Relation Between Glycemic Control and Cardiac Autonomic Neuropathy in Patients With Diabetes Mellitus Type 2.

BACKGROUND: Glycemic control is very important in type 2 diabetic patients. Microangiopathy is the first chronic complications in type 2 diabetic patients. Cardiac autonomic neuropathy can be used as a tool for early detection of complication in type 2 diabetic that relates well with cardiovascular morbidity and mortality. The aim of this study was to analyze the correlation between glycemic control and cardiac autonomic neuropathy in type 2 diabetic patients. METHODS: It was an observational cross sectional with correlative analysis conducted on type 2 diabetic at Hasan Sadikin hospital within July until August 2019. Value of HbA1c, fasting plasma glucose, and post prandial plasma glucose within 2 years were obtained with NGSP standard of examination. Cardiac autonomic neuropathy was assessed by Cardiovascular Autonomic Reflex Testing's (CARTs) with Bellevere scoring system. RESULT: The research was conducted on 39 subjects with mean age 56 ± 7,05 years (48,7% males and 51,3% women). Median value of the last HbA1c was 7,6% (5,2%-12,9%) and mean HbA1c in the last 2 years was 8,1 ± 1,88%. Median CARTs score was 5 (1-8). Rank-Spearman correlation analysis showed significant moderately positive correlation between HbA1c and CARTs score (r = 0,454, CI 95% 0,187-0,772, P = 0,004) and also mean HbA1c within the last 2 years with CARTs score (r = 0,564, IK 95% 0,289-0,839, P = 0,000). Multivariate analysis, mean HbA1c remained correlated significantly with CARTs score even after adjustment toward age, gender, duration of diabetes, and diabetic therapy. CONCLUSION: There is significant moderately positive correlation between glycemic control and cardiac autonomic neuropathy in type 2 diabetic patients.

Expert Opinion on Diabetes Management Challenges and Role of Basal Insulin/GLP-1 RA Fixed-Ratio Combination in People with Type 2 Diabetes from Indonesia.

Indonesia is struggling with a rapidly growing burden of diabetes due to rapid socioeconomic transition. People with type 2 diabetes mellitus (T2DM) need appropriate treatment strategies to maintain glycemic control. New modalities with simplicity, such as fixed-ratio combination of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA), further referred to as FRC, have proven to be an effective and practical therapeutic approach that may address this issue. In January 2021, a scientific expert meeting was held with the participation of endocrinologists from Indonesia to provide expert opinions regarding the optimal practical use of the FRC basal insulin/GLP1-RA. Topics discussed in the meeting included the challenges in diabetes management, clinical inertia with insulin therapy, local and international guideline positioning, initiation, titration, and switching of basal insulin and GLP-1 RA, including FRC, and the management of T2DM.