Determination of a redox compensation index and its relationships to glycaemic control in type 2 diabetes mellitus.

The measurement of single parameters of oxidative stress in biological fluids can often give results difficult to interpret as to the real involvement of oxidative processes in a given disease condition. In the present study we propose a novel integrated parameter, called "redox compensation index", obtained by combining the results of two established and convenient procedures, i.e. the Fox-2 assay for plasma lipid hydroperoxides and the ferric reducing/antioxidant power (FRAP) assay for total antioxidant potential of plasma. These procedures were employed for the evaluation of oxidative stress in a group of patients with type 2 diabetes mellitus, a condition in which oxidative processes are implicated in the development of complications. In type 2 diabetic patients, plasma lipid hydroperoxides were directly correlated with levels of glycated hemoglobin. On the other hand, a significant inverse correlation was observed between levels of glycated hemoglobin and redox compensation values. The data reported suggest that the redox compensation index could represent a convenient parameter for the direct appraisal of oxidative status in clinical subjects, and are in support of the proposed role of protein glycation in production of oxidative alterations during type 2 diabetes mellitus.     

Serum fructosamine in the assessment of glycaemic control in diabetes mellitus

Serum fructosamine determination was evaluated in the assessment of glycaemic control in diabetes mellitus. Intra- and inter-assay variation of the method was 0.5-0.8 and 1.5-2.9%, respectively. The fructosamine concentration in serum was found to be stable for at least 10 days independent of prevailing serum glucose concentration is stored at +4 degrees C or colder. Stability of serum fructosamine with respect to rapid fluctuations of blood glucose was of the same order as that of HbA1c. The reference interval (mean +/- 2 SD) for 92 non-diabetic individuals was 1.9-2.7 mmol/l. Good correlation was found between HbA1c and serum fructosamine (r = 0.79). Serum fructosamine and HbA1c correlated well with the mean blood glucose values of the preceding week (r = 0.88 and 0.75, respectively, p less than 0.001). Significant correlations of fructosamine and HbA1c with fasting blood glucose were also found (r = 0.53 and 0.55, respectively, p less than 0.001). Fructosamine determined simultaneously with fasting blood glucose in 65 oral glucose tolerance tests (OGTT) did not separate normal subjects from those with impaired glucose tolerance. Two of the three subjects with diabetic response in the OGTT had, however, elevated fructosamine concentrations. Determination of serum fructosamine is a technically simple, reproducible and moderately inexpensive method for the assessment of glycaemic control in diabetes mellitus. Standardization of the method is, however, not without problems. Uniformity of the calibration and assay protocol is essential for reliable interlaboratory comparison of results. Physiological states altering the rate of synthesis or elimination of serum proteins should be considered in the interpretation of fructosamine levels.(ABSTRACT TRUNCATED AT 250 WORDS)     

Sleep quality and its impact on glycaemic control in patients with type 2 diabetes mellitus

PurposeTo investigate the sleep quality of patients with type 2 diabetes (T2D) and its impact on glycaemic control.MethodsUsing a convenience sampling method, 220 patients with T2D were recruited. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality with threshold at PSQI ≥ 8. The glycosylated haemoglobin A1c (HbA1c) test was used to measure the glycaemic control with threshold at HbA1c < 7%.ResultsThe PSQI score was 8.30 ± 4.12. The sleep disorder incidence rate was 47.1%. Patients with HbA1c ≥ 7% had significantly lower PSQI global and factor scores (p < 0.01) versus the control group. Sleep latency, sleep disturbance, and daytime dysfunction were the risk factors for poor glycaemic control.ConclusionPatients with T2D have high sleep disorder rate negatively impacting glycaemic control. Health care providers should pay close attention to the sleep quality of T2D patients, and provide them with appropriate educational material.     

