postprandial hyperglycemia becomes the main contributor to hyperglycemic exposure, necessitating the timely initiation of prandial treatment. Finally, insulin treatment can be limited by factors like the number of injections, mealtime restrictions, complex titration algorithms and patient adherence. Recent developments in antidiabetes drug research have brought more convenient basal and postprandial regimens closer. Clinical evaluation of the efficacy and safety of basal insulins plus add-on glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has yielded promising results. Primary care physicians are continually challenged to optimize insulin treatment strategies to maximize patient outcomes. Emerging strategies such as long-acting basal insulin analogs and short-acting GLP-1 RAs are particularly appealing to address this challenge.     

血清apelin水平与2型糖尿病并颈动脉粥样硬化的关系

目的 探讨血清apelin水平与2型糖尿病(T2DM)惠者并颈动脉粥样硬化的关系.方法 分别测定正常时照组(30例)、T2DM无颈动脉粥样硬化组(简称:T2DM组,35例)、T2DM伴颈动脉粥样硬化组(35例)的体质量指数(BMI),空腹血糖(FPG),糖化血红蛋白(HbA1c),血脂,空腹胰岛素(FINS),胰岛素抵抗指数(HOMA-IR)等,采用酶联免疫吸附法(ELISA)测定血清apelin水平.结果 与正常对照组比较,血清apelin水平在T2DM组明显升高,(53.79±9.17)μg/L vs(44,44±9,20)μg/L(P<0.01);与T2DM组比较,血清apelin水平在T2DM伴颈动脉粥样硬化组也升高,(61.52±5.18)μg/L vs(53.79±9.17)μg/L(P<0.01).偏相关分析显示,血清apelin与HOMA-IR、FPG、总胆固醇(TC)呈正相关(r=0.486,0.400,0.491,P<0.05,P<0.01).logistic回归示:apelin、HOMA-IR是T2DM患者颈动脉粥样硬化的危险因素.结论 T2DM颈动脉粥样硬化患者的血清apelin水平升高,且与In、(HOMA-IR),FPG、TC呈正相关,推测apelin可能参与构成胰岛素抵抗综合征和动脉粥样硬化的病理生理基础.     

Associations of serum amyloid A and 25‐hydroxyvitamin D with diabetic nephropathy: A cross‐sectional study

BackgroundThe present study investigated the relationships between serum amyloid A (SAA), 25‐hydroxyvitamin D (25(OH)VD) and diabetic nephropathy (DN) to provide evidence for the prevention and management of DN.MethodsA total of 182 patients with type 2 diabetes mellitus (T2DM) were enrolled in this study. The levels of SAA, 25(OH)VD, and other conventional indicators were measured and analyzed. Receiver operating characteristic curve analysis was applied for the combined measurement of SAA and 25(OH)VD, and risk factors for DN were evaluated using binary logistic regression analysis.ResultsThe levels of SAA in T2DM patients were significantly higher than those in healthy subjects, and the level significantly increased with the progression of DN (p < 0.05). In contrast, the level of 25(OH)VD in T2DM patients was significantly lower than that in healthy subjects, and the level significantly decreased with the progression of DN (p < 0.05). The combined measurement of SAA and 25(OH)VD distinguished DN patients from T2DM patients better than the measurement of SAA or 25(OH)VD alone. SAA was an independent risk factor for DN, and 25(OH)VD was an independent protective factor for DN.ConclusionSAA and 25(OH)VD might be used as potential markers to identify patients at increased risk of developing DN.     

New measures of diabetes self‐care agency,diabetes self‐efficacy,and diabetes self‐management for insulin‐treated individuals with type 2 diabetes

