Individualized Nutritional Management Using Dishcook Improves Nutrition Status Markers in Patients with Intellectual Disability.

Dishcook is a new cooking system that allows individual cooking using a dedicated induction heater. This study investigated whether Dishcook use affects the nutritional value of individuals with intellectual disabilities. This study was conducted on users receiving support from a continuous-employment office in Obama City, Fukui Prefecture, in 2022. Of these participants, 18 (seven women and 11 men) who requested the use of the Dishcook were included in the analysis. The study period was from January to August 2023. The mean age was 48.72±16.24 y. A significant increase in the overall phase angles of the limbs was observed. Triglyceride, LDL cholesterol, HbA1c, and serum zinc levels improved in patients who used the Dishcook. The phase angle obtained using Bioelectrical Impedance Analysis also improved, indicating the usefulness of the Dishcook in treating metabolic diseases and the possibility of individualized nutritional management.

Effects of glycaemic control on memory performance, hippocampal volumes and depressive symptomology.

BACKGROUND: Diabetes and poor glycaemic control have been shown to negatively impact cognitive abilities, while also raising risk of both mood disorders and brain structural atrophy. Sites of atrophy include the hippocampus, which has been implicated in both memory performance and depression. The current study set out to better characterise the associations between poor glycaemic control, memory performance, and depression symptoms, and investigate whether loss of hippocampal volume could represent a neuropathological mechanism underlying these. METHODS: 1331 participants (60.9% female, age range 18-88 (Mean = 44.02), 6.5% with likely diabetes) provided HbA1c data (as an index of glycaemic control), completed a word list learning task, and a validated depression scale. A subsample of 392 participants underwent structural MRI; hippocampal volumes were extracted using FreeSurfer. RESULTS: Partial correlation analyses (controlling for age, gender, and education) showed that, in the full sample, poorer glycaemic control was related to lower word list memory performance. In the MRI sub-sample, poorer glycaemic control was related to higher depressive symptoms, and lower hippocampal volumes. Total hippocampus volume partially mediated the association between HbA1c levels and depressive symptoms. CONCLUSIONS: Results emphasise the impact of glycaemic control on memory, depression and hippocampal volume and suggest hippocampal volume loss could be a pathophysiological mechanism underlying the link between HbA1c and depression risk; inflammatory and stress-hormone related processes might have a role in this.

Association of haemoglobin glycation index with all-cause and cardiovascular disease mortality in diabetic kidney disease: a cohort study.

BACKGROUND: While the high haemoglobin glycation index (HGI) has been extensively investigated in diabetic populations, its impact on patients with diabetic kidney disease (DKD) remains unclear. METHODS: We examined data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 1999 and 2018. HGI was determined using the formula recommended by Hempe et al., which calculates the difference between measured and predicted HbA1c. Predicted HbA1c was derived from the equation: 0.024 FPG + 3.1. National death index records up to December 31, 2019, were utilized to assess mortality outcomes. To estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for both all-cause and cardiovascular disease (CVD) mortality, we utilized Cox proportional hazard models. A restricted cubic spline analysis was performed to explore the potential nonlinear relationship between HGI levels and mortality. RESULTS: Our cohort study comprised data from 1,057 participants with DKD (mean [SE] age, 61.61 [0.57] years; 48.24% female). The mean HGI level was 0.44 (SE 0.04). Over a median follow-up period of 6.67 years, we observed 381 deaths, including 140 due to CVD. Compared with participants in the second tertile of HGI levels (0.03-0.74), those in the lowest tertile of HGI (-5.29-0.02) exhibited an all-cause mortality hazard ratio of 1.39 (95% CI, 1.02-1.88) and a CVD mortality hazard ratio of 1.10 (95% CI, 0.67-1.81). Conversely, participants in the highest tertile (0.75-9.60) demonstrated an all-cause mortality hazard ratio of 1.48 (95% CI, 1.05-2.08) and a CVD mortality hazard ratio of 2.06 (95% CI, 1.13-3.77) after further adjusting for HbA1c and other important variables. Additionally, a restricted cubic spline analysis revealed a U-shaped relationship between HGI and all-cause mortality (P < 0.001 for nonlinearity) and a J-shaped relationship between HGI and CVD mortality (P = 0.044 for nonlinearity). CONCLUSIONS: Our cohort study suggests that HGI in DKD populations exhibits a U-shaped association with all-cause mortality and a J-shaped association with CVD mortality, independent of HbA1c levels.

