Effect of probiotics on glycemic control and lipid profiles in patients with type 2 diabetes mellitus: a randomized, double blind, controlled trial.

Introduction: This double-blind, placebo-controlled, randomized (1:1) clinical trial was conducted at the West China Hospital, Sichuan University, from March to September 2017. Methods: Eligible participants included adults aged 18 years and older, living in the community, diagnosed with type 2 Diabetes Mellitus according to ADA guidelines, capable of self-managing their diabetes, and able to visit the study site for follow-up. The intervention group received 25 ml of a probiotic beverage containing with over 10^8 CFU/mL of Lactobacillus, administered four times daily. An equal volume of inactivated Lactobacillus was administered to the control group and the control group was administered the same volume of inactivated Lactobacillus. This study aimed to evaluate the effectiveness of probiotics on glycemic control and other diabetes-related outcomes in patients with type 2 diabetes patients. The primary outcomes were changes in HbA1c and FBG levels post-intervention. Investigators, participants, and study site personnel were blinded to the treatment allocation until the conclusion of the study. This double-blind, randomized, placebo-controlled clinical trial was registered in the Chinese Clinical Trial Registry (ChiCTR-POR-17010850). Results: Of the 490 participants screened, 213 were randomized to either the probiotics group (n = 103) or the placebo group (n = 110). After 16 weeks of follow-up, the probiotic group showed reductions in HbA1c [-0.44 (-0.66 to -0.22)] and FBG [-0.97 (-1.49 to 0.46)] post-intervention, similar to the placebo group with reductions in HbA1c [-0.33 (-0.52 to -0.15)] and FBG [-0.90 (-1.32 to -0.47)], but these changes were not statistically significant in PP and ITT analyses (P>0.05). Adverse events were similarly distributed among groups, indicating comparable safety profiles. Discussion: Overall, 16-week probiotic supplementation showed no beneficial effects on glycemic control, lipid profiles, or weight. Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=18421, identifier ChiCTR-POR-17010850.

A comparative study between current and past Helicobacter pylori infection in terms of microalbuminuria in patients with type 2 diabetes.

BACKGROUND: The prevalence of Helicobacter pylori (H. pylori) infection and its potential relationship to various diseases is currently a focus of attention. The aim of this study is to investigate the association between current and past H. pylori infections and elevated levels of microalbuminuria in type 2 diabetic patients. METHODS: Two hundred patients with type 2 diabetes mellitus were tested for the presence of H. pylori infection. They were divided into three groups: 52 had a current H. pylori infection, 38 had a past H. pylori infection, and 110 had no H. pylori infection. All study participants underwent assessments of plasma glucose levels, glycated hemoglobin (HbA1c), albuminuria levels, inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), as well as other relevant investigations. RESULTS: The prevalence of H. pylori infection (current and past) was detected in 90 out of 200 diabetic patients (45%). There was no statistically significant difference between the three groups in terms of age, diabetes duration, family history of DM, family history of hypertension, residence, or dyspeptic symptoms, indicating that current or past infection with H. pylori has no association with these variables. The current H. pylori infection group showed the highest levels of inflammatory markers, ESR and CRP, which were significantly different from those in the non-infected group (p = 0.013 and p < 0.001, respectively). The median (IQR) of albuminuria levels in the current H. pylori infection group, the past H. pylori infection group, and the non-infected group were 125 (4.8-290), 7.6 (2.4-271), and 5.1 (1.2-173), respectively. The current H. pylori infection group showed the highest albuminuria level, which was significantly different from that of the non-infected group (p = 0.001). CONCLUSION: There might be an association between microalbuminuria levels, general inflammatory markers (ESR and CRP), and current H. pylori infection in type 2 diabetic patients.

Patients with diabetes struggling to afford food and control their HbA1c in food-insecure areas in Bronx, NY.

