Contribution of glimepiride to basal-prandial insulin therapy in patients with type 2 diabetes

Aim

To investigate the efficacy of continuing glimepiride in combination with basal-prandial insulin therapy in type 2 diabetes.

Methods

An open crossover study was performed with arms of discontinuation and continuation of glimepiride in 25 subjects with mean diabetes duration of 17 years and 5 years of insulin treatment combined with glimepiride plus metformin. At entry and at the end of each 3-month arm, meal tolerance tests were performed for measurements of blood glucose and C-peptide.

Results

In terms of between-treatment differences (discontinuation vs. continuation arm of glimepiride) during meal tolerance tests performed at the ends of arms, significant increases in plasma glucose were seen on the discontinuation arm at 0-, 30-, and 60-min, while significant decreases in serum C-peptide were observed at 60- and 120-min. A1C values of the discontinuation arm significantly increased (from 6.6 ± 0.6 at baseline to 7.7 ± 0.8 at 3-months, p < 0.0001). Increases in A1C were closely correlated with decreases in area under the curve of meal-stimulated serum C-peptide (r = −0.61, p < 0.0001).

Conclusions

Since endogenous insulin secretion is more physiological than subcutaneous insulin injection, continuing glimepiride may remain beneficial, partly through enhancing insulin secretion, in individuals with a long duration of diabetes and basal-prandial insulin therapy.     

Indexes of β-cell function from the oral glucose tolerance test can modestly predict pancreatic β-cell area in Korean

Aims

Pancreatic β-cell function indexes have been suggested using the oral glucose tolerance test (OGTT). Here, we investigated whether β-cell function index from the OGTT reflects pancreatic β-cell area in Korean patients.

Methods

The study consisted of 45 patients who underwent pancreatectomies. Before operation, a 75-g OGTT was performed. Immunohistochemical staining was performed, and indexes of β-cell function from the OGTT data were compared with the pancreatic β-cell area.

Results

The β-cell area of the pancreas was 1.07 ± 0.33% in the normal glucose tolerance group, 1.71 ± 0.85% in the pre-diabetes group (impaired glucose tolerance and impaired fasting glucose), and 1.08 ± 0.57% in the diabetes group. The β-cell area of the pre-diabetes group was significantly higher than that of the diabetes group. Pancreatic β-cell area showed a significant correlation with a homeostasis model assessment of β-cell function (r = 0.358, P = 0.016), disposition index (r = 0.336, P = 0.024), fasting glucose (r = −0.359, P = 0.015), and the C-peptide/glucose 30 min ratio (r = 0.319, P = 0.035).

Conclusions

Some parameters of β-cell function from the OGTT showed a significant relationship with the β-cell area of pancreas.     

Postprandial metabolic responses to mixed versus liquid meal tests in healthy men and men with type 2 diabetes

Aims

Compare metabolic responses after mixed versus liquid meals of similar caloric/nutritional content in healthy and type 2 diabetes (T2D) subjects.

Methods

Ten healthy men and 10 men with T2D received mixed and liquid meals after an overnight fast. Classical (insulinogenic index; insulin/glucose areas under curves, AUC_insulin/AUC_glucose) and model-based (beta-cell glucose sensitivity; rate sensitivity; potentiation factor ratio, PFR) beta-cell function estimates were calculated. Between-meal differences in glucose, insulin, C-peptide, triglyceride (TG), beta-cell function and oral glucose insulin sensitivity (OGIS) and between-meal correlations for beta-cell function and OGIS were evaluated.

Results

Among healthy subjects, beta-cell function and OGIS were similar between meals. C-peptide (p = 0.03), insulin (p = 0.002), AUC_insulin/AUC_glucose (p = 0.004) and insulin secretion (p = 0.04) were higher after the liquid meal. Among T2D subjects, glucose, insulin, C-peptide, beta-cell function, and OGIS were similar. PFR was higher (p = 0.004) and TG increased more slowly (p = 0.002) after the liquid meal. OGIS and beta-cell function were correlated during both meals in both groups (r = 0.66-0.98), except incremental AUC_insulin/AUC_glucose, rate sensitivity, and, in healthy subjects, PFR.