Glycated haemoglobin variability and risk of renal function decline in type 2 diabetes mellitus: An updated systematic review and meta-analysis.

OBJECTIVE: To assess the association between glycated haemoglobin (HbA1c) variability and risk of renal function decline in type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS: A comprehensive search was carried out in PubMed, Embase, Web of Science and the Cochrane Library (until 12 March 2024). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines were followed for this meta-analysis. HbA1c variability was presented as indices of the standard deviation (SD), coefficient of variation (CV), HbA1c variability score (HVS) and haemoglobin glycation index (HGI). This meta-analysis was performed using random-effect models. RESULTS: Eighteen studies met the objectives of this meta-analysis. The analyses showed positive associations between HbA1c variability and kidney function decline, with hazard ratio (HR) 1.26 (95% confidence interval [CI] 1.15-1.38) for high versus low SD groups, HR 1.47 (95% CI 1.30-1.65) for CV groups, HR 1.32 (95% CI 1.10-1.57) for HVS groups and HR 1.53 (95% CI 1.05-2.23) for HGI groups. In addition, each 1% increase in SD and CV was linked to kidney function decline, with HR 1.26 (95% CI 1.17-1.35), and 1.13 (95% CI 1.03-1.23), respectively. Also, each 1-SD increase in SD of HbA1c was associated with deterioration in renal function, with HR 1.17 (95% CI 1.07-1.29). CONCLUSIONS: The four HbA1c variability indicators were all positively associated with renal function decline progression; therefore, HbA1c variability might play an important and promising role in guiding glycaemic control targets and predicting kidney function decline progression in T2DM.

Degree of Blood Glucose Control and Risk of Hypertension in Chinese Adults with T2DM: A Cross-Sectional Study.

Background: Diabetes mellitus and hypertension often coexist and share common risk factors. This study investigated the correlation between glycemic management and the prevalence of hypertension among Chinese adults diagnosed with type 2 diabetes mellitus (T2DM). Methods: This study included 1715 patients with T2DM from four cities in Anhui Province, China. Sociodemographic characteristics of the sample participants were collected via questionnaires. A univariate analysis of variance (ANOVA) was utilized for continuous variables, and chi-square testing was used for categorical variables. Binary logistic regression was utilized to examine the relationship between blood pressure and variables including fasting plasma glucose (FPG), glycosylated haemoglobin (HbA1c), body mass index (BMI), waist circumference (WC), physical activity, dyslipidemia, and family history of hypertension. Results: FPG levels did not increase the risk of hypertension, while HbA1c was significantly and negatively associated with hypertension risk. HbA1c levels ranged from 7.2 to 8.6%, with odds ratios (OR) of 0.68 and 95% confidence intervals (CI) of 0.48 to 0.97 and a significant p value of less than 0.05. For the HbA1c levels above 8.6%, the OR was 0.58 with a 95% CI of 0.39 to 0.87 and a significant p value of less than 0.01. Furthermore, advanced age, higher BMI, greater waist circumference, presence of dyslipidemia, and positive family history of hypertension were all found to be significantly and independently linked to a heightened risk of developing hypertension. These associations remain significant after further adjustment. Conclusion: There was a negative association between HbA1c and the risk of hypertension, and the association remained significant after adjustment for antihypertensive drug use.

Assessment of Health-Related Quality of Life and Its Determinants in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study.