OBJECTIVE: To characterise the association between risk of poor glycaemic control and self-reported and area-level food insecurity among adult patients with type 2 diabetes. DESIGN: We performed a retrospective, observational analysis of cross-sectional data routinely collected within a health system. Logistic regressions estimated the association between glycaemic control and the dual effect of self-reported and area-level measures of food insecurity. SETTING: The health system included a network of ambulatory primary and speciality care sites and hospitals in Bronx County, NY. PARTICIPANTS: Patients diagnosed with type 2 diabetes who completed a health-related social need (HRSN) assessment between April 2018 and December 2019. RESULTS: 5500 patients with type 2 diabetes were assessed for HRSN with 7·1 % reporting an unmet food need. Patients with self-reported food needs demonstrated higher odds of having poor glycaemic control compared with those without food needs (adjusted OR (aOR): 1·59, 95 % CI: 1·26, 2·00). However, there was no conclusive evidence that area-level food insecurity alone was a significant predictor of glycaemic control (aOR: 1·15, 95 % CI: 0·96, 1·39). Patients with self-reported food needs residing in food-secure (aOR: 1·83, 95 % CI: 1·22, 2·74) and food-insecure (aOR: 1·72, 95 % CI: 1·25, 2·37) areas showed higher odds of poor glycaemic control than those without self-reported food needs residing in food-secure areas. CONCLUSIONS: These findings highlight the importance of utilising patient- and area-level social needs data to identify individuals for targeted interventions with increased risk of adverse health outcomes.

Relationship between dietary sialic acid intake and serum HbA1c: a population-based study in Xiamen, China.

This study investigates the correlation between dietary sialic acid intake which mainly come from eggs, red meat, and dairy products and serum HbA1c levels. A survey among Xiamen's general population, China, collected dietary data from 2,908 participants over the past year. A semi-quantitative food frequency questionnaire (FFQ) was employed. Sialic acid intake was calculated, along with measurements of biochemical indicators, including fasting blood glucose, HbA1c, blood lipids, and insulin. Sociodemographic and physical data were also collected. Logistic regression models evaluated the relationship between dietary sialic acid and HbA1c levels. The daily sialic acid intake in Xiamen's general population was 48.55 (21.68, 65.23) mg/1000Kcal, accompanied by a 1.96% rate of high HbA1c. A significant negative correlation between dietary sialic acid and HbA1c was observed. Individuals in the highest quartile of sialic acid intake (> 65.48 mg/1000 kcal) had a lower risk of high HbA1c compared to those in the lowest quartile (< 23.63 mg/1000 kcal) [OR: 0.123 (0.022, 0.689)]. A high dietary sialic acid intake within a specific range may reduce the risk of elevated HbA1c levels, suggesting a potential preventive effect. Note that this effect is limited to specific intake ranges.

Exploring the association of social connections and food security among adults with uncontrolled type 2 diabetes: a population-based study.

BACKGROUND: Primary health care professionals are held accountable for various quality measures in the treatment of patients with chronic diseases such as diabetes. Uncontrolled type 2 diabetes (T2D) remains a considerable health problem; thus, further studying patients with this condition is important for delivering effective interventions. Social determinants of health (SDoH) have been shown to affect various aspects of diabetes care in different subpopulations. We studied the association of SDoH with uncontrolled T2D in a population of adult primary care patients. METHODS: We retrospectively searched our electronic health record for adult patients (≥18 years) with a diagnosis of T2D and a hemoglobin A1c (HbA1c) level of 8% or higher. Patients were empaneled to 2 primary care clinic sites between January 1, 2021, and January 31, 2022. Patients were grouped by HbA1c level to stratify patients according to the extent of uncontrolled T2D. Patient characteristics were compared among groups. Unadjusted and adjusted multinomial logistic regression analysis was used to estimate the odds of various SDoH factors among patient groups with different levels of uncontrolled T2D. RESULTS: The study cohort included 1,596 patients. Most patients were White (79%), and the median age was 58.8 years. The median HbA1c level was 8.9%, and approximately 68% of patients were obese (body mass index [BMI] ≥30). When the study population was grouped by HbA1c level (8% to < 9% [n = 806], ≥9% to < 12% [n = 684], and ≥12% [n = 106]), significant differences among groups were observed in age group (P < .001), marital status (P < .001), race (P < .001), ethnicity (P = .001), and BMI category (P = .01). In groups with higher HbA1c levels, we noticed a higher percentage of patients who were aged 51 to 65 years or single. Among patients with uncontrolled HbA1c levels, more patients were obese than overweight. Patients in the intermediate HbA1c group had increased odds of food insecurity and some decreased social connections, even after adjusting for age, sex, race, ethnicity, and marital status. CONCLUSIONS: Among patients with uncontrolled T2D, higher HbA1c levels were associated with decreased social connections and increased food insecurity. Our findings provide insight into the role of these SDoH in managing T2D and have important implications for primary care practice.

