Effect of patient-centered self-management intervention on glycemic control, self-efficacy, and self-care behaviors in South Asian adults with type 2 diabetes mellitus: A multicenter randomized controlled trial.

BACKGROUND: This study aimed to test the efficacy of patient-centered self-management intervention (PACE-SMI) to improve HbA1c, self-efficacy, and self-care behaviors in adults with type 2 diabetes mellitus (T2DM). METHODS: In this multicenter, parallel two-arm randomized controlled trial, 612 adults with T2DM and HbA1c ≥ 7% were enrolled and assigned to the control group (n = 310) and the intervention group (n = 302) using stratified permuted block randomization. The control group received usual care, whereas the intervention group received usual care plus nurse-led, theory-driven, culturally tailored PACE-SMI, comprising eight weekly sessions of individualized education, counseling, behavioral training, and home visit. Outcomes were assessed at baseline, postintervention, and 3 months follow-up. RESULTS: Data at 3 months were provided by 583 participants (control: n = 295, intervention: n = 288). Per-protocol analysis showed that the intervention group had a lower mean HbA1c (8.49% [standard deviation (SD), 1.58]) than the control group (8.74% [SD, 1.62]), with small yet statistically significant mean difference of 0.25% (95% confidence interval [CI], -0.01 to 0.51; Cohen's d = 0.16; p = 0.03). Self-efficacy and self-care behaviors significantly improved in the intervention group (116.89 [SD, 25.50] and 70.01 [SD, 17.97]) compared to the control group (75.43 [SD, 18.99] and 51.54 [SD, 12.04]), with mean differences of 41.48 (95% CI, 37.83-45.13; Cohen's d = 1.84; p < 0.0001) and 18.56 (95% CI, 16.08-21.04; Cohen's d = 1.22; p < 0.0001), respectively. Linear regression analysis indicated the effect of PACE-SMI on HbA1c was significantly mediated by improvements in self-efficacy and self-care behaviors (R2 = 0.232, p < 0.001). CONCLUSION: PACE-SMI led to modest but significant improvement in HbA1c and substantial enhancements in self-efficacy and self-care behaviors in adults with T2DM.

The effect of vitamin D supplementation on markers of insulin resistance in women with polycystic ovarian syndrome: a systematic review.

BACKGROUND: Insulin resistance (IR) is a common pathology in women with polycystic ovarian syndrome (PCOS) involved in increased rates of cardiometabolic disease such as diabetes and cardiovascular disease. Low serum vitamin D is often associated with insulin resistance but there is no consensus on whether vitamin D supplementation can ameliorate markers of IR in PCOS. OBJECTIVES: We assessed evidence on the effects of vitamin D supplementation (≥ 1000 IU/day), without the use of additional supplements or other pharmacological treatments known to affect IR, on markers of IR and glycemic control in women with PCOS. DESIGN: A systematic search was conducted using PubMed, Medline and Web of Science databases from January 2000 up to November 2023. Randomized controlled trials that assessed the effects of vitamin D supplementation in women with PCOS, on fasting glucose, fasting insulin, glycated haemoglobin (HbA1c) or homeostatic model assessment for insulin resistance (HOMA-IR) were included. RESULTS: 9 studies were identified. Study populations ranged from 28 to 180 participants, with mean ages ranging from 22 to 30 years. Daily vitamin D doses ranged from 1714-12,000 IU. Of the included studies, 3 reported statistically significant reductions in fasting glucose, 2 reported reductions in fasting insulin, 2 reported reductions in HOMA-IR, none reported reductions in HbA1c and 5 reported no differences in any of the relevant outcomes. CONCLUSIONS: In conclusion, in RCTs of vitamin D supplementation in women with PCOS, the majority of studies do not report statistically significant improvements in fasting glucose, fasting insulin, HbA1c or HOMA-IR. However, as a minority of studies report some statistically significant results, further investigation may be warranted. REGISTRY: PROSPERO ID: CRD42023486144.

Adherence to the Mediterranean diet and sleep quality are inter-correlated with flash glucose monitoring (FGM)-measured glycemia among children with type 1 diabetes.