Background Type 2 diabetes mellitus is a complex metabolic disorder associated with several complications that determine the quality of life of the patients. Health-related quality of life (HRQoL) is a measurable outcome of the self-perception of a patient's health which is affected due to age, lifestyle changes, medication, and treatment modalities. This study was undertaken to understand the impact of individual parameters of age, medication type and duration, diabetes-associated complications, and levels of glycated hemoglobin (HbA1c) on the quality of life (QoL) of the patient.  Methodology This single-center prospective, cross-sectional study was conducted at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. Participants were recruited from the Outpatient Department of General Medicine, IGIMS. HRQoL was measured using a validated and reliable EuroQol 5-dimensions 5-levels (EQ-5D-5L) questionnaire developed by the EuroQol Research Foundation, along with the EuroQol-Visual Analogue Scale (EQ-VAS). The eligibility criteria included adult diabetic patients above 18 years of age with complete medical records, who had been treated at the outpatient department for a minimum of three months and could be interviewed. Results The results from this study show that 46% of the patients belonged to the age group of 45-65 years. The quality of health index scores and EQ-VAS scores significantly correlated with age (p-values: 1.11 e-4 and 3.09 e-5; <0.05). Of the subjects, 66.4%, 6.7%, and 26.8% were under oral hypoglycaemic agents (OHA), insulin, and both insulin with OHA medications respectively. HbA1C levels were statistically significantly correlated with mobility, self-care, usual activities, pain or discomfort, and anxiety or depression (p-value 0.032; <0.05), along with self-perception of the patient's health (p-value 0.00026; <0.05). Also, the perception of having slight problems in mobility, self-care, usual activities, pain or discomfort, and anxiety or depression was similar irrespective of gender (EQ-5D-5L score for males: 9.47 and females: 9.3). Despite suffering from diabetes-associated chronic complications, 60.5% of the subjects perceived their overall health to be good as indicated by the scores. Conclusion The self-perception of HRQoL concerning mobility, self-care, usual activities, pain or discomfort, and anxiety or depression was correlated with age, duration of anti-diabetic medication, and HbA1C level. Good mobility, self-care, and performing usual activities reduce anxiety or depression as opposed to age, pain, and discomfort. However, the subjects in this study cohort perceived overall good health in themselves in terms of EQ-VAS and 5D-5L scores, indicating effective diabetic care and management options available to them.

Association Between COVID-19 and Diabetes Management Indices in Japanese Type 2 Diabetes Mellitus Patients: A Single-Center, Retrospective Study.

Purpose: The aim of the study was to determine the association between coronavirus disease 2019 (COVID-19) infection and diabetes management indices in patients with type 2 diabetes mellitus. Patients and Methods: A single-center, retrospective, observational study of patients with type 2 diabetes mellitus at Kenwakai Hospital (Nagano, Japan) was conducted. Data of 95 patients (mean age, 72 ± 12 years; men, 67.4%) who visited between March 1, 2019 and February 28, 2022 were obtained from the hospital's electronic information system. COVID-19 was diagnosed by a chemiluminescent enzyme immunoassay (CLEIA). Results: There was no association between COVID-19 infection and age, sex, hemodialysis treatment status, or the Charlson Comorbidity Index. After adjustment for possible confounding factors, the incidence of COVID-19 infection was significantly correlated with HbA1c ≥7.0% (odds ratio [OR], 5.51; 95% confidence interval [CI], 1.30-23.26). Conclusion: The results suggest an association between high HbA1c levels and COVID-19 infection in patients with type 2 diabetes mellitus. Appropriate management of diabetes mellitus, focusing on HbA1c levels, may help prevent COVID-19 infection and severe disease after infection.

Long-term tracking of glycosylated hemoglobin levels across the lifespan in type 1 diabetes: from infants to young adults.

PURPOSE: Glycosylated hemoglobin (HbA1c) is commonly used as a monitoring tool in diabetes. Due to the potential influence of insulin resistance (IR), HbA1c level may fluctuate over a person's lifetime. This study explores the long-term tracking of HbA1c level in individuals diagnosed with type 1 diabetes mellitus (T1DM) from infancy to early adulthood. METHODS: The HbA1c levels in 275 individuals (121 males, 43.8%) diagnosed with T1DM were tracked for an average of 9.4 years. The distribution of HbA1c levels was evaluated according to age with subgroups divided by gender, use of continuous glucose monitoring (CGM), and the presence of complications. RESULTS: HbA1c levels were highest at the age of 1 year and then declined until age 4, followed by a significant increase, reaching a maximum at ages 15-16 years. The levels subsequently gradually decreased until early adulthood. This pattern was observed in both sexes, but it was more pronounced in females. Additionally, HbA1c levels were higher in CGM nonusers compared with CGM users; however, regardless of CGM usage, an age-dependent pattern was observed. Furthermore, diabetic complications occurred in 26.8% of individuals, and the age-dependent pattern was observed irrespective of diabetic complications, although HbA1c levels were higher in individuals with diabetic complications. CONCLUSION: HbA1c levels vary throughout the lifespan, with higher levels during adolescence. This trend is observed regardless of sex and CGM usage, potentially due to physiological IR observed during adolescence. Hence, physiological IR should be considered when interpretating HbA1c levels during adolescence.

The association of continuous glucose monitoring with glycemic parameters in patients with uncontrolled type 2 diabetes: A prospective observational study.