Comparing Glucagon-like peptide-1 receptor agonists versus metformin in drug-naive patients: A nationwide cohort study.

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are increasingly being prescribed in drug-naive patients. We aimed to contrast add-on therapy, adherence, and changes in biomarkers, 1 year after treatment initiation with GLP-1 RA or metformin. METHODS: Using Danish nationwide registers, we included incident GLP-1 RA or metformin users from 2018 to 2021 with glycated hemoglobin (HbA1c) ≥ 42 mmol/mol. GLP-1 RA initiators were matched to metformin initiators in a ratio of 1:1 to assess outcomes in prediabetes and diabetes. Main outcomes analyzed were 1-year risk of add-on glucose-lowering medication and 1-year risk of nonadherence. One-year risks were estimated with multiple logistic regression and standardized. Multiple linear regression was used to estimate the average differences in biomarker changes. RESULTS: In total, 1778 individuals initiating GLP-1 RA and metformin were included. After standardizing for various factors, GLP-1 RA compared with metformin was associated with reduced 1-year risk of add-on glucose-lowering treatment in patients with prediabetes (1-year risk ratio [RR]: 0.27, 95% confidence interval [CI]: 0.10-0.44) and diabetes (RR: 0.67, 95% CI: 0.37-0.98). GLP-1 RA was associated with higher 1-year risk of nonadherence among patients with prediabetes (RR: 1.60, 95% CI: 1.45-1.75), but no difference in patients with diabetes (RR: 0.88, 95% CI: 0.70-1.06). Compared to metformin, GLP-1 RA was associated with greater HbA1c reduction (prediabetes: -2.59 mmol/mol 95% CI: -3.10 to -2.09, diabetes: -3.79 mmol/mol, 95% CI: -5.28 to -2.30). CONCLUSIONS: GLP-1 RA was associated with a reduced risk of additional glucose-lowering medication, achieving better glycated hemoglobin control overall. However, among patients with prediabetes, metformin was associated with better adherence.

Prevalence of and factors associated with pre-diabetes among adolescents in Eastern Sudan: a community-based cross-sectional study.

OBJECTIVES: There is an increasing trend of pre-diabetes and diabetes mellitus (DM) among adolescents, and sub-Saharan Africa is no exception. However, few published data on pre-diabetes among adolescents in Sudan exist. We aimed to investigate the prevalence of and factors associated with pre-diabetes among adolescents in Eastern Sudan. DESIGN: A community-based cross-sectional study was conducted from August to October 2023. SETTINGS: This community-based study was conducted in Gadarif city, the capital of Gadarif state, Eastern Sudan. PARTICIPANTS: Adolescents (within the ages of 10-19 years). MAIN OUTCOME MEASURES: A questionnaire was used to collect socio-demographic information. Anthropometric and glycated haemoglobin (HbA1c) measurements were performed in accordance with standard procedures. Multivariate logistic regression analysis was performed. RESULTS: Of the 387 enrolled adolescents, 207 (53.5%) were female and 180 (46.5%) were male. The median (IQR) age was 14.0 (12.0-16.0) years. 39.5% of the participants' fathers were employed. The median (IQR) HbA1c was 5.5% (5.2%-5.8%). One-third (32.6%) of the adolescents had pre-diabetes or DM. Of the participants, 67.4%, 30.0% and 2.6% had no DM, pre-diabetes or type 2 DM, respectively. In the univariate analysis, the father's employment (OR=1.60, 95% CI=1.03 to 2.50) was associated with increased odds of pre-diabetes; age, sex, parents' education, the mother's occupation, body mass index z-score, cigarette smoking and a family history of DM were not associated with pre-diabetes. In the multivariate analysis, the father's employment (adjusted OR=1.70, 95% CI=1.03 to 2.50) was associated with increased odds of pre-diabetes. CONCLUSION: Pre-diabetes is a significant public health problem among adolescents in Eastern Sudan. The introduction of early screening programmes for pre-diabetes at the community level is recommended to halt the progression of pre-diabetes to DM and to deal with existing DM among adolescents.