BACKGROUND: We examined the inter-correlation between diet quality, objectively measured sleep duration, and subjectively measured sleep quality with flash glucose monitoring (FGM)-measured glycemia among young patients with type 1 diabetes (T1D). MATERIALS AND METHODS: Following cross-sectional design, Fitbit® accelerometers were used to objectively assess sleep duration, while the validated questionnaires Pittsburgh sleep quality index and Mediterranean diet (MD) adherence were used to subjectively assess sleep quality and diet quality, respectively. Glycated hemoglobin (HbA1c) and FGM-reported glycemia components among children with T1D were assessed as well. RESULTS: Of the 47 participants surveyed (25 boys, 22 girls, 9.31 ± 2.88 years), the majority reported high HbA1c, good sleep quality, and high adherence to the MD. However, only one-third of the participants reported a healthy sleep duration. Only the sleep latency was significantly (P < 0.05) associated with the time above range level 2 and time below range level 2 (P = 0.048) components of the FGM. A positive correlation (r = 0.309, P = 0.035) was reported between adherence to MD and time in range of the FGM. CONCLUSIONS: Diet quality and sleep quality are variably inter-correlated with FGM-measured glycemia among young patients with T1D and are suggested to be considered influential factors in FGM-monitored diabetes research on this age group.

The Efficacy of Roux-en-Y Gastric Bypass in Young-Onset Diabetes Mellitus: A Narrative Review.

Type 2 diabetes mellitus (T2DM) in youth is invading the communities because, if not controlled on time, the long-term complications include cardiovascular diseases, nephropathy, neuropathy, and retinopathy that cause immense mortality and morbidity. Lifestyle changes and antidiabetic drugs are considered the foundation of T2DM therapy. However, these adjustments usually do not effectively produce long-term glycemic regulation, especially in patients with obesity of the third and fourth degrees. Bariatric surgery has also been identified as an efficacious intervention for obesity and obesity-related complications such as T2DM. Roux-en-Y gastric bypass (RYGB) has proven to be one of the most effective procedures in causing considerable weight loss and enhancing glycemic changes. This review provides a comprehensive analysis of RYGB in patients with young-onset T2DM regarding the improvement of glycemic control, weight loss, and diabetes comorbidities. RYGB has been established as a practice in the treatment of T2DM and severe obesity. This narrative review underscores the various effects of RYGB, such as enhanced glycemic control, considerable and long-term weight loss, and reduced cardiovascular disease risks. However, the review also points toward the directions and the adverse effects of RYGB regarding metabolic and skeletal health. There are risks of nutritional deficiencies, increased fracture rates, and even relapse to diabetes, which make patient selection, proper pre and postoperative investigation, and critical monitoring.

Dapagliflozin in Heart Failure and Acute Myocardial Infarction: A Systematic Review of the Association in Diabetic Patients.

This systematic review explores the impact of dapagliflozin on heart failure (HF) and acute myocardial infarction (MI) in patients with type 2 diabetes mellitus. By analyzing recent studies, including both randomized controlled trials (RCTs) and retrospective analyses, this review provides insights into the cardiovascular effects of this sodium-glucose cotransporter 2 (SGLT2) inhibitor. The findings consistently demonstrate the benefits of dapagliflozin in reducing HF-related hospitalizations and improving outcomes for patients with established HF. These positive effects appear to extend beyond glycemic control, suggesting multiple mechanisms of action. The impact of dapagliflozin on acute MI outcomes is less clear, with mixed results across studies. Importantly, dapagliflozin shows promise in improving the quality of life of patients and is generally well-tolerated. The review suggests that dapagliflozin may play a significant role in managing cardiovascular risk in diabetic patients, particularly those with or at risk of HF. While the evidence is encouraging, the review also highlights areas requiring further investigation. These include determining the patient subgroups most likely to benefit from dapagliflozin, elucidating the precise mechanisms underlying its cardioprotective effects, and carrying out long-term outcome studies.

Derived Time in Range and Other Metrics of Poor Glycemic Control Associated With Adverse Hospital Outcomes in Patients With Diabetes Mellitus Admitted to Non-ICU Wards at a Tertiary-Level Hospital in Colombia: A Cross-Sectional Study.

Aim: This study is aimed at assessing the prevalence of poor glycemic control using different metrics and its association with in-hospital adverse outcomes. Methods: This cross-sectional study was conducted in diabetic patients admitted to a third-level hospital in Colombia between January and July 2022. Poor glycemic control was determined using capillary glucose metrics, including mean glucose values outside the target range, derived time in range (dTIR) (100-180 mg/dL) < 70%, coefficient of variation (CV > 36%), and hypoglycemia (<70 mg/dL). Multiple regression models were adjusted for hospital outcomes based on glycemic control, as well as other sociodemographic and clinical covariates. Results: A total of 330 Hispanic patients were included. A total of 27.6% had mean glucose measurements outside the target range, 33% had a high CV, 64.8% had low dTIR, and 28.8% experienced hypoglycemia. The in-hospital mortality rate was 8.8%. An admission HbA1c level greater than 7% was linked to an increased mortality risk (p = 0.016), as well as a higher average of glucometer readings (186 mg/dL vs. 143 mg/dL; p < 0.001). A lower average of dTIR (41.0% vs. 60.0%; p < 0.001) was also associated with a higher mortality risk. Glycemic variability was correlated with an increased risk of mortality, hypoglycemia, delirium, and length of hospital stay (LOS). Conclusion: A significant number of hospitalized diabetic patients exhibit poor glycemic control, which has been found to be associated with adverse outcomes, including increased mortality. Metrics like dTIR and glycemic variability should be considered as targets for glycemic control, highlighting the need for enhanced management strategies.