Background: Uncontrolled glycemic parameters in type 2 diabetes mellitus (T2DM) are a major concern. The present study aimed to evaluate the effectiveness of continuous glucose monitoring (CGM) on glycemic control in type 2 diabetics on insulin therapy. Materials and Methods: This prospective observational study was done in the Outpatient Department of General Medicine from January 1, 2021 till December 31, 2021 on patients with confirmed T2DM and on insulin therapy. Patients underwent detailed history and physical examination. The CGM device was inserted to record blood glucose levels throughout the day and night for monitoring. Parameters like glycosylated hemoglobin (HbA1c), fasting blood sugar (FBS), post-paradial blood sugar (PPBS), and lipid profile parameters [cholesterol, triglyceride (TG), and low-density lipoprotein (LDL)] were compared at baseline and after a follow-up of 3 months. P-value < 0.05 was used to indicate significant difference. Results: Of 107 patients screened, 100 were included in the study and seven were excluded. The mean age of the patients was 60.6 ± 11.1 years. Fifty-six (56%) of the patients were males, and 44 (44%) were females. The mean body mass index (BMI) was 22.9 ± 2.4 kg/m2. Compared to baseline values, after 3 months of CGM, there was significantly decreased HbA1c (9.41 ± 0.83 vs 9.87 ± 1.16 g%, P < 0.001), FBS (194.640 ± 22.4587 vs 205.10 ± 35.7758 mg/dl, P = 0.002), PPBS (271.160 ± 29.1235 vs 299.180 ± 42.3798, P < 0.001), cholesterol (184.470 ± 28.5192 vs 198.430 ± 38.8367 mg/dl, P < 0.001), LDL (102.410 ± 22.8973 vs 112.040 ± 30.8859, P < 0.001), and TG (140.890 ± 18.0979 vs 146.730 ± 20.8665 mg/dl, P < 0.001). Conclusion: There was a significant improvement in the glycemic parameters and lipid profile parameters with the adoption of CGM. Overall, CGM is a novel method for practical use for management of patients with T2DM.

Indicators of biochemical control of diabetes mellitus during limited availability of health service in the context of hypoglycemic therapy.

OBJECTIVE: Aim: Type 2 diabetes mellitus (T2DM) is a widespread disease that leads to many complications if not adequately controlled. The pandemic and its limitations on healthcare access impaired the management of chronic conditions. The aim of our study was to examine its effects in context of different antidiabetic therapies on key health related factors in patients with T2DM. PATIENTS AND METHODS: Materials and Methods: To the study we enrolled 598 adult patients with diagnosed T2DM treated in diabetology outpatient department of the University Clinical Centre (UCC) of the Medical University of Warsaw. Data on body weight, glycated hemoglobin (HbA1c), and creatinine concentration were collected throughout the first COVID-19 pandemic wave and compared to the results obtained before the 4th of March, 2020 (1st confirmed COVID-19 case in Poland). RESULTS: Results: The HbA1c mean baseline level was 7.15% (±1.39) and increased significantly (7.34% (±1.37), p=0.02) during observation. Importantly, the attendance of patients for HbA1c testing decreased by 57.82% in comparison to the pre-pandemic period. Similarly, creatinine concentrations increased (from 1.27 mg/dl (±0.76) to 1.34 mg/dl (±1.02), (p=0.004)). The increase in creatinine concentration was significantly lower in the group treated with regimens including metformin compared to other regimens. Somewhat surprisingly, the mean body mass remained unchanged. CONCLUSION: Conclusions: The pandemic period had a significant impact on the tested biochemical parameters. The lesser changes of renal parameters in the group of patients treated with metformin confirms its nephroprotective effect and its value as a first-line treatment in T2DM.

Folic Acid as a Potential Vitamin in Glycemic Control: A Systematic Review.

PURPOSE: This systematic review aims to examine the relationship between serum folate level and folic acid supplements with glycemic control parameters (fasting blood glucose (FBG), insulin level, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and Hemoglobin A1C (HbA1c)) in adult individuals with current studies. METHODS: In this study, which was designed as a systematic review, the searches were performed on Web of Science, Science Direct, Medline, Wiley, and Cochrane Library databases between April 10, 2023, and May 10, 2023, and the searches were updated between October 16, 2023, and November 14, 2023. Of the 1855 studies obtained from the screening, 17 met the criteria and were included in the systematic review. The PROSPERO system registered the study protocol (ID: CRD42023472434). RECENT FINDINGS: Although no significant correlation was found between serum folate levels and glycemic control parameters in most of the cross-sectional studies included in this systematic review, most of the randomized controlled trials showed that glycemic control parameters (FBG, insulin, HOMA-IR) decreased significantly in the intervention group receiving folic acid supplementation compared to the control group. However, study durations were short, and HbA1c needed to be evaluated in most studies. This makes it difficult to get information about the long-term effects of folic acid supplementation. More comprehensive studies should be conducted to draw more precise conclusions about the relationship between folic acid levels and folic acid supplementation with glycemic control parameters.