Conclusions

Metabolic responses after mixed or liquid meals of similar content were highly correlated in T2D and healthy subjects. In T2D, the liquid meal produced beta-cell function estimates generally similar to the mixed meal.     

Effects of short-term therapy with glibenclamide and repaglinide on incretin hormones and oxidative damage associated with postprandial hyperglycaemia in people with type 2 diabetes mellitus

Aim

To examine the effects of glibenclamide and repaglinide on glucose stimulated insulin release, incretins, oxidative stress and cell adhesion molecules in patients with type 2 diabetes suboptimally treated with metformin.

Methods

A randomized clinical trial was performed recruiting 27 subjects (HbA_1c between 7.5 and 10.5%) free from cardiovascular and renal disease. Glucose, insulin, C-peptide, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), total antioxidant status, F₂-isoprostane, interleukin-6 and cell adhesion molecules were measured during an oral glucose load at baseline and after eight weeks of treatment. The areas under the curve were analysed at 45, 60 and 120 min (AUC₄₅, AUC₆₀, AUC₁₂₀).

Results

Significant improvements in glucose were observed with repaglinide (HBA_1c: −1.5%, fasting glucose: −2.8 mmol/L, 2-h glucose: −3.7 mmol/L, AUC₁₂₀: −18.9%) and glibenclamide (−1.0%, −2.2 mmol/L, −2.5 mmol/L, −17.5%). Repaglinide was also associated with an increase in the AUC₆₀ and AUC₁₂₀ for insulin (+56%, +61%) and C-peptide (+41%, +36%). GLP-1, GIP, IL-6, ICAM-1 and E-selectin levels did not change in either group. No association was observed between GLP-1, GIP-1 and plasma markers of oxidative stress.

Conclusion

Repaglinide is associated with improved postprandial glycaemic control via insulin and C-peptide release. We observed no direct effects of glibenclamide or repaglinide on plasma levels of GLP-1 or GIP. We observed no associations of GLP-1 and GIP with plasma markers of oxidative stress.     

The association between in utero hyperinsulinemia and adolescent arterial stiffness

Aim

To determine the relationship between in utero hyperinsulinemia and children's arterial stiffness at adolescence.

Methods

Indices of arterial stiffness were measured using the SphygmoCor apparatus in 129 adolescents (42 offsprings of mother with gestational diabetes and 87 offsprings of mother with normal glucose tolerance during pregnancy) at 15 years of age.

Results

Adolescent of mothers with gestational diabetes had similar central aortic blood pressure, augmentation pressure (AP), augmentation index (AI), and carotid-femoral pulse wave velocity (PWV) as that of controls. However, both umbilical cord C-peptide and insulin levels correlated positively AI (R = 0.28 and 0.24; p = 0.011 and 0.035, respectively), and umbilical insulin level correlated positively with AP (R = 0.25; p = 0.025). The correlations were significant between umbilical cord C-peptide and AP (R = 0.24; p = 0.035) and AI (R = 0.29; p = 0.011) after adjustment for subjects’ age, sex, body weight and height. Adolescents who had umbilical cord C-peptide levels at highest quartile (n = 25), based on the reference ranges of the original cohort, had a significant greater PWV (5.26 ± 0.12 m/s vs 4.98 ± 0.12 m/s; p = 0.0049) than those with C-peptide levels at the lower 3 quartiles (n = 57) after adjustment for age, sex, body weight and height.

Conclusions

In utero hyperinsulinemia appears to increase the offspring's arterial stiffness at early adolescence.     

Key elements for successful intensive insulin pump therapy in individuals with type 1 diabetes

Objective

Clinical trials have demonstrated that in individuals with type 1 diabetes the use of CSII pump resulted in better glucose control. Advantages of pumps therapy include many features such as the bolus calculators (wizard). These features are optional and therefore it is important to determine whether their use is associated with better glucose control. Thus, the aim of this analysis was to assess which features and parameters of insulin pump use are associated with better glucose control.

Methods

Data regarding consecutive patients with type 1 diabetes treated with an insulin pump and attending a tertiary referral for intensive glucose control was included in this analysis. The relationship between glycemic indices and treatment parameters (number of insulin units, number of glucose readings, bolus calculator use etc.) was assessed.