A study of the relationship between social support, depression, alexithymia and glycemic control in patients with type 2 diabetes mellitus: a structural equation modeling approach.

Aim: The aim of this research was to ascertain the correlations between alexithymia, social support, depression, and glycemic control in patients diagnosed with type 2 diabetes mellitus. Additionally, this study sought to delve into the potential mediating effects of social support and depression in the relationship between alexithymia and glycemic control. Method: A purposive sampling methodology was employed to select a cohort of 318 patients afflicted with type 2 diabetes mellitus, hailing from a care establishment situated in Chengdu City. This investigation embraced a cross-sectional framework, wherein instruments such as the General Information Questionnaire, the Toronto Alexithymia Scale 20, the Social Support Rating Scale, and the Hamilton Depression Scale were judiciously administered. The primary objective of this endeavor was to unravel the interplay that exists amongst alexithymia, social support, depression, and glycemic control. The inquiry discerned these interrelationships through both univariate and correlational analyses, subsequently delving into a comprehensive exploration of the mediating ramifications engendered by social support and depression in the nexus between alexithymia and glycemic control. Results: The HbA1c level of patients diagnosed with type 2 diabetes mellitus was recorded as (8.85 ± 2.107), and their current status with regards to alexithymia, social support, and depression were measured as (58.05 ± 4.382), (34.29 ± 4.420), and (7.17 ± 3.367), respectively. Significant correlations were found between HbA1c and alexithymia (R=0.392, P<0.01), social support (R=-0.338, P<0.01), and depression (R=0.509, P<0.01). Moreover, alexithymia correlation with social support (R=-0.357, P<0.01) and with depression (R=0.345, P<0.01). Regarding the mediation analysis, the direct effect of alexithymia on HbA1c was calculated to be 0.158, while the indirect effect through social support and depression were 0.086 and 0.149, respectively. The total effect value was determined to be 0.382, with the mediating effect accounting for 59.95%, and the direct effect accounting for 40.31%. Conclusion: Alexithymia exerts both direct and indirect adverse effects on glycemic control, thereby exacerbating disease outcomes. Hence, it is imperative to prioritize the mental health status of individuals with type 2 diabetes to enhance overall well-being, ameliorate diabetes-related outcomes, elevate patients' quality of life, and alleviate the psychological distress and financial burden associated with the condition.

Evaluation of serum vitamin D metabolites, phagocytosis, and biomarkers of inflammation in dogs with naturally occurring diabetes mellitus.

Naturally occurring diabetes mellitus (NODM) is one of the most common endocrine disorders in dogs and its etiology closely resembles type 1 diabetes mellitus (T1DM) in people. Human patients with T1DM commonly have cellular derangements consistent with inflammation, impaired immune function, and hypovitaminosis D. There is little information available regarding inflammatory biomarkers, immune function, and vitamin D status in diabetic dogs. Therefore, our objectives were to assess inflammatory biomarkers, vitamin D metabolites, and phagocytic capacity in diabetic dogs and determine whether associations exist with these variables and the level of clinical control or vitamin D metabolites. This was a prospective case-control study that included 20 otherwise healthy diabetic dogs (clinically controlled, n = 10; uncontrolled, n = 10) and 20 non-diabetic, healthy, age (± 2 years), breed, and sex matched controls. Complete blood count, biochemical panel, urinalysis, and fructosamine were performed at a single commercial reference laboratory. Basal plasma tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, and IL-10 were measured using a canine-specific multiplex bead-based assay. Serum C-reactive protein (CRP) was measured using a commercially available ELISA kit. Serum 25-hydroxyvitamin (OH)D3 and 24,25-dihydroxyvitamin (OH)2D3 were measured with HPLC. Phagocytosis of opsonized-Escherichia coli (E. coli) was evaluated with flow cytometry. Diabetic dogs had higher serum CRP concentrations than controls (p = 0.02). Plasma IL-8 concentrations were higher in diabetic dogs with uncontrolled clinical disease compared to controls (p = 0.02). Diabetic dogs had a lower percentage of leukocytes that phagocytized opsonized-E. coli (p = 0.02), but an increased number of bacteria phagocytized per cell (p < 0.001) compared to controls. No between-group differences were identified in vitamin D metabolites, nor were associations found between vitamin D and any variables. Fructosamine had a positive association with serum CRP concentration (rho = 0.35, p = 0.03) and number of bacteria phagocytized per cell (rho = 0.45, p = 0.004) in our cohort (n = 40). Like people with T1DM, diabetic dogs have a proinflammatory phenotype and phagocytic dysregulation that may be correlated with glycemic control.