Evaluation of Mean Plasma Glucose Levels Using HbA1C in Patients With Severe Eating Disorders.

OBJECTIVE: Hypoglycemia causes significant morbidity and mortality in patients with severe eating disorders. We measured average glycemic levels using hemoglobin A1C (HbA1C) in patients hospitalized for extreme anorexia nervosa (AN) and avoidant restrictive food intake disorder (ARFID). METHODS: This was a prospective, single-center cohort study conducted in an inpatient medical stabilization unit. Clinical outcomes were compared using paired t-tests. Additional analysis comparing clinical variables between undetectable and detectable HbA1c used two-sample t-tests. RESULTS: The study cohort consisted of 148 individuals, 90% female, average age of 31 years, average admit body mass index of 12.5 kg/m2, and mean percentage ideal body weight of 60.1%. Diagnoses included AN-restricting (54%), AN-binge purge (39%), and ARFID (7%). HbA1C and fructosamine levels decreased from admission to discharge. Serum glucose levels increased significantly from admission to discharge. Mean HbA1C was 4.7% on admission and 4.3% on discharge. DISCUSSION: This study evaluated mean blood glucose levels using HbA1C in patients with extreme forms of AN and ARFID. Given the concern for morbidity and mortality from hypoglycemia in this population, which can be overlooked on a single point-of-care glucose measurement, HbA1C is a valuable laboratory measure of glycemic status in patients with extreme forms of eating disorders.

Correlation Between the First Trimester Two-Hour Postprandial Blood Glucose Greater Than 110 mg/dL for the Prediction of Gestational Diabetes Mellitus.

AIM: To determine the correlation between first-trimester two-hour postprandial blood glucose (PPBG) > 110 mg/dL for predicting gestational diabetes mellitus (GDM). METHODS: This prospective cohort study enrolled 200 women between 8 and 10 weeks of gestation from February 2022 to February 2024. All recruited pregnant women underwent testing for two-hour PPBS at 8-10 weeks and were followed up till delivery. GDM screening was done during 14-16, 24-28, and 32-34 weeks of gestation. RESULTS: Amongst women having PPBS > 110 mg/dL, 95.9% developed GDM, while in the group with PPBS < 110 mg/dL, only 4% developed GDM. In the PPBS > 110 mg/dL group, a significantly higher number of women were in the older age group (p < 0.049), had a higher BMI (p < 0.001), a family history of diabetes (p < 0.001), and previous history of abortion (p < 0.001). Women with PPBS > 110 mg/dL had significantly higher rates of cesarean section (p < 0.01), preterm delivery (p < 0.001), and macrosomia (p < 0.001). A positive correlation (r = 0.677; p < 0.001) was observed between first trimester two-hour PPBS and cord blood glucose levels. Similarly, a positive correlation (r = 0.465; p < 0.001) was present between insulin levels measured during the first trimester with cord blood insulin. The area under the curve (AUC) for PPBS was 0.969 (p < 0.001) with 95% CI: 0.933-0.988. PPBS > 110 mg/dL has a sensitivity of 95.9%, specificity of 95.6%, positive predictive value (PPV) of 95.9%, negative predictive value (NPV) of 95.7%, and diagnostic accuracy of 95.77% to predict GDM. CONCLUSION: PPBS > 110 mg/dL at two hours exhibits high levels of diagnostic accuracy for the prediction of GDM and is associated with adverse fetomaternal outcomes. PPBG is a superior, physiologic, and low-cost option compared to HbA1c for early prediction of GDM and can also be performed as a simple point-of-care test with a glucometer at home or in the periphery by healthcare workers (HCW) and in wellness centers.

Efficacy of Save Medical Corporation (SMC)-01, a Smartphone App Designed to Support Type 2 Diabetes Self-Management Based on Established Guidelines: Randomized Controlled Trial.