A systematic review of vanadium oral supplements for glycaemic control in type 2 diabetes mellitus

Objective: To assess the effectiveness of oral vanadium supplementationfor glycaemic control in type 2 diabetes by conducting a systematicreview of the literature. Design and Methods: Eligible studies were identified by searching14 databases using standardized terms. Experts, study authorsand manufacturers were also contacted. Hand-searching was notundertaken. Selection criteria for inclusion in the review werecontrolled human trials of vanadium vs. placebo in adults withtype 2 diabetes of minimum 2 months duration, and a minimumof 10 subjects per arm. Data extraction, assessment of studyquality and outcome analysis were undertaken by two independentreviewers. Results: One hundred and fifty one studies were found but nonemet the inclusion criteria. We proceeded to summarize the stateof existing evidence and plan for a future clinical trial byapplying revised, less restrictive criteria to our search, forclinical trials of 30–150 mg daily oral vanadium supplementationin diabetic humans. Only five were identified. These demonstratedsignificant treatment-effects, but due to poor study quality,must be interpreted with caution. Treatment with vanadium oftenresults in gastrointestinal side-effects. Conclusion: There is no rigorous evidence that oral vanadiumsupplementation improves glycaemic control in type 2 diabetes.The routine use of vanadium for this purpose cannot be recommended.A large-scale randomized controlled trial is needed to addressthis clinical question.     

Adherence to self-care and glycaemic control among people with insulin-dependent diabetes mellitus

AIM OF THE STUDY: Factors associated with adherence to self-care and glycaemic control were studied in 213 people with insulin-dependent diabetes mellitus using a self-report questionnaire and a biochemical indicator (glycosylated haemoglobin). METHODS: The data were collected in the Oulu Health Center and the Central Hospital of Lapland in Northern Finland. The response rate was 76%. In order to verify the reliability and validity of the instruments, we used correlation coefficients, factor analysis and item-total analysis. Internal consistency was checked by Cronbach's alpha. The connections between self-care and the background variables were examined by cross-tabulation. FINDINGS: The majority of subjects accomplished their insulin treatment as scheduled, but had more difficulties with the other aspects of self-care. According to the findings, a fifth (19%) of the respondents were neglecting their self-care. The others undertook flexible (46%), regimen-adherent (16%) or self-planned self-care (19%). The subjects who were adherent to self-care had better metabolic control than those who neglected self-care. According to logistic regression analysis, poor metabolic control (P=0.003), smoking (P=0.009) and living alone (P=0.014) were associated with neglect of self-care. Gender, concurrent diseases and complications as a result of diabetes increased the risk, but had no significant association with adherence to or neglect of self-care. CONCLUSION: The findings demonstrated that adherence to self-care does not always lead to good metabolic control, but neglect of self-care is likely to lead to poor metabolic control.     

Interaction between angiotensin-converting enzyme genotype and glycaemic control influences lipoprotein levels in type 2 diabetes mellitus

AIMS: To evaluate the influence of the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism on lipid levels in patients with Type 2 diabetes. PATIENTS AND METHODS: 109 patients with Type 2 diabetes were included. The patients were not on any lipid-lowering treatment. The groups with different ACE genotypes had similar ages, sex distributions, body mass indices, systolic blood pressures and indices of glycaemic control. ACE gene I/D polymorphism was determined using polymerase chain reaction. RESULTS: The mean apolipoprotein B (apoB) level was significantly higher in the group of DD homozygotes compared with the subjects with at least one insertion allele (DD: 1.21 +/- 0.25 g/l vs. ID + II: 1.04 +/- 0.27 g/l; P = 0.007). Significant correlations between glycated haemoglobin (HbA1c) and both apoB and cholesterol levels were found (r = 0.27; P < 0.01). For the apoB, this correlation was highly significant in the DD-genotype subgroup (r = 0.54; P < 0.01), and was not significant in the subgroup of patients with genotypes ID or II. In the multivariate analysis, HbA1c and the interaction of genotype DD with HbA1c were significant independent predictors of apoB (r2 = 0.17) and cholesterol levels. CONCLUSION: The present study showed that the interaction between the DD genotype of angiotensin-converting enzyme and chronic hyperglycaemia (expressed by HbA1c level) is related to higher plasma levels of atherogenic lipoproteins, such as apoB and cholesterol, in patients with Type 2 diabetes.     

Self-monitoring of blood glucose and glycaemic control in type 2 diabetes

Objective. To examine changes in the numbers of inpatient episodes and inpatient days and length of stay in acute exacerbations of COPD (chronic obstructive pulmonary disease) by specialization and by age group and sex distribution relative to the total population in the years 1995–2001.

Design. A register-based study.

Subjects. Data on inpatient episodes for patients aged 45 years or over with a principal diagnosis of COPD beginning in 1995–2001 and lasting less than 90 days were extracted from the hospital discharge register of the Finnish National Research and Development Centre for Welfare and Health.

