The Impact of Adding Prandial Insulin to a Basal Based Regimen with Insulin Glargine in Type 2 Diabetic Patients.

Background: Type 2 diabetes (T2D) is a progressive disease that should be managed with insulin in case of oral glucose lowering drugs (OGLDs) failure. If basal insulin is not sufficient, rapid acting insulin will be added before the largest meal. We assessed the impact of adding one prandial insulin to a basal based regimen and insulin glargine in patients with type 2 diabetes to measure the percentage of subjects achieving the HbA1c target by the end of 24 weeks of treatment in routine clinical practice. Methods: This study was a 24-week observational study of patients with T2D not adequately controlled with OGLDs and basal insulin, for whom the physician had decided to initiate prandial insulin. The study endpoint was assessed at visit 1 (baseline), visit 2 at week 12 (±1 week) and visit 3 at week 24 (±1 week). The percentage of patients who achieved HbA1c targets was assessed at week 24. Statistical analyses were performed using IBM SPSS for Windows v 19 (IBM, Armonk, New York, USA). Logistic regression analysis was used to detect predicting factors of achieving the HbA1c target by week 24. P<0.05 was considered as significant level. Results : Four hundred and eighteen patients with a mean±SD age of 56.24±9.85 years and a mean±SD duration of diabetes of 12.50±7.16 years were included. The median total daily dose of basal insulin was 24 units, while prandial insulin was started with 6 (4, 10) U/day, titrating up to 10 (8, 18) U/day at week 24. The daily dose of prandial insulin was the only factor that could significantly predict achieving targeted HbA1c by week 24 [OR: 1.04; 95% CI: 1.007,1.079; p-value: 0.019]. At week 24, 96 (22.9%) subjects achieved the HbA1c target with one prandial insulin. Conclusion : The results of our study suggest that "basal plus therapy" can lead to good glycemic control with a low risk of hypoglycemia and weight gain in patients with type 2 diabetes.

Association of common single-nucleotide polymorphism of HHEX with type 2 diabetes mellitus.

Background: Type 2 diabetes mellitus (T2DM) is a complex metabolic disease that occurs as a result of insulin resistance and low insulin production. T2DM involves many organ systems that include macro-vascular and micro-vascular complications. Several genome-wide association studies (GWAS) and candidate gene studies have suggested a large number of single nucleotide polymorphisms (SNPs) on several genes such as HHEX that were associated with T2DM susceptibility. The current study aims to look at the relationship between the risk of T2DM and the HHEX gene variant rs7923837. Methods: In this case-control study genotyping of rs7923837 of the HHEX gene was performed using the PCR-RFLP and Sanger sequencing method. Results: Frequencies of GG genotype of rs7923837 polymorphism of HHEX among subjects with and without diabetes mellitus were 33.77% and 25.47% respectively. Corresponding prevalence for the AG genotype was 51.08% and 64.15% among subjects with and without diabetes mellitus respectively. The differences were not statistically significant (p = 0.08). Conclusion: Our study revealed that polymorphisms rs7923837 of HHEX were not associated with T2DM. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-024-01407-5.

Predicting mortality in brain stroke patients using neural networks: outcomes analysis in a longitudinal study.

In this study, Neural Networks (NN) modelling has emerged as a promising tool for predicting outcomes in patients with Brain Stroke (BS) by identifying key risk factors. In this longitudinal study, we enrolled 332 patients form Imam hospital in Ardabil, Iran, with mean age: 77.4 (SD 10.4) years, and 50.6% were male. Diagnosis of BS was confirmed using both computerized tomography scan and magnetic resonance imaging, and risk factor and outcome data were collected from the hospital's BS registry, and by telephone follow-up over a period of 10 years, respectively. Using a multilayer perceptron NN approach, we analysed the impact of various risk factors on time to mortality and mortality from BS. A total of 100 NN classification algorithm were trained utilizing STATISTICA 13 software, and the optimal model was selected for further analysis based on their diagnostic performance. We also calculated Kaplan-Meier survival probabilities and conducted Log-rank tests. The five selected NN models exhibited impressive accuracy ranges of 81-85%. However, the optimal model stood out for its superior diagnostic indices. Mortality rate in the training and the validation data set was 7.9 (95% CI 5.7-11.0) per 1000 and 8.2 (7.1-9.6) per 1000, respectively (P = 0.925). The optimal model highlighted significant risk factors for BS mortality, including smoking, lower education, advanced age, lack of physical activity, a history of diabetes, all carrying substantial importance weights. Our study provides compelling evidence that the NN approach is highly effective in predicting mortality in patients with BS based on key risk factors, and has the potential to significantly enhance the accuracy of prediction. Moreover, our findings could inform more effective prevention strategies for BS, ultimately leading to better patient outcomes.