BACKGROUND: Lifestyle modifications are a key part of type 2 diabetes mellitus treatment. Many patients find long-term self-management difficult, and mobile apps could be a solution. In 2010, in the United States, a mobile app was approved as an official medical device. Similar apps have entered the Japanese market but are yet to be classified as medical devices. OBJECTIVE: The objective of this study was to determine the efficacy of Save Medical Corporation (SMC)-01, a mobile app for the support of lifestyle modifications among Japanese patients with type 2 diabetes mellitus. METHODS: This was a 24-week multi-institutional, prospective randomized controlled trial. The intervention group received SMC-01, an app with functions allowing patients to record data and receive personalized feedback to encourage a healthier lifestyle. The control group used paper journals for diabetes self-management. The primary outcome was the between-group difference in change in hemoglobin A1c from baseline to week 12. RESULTS: The change in hemoglobin A1c from baseline to week 12 was -0.05% (95% CI -0.14% to 0.04%) in the intervention group and 0.06% (95% CI -0.04% to 0.15%) in the control group. The between-group difference in change was -0.11% (95% CI -0.24% to 0.03%; P=.11). CONCLUSIONS: There was no statistically significant change in glycemic control. The lack of change could be due to SMC-01 insufficiently inducing behavior change, absence of screening for patients who have high intention to change their lifestyle, low effective usage of SMC-01 due to design issues, or problems with the SMC-01 intervention. Future efforts should focus on these issues in the early phase of developing interventions. TRIAL REGISTRATION: Japan Registry of Clinical Trials jRCT2032200033; https://jrct.niph.go.jp/latest-detail/jRCT2032200033.

The Impact of Low-Volume High-Intensity Interval Training (LV-HIIT) on Fatty Liver Index (FLI) and Estimated Glomerular Filtration Rate (eGFR) in Patients with Type 2 Diabetes Mellitus (T2DM).

BACKGROUND: Prevention and reduction of liver fat accumulation and maintenance of Glomerular Filtration Rate (GFR) have been proposed as important therapeutic goals in patients with Type 2 Diabetes Mellitus (T2DM). AIM: This study aimed to determine the effect of Low-Volume High-Intensity Interval Training (LV-HIIT) on fatty liver index (FLI) and GFR estimation in patients with T2DM. METHODS: This randomized controlled trial included 80 patients with T2DM and a sedentary lifestyle, randomly divided into HIIT (n=40) and a control group (n=40). Patients with a history of T2DM for at least one year and HbA1C levels between 6.4% and 10% were selected. The intervention group underwent a 4-week LV-HIIT course, comprising 3 sessions per week, while the control group did not receive any intervention. FLI, eGFR, anthropometric measurements, and laboratory variables were assessed in all participants before and after the intervention. RESULTS: FLI (62.0 at baseline, 53.0 at follow-up) significantly decreased in the LV-HIIT group after the intervention, while eGFR (71.0 at baseline, 73.6 at follow-up) significantly increased (P<0.001). However, the control group showed a significant reduction only in Fasting Blood Sugar (FBS) (P<0.05). After the intervention, the LV-HIIT group had significantly lower FBS (129.0 at baseline, 121.0 at follow-up), Alanine Aminotransferase (ALT) (24.0 at baseline, 18.0 at follow-up), and Gamma-Glutamyl Transferase (GGT) (22.0 at baseline, 19.0 at follow-up), as well as higher eGFR, compared to the control group (P<0.05). CONCLUSIONS: LV-HIIT exercise appears to be a promising and effective training method for improving FLI and eGFR in patients diagnosed with T2DM.

The Relation of Preoperative HbA1c Level With Intraoperative and Postoperative Complications in Type-2 Diabetic Patients: An Observational Study.

Background Perioperative dysglycemia increases morbidity and mortality, particularly among those with diabetes mellitus (DM), and elevated HbA1c levels, reflecting long-term blood glucose, are linked to poor healing and higher infection rates. This study investigates the link between preoperative HbA1c levels and perioperative outcomes in type-2 DM patients. Methodology This prospective observational study was conducted in India between January 2021 and April 2022. Sixty patients aged 18-60 with type-2 DM who underwent elective surgery under general anesthesia (GA) were included; the American Society of Anesthesiologists class >III and patients with severe organ failures were excluded. Participants were divided into two groups: A (HbA1c ≤7.5%) and B (HbA1c >7.5%). Data on preoperative vitals, intraoperative hemodynamics, and postoperative complications were collected. SPSS v23 was used for data analysis; p-value <0.05 was considered significant. Results The mean age of the participants was 48.22 years; males comprised 58.3%. Group A had a higher proportion of oral hypoglycemic agents. Group B showed higher maximum mean blood pressure and intraoperative blood sugar levels at one hour. Postoperatively, Group B had higher glucose levels, more prevalent hyperglycemia, and higher preoperative and postoperative blood urea levels. No significant differences were found in postoperative outcomes like acute kidney injury (AKI), leukocytopenia, leucocytosis, fever, and intensive care admission. Surgical site infection (SSI) incidence was higher in group B, though not statistically significant. Group B had more extended hospital stays. Conclusion Preoperative HbA1c above 7.5% was associated with impaired perioperative glycemic control and higher dysglycemic episodes. Higher preoperative HbA1c was found to be linked to increased postoperative hyperglycemia, AKI, intensive care admissions, and more extended hospital stays, though not statistically significant. SSI incidence was higher, highlighting its importance over preoperative HbA1c.