Results

A statistically significant relationship was found between glycemic indices and wizard use. Thus, individuals that used the wizard function in 50% of their boluses had an A1C, mean blood glucose values that were 0.6% (p = 0.008) and 25 mg/dL (p = 0.000) lower respectively.

Conclusion

The use of the bolus calculator feature was associated with better glucose control. Larger prospective clinical trials are needed in order to further validate this finding.     

No Effect of Selenium Supplementation on Serum Glucose Levels in Men with Prostate Cancer

Background

Literature indicates a relationship between selenium supplementation and risk of diabetes. However, because these data are inconclusive, we investigated the effect of selenium supplementation on serum glucose levels in men with prostate cancer enrolled in a clinical trial testing of the effect of selenium on prostate cancer progression.

Methods

Subjects were randomized to receive placebo (n = 46), selenium 200 μg/day (n = 47), and selenium 800 μg/day (n = 47). Serum glucose levels were obtained every 6 months for up to 5 years. Longitudinal analysis was carried out to assess whether rate of change of serum glucose levels was significantly different in the selenium-supplemented groups as compared with placebo. Sensitivity analyses were performed to assess the robustness of findings.

Results

Changes in serum glucose levels during the course of the trial were not statistically significantly different as compared with placebo for the selenium 200 μg/day (P = .56) or selenium 800 μg/day (P = .91) treatment groups.

Conclusion

These results do not support a relationship between selenium supplementation and changes in serum glucose levels. Recommendations about selenium supplementation and risk of diabetes will require more definitive studies.     

Glucometabolic responses during Glucose Tolerance Test: A comparison between known diabetes and newly detected diabetes after acute myocardial infarction

Background

Glucose Tolerance Test (GTT) newly detects diabetes (new diabetes) in a substantial number of patients without a history of diabetes (known diabetes) after acute myocardial infarction (AMI). Patients with new diabetes have poor outcomes, despite their lower HbA1c levels.

Methods

This study consisted of 53 patients with new diabetes and 47 patients with known diabetes who underwent GTT 1 week after AMI. Sixty-eight patients with normal GTT and 78 patients with impaired glucose tolerance served as control. Plasma glucose and insulin were measured at fasting, 30 m, 60 m and 120 m after glucose load. Peak glucose-fasting glucose was used as a measure of glucose fluctuation. Homeostasis model assessment of insulin resistance and the Stumvoll's equations were used to assess insulin sensitivity and ß-cell function, respectively.

Results

Fasting glucose (115 ± 20 mg/dl versus 129 ± 41 mg/dl, p = 0.02) and hemoglobin A1C (5.7 ± 0.5% versus 6.7 ± 1.4%, p < 0.001) in new diabetes were significantly lower than known diabetes. Insulin sensitivity was similarly impaired in both new diabetes and known diabetes (3.2 ± 2.2 versus 3.0 ± 1.9, p = 0.58). Impairment of insulin secretion was less severe in new diabetes than in known diabetes. Peak glucose-fasting glucose was significantly greater in diabetic patients than inpatients with normal GTT (75 ± 30 mg/dl, p < 0.001) and impaired glucose tolerance (95 ± 24 mg/dl, p < 0.001), with no difference between new diabetes and known diabetes (156 ± 36 mg/dl versus 165 ± 57 mg/dl, p = 0.36).

Conclusions

These findings suggested that insulin resistance and exaggerated glucose fluctuation could be attributable to poor outcomes after AMI in patients with new diabetes.     

Early phase insulin secretion is increased in subjects with normal fasting glucose and metabolic syndrome: a premature feature of beta-cell dysfunction

Background and Aims

Metabolic syndrome (MS) has been mainly related to insulin resistance, but the role of changes in insulin secretion has not been thoroughly investigated.