Aims and objectives. To develop and refine three new scales that measure diabetes self‐care agency, diabetes self‐efficacy and diabetes self‐management to reflect the American Diabetes Association current standards of diabetes care and the American Association of Diabetes Educators self‐care behaviours. And, to establish the clarity, consistency and content validity of the scales. Background. There is a need to have valid and reliable instruments or scales to assess an individual’s diabetes self‐care agency, self‐efficacy and self‐management to plan appropriate interventions that can be effective in improving glycaemic control and delaying or preventing diabetes‐related complications. Design. A methodological design was used to conduct this study. Methods. Ten clinicians and 10 insulin‐treated individuals with type 2 diabetes (T2DM) from a diabetes care center in the southern USA participated in this study. Analysis consisted of inter‐rater agreement to determine clarity and consistency with standards of diabetes care and content validity of individual items on the scales (I‐CVI) and the overall scales (S‐CVI/Ave) to determine relevance for current diabetes care practice. Results. All I‐CVI and S‐CVI/Ave of the DSES exceeded the minimum acceptable criteria. All I‐CVI and the S‐CVI of the DSMS also exceeded the minimum accepted criteria, except for one item that had I‐CVI = 0·70. Evaluation of the items and the directions of the scales by the sample of insulin‐treated individuals with T2DM exceeded the minimum criteria of 80% inter‐rater agreement. Relevance to research and clinical practice. Further psychometric testing of the scales with samples of insulin‐treated individuals with diabetes is warranted and will lay the groundwork for further research and clinical practice to enhance the capability, confidence and actual performance of diabetes self‐management activities among insulin‐treated individuals with T2DM. Conclusions. The scales can be used by diabetes care providers to assess and follow‐up individuals with diabetes who need intense case management. They also can be the measures of choice to conduct future research to test the effects of interventions among insulin‐treated individuals with T2DM.     

Commentary on the Impact of Obesity on PediatricDiabetes

While conventionally most children diagnosed with diabetes are thought to have type 1 diabetes mellitus (T1DM), with the increased prevalence of obesity, more are being affected by type 2 (T2) DM. Obesity leads to increased insulin resistance, which over time can lead to progressive β-cell failure and ultimately T2DM. However, patients developing T1DM may also be obese, making both the proper classification and management of diabetes in children more challenging. In this commentary, the authors discuss the impact ofobesity on the presentation of pediatric diabetes, how to differentiate between T1DM and T2DM, and the proper management of both diseases.     

Serum IL‐36 cytokines levels in type 2 diabetes mellitus patients and their association with obesity,insulin resistance,and inflammation

BackgroundThe interleukin (IL)‐36 cytokines include IL‐36α, IL‐36β, IL‐36γ, and IL‐36Ra. Little was known about their roles in type 2 diabetes mellitus (T2DM).MethodsThe study included 40 T2DM patients and 42 healthy control subjects. The anthropometric and biochemical measurements were performed using automatic biochemical analyzer, high‐performance liquid chromatography, and electrochemiluminescence immunoassay. Circulating IL‐36α, IL‐36γ, IL‐36Ra, and IL‐17 levels were determined by enzyme‐linked immunosorbent assay.ResultsSerum IL‐36α, IL‐36γ, and IL‐17 levels in T2DM patients were significantly higher than those in controls, whereas serum IL‐36Ra levels in T2DM patients were lower. Correlation analysis showed that serum IL‐36α was positively correlated with high sensitivity C‐reactive protein. Serum IL‐36α was negatively correlated with IL‐36Ra. Serum IL‐17 was negatively correlated with low‐density lipoprotein cholesterol.ConclusionsThis study demonstrated that T2DM patients displayed increased IL‐36α and IL‐36γ expression and decreased IL‐36Ra expression. Moreover, the inflammatory cytokine levels were directly proportional to the inflammation and blood lipid levels. Our results suggest that IL‐36 cytokines may be a new target for the diagnosis or treatment of T2DM.     

Cardiovascular benefits and safety of non-insulin medications used in the treatment of type 2 diabetes mellitus

Diabetes mellitus is a growing in exponential proportions. If the current growth trend continues, it may result in every third adult in the United States having diabetes mellitus by 2050, and every 10^th adult worldwide. Type 2 diabetes mellitus (T2DM) confers a 2- to 3-fold increased risk of cardiovascular (CV) events compared with non-diabetic patients, and CV mortality is responsible for around 80% mortality in this population. Patients with T2DM can have other features of insulin resistance-metabolic syndrome like hypertension, lipid abnormalities, and obesity which are all associated with increased CV disease and stroke risk even in the absence of T2DM. The management of a T2DM calls for employing a holistic risk factor control approach. Metformin is the first line therapy for T2DM and has been shown to have cardiovascular beneficial effects. Intense debate regarding the risk of myocardial infarction with rosiglitazone led to regulatory agencies necessitating cardiovascular outcome trials with upcoming anti-diabetic medications. Glucagon like peptide-1 agonists and sodium glucose co-transporter-2 inhibitors have shown promising CV safety and additional CV benefit in recent clinical trials. These drugs have favorable effects on traditional CV risk factors. The findings from these studies further support that fact that CV risk factor control plays an important role in reducing morbidity and mortality in T2DM patients. This review article will discuss briefly the cardiovascular safety and benefits of the oral medications which are currently being used for T2DM and will then discuss in detail about the newer medications being investigated for the treatment of T2DM.