Real-World Clinical Effectiveness of Glucagon-Like Peptide-1 Receptor Agonist on Mild-to-Moderate Diabetic Kidney Disease in Patients with Type 2 Diabetes: A Retrospective, Single-Arm Clinical Trial.

Background: Cardiovascular outcome trials indicate renal benefits of glucagon-like peptide-1 receptor agonists (GLP-1RAs); however, real-world efficacy and safety studies in Diabetic kidney disease (DKD) are scarce. Methods: This retrospective, single-arm real-world trial involved adults with DKD treated with GLP-1RA for at least 6 months. The primary endpoint was hemoglobin A1c (HbA1c) levels after 6 months. Results: This study included a total of 364 patients with DKD, 153 (42.0%) of whom were female. The median disease duration was 8.0 years, and the mean values of age, HbA1c level, body mass index, and the urinary albumin-to-creatinine ratio (UACR) were 52.1 years, 8.6%, 27.8 kg/m2, and 88.0 mg/g, respectively. Additionally, 73.6% and 26.4% of patients had mild and moderate DKD, respectively. Following 6 months of GLP-1RA treatment, the mean HbA1c level and UACR declined by 1.77% and 40.3%, respectively (both p < 0.001). Compared to their baseline values, patients exhibited significant improvements in 24-h urinary protein, estimated glomerular filtration rate (eGFR), fasting blood glucose, body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (all p < 0.001). Patients with a disease duration of <10 years had more pronounced changes in the HbA1c level, UACR, and eGFR (all p < 0.001) than those with a disease duration of ≥10 years. Changes in SBP and DBP were more pronounced in patients also taking angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEis/ARBs) than in those not taking ACEis/ARBs, whereas the changes in UACR and eGFR did not significantly differ. Conclusion: Six-month GLP-1RA treatment improves glucose, blood pressure, lipids, and body weight in patients with mild-to-moderate DKD while slowing down kidney disease progression. It independently reduces proteinuria beyond ACEi/ARB impact, with early use yielding faster outcomes, supporting evidence-based practice.

Diabetes Self-Efficacy on Glycemic Control and Well-Being of Patients With Type 2 Diabetes Mellitus: An Analytical Cross-Sectional Study.

INTRODUCTION: Diabetes mellitus is a major, chronic, and progressive lifestyle disease. It adversely affects patients' quality of life, effectiveness, and well-being. Self-care practices are universally recognized as imperative to keep the illness under control and prevent complications. Self-efficacy is one of the factors involved in the successful self-care of diabetic patients. The primary objective of the study was to estimate the proportion of diabetes self-efficacy and to assess the correlation of diabetes self-efficacy with glycemic control, and the well-being of patients with type 2 diabetes mellitus (T2DM). The secondary objective was to assess the factors associated with diabetes self-efficacy. METHODS: An analytical cross-sectional study was conducted among T2DM patients attending the non-communicable disease clinic in the outreach centers of Government Medical College, Thiruvananthapuram, Kerala, India. Four hundred patients with T2DM were included in the study. Diabetes self-efficacy was assessed by the Stanford Diabetes Self-Efficacy Scale and the WHO-5 index scale was used to assess wellbeing. Glycemic control was determined by HbA1C estimation, with ≤7% as good control. RESULTS: Among 400 patients with T2DM, 51.25 % (95% CI: 46.2-56.2) had high diabetes self-efficacy. A significantly negative correlation was found between HbA1C and self-efficacy (r =- 0.208, p = 0.01), and a positive correlation was shown between well-being and self-efficacy (r = 0.418, p = 0.01). Logistic regression analysis found that factors associated with diabetes self-efficacy were upper socioeconomic status (OR = 8.53, 95% CI: 3.06-13.82), family support (OR = 1.97, 95% CI: 1.10-3.54), participation in diabetes education classes (OR = 1.95, 95% CI: 1.10-3.54), diet compliance (OR = 4.74, 95% CI: 2.80-8.01), glycemic control (OR = 1.69, 95% CI: 1.01-2.84), and overall wellbeing (OR = 6.7, 95% CI: 3.84-11.64). CONCLUSION: The proportion of high diabetes self-efficacy was 51.25% (95% CI: 46.2-56.2). The factors associated with diabetes self-efficacy were family support, participation in diabetes education classes, high socioeconomic status, absence of complications, good glycemic control, and well-being. The study findings depicted that high self-efficacy was significantly correlated with good glycemic control and well-being of patients with T2DM.