Effectiveness and safety of glucose-lowering drugs as an adjunct to insulin therapy in Chinese patients with type 1 diabetes: a retrospective, observational study.

AIM: To assess the real-world impact of glucose-lowering drugs (GLDs) as an adjunct to insulin in Chinese patients with type 1 diabetes (T1DM). METHODS: This dual-center, observational, retrospective study included 121 T1DM patients receiving GLDs as adjuncts and 56 participants with insulin-only drugs as comparators. Glycated hemoglobin A1c (HbA1c), daily insulin dosage, fasting blood glucose (FBG), postprandial blood glucose (PBG), nocturnal blood glucose (NBG) and the difference in trough and peak blood glucose levels on the same day (Δ TP) were assessed at baseline and at the end of the study. RESULTS: In total, HbA1c decreased by 1.14% in the GLD+insulin group (p < 0.0001) and 0.36% in the insulin-only group (p = 0.0423, mean adjusted difference, -0.09% [95% CI, -0.55 to 0.37]). The total daily insulin concentration was reduced by 7.34 U per day in the GLD+insulin group vs. 5.55 U per day in the insulin-only group (mean adjusted difference, -2.32 U [95% CI, -4.97 to 0.33]). In particular, among patients with fasting C-peptide levels < 17 pmol/L, the total daily insulin concentration was significantly reduced by 9.22 U vs. 5.09 U per day (mean adjusted difference, -3.84 [95% CI, -6.85-0.84]; p = 0.0129). There were no notable differences in the other glycemic indices between the two groups. A gradual downward trend in changes in glycemic outcomes was observed among patients treated with various combinations of metformin, acarbose, and dipeptidyl peptidase 4 inhibitor (DPP-4i). Similar reductions in the daily insulin dose were also detected in most of the GLD+insulin group in addition to the DPP-4i-only group. No severe hypoglycemia was induced by additional GLDs. CONCLUSIONS: The use of additional GLDs tends to improve glycemic outcomes and reduce insulin requirements in patients with T1DM. These results indicate that the use of GLDs as an adjunctive therapy may have been an effective treatment strategy among adults with T1DM in China.

Analytical Performance of the FreeStyle Libre 2 Glucose Sensor in Healthy Male Adults.

Continuous Glucose Monitoring (CGM) not only can be used for glycemic control in chronic diseases (e.g., diabetes), but is increasingly being utilized by individuals and athletes to monitor fluctuations in training and everyday life. However, it is not clear how accurately CGM reflects plasma glucose concentration in a healthy population in the absence of chronic diseases. In an oral glucose tolerance test (OGTT) with forty-four healthy male subjects (25.5 ± 4.5 years), the interstitial fluid glucose (ISFG) concentration obtained by a CGM sensor was compared against finger-prick capillary plasma glucose (CPG) concentration at fasting baseline (T0) and 30 (T30), 60 (T60), 90 (T90), and 120 (T120) min post OGTT to investigate differences in measurement accuracy. The overall mean absolute relative difference (MARD) was 12.9% (95%-CI: 11.8-14.0%). Approximately 100% of the ISFG values were within zones A and B in the Consensus Error Grid, indicating clinical accuracy. A paired t-test revealed statistically significant differences between CPG and ISFG at all time points (T0: 97.3 mg/dL vs. 89.7 mg/dL, T30: 159.9 mg/dL vs. 144.3 mg/dL, T60: 134.8 mg/dL vs. 126.2 mg/dL, T90: 113.7 mg/dL vs. 99.3 mg/dL, and T120: 91.8 mg/dL vs. 82.6 mg/dL; p < 0.001) with medium to large effect sizes (d = 0.57-1.02) and with ISFG systematically under-reporting the reference system CPG. CGM sensors provide a convenient and reliable method for monitoring blood glucose in the everyday lives of healthy adults. Nonetheless, their use in clinical settings wherein implications are drawn from CGM readings should be handled carefully.

Association between dietary patterns and glycemic control in type II diabetes mellitus patients.