Characteristics and risk factors associated with developing prediabetes in Saudi Arabia.

OBJECTIVE: Prediabetes is prevalent in Saudi Arabia and globally. It is associated with adverse health outcomes and complications. Consequently, this study aimed to determine the risk factors associated with developing prediabetes in Saudi Arabia. METHODS: This is a case-control study conducted at the Family and Community Medicine Department at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. The cases included individuals with prediabetes (prediabetes group), and the control group included individuals with normal HbA1c levels who were not diagnosed with prediabetes or diabetes. The data collected included sociodemographic data, clinical parameters, laboratory tests, and medical conditions. RESULTS: The study included 46,201 patients (16,029 patients with prediabetes and 30,173 in the control group). The age of the patients (mean ± SD) with prediabetes was significantly higher than that of the control group (47.22 ± 14.04 versus 36.12 ± 11.83, p < 0.0001). A higher proportion of men was noted in the prediabetes group compared to the control group (36.32% versus 26.54%, p < 0.0001). The body mass index (mean ± SD) was higher in the prediabetes group compared to the control group (33.76 ± 6.75 versus 30.16 ± 7.26, p < 0.0001). The multiple logistic regression analysis showed six independent risk factors associated with prediabetes. These included age (aOR [95% CI] = 1.067 [1.065-1.069]) and gender, with women at a lower risk compared to men (aOR [95% CI] = 0.695 [0.664-0.728]). Other independent risk factors included polycystic ovarian syndrome (aOR [95% CI] = 58.102 (35.731-94.479]), obesity (aOR [95% CI] = 1.265 [1.075-1.487]), cardiac conditions (aOR [95% CI] = 4.870 [1.024-23.154]), and hypertension (aOR [95% CI] = 1.133 [1.031-1.245]). CONCLUSIONS: The study showed that several risk factors are associated with the development of prediabetes in the Saudi population. Addressing these factors can help prevent prediabetes, and consequently, its burden and further progression to diabetes.

Scoring and validation of a simple model for predicting diabetic retinopathy in patients with type 2 diabetes based on a meta-analysis approach of 21 cohorts.

AIM: To develop and validate a model for predicting diabetic retinopathy (DR) in patients with type 2 diabetes. METHODS: All risk factors with statistical significance in the DR prediction model were scored by their weights. Model performance was evaluated by the area under the receiver operating characteristic (ROC) curve, Kaplan-Meier curve, calibration curve and decision curve analysis. The prediction model was externally validated using a validation cohort from a Chinese hospital. RESULTS: In this meta-analysis, 21 cohorts involving 184,737 patients with type 2 diabetes were examined. Sex, smoking, diabetes mellitus (DM) duration, albuminuria, glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and TG were identified to be statistically significant. Thus, they were all included in the model and scored according to their weights (maximum score: 35.0). The model was validated using an external cohort with median follow-up time of 32 months. At a critical value of 16.0, the AUC value, sensitivity and specificity of the validation cohort are 0.772 ((95% confidence interval (95%CI): 0.740-0.803), p < .01), 0.715 and 0.775, respectively. The calibration curve lied close to the ideal diagonal line. Furthermore, the decision curve analysis demonstrated that the model had notably higher net benefits. The external validation results proved the reliability of the risk prediction model. CONCLUSIONS: The simple DR prediction model developed has good overall calibration and discrimination performance. It can be used as a simple tool to detect patients at high risk of DR.

Continuous glucose monitoring (Dexcom g6) in people with diabetes after kidney transplantation.