Methods and Results

Using an oral glucose tolerance test (OGTT) we studied beta-cell function and insulin sensitivity in subjects with normal fasting glucose with and without MS, and their relationship to fatty liver which was evaluated by abdominal-ultrasonography. In MS early phase insulin secretion, as measured by insulinogenic index (IG₃₀), was increased (p < 0.05) independently from insulin sensitivity. Furthermore IG₃₀ was progressively higher as the number of factors needed for the diagnosis of MS increased (p < 0.01). Insulin and C-peptide AUC were also increased (p < 0.01 and p < 0.05, respectively) but, in contrast to IG_30, these differences disappeared when ISI was used as a covariate. After OGTT, 51% of the subjects with MS had altered post-load glucose tolerance compared to 24.9% without MS (p < 0.01). In both groups, the altered glucose tolerance was associated with a similar IG₃₀ reduction. In normo-tolerant subjects with MS the IG₃₀ was higher (+54.1%, p < 0.01), and this elevation occurred irrespective of ISI; however, the beta-cell compensatory capacity for insulin resistance (disposition index) was impaired (p < 0.001). Fatty liver was more frequent (p < 0.001) and more severe (p < 0.01) in MS, and it was significantly related to total AUC-insulin (p < 0.001), independently from ISI.

Conclusion

These findings indicate that the prevalence of altered tolerance is more frequent in subjects with normal fasting glucose and MS. The hyperinsulinemia might not only be an adaptive response to insulin resistance, but a primary defect of beta-cell function contributing to glucose intolerance.     

Acute angiotensin II receptor blockade improves insulin-induced microvascular function in hypertensive individuals

Objective

An effect of insulin that is crucial for stimulating glucose uptake is its ability to increase the number of perfused capillaries, and thereby enhance its own delivery, and that of glucose, to muscle cells. To unravel possible mechanisms involved in the insulin-sensitizing effects of angiotensin II receptor blockers (ARBs) in hypertensive individuals we investigated the effect of single-dose ARB administration on insulin-mediated microvascular perfusion in hypertensive individuals.

Methods

We examined the effects of ARB administration on hyperinsulinemia-associated capillary density by measuring baseline skin capillary density, capillary density during reactive hyperemia (hyperemic capillary recruitment), and capillary density during venous congestion in 17 hypertensive individuals in the basal state, during a hyperinsulinemic euglycemic clamp, and during a hyperinsulinemic clamp with acute ARB administration (600 mg irbesartan), acute calcium channel blockade (CCB; 10 mg felodipine ER), as a control for the reduction in blood pressure, or placebo. In addition, insulin sensitivity and blood pressure were measured.

Results

Compared to the basal state, hyperinsulinemia increased baseline capillary density (57.3 ± 6.8 vs. 60.3 ± 7.9 n/mm², P < 0.01), but not hyperemic capillary recruitment. ARB and CCB treatment induced similar blood pressure reductions. Compared to placebo, ARB, but not CCB, increased hyperinsulinemia-associated baseline capillary density (+ 2.3 ± 3.4 (P = 0.02) and − 0.4 ± 4.4 n/mm², respectively). Hyperinsulinemia-associated hyperemic capillary recruitment was not altered by either treatment. Compared to placebo, neither ARB nor CCB treatment enhanced insulin sensitivity.

Conclusions

Acute ARB administration increases insulin-induced microvascular perfusion in mildly hypertensive individuals; this beneficial effect on microvascular perfusion was however not associated with increased insulin-mediated glucose uptake.     

Contribution of first trimester fasting plasma insulin levels to the incidence of glucose intolerance in later pregnancy: Tanaka women's clinic study

Aims

To clarify risk factors predictive of glucose intolerance in later pregnancy.

Methods

We prospectively studied 509 pregnant women who visited the obstetrics clinic in Tokyo prior to week 13 of gestation, between September 2008 and January 2010. Biochemical parameters were measured in fasting plasma samples collected at week 8.0 ± 2.0 of gestation. A 50 g glucose challenge test (GCT) was performed between weeks 26 and 29: plasma glucose levels ≥7.8 mmol/l 1 h after ingestion indicated a positive GCT. Logistic regression was performed, adjusting for relevant covariates.

Results

We identified 114 patients with positive GCTs, including 8 with gestational diabetes mellitus (GDM). After correcting for baseline body mass index, only the homeostasis model assessment of insulin resistance value remained a significant predictor of GCT positivity (OR 2.07; 1.21-3.55). We identified threshold values of fasting plasma glucose (FPG) ≥3.66 mmol/l and fasting plasma insulin (FPI) ≥36.69 pmol/l as indicative of a higher risk of positive GCT (OR 2.38; 1.49-3.80).