Correction to: Association of eNOS and ACE gene polymorphisms as a genetic risk factor in gestational diabetes in Iranian women.

[This corrects the article DOI: 10.1007/s40200-018-0348-4.].

Association of eNOS and ACE gene polymorphisms as a genetic risk factor in gestational diabetes in Iranian women.

BACKGROUND: Gestational diabetes mellitus (GDM) is the most popular metabolic disease during pregnancy. The aim of the present study was to investigate any possible association between eNOS Glu298Asp and ACE I/D gene polymorphisms and the risk of GDM in a group of Iranian pregnant women. METHODS: In this case-control study 204 pregnant women were recruited (94 cases and 110 controls). Genomic DNA was isolated from whole blood and genotyping was performed by the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR- RFLP) and only PCR for eNOS and ACE polymorphisms respectively. RESULTS: Frequencies of GT and TT genotype of eNOS polymorphism among women with and without GDM were 67.90% vs. 74.47 and 7.41% vs. 8.51% respectively (P = 0.4). Corresponding figures for DD genotype of ACE polymorphism among GDM patients was more than that in healthy women (51.65% vs. 63.81% respectively). Conversely, ACE heterozygote genotype was more common in diabetic women (35.16% vs. 26.67% respectively). Although these differences were not statistically significant (P = 0.2). CONCLUSIONS: Our study showed that there is no association between the presence of eNOS and ACE gene polymorphisms and developing gestational diabetes mellitus among pregnant women in our population. Further longitudinal and multicenter studies should be carried out to assess the exact metabolic effects of these polymorphisms.

Controlling type 2 diabetes mellitus with herbal medicines: A triple-blind randomized clinical trial of efficacy and safety.

BACKGROUND: The use of alternative medicines is common in patients with diabetes mellitus. The primary aim of the present study was to determine the effects of cinnamon and Caucasian whortleberry (Vaccinium arctostaphylos L.) on blood glucose control, lipid profile and body mass index (BMI) in patients with type 2 diabetes (T2DM). METHODS: In all, 105 T2DM patients were recruited to the present randomized triple-blinded clinical trial. Patients were randomly divided into three groups and administered either placebo, cinnamon or whortleberry supplements (1 g/day) for 90 days. Fasting blood glucose (FBG), serum insulin, lipid profiles, and HbA1c were measured before and after the study. RESULTS: There were no significant differences in baseline characteristics among the three groups. After treatment, FBG, 2-h blood postprandial glucose and homeostasis model assessment of insulin resistance (HOMA-IR) scores were significantly reduced in patients in the whortleberry group, but not in the placebo group. After treatment, there was a significant difference in BMI between the cinnamon and control groups (P = 0.02). There were no significant differences in any variables between the cinnamon and whortleberry groups (P>0.05 for all). In addition, there was a significant decrease in all indices of glucose control in all the cinnamon and whortleberry groups (P < 0.05). CONCLUSIONS: There were no significant differences in blood glucose levels, insulin sensitivity or lipid profile among the three groups. However, the use of cinnamon and whortleberry in addition to conventional medical treatment is recommended to adjust weight and blood glucose levels in patients with T2DM, respectively.

Feasibility, reliability and validity of the Iranian version of the Diabetes Quality of Life Brief Clinical Inventory (IDQOL-BCI).

AIMS: To validate and culturally adapt the Diabetes-specific Quality of Life Brief Clinical Inventory (DQOL-BCI) for the Iranian population. METHODS: After translation - back translation, content validity was assessed utilizing a panel of six experts. Based on a sample of 180 diabetic patients referred to two Diabetics Clinic Centers from September to May 2011 in Karaj, Iran, construct validity via detecting the factor structure, and convergent and discriminant validity were evaluated by scale-item correlations and known group analyses. Internal consistency and test-retest reliability were assessed in sample of 30 patients by Cronbach's and intraclass correlation coefficient (ICC). RESULTS: The IDQOL-BCI showed good content validity (CVI values>0.75 and CVR values>0.99), internal consistency (α=0.75) and test-retest reliability (ICC=0.81). A 3-factor solution was found. In addition, high values of item-scale correlations confirmed the convergence validity, and some subscales and total scores differentiate between groups defined by sex, disease duration, income levels, drug using status and physical activity demonstrated the discriminant validity. CONCLUSIONS: Our findings demonstrate the initial feasibility, reliability and validity of the Iranian version of the IDQOL-BCI as a measure of diabetic-specific QOL measure in Iranian patients.