OBJECTIVE: To assess the association between dietary patterns and glycemic control among patients with type II diabetes mellitus (T2DM). DESIGN: A cross-sectional study. SITE: The 2015-2018 National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS: A total of 1646 T2DM patients were included, of whom 854 were hyperglycemia. METHODS: Main dietary patterns were identified using the sparse principal components analysis (SPCA). Logistic regression analysis was applied to investigate the association between each dietary pattern and the risk of hyperglycemia with odds ratios (OR) and 95% confidence intervals (CI). SPCA analysis yielded five significant principal components (PC), which represented five main dietary patterns. RESULTS: PC1, characterized by a high intake of sweets, red meat and processed meat, was associated with higher odds of hyperglycemia in patients who underwent hyperglycemic drug or insulin treatments (OR: 1.71, 95% CI: 1.10-2.64). PC5, characterized by high in red meat, while low in coffee, sweets, and high-fat dairy consumption. The relationship between the PC5 and hyperglycemia was marginal significance (OR: 0.63, 95% CI: 0.38-1.02). PC2 was characterized by a high consumption of green vegetables, other vegetables, and whole grains, and low intake of potatoes and processed meat. In patients with the hyperglycemic drug and insulin free, higher PC2 levels were related to lower odds of hyperglycemia (OR: 0.45, 95% CI: 0.21-0.96). CONCLUSIONS: High intake of sweets, red meat, and processed meat might be detrimental to glycemic control in patients with drug-treated T2DM. High in red meat, while low in coffee, sweets, and high-fat dairy consumption may be beneficial to glycemic control. In addition, high consumption of green vegetables, other vegetables, and whole grains, and low intake of potatoes and processed meat may be good for glycemic control in patients without drug-treated T2DM.

Dual effects of dulaglutide on glycemic control and knee osteoarthritis pain in elderly patients with Type 2 diabetes.

Aim: This study aims to evaluate the dual benefits of dulaglutide in improving glycemic control and reducing knee OA pain.Patients & methods: Elderly T2DM patients diagnosed with bilateral knee OA on conventional OA treatment for at least 3 months were studied for their glycemic metrics, OA pain scores and NSAID consumption at baseline, 3 months and 6 months.Results: Significant improvements in glycemic control were observed, HbA1c decreased from 8.7% to 6.5% over 6 months. Pain scores, NSAID, body weight and BMI showed substantial reductions over time. Positive correlation (r = 0.73, p < 0.001) was found between glycemic control and pain reduction.Conclusion: Dulaglutide improves glycemic control, knee joint OA pain and weight management in elderly patients with T2DM.

What is this article about? We looked into how well dulaglutide works to both control blood sugar and reduce knee pain in people with type 2 Diabetes and osteoarthritis. This could be a useful treatment for older patients dealing with both conditions.What were the results? The most relevant findings were:Better Blood Sugar Control: After using dulaglutide for three and 6 months, there were noticeable improvements in blood sugar levels.Less Knee Pain: People experienced less knee pain from osteoarthritis and used fewer painkillers.Weight Loss: The average body weight and body mass index (BMI) decreased with this treatment.Pain Relief Linked to Better Blood Sugar: As blood sugar levels improved, knee pain from osteoarthritis also lessened.What do the results of the study mean? The results showed that elderly T2DM patients prescribed with dulaglutide would be able to achieve improved glycemic control, knee joint OA pain and weight management.

Evaluating Preferences of Hospitalized Diabetes Patients for Hospital-Wide Glycemic Control Programme: A Discrete Choice Experiment.

Background: Effective glycemic control is crucial for hospitalized patients, leading to benefits such as shorter hospital stays and reduced postoperative infection rates. While previous studies have emphasized the effectiveness of multidisciplinary collaborative stewardship for hospital-wide hyperglycemia management, patient perspectives and preferences have not been adequately considered. Objective: To identify factors influencing treatment preferences of Chinese hospitalized diabetes patients using discrete choice experiments (DCEs) and provide practical insights for the construction of a hospital-wide glycemic control programme. Methods: A face-to-face survey was conducted among diabetes patients admitted to nonendocrine departments in a tertiary hospital in Nanjing, China. The attributes and levels were determined based on DCE principles, and a conditional logit model was used to quantify patients' preferences. Results: A total of 157 respondents were analyzed. Antihyperglycemic effectiveness, healthcare providers, treatment regimen, monitoring frequency, and adverse reactions were the five attributes that significantly influenced patient preference (p < 0.05). Notably, an 80% glycemic control rate (ß = 2.009) and a multidisciplinary management team involving clinical pharmacists (ß = 1.346) had the greatest impact. Negative effects were observed for hypoglycemia (ß = -1.008), insulin pump use (ß = -0.746), and frequent glucose monitoring (ß = -0.523). Female patients exhibited higher concern for healthcare providers (ß = 1.172) compared to males. Younger and shorter-course patients prioritized antihyperglycemic effectiveness (ß = 3.330, ß = 1.510), while older patients preferred multidisciplinary management (ß = 1.186) and opposed increased monitoring frequency (ß = -0.703). Patients with higher educational backgrounds showed greater acceptance of continuous glucose monitoring (ß = 1.983), and those with higher annual income placed more emphasis on glycemic control rate. Conclusion: Treatment preferences of hospitalized diabetes patients are mainly influenced by antihyperglycemic effectiveness, adverse reactions, healthcare providers, and individual characteristics. Comprehensive consideration and an individualized therapy strategy should be given when constructing a hospital-wide glycemic control programme.