Conclusions

First trimester FPI levels improve the predictive ability of FPG level on subsequent GCT positivity.     

An observational non-interventional study of people with diabetes beginning or changed to insulin analogue therapy in non-Western countries: the A1chieve study

Aim

The aim of A₁chieve was to remedy the deficit of data on the efficacy and safety of insulin analogues in routine clinical care in less well-resourced/newly developed countries.

Methods

A non-interventional, 6-month, observational study of 66,726 people with type 2 diabetes, both insulin users and non-insulin users, started on insulin detemir, insulin aspart or biphasic insulin aspart in 28 countries across four continents.

Results

Baseline HbA_1c (±SD) was poor: 9.5 ± 1.8%. At 6 months, improvement was −2.1 ± 1.7% in the entire cohort, and −2.2 ± 1.7% and −1.8 ± 1.7% for prior non-insulin users and insulin users. All three analogue therapies gave similar results, again independently of prior insulin use, but also from seven pre-specified country groupings. Overall, hypoglycaemia did not increase in those new to insulin, and fell in those switching insulins. There was no change in body weight (−0.1 ± 3.7 kg), while lipid profile and systolic blood pressure (−6.3 ± 17.1 mmHg) were improved.

Conclusions

Beginning insulin analogue therapy in people with type 2 diabetes and poor blood glucose control is associated with marked improvements in diverse aspects of vascular risk factor profile without evidence of clinically significant safety or tolerability problems.     

Nateglinide and acarbose for postprandial glucose control after optimizing fasting glucose with insulin glargine in patients with type 2 diabetes

Aims

Basal insulin treatment is frequently used in type 2 diabetes, but the successful control of postprandial glucose is challenging. We compared the effect of preferential postprandial glucose targeting drugs for postprandial glucose control after optimizing fasting glucose with basal insulin.

Methods

This study was performed in 58, insulin naïve type 2 diabetes. After fasting glucose was optimized by insulin glargine, nateglinide or acarbose was initiated and then crossed over after second wash out period. 75 g oral glucose tolerance test and 7 point self monitoring blood glucose for 3days at the end of each period was performed.

Results

Both drugs effectively reduced postprandial glucose levels compared with the insulin glargine monotherapy. No significant differences were found between nateglinide and acarbose in terms of mean glucose level, standard deviation of glucose levels, mean average glucose excursion and average daily risk range. Homeostasis model analysis (HOMA)% β, corrected insulin response and insulin-to-glucose ratio were significantly higher in the responder group compared with the non-responder. There was no episode of severe hypoglycemia.

Conclusions

Nateglinide and acarbose are equally effective in type 2 diabetes for postprandial glucose excursions during basal insulin treatment. The markers of beta cell function might be used for predicting response. (Clinical trial reg. no. NCT 00437918, clinicaltrail.gov.)     

Impairment of insulin action in non-obese, normal-glucose tolerant, first-degree relatives of Chinese type 2 diabetic patients

Aims

To investigate first-phase insulin release and peripheral insulin sensitivity of non-obese, normal-glucose tolerant, first-degree relatives of Chinese type 2 diabetic patients.

Methods

12 euglycemic first-degree relatives of type 2 diabetic patients (ERDM), 12 newly diagnosed type 2 diabetic patients (DM-2) and 12 healthy individuals (control) participated in the study. All subjects were non-obese (BMI < 25 kg/m²). Intravenous glucose tolerance test and euglycemic hyperinsulinemic clamp test were performed to evaluate first-phase insulin release and quantify insulin sensitivity, respectively.

Results

The first-phase insulin release did not differ between the ERDM and control subjects (p = 0.532), while the acute insulin response was absent in the DM-2 patients (p = 0.001). Peripheral glucose deposit rate (GDR) was significantly lower in the ERDM (10.6 ± 2.1 mg/kg·min, p = 0.000) and DM-2 (9.6 ± 1.1 mg/kg·min, p = 0.000) groups than that in the control group (13.2 ± 1.2 mg/kg·min). There was no statistical difference in GDR between the ERDM and DM-2 groups (p = 0.110). Fasting FFA levels of the ERDM (p = 0.007) and DM-2 (p = 0.000) subjects were significantly higher than those of the controls.