OBJECTIVES: Use of continuous glucose monitoring-CGM in patients on kidney replacement therapy including kidney transplant recipients, may improve glycemic control and detection of hypoglycemia. However, studies in this population in particular in kidney transplant recipients are very limited. METHODS: The study aimed to evaluate glycemic profiles using the Dexcom G6 CGM system for 30 d a personal smartphone in people with diabetes after kidney transplantation and to assess the impact of monthly use of the CGM system on glycemic control and quality of life in this group. RESULTS: Over 8 months, 9 people after kidney transplantation were included in the study (7 women, median age 57 years), 8 people with new-onset diabetes after transplantation (NODAT), and 1 person with diabetes mellitus type 1. The time since kidney transplantation in each of the study participants was less than 2 years. In 7 people with NODAT, the time in range was above 70%. In all study participants, hyperglycemia was observed mainly in the afternoon (2-6 pm). In some patients, pressure-induced sensor attenuations (PISAs) were noted. There was no effect of the use of Dexcom G6 on the HbA1c value. There was no impact of the use of the Dexcom G6 system on the perception of overall quality of life, but monthly use had a positive impact on the perception of the quality of health. CONCLUSIONS: CGM systems seem to be a promising method for assessing glycemic control in people with diabetes after kidney transplantation. More extensive research is needed to assess safety and usefulness in everyday practice.

Improving Hypertension and Diabetes Mellitus Control with a Dedicated Patient Navigator.

OBJECTIVES: Hypertension and diabetes mellitus (DM) are the leading causes of cardiovascular, cerebrovascular, and chronic kidney diseases. They affect an estimated 47% and 11% of Americans, respectively. In this study, we assessed whether a dedicated patient navigator embedded within a patient-centered medical home (PCMH) using a structured panel management and patient outreach strategy could improve blood pressure and glycemic control in primary care patients with uncontrolled hypertension and DM. METHODS: We performed a prospective study comparing blood pressure and glycemic control in primary care patients before and after implementation of a patient navigator executing a hypertension and DM-focused panel management plan. RESULTS: From January 2014 to October 2019, inclusion criteria were met 5164 times, which comprised 1958 unique patients within a PCMH. Multivariate regression analysis reveals a significant decrease in uncontrolled systolic blood pressure (SBP) over time, with an actual decrease of roughly 40% of uncontrolled episodes of SBP becoming controlled by 12 months. Multivariate regression analysis reveals a significant decrease in uncontrolled hemoglobin A1c (HbA1c) over time for each plot (P < 0.0001), with an actual decrease of roughly 30% of uncontrolled episodes of HbA1c becoming controlled by 12 months. CONCLUSIONS: This study demonstrated the benefit of a dedicated patient navigator embedded within a PCMH on improving BP and glycemic control in primary care patients with uncontrolled hypertension and DM. Glycemic control was achieved, with 30% of episodes reaching an HbA1c of <8% and BP control achieved for 40% of episodes with SBP <140 mm Hg at 12 months. There were no differences by the social determinants of race and poverty.

Pharmacometabolomics of sulfonylureas in patients with type 2 diabetes: a cross-sectional study.

Background: Sulfonylureas have been a longstanding pharmacotherapy in the management of type 2 diabetes, with potential benefits beyond glycemic control. Although sulfonylureas are effective, interindividual variability exists in drug response. Pharmacometabolomics is a potent method for elucidating variations in individual drug response. Identifying unique metabolites associated with treatment response can improve our ability to predict outcomes and optimize treatment strategies for individual patients. Our objective is to identify metabolic signatures associated with good and poor response to sulfonylureas, which could enhance our capability to anticipate treatment outcome. Methods: In this cross-sectional study, clinical and metabolomics data for 137 patients with type 2 diabetes who are taking sulfonylurea as a monotherapy or a combination therapy were obtained from Qatar Biobank. Patients were empirically categorized according to their glycosylated hemoglobin levels into poor and good responders to sulfonylureas. To examine variations in metabolic signatures between the two distinct groups, we have employed orthogonal partial least squares discriminant analysis and linear models while correcting for demographic confounders and metformin usage. Results: Good responders showed increased levels of acylcholines, gamma glutamyl amino acids, sphingomyelins, methionine, and a novel metabolite 6-bromotryptophan. Conversely, poor responders showed increased levels of metabolites of glucose metabolism and branched chain amino acid metabolites. Conclusion: The results of this study have the potential to empower our knowledge of variability in patient response to sulfonylureas, and carry significant implications for advancing precision medicine in type 2 diabetes management.