Identification of phase angle and Triglyceride-Glucose index as biomarkers for prediction and management of diabetic foot disease.

Introduction: Approximately 25 % of diabetic patients develop diabetic foot ulcers (DFUs), significantly increasing morbidity, mortality, and healthcare costs. Effective control and prevention are crucial. Objective: This study aims to identify easily measurable parameters for predicting DFU risk by assessing the correlation between Phase Angle (PA) and the Triglyceride-Glucose (TyG) index with DFU risk. Materials and methods: A comparative case-control study was conducted at the General Hospital of Elche from March to June 2023 with 70 participants (33 with diabetes, 37 without). Cases had diabetes for over five years and a diabetic foot risk grade of 0, 1, or 2 (IWGDF 2019). Exclusion criteria included inability to walk, prior use of orthoses, and severe complications like edema or wounds. Predictive variables were PA, TyG index, body composition, and biochemical markers. Statistical analyses included Pearson/Spearman tests for correlations, Student's t-test/Mann-Whitney test for group comparisons, and ANOVA/Kruskal-Wallis tests for normally and non-normally distributed variables. Results: PAand TyG index were strongly linked to diabetic foot risk, supporting their potential as biomarkers. Significant relationships with other relevant biomarkers were also confirmed. Conclusion: PA and TyG index are valuable, easily measurable biomarkers for assessing diabetic foot risk, and can be monitored in primary care settings. Implementing these biomarkers in routine practice could enhance the management of diabetic complications, particularly in resource-limited settings, by enabling early detection and intervention, thus improving patient outcomes and reducing the burden of advanced complications.

Age-based challenges to type 1 diabetes management in the pediatric population.

Type 1 diabetes is rising in the pediatric population, affecting approximately 1.2 million children and adolescents globally. Its complex pathogenesis involves the interaction between genetic predisposition and environmental factors, leading to T cell-mediated destruction of insulin-producing pancreatic beta-cells. This destruction results in insulin insufficiency and hyperglycemia. Hence, managing type 1 diabetes requires a comprehensive approach that includes various aspects such as blood glucose monitoring, insulin therapy, carbohydrate counting, caloric intake monitoring, considering family habits and food preferences, planning daily schedules, and incorporating physical activity. Children with type 1 diabetes encounter age-specific challenges in disease management that may exacerbate the risk of metabolic complications and adverse health outcomes. These risk factors may be neurological, physiological, behavioral, psychological, or social, complicate management and necessitate tailored approaches for effective care. Regardless of the age group, primary caregivers have a high responsibility to maintain optimal glycemic control, including monitoring diet, daily activity, and administering insulin. By reviewing research on the challenges faced by pediatric patients with type 1 diabetes, we summarized key insights aimed at developing targeted interventions and support systems that enhance diabetes management and improve health outcomes in this vulnerable population.

Culturally adapted mobile application for optimizing metabolic control in type 1 diabetes: a pilot study.

Objective: To evaluate whether use of a culturally adapted mobile application (app) for adolescents with type 1 diabetes is associated with improved metabolic control. Methods: The Dominican Republic's National Institute of Diabetes, Endocrinology, and Nutrition and the Learning to Live clinic recruited 23 pediatric participants for the study. Blood tests were performed before and after use of the app for a period of 3 months. Based on the user profile, participants were encouraged to use the app's bolus insulin calculator after each meal. The app included a list of regionally and culturally specific foods, color-coded to indicate a high glycemic index (GI) as red; medium GI as yellow; and low GI as green. The color-coding was designed to assist participants in making healthier eating choices. Results: There were statistically significant improvements in lipid profile. Mean high-density lipoprotein values rose to acceptable levels, while low-density lipoproteins and triglyceride levels fell to the recommended values. The overall quality of life increased, although glycated hemoglobin levels showed no statistically significant changes. Conclusion: The findings of this study suggest that using this culturally tailored app can help young patients with type 1 diabetes to improve metabolic health.