Conclusions

Non-obese, first-degree relatives of type 2 diabetic patients with normal glucose tolerance (NGT) exhibit remarkable impairment of insulin sensitivity and increased FFA levels. Insulin resistance is independent of obesity and blood glucose level. Progression from NGT to type 2 diabetes may mainly be attributed to deterioration of early insulin secretion.     

An innovative prognostic model for predicting diabetes risk in the Thai population

Objective

To estimate the prevalence and type 2 diabetes, and to develop a prognostic model for identifying individuals at high risk of undiagnosed type 2 diabetes.

Research design and methods

The study was designed as a cross-sectional investigation with 4314 participants of Thai background, aged between 15 and 85 years (mean age: 48). Fasting plasma glucose was initially measured, and repeated if the first measurement was more than 126 mg/dl. Type 2 diabetes was diagnosed using the World Health Organization's criteria. Logistic regression model was used to develop prognostic models for men and women separately. The prognostic performance of the model was assessed by the area under the receiver operating characteristic curve (AUC) and a nomogram was constructed from the logistic regression model.

Results

The overall prevalence of type 2 diabetes was 7.4% (n = 125/1693) in men and 3.4% (n = 98/2621) in women. In either gender, the prevalence increased with age and body mass index (BMI). Gender, age, BMI and systolic blood pressure (SBP) were independently associated with type 2 diabetes risk. Based on the estimated parameters of model, a nomogram was constructed for predicting diabetes separated by gender. The AUC for the model with 3 factors was 0.75.

Conclusions

These data suggest that the combination of age, BMI and systolic blood pressure could help identify Thai individuals at high risk of undiagnosed diabetes.     

Effect of folic acid supplementation on biochemical indices in overweight and obese men with type 2 diabetes

Aims

This study performed to determine the effects of folate supplementation on indices of glycemic control, insulin resistance and lipid profile in overweight and obese men with type 2 diabetes under metformin (at least 1500 mg daily) treatment.

Methods

The study was a double-blind randomized controlled clinical trial. Forty-eight overweight and obese men (aged 58.2 ± 8.9 years; BMI = 28.6 ± 2.9 kg/m²) with type 2 diabetes participated in the study. Patients were divided randomly into two groups of folic acid (5 mg/d) and placebo. All patients received the tablets for eight weeks.

Results

Supplementation with folic acid led to 8% decrease in HbA1C (p = 0.048), 7.5% in fasting blood glucose (p = 0.051), 16.2% in serum insulin (p = 0.021), 20.5% in insulin resistance (p = 0.041) and 21.2% in plasma homocysteine (p = 0.000). A significant increase in serum folate and B12 levels (19% and 17.3%, p = 0.000, respectively) were observed in the folic acid group, whereas no significant changes occurred in the placebo group. Also, in the folic acid and placebo groups, there were no significant changes in body weight.

Conclusions

Folic acid supplementation lowered plasma level of homocysteine, improved glycemic control and insulin resistance in patients with type 2 diabetes.     

Men with hyperferritinemia and diabetes in the Mediterranean area do not have a higher iron overload than those without diabetes

Aim

To assess the role of iron overload in type 2 diabetic men with hyperferritinemia.

Methods

150 men were recruited from a genetic screening programme for hereditary hemocromatosis (HH) and were tested for type 2 diabetes, other components of the metabolic syndrome, beta cell function (BCF), insulin sensitivity, high-sensitivity C-reactive protein and iron overload.

Results

Fifty-one men had type 2 diabetes. They were older (p = 0.017) and 99 had lower BCF (p < 0.001) than non-diabetic men. None of the iron overload indexes was associated with diabetes.

Conclusions

Our findings dispute a role of iron overload in the pathogenesis of type 2 diabetes.     