Serum ferritin level and associated factors among uncontrolled adult type II diabetic follow-up patients: comparative based cross-sectional study.

BACKGROUND: Uncontrolled type 2 diabetes mellitus (UT2DM) and its associated consequences nowadays have been a global health crisis, especially for adults. Iron has the property to oxidize and reduce reversibly, which is necessary for metabolic processes and excess accumulation of iron indicated by serum ferritin levels could have a significant impact on the pathophysiology of T2DM via generation of reactive oxygen species (ROS). However, no conclusive evidence existed about the association of serum ferritin with the state of glycemic control status. Therefore, this study aimed to evaluate serum ferritin levels and associated factors in uncontrolled T2DM patients and compare them with those of controlled T2DM and non-diabetic control groups. METHODS: A hospital-based comparative cross-sectional study was conducted among conveniently selected 156 study participants, who were categorized into three equal groups of uncontrolled T2DM, controlled T2DM, and non-diabetic control groups from October 2 to December 29, 2023 at St. Paul's Hospital Millennium Medical College. A pre-tested structured questionnaire was used to collect socio-demographic and diabetes-related information. The laboratory tests were done using an automated chemistry analyzer and IBM-SPSS statistical software (version-27) was utilized for data entry and analysis with a significance level of p < 0.05. RESULT: The mean serum ferritin level was noticeably higher in uncontrolled T2DM patients as compared to controlled T2DM and control groups (p < 0.001). It was significantly correlated with HbA1c [r = 0.457, p < 0.001], fasting blood sugar (FBs) [r = 0.386, p < 0.001], serum iron [r = 0.430, p < 0.001], and systolic blood pressure (SBP) [r = 0.195, p = 0.047] in T2DM patients. A multivariate logistic regression model revealed that a rise in HbA1c (AOR = 3.67, 95% CI(1.50-8.98), serum iron (AOR = 1.02, 95% CI(1.01-1.04), male gender (AOR = 0.16, 95% CI(0.05-0.57) and being on oral hypoglycemic agent (OHA) monotherapy (AOR = 0.26, 95% CI(0.07-0.95) were key associated factors for the elevated serum ferritin among T2DM patients. CONCLUSION: The present study demonstrated that T2DM patients had elevated serum ferritin levels which might be related to the existence of long-term hyperglycaemia and that serum ferritin had a significant positive association with HbA1c and FBs, implying that it could be used as an additional biomarker to predict uncontrolled T2DM patients.

Sex-Specific Variations in Glycated Hemoglobin Responses to Structured Exercise in Type 2 Diabetes: Healthcare Implications of Walking and Strength Training on Glycemic Control.

Type 2 diabetes mellitus (T2DM) affects one in ten individuals in the United States, with rates expected to rise significantly. This novel study aimed to evaluate the impact of a structured exercise program on glycated hemoglobin (HbA1c) levels among males and females with T2DM, and to compare the effects of different volumes of combined aerobic and resistance exercise. A total of 67 adult participants with T2DM were randomly assigned to two groups: Group 1 (exercise classes and walking sessions) and Group 2 (exercise classes only). After 10 weeks, 39 participants completed the intervention and 34 had complete HbA1c records. Results indicated a significant improvement in HbA1c levels overall, with males exhibiting a greater decrease compared to females. Minimal baseline differences were observed between the walking and non-walking groups and improvements in HbA1c were noted in both groups with no significant differences. These findings suggested potential sex-specific differences in response to structured exercise programs. The study highlighted the importance of tailored exercise interventions in healthcare while managing T2DM. Further research is necessary to optimize exercise prescriptions and evaluate long-term benefits, but the current evidence supports structured exercise as a valuable component of comprehensive diabetes care. This research underscores the need for personalized approaches in exercise regimens, contributing to the growing body of knowledge on sex-specific responses to T2DM interventions.