The impact of diabetes and presurgical glycemic control on wound morbidity following open complex abdominal wall reconstruction: a single-center experience.

INTRODUCTION: Numerous studies have identified diabetes mellites (DM) as a significant risk factor for postoperative wound morbidity, with suboptimal preoperative glycemic control (GC) posing an even greater risk. However, this data largely excludes ventral hernia patients. Our study examined the association between diabetes and preoperative GC and postoperative outcomes following open complex abdominal wall reconstruction (AWR). METHODS: We identified diabetic patients who had undergone open, elective, clean VHR with transversus abdominis release (TAR) and permanent synthetic mesh at the Cleveland Clinic Foundation between January 2014 and December 2023. Their 30-day outcomes were compared to non-diabetic patients undergoing the same procedure. Subsequently, diabetic patients were categorized based on GC. status: "Optimal GC" (HbA1c < 7%), "Sub-optimal GC" (HbA1c 7-8.4%), and "Poor GC" (HbA1c ≥ 8.5%) and their outcomes were compared. RESULTS: 514 patients with DM who underwent clean elective TAR were identified, of which 431 met the inclusion criteria. GC was deemed optimal in 255 patients, sub-optimal in 128, and poor in 48 patients. Demographics were similar, except for anticoagulation treatment (p = 0.014). The entire study population exhibited significantly higher rates of wound morbidities and overall complications compared to non-diabetic patients. However, rates of surgical site infection (SSI), surgical site occurrence (SSO), SSO requiring procedural intervention (SSOPI), and reoperation did not differ significantly among the three cohorts of presurgical glycemic control (p = 0.82, p = 0.46, p = 0.51, p = 0.78), respectively. No occurrence of mesh removal was documented. CONCLUSION: In general, diabetes is a marker for increased wound morbidity and complications following complex abdominal wall reconstruction. However, we could not establish a hard cutoff to justify withholding surgery in symptomatic patients based on an arbitrary HbA1C level. We believe this data is important for shared decision-making when considering AWR for symptomatic ventral hernias in diabetic patients.

Glycemic Control Contributes to the Neuroprotective Effects of Mediterranean and Green-Mediterranean Diets on Brain Age; The DIRECT PLUS Brain-MRI Randomized Controlled Trial.

BACKGROUND: We recently reported that Mediterranean (MED) and green-MED diets significantly attenuated age-related brain atrophy by ∼50% within 18 months. OBJECTIVE: To explore the contribution of specific diet-induced parameters to brain volume deviation from chronological age. METHODS: A post-hoc analysis of the 18-month DIRECT-PLUS trial, where participants were randomly assigned to: (1)-healthy-dietary-guidelines (HDG); (2)-MED diet; or (3)-green-MED diet, high in polyphenols and low in red meat. Both MED groups consumed 28g walnuts/day (+440mg/day polyphenols). The green-MED group further consumed green-tea (3-4 cups/day) and Mankai green shake (Wolffia-globosa aquatic plant) (+800mg/day polyphenols). We collected blood samples through the intervention and followed brain structure volumes by magnetic-resonance-imaging (MRI). We used hippocampal-occupancy (HOC) score (hippocampal and inferior-lateral-ventricle volumes ratio) as a neurodegeneration marker and brain age proxy. We applied multivariate-linear-regression models. RESULTS: Of 284 participants (88% male; age=51.1years; BMI=31.2kg/m2; HbA1c=5.48%; APOE-ε4 genotype=15.7%), 224 completed the trial with eligible whole-brain MRIs. Individuals with higher HOC-deviations (i.e., younger brain age) presented lower body weight (r=-0.204;95%CI[-0.298,-0.101]), waist-circumference (r=-0.207;95%CI[-0.310,-0.103]), diastolic (r=-0.186;95%CI[-0.304,-0.072]), and systolic blood pressure (r=-0.189;95%CI[-0.308,-0.061]), insulin (r=-0.099;95%CI[-0.194,-0.004]) and HbA1c (r=-0.164;95%CI[-0.337,-0.006]) levels. After 18 months, greater changes in HOC-deviations (i.e., brain-age decline attenuation) were independently associated with improved HbA1c (ß=-0.254;95%CI[-0.392,-0.117]), HOMA-IR (ß=-0.200;95%CI[-0.346,-0.055]) fasting glucose (ß=-0.155;95%[CI -0.293,-0.016]), and s-CRP (ß=-0.153;95%[CI -0.296,-0.010]). Improvement in diabetes status was associated with greater HOC-deviation changes compared to either no change in diabetes status (0.010;95%CI]0.002,0.019[) or with an unfavorable change (0.012;95%CI]0.002,0.023]). A decline in HbA1c is further associated with greater deviation changes in the Thalamus, Caudate nucleus, and Cerebellum (p<0.05). Greater consumption of Mankai and green-tea (green-MED diet components) were associated with greater HOC-deviation changes beyond weight loss. CONCLUSIONS: Glycemic control contributes to the neuroprotective effects of the MED and green-MED diets on brain age. Polyphenols-rich diet components as Mankai and green-tea may contribute to a more youthful brain age. TRIAL-REGISTRATION-CLINICAL-TRIALS-IDENTIFIER: NCT03020186 URL OF REGISTRATION: https://clinicaltrials.gov/study/NCT03020186.