Impact of dose adjustment for normal eating in Australia (OzDAFNE) on subjective wellbeing, coping resources and negative affects in adults with type 1 diabetes: a prospective comparison study

Aim

This prospective study examined the impact of a structured education program (OzDAFNE) on subjective wellbeing, coping resources, and negative affects in adults with type 1 diabetes. Participants completing the OzDAFNE program were compared to those using continuous subcutaneous insulin (CSII) and multiple daily injections (MDI) over the same time period.

Methods

Participants in the OzDAFNE group (N = 144) were recruited from diabetes centres throughout Australia. The comparison groups were recruited from Diabetes Australia-Victoria's membership database and comprised 383 people using MDI and 64 people using CSII. All participants completed self-report questionnaires at baseline and 12-months later. Additional assessments for OzDAFNE participants were conducted at the end of the education program and at three and six-months following the training.

Results

The results demonstrated that participants completing the OzDAFNE program experienced improved subjective wellbeing (p < .01), a greater sense of mastery and control in managing their diabetes (p < .001), and reduced diabetes-related distress (p < .001) compared to the CSII and MDI groups. However, the CSII group recorded a significant drop in self-esteem (p < .001) over the duration of the study.

Conclusions/Interpretations

The OzDAFNE program provides a powerful mastery experience for participants, positively influencing subjective wellbeing and diabetes-related distress.     

Clinical factors associated with absolute and relative measures of glycemic variability determined by continuous glucose monitoring: An analysis of 480 subjects

Aim

Factors associated with absolute and relative measures of glycemic variability have not been determined by continuous glucose monitoring (CGM) and concurrent measurement of fasting C-peptide levels.

Methods

We analyzed CGM data for subjects with type 1 diabetes (T1D; n = 81) and type 2 diabetes (T2D; insulin-treated, n = 168; not insulin-treated, n = 231) who underwent CGM between October 2009 and September 2011 at Samsung Medical Center. Correlations between clinical factors and both standard deviation (SD) and coefficient of variance (CV) in CGM were analyzed by multiple regression.

Results

Regardless of the type of diabetes and insulin therapy, higher CV, but not SD, was significantly associated with a minimum glucose level of <70 mg/dL (3.9 mmol/l) in CGM (p < 0.001). In T1D, fasting C-peptide levels inversely correlated with SD while BMI inversely correlated with CV, and duration of diabetes, and HDL levels positively correlated with CV. Use of pre-mixed insulin increased both SD and CV. In insulin-treated T2D, fasting C-peptide levels inversely correlated with both SD and CV while HbA1c correlated with SD, and duration of diabetes positively correlated with CV. In T2D without insulin therapy, age, BMI, HbA1c, HDL, triglyceride levels and use of sulfonylurea positively correlated with SD while HDL levels and use of sulfonylurea positively correlated with CV, and LDL levels inversely correlated with CV.

Conclusions

Relative glycemic variability (CV) was determined by factors different from those that affect absolute glycemic variability (SD). Some of these factors were indicators of higher insulin sensitivity and residual insulin secretion.     

Development and initial validation of the barriers to diabetes adherence measure for adolescents

Aims

The purpose of this study was to develop a measure of psychosocial barriers to adherence in adolescents with type 1 diabetes (T1D) and examine relationships to patient characteristics, adherence, and hemoglobin A1C (A1C).

Methods

Barriers to diabetes adherence (BDA) items were generated by researchers, clinicians, and patients. Adolescents aged 12-17 with T1D completed the BDA and an adherence measure. Hemoglobin A1C was obtained through medical chart review.

Results

Factor analysis from 123 adolescents resulted in a 21-item, five-component solution that accounted for 64.5% of the variance. The components were stress and burnout, time pressure and planning, social support, parental autonomy support, and stigma. The BDA total and subscales were internally consistent. The BDA total and some components were associated with adherence and A1C. The BDA was the only predictor of A1C compared to demographic, clinical, and adherence variables (F 6.17, p < .05). Subjects with higher A1C (>8.5) showed a higher level of barriers (F 15.20, p < .001) and a differential profile of barriers (F 5.75, p < .05).

Conclusions

The BDA may be useful in research and clinical settings as a compliment to adherence measures and to tailor educational programs. Additional research is necessary to establish test-retest reliability and discriminant validity.