Main outcome measures. Numbers of inpatient episodes and days by age and sex in the specialities of general practice, pulmonary medicine, and internal medicine.

Results. The annual number of inpatient episodes increased by 10.9% from 1995 to 2001. The number of emergency treatment episodes supervised by a general practitioner increased by 36.8% during the same period and the number of such episodes supervised by a pulmonary specialist by 17.8%. The increase in age-adjusted emergency treatment episodes for men was 0.8% and that for women 18.5%. The average hospital stay shortened from 8.0 (SD 8.0) to 6.5 (SD 6.2) for men and from 8.7 (SD 8.5) to 7.3 (SD 6.8) for women.

Conclusions. The greater increase in inpatient episodes for exacerbations of COPD in relation to the total population among women than among men may be attributed to differences in smoking habits and ageing between the sexes. Responsibility for COPD cases is clearly shifting to general practitioners. This is due partly to the national programme for the treatment of obstructive pulmonary diseases and the associated in-service training provided for general practitioners and partly to financial reasons. More detailed investigations should be made into the quality of the treatment.     

Self-monitoring of blood glucose and glycaemic control in type 2 diabetes

OBJECTIVE: Previous studies have shown inconsistent results with regard to whether or not self-monitoring of blood glucose (SMBG) is related to better glycaemic control in type 2 diabetes. The aim of this study was to explore the use of SMBG and its association with glycaemic control in patients with type 2 diabetes in primary care. DESIGN: A cross-sectional observational study was conducted in 2003 at 18 primary health care centres in Sweden, in which all known patients with diabetes were surveyed. The study included 6495 patients with type 2 diabetes. A sample of 896 patients was selected for further exploration of data from medical records. A telephone interview was performed with all patients in this group using SMBG (533 patients). RESULTS: There were no differences in HbA1c levels between users (6.9%) and non-users (6.8%) of SMBG in patients treated with insulin or in patients treated with oral agents (6.3% in both groups). In patients treated with diet only, users of SMBG had higher levels of HbA1c compared with non-users (5.5% vs. 5.4%, p =0.002). Comparing medical records between users and non-users of SMBG showed no differences in diabetes-related complications in any treatment category group. CONCLUSION: The use of SMBG was not associated with improved glycaemic control in any therapy category of patients with type 2 diabetes in primary care. The absence of difference in glycaemic control between users and non-users of SMBG could not be explained by differences in comorbidity between users and non-users of SMBG.     

Urinary excretion of albumin in adolescents with type 1 diabetes: persistent versus intermittent microalbuminuria and relationship to duration of diabetes, sex, and metabolic control.

OBJECTIVE: Urinary excretion of albumin is a marker for incipient diabetic nephropathy in adults. The intra-individual variability, as well as the relationship to duration of diabetes, onset of the disease, and long-term metabolic control, have not been evaluated in a large sample of pediatric patients. RESEARCH DESIGN AND METHODS: A total of 5,722 nocturnal urinary albumin excretion rates were determined in 447 children, adolescents, and young adults with type 1 diabetes, comprising 1,821 years of observation. Excretion rates were related to duration of diabetes, age at onset of diabetes, sex, blood pressure, and metabolic control. RESULTS: Based on repeated measurements in individual patients, the positive predictive value of one sample was 76%, the negative 99.5%. After a duration of diabetes of 11 years, 5% of patients displayed persistent microalbuminuria (10% after 13 years). The duration of diabetes until persistent microalbuminuria was identical for patients with prepubertal or pubertal onset of diabetes. In addition to duration, female sex (P < 0.03) and insufficient long-term metabolic control (P < 0.03) contributed significantly and independently to urinary albumin excretion. CONCLUSIONS: Determination of urinary albumin excretion rate is useful in pediatric patients. Female subjects with a long duration of diabetes and insufficient metabolic control are especially at risk for microalbuminuria. Even if persistent microalbuminuria usually becomes evident in patients aged > 11 years, the prepubertal duration of diabetes contributes equally to this risk. Good metabolic control therefore should be aspired to from the onset of diabetes.     