Glycemic Control in Diabetic Foot Ulcers: A Comparative Analysis of Wound and Wound-free Periods in Adult Patients with type 1 and type 2 diabetes mellitus.

AIM: To determine whether there are differences in glycemia during wound and wound-free states among individuals with diabetes at a Multidisciplinary Diabetic Foot and Wound Clinic from 2012-2019. METHODS: We conducted a retrospective analysis of prospectively collected data over 7.4 years from the Johns Hopkins Multidisciplinary Diabetic Foot and Wound Clinic. Participants with diabetic foot ulcers (DFUs) were observed during at least one wound period and one wound-free period and had at least one hemoglobin A1C (A1C) measurement in both a wound and wound-free period. The A1C measurements were aggregated and summarized across wound and wound-free periods, and compared using the Wilcoxon matched-pairs signed rank test. RESULTS: 206 eligible participants with a total of 623 wounds were included in this analysis. Participants were followed for a median period of 2.4 years (876 days). There were no significant differences in mean, minimum, and maximum A1C between the aggregate wound and wound-free period, with median (interquartile range [IQR]) values of 7.6% (6.6%, 9.1%) and 7.5% (6.6%, 9.1%) for mean A1C (p = 0.43), 6.9% (6.0%, 8.0%) and 6.8% (6.0%, 8.1%) for minimum A1C (p = 0.78), and 8.6% (7.1%, 10.9%) and 8.5% (7.0%, 10.7%) for maximum A1C (p = 0.06) in the wound and wound-free period respectively. CONCLUSIONS: This retrospective study showed similar levels of A1C during wound and wound-free periods, but given limitations of missing A1C and small sample size, further studies leveraging continuous glucose monitoring (CGM) data are needed to understand whether glycemia worsens in the setting of a DFU.

Modeling the Clinical and Economic Burden of Therapeutic Inertia in People with Type 2 Diabetes in Saudi Arabia.

INTRODUCTION: Therapeutic inertia in type 2 diabetes, defined as a failure to intensify treatment despite poor glycemic control, can arise due to a variety of factors, despite evidence linking improved glycemic control with reductions in diabetes-related complications. The present study aimed to evaluate the health and economic burden of therapeutic inertia in people with type 2 diabetes in Saudi Arabia. METHODS: The IQVIA Core Diabetes Model (v.9.0) was used to evaluate outcomes. Baseline cohort characteristics were sourced from Saudi-specific data, with baseline glycated hemoglobin (HbA1c) tested at 8.0%, 9.0%, and 10.0%. Modeled subjects were brought to an HbA1c target of 7.0% immediately or after delays of 1-5 years across time horizons of 3-50 years. Outcomes were discounted annually at 3.0%. Costs were accounted from a societal perspective and expressed in 2023 Saudi Arabian Riyals (SAR). RESULTS: Immediate glycemic control was associated with improved or equal life expectancy and quality-adjusted life expectancy and cost savings in all scenarios compared with delays in achieving target HbA1c. Combined cost savings ranged from SAR 411 (EUR 102) per person with a baseline HbA1c of 8.0% versus a 1-year delay over a 3-year time horizon, to SAR 21,422 (EUR 5291) per person with a baseline HbA1c of 10.0% versus a 5-year delay over a 50-year time horizon. Discounted life expectancy and quality-adjusted life expectancy were projected to improve by up to 0.4 years and 0.5 quality-adjusted life years (QALYs), respectively, with immediate glycemic control. CONCLUSION: Therapeutic inertia was associated with a substantial health and economic burden in Saudi Arabia. Interventions and initiatives that can help to reduce therapeutic inertia are likely to improve health outcomes and reduce healthcare expenditure.