Thrombin and plasmin activity in diabetes mellitus and their association with glycaemic control

Abnormalities of haemostasis are common in diabetes mellitus. As indicators of fibrinolysis and coagulation, plasmin and thrombin activity were assessed by assay of the fibrinogen peptide derivatives B beta 15-42 and fibrinopeptide A respectively in 60 diabetic patients and 50 control subjects in a cross-sectional study. Glycosylated haemoglobin (HbA1) correlated with B beta 15-42 (r = -0.26, p less than 0.05) and fibrinopeptide A (r = 0.30, p less than 0.05) in the diabetic patients suggesting that poor glycaemic control (i.e. high HbA1 levels) was associated with depressed plasmin and enhanced thrombin activity. Compared to controls, fibrinopeptide A levels were increased in diabetics (p less than 0.001) irrespective of sex or type of diabetes. B beta 15-42 levels were normal in diabetic females but increased in diabetic men (p less than 0.001) possibly secondary to the activation of coagulation. These results suggest that in diabetes mellitus activation of coagulation is the dominant haemostatic abnormality and that better glycaemic control could influence in-vivo plasmin and thrombin activity favourably.     

Near-normal glycaemic control does not correct abnormal platelet reactivity in diabetes mellitus

The effect of improved glycaemic control, effected by 16 weeks continuous subcutaneous insulin infusion (CSII), on platelet aggregation and platelet prostaglandin biosynthesis has been assessed in a group of 11 diabetic patients with painful peripheral neuropathy. Before CSII and compared with results obtained on samples from age- and sex-matched control subjects, there was enhanced reactivity of the platelets from diabetic patients to ADP, collagen and sodium arachidonate (NaAA). There was also increased thromboxane B2 (TXB2) production after platelet stimulation by NaAA. In contrast, collagen-induced thromboxane production by platelets from diabetic patients was significantly less than that of platelets from controls. Treatment by CSII resulted in a statistically significant improvement in glycaemic control and this was maintained for the 16 week period of the study. At 16 weeks and in the presence of near-normal glycaemic control, the enhanced platelet reactivity in response to collagen and NaAA persisted and that to ADP was further increased. Collagen-induced thromboxane production was, however, corrected by CSII.     

Immunotherapies in diabetes mellitus type 1

Type 1 diabetes is an autoimmune disease that gradually destructs insulin-producing beta cells. Over the years, clinicians' knowledge regarding the immunopathogenesis of this disease has greatly increased. Immunotherapies that can change the course of immune-mediated destruction and preserve and possibly regenerate the pancreatic beta cells seem to be promising in preclinical trials but so far have been unsuccessful in human studies. This article reviews the important immune interventions for type 1 diabetes that have been tried so far targeting the different stages of disease development and provides an insight into what the future might hold.     

Effect of oral vitamin D and calcium replacement on glycaemic control in South Asian patients with type 2 diabetes

Background: Vitamin D deficiency is associated with a greater risk of developing type 2 diabetes mellitus (T2DM). Studies looking at the effect of vitamin D replacement on glycaemic control in type 2 diabetics are few and conflicting. In addition, none have been published looking at the South Asian population despite both T2DM and vitamin D deficiency being gross burdens in this population. The aim of this study was to determine the effect of using vitamin D and calcium replacement therapy on glycaemic control in South Asian patients with T2DM and vitamin D inadequacy. Materials and Methods: Data were collected retrospectively from patients’ records focusing on South Asians with established T2DM treated with combined oral vitamin D₃ and calcium supplementation. Vitamin D, parathyroid hormone (PTH), HbA1c and weight were recorded before and after 3 months on this therapy. Results: Post‐treatment, all patients’ (n = 52) vitamin D levels were normalised (> 50nmol/l). There was a mean decrease in HbA1c of 0.70 ± 0.77% (p < 0.001) in the vitamin D deficient group (n = 29) and 0.21 ± 0.28% (p = 0.001) in the vitamin D insufficient group (n = 23). The change in weight post‐treatment was only significant in the vitamin D deficient group at ?0.80 ± 1.11 kg (p = 0.001). Overall, there were negative correlations between the changes in HbA1c and weight with the change in vitamin D (p < 0.05). Conclusion: This study shows that vitamin D and calcium replacement therapy in South Asian patients with T2DM causes a significant decrease in both HbA1c and weight, which may be attributed to the increase in vitamin D levels post‐treatment.     

How to maintain optimal glycaemic control in diabetes

Despite national and local guidelines for glycaemic control, current management of glycaemia can fall significantly short of accepted goals. This article discusses the recommended glycaemic control goals and barriers that can prevent their achievement. It examines key recommendations to enable health care providers to overcome these barriers.