Influence of preoperative HbA1c levels on the occurrence of postoperative complications in patients undergoing coronary artery bypass grafting.

OBJECTIVE: To explore the impact of preoperative HbA1c levels on postoperative complications in coronary heart disease patients undergoing coronary artery bypass grafting (CABG). METHODS: From September 2020 to November 2022, 98 patients with coronary heart disease who were preparing to receive CABG treatment in a cardiac surgery department of a certain hospital were included in the study using the retrospective analysis. According to the preoperative serum hemoglobin A1C (HbA1c) test results, patients were divided into a low-level group (HbA1c < 5.7%, 20 cases), a medium level group (HbA1c: 5.7% ~ 7.0%, 59 cases), and a high level group (> 7%, 19 cases). The surgical outcomes and postoperative complications among the three groups were compared. RESULTS: There was no statistically significant difference in the number of bypass grafts, mechanical ventilation time, and hospitalization time among the three groups of patients (P > 0.05). The high-level group stayed in the ICU longer than the other two groups, while the middle level group had a longer stay than the low-level group (P < 0.05). Within one year of postoperative follow-up, the occurrence of postoperative complications was 20.00%, 32.20%, and 47.37%, respectively, with no statistically significant difference (P > 0.05). Among them, the incidence of acute kidney injury in the high-level group was higher than that in the other groups (P < 0.05), but the correlation difference between the middle and low level groups is P > 0.05. The incidence of infection in the middle level group was higher than that in the low level group (P < 0.05), but the incidence of infection in the high and low level groups was P > 0.05 compared to the medium level group. CONCLUSION: For patients with coronary heart disease undergoing CABG, the higher the preoperative HbA1c level, the longer their postoperative stay in the ICU, and the higher the risk of acute renal function damage.

Predictors of medication regimen complexity and its impact on hemoglobin a1c in type 2 diabetes patients: a retrospective analysis in ambulatory care in Makkah City.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a widespread chronic disease that poses a significant management challenge due to the complexity of the associated medication regimens, which can have a considerable impact on patient outcomes. OBJECTIVES: Explore the complexity level of diabetes medications among patients with T2DM and to identify the predictors of medication regimen complexity (MRC) and its correlation with hemoglobin A1C (HbA1c) levels. DESIGN: Retrospective, cross-sectional study. SETTING: An ambulatory care setting of a tertiary hospital in Makkah City, Saudi Arabia. PATIENTS AND METHODS: Patients with T2DM referred to the diabetic clinic were identified and assessed for eligibility. The data were collected from patient electronic medical records between October 2022 and September 2023. The MRC Index was used to evaluate the complexity of the patients' medication regimens. MAIN OUTCOMES MEASURES: MRC index scores and HbA1c levels. SAMPLE SIZE: 353 records of patients with T2DM. RESULTS: The analysis revealed that 61.8% (n=218) of patients had high MRC, with the dosing frequency contributing significantly to their MRC (mean=3.9, SD=1.9). Having polypharmacy and longstanding T2DM were predictors of high MRC (odds ratios=4.9 and 2.6, respectively; P≤.01). Additionally, there was an inverse association between the patients' diabetes-specific MRC index scores and their glycemic control (odds ratios=0.2, P<.001). CONCLUSION: The study findings highlight the importance of considering MRC in managing T2DM. Simplifying medication regimens and optimizing medication management strategies can improve patient outcomes. Further research is needed to explore interventions to reduce MRC and enhance diabetes management in this population. LIMITATIONS: Retrospective study design measuring the MRC at a diabetes-specific level.

Health Literacy and Adherence to Therapy in Type 2 Diabetes: A Cross-Sectional Study in Portugal.

BACKGROUND: Therapy adherence is a key factor in the control of type 2 diabetes mellitus (T2DM). Optimal self-care requires skills in health literacy (HL). OBJECTIVE: This study aims to analyze the relationship between HL and adherence to therapy and to understand the possible influence of other sociodemographic and disease variables. METHODS: A multicenter, cross-sectional study was conducted in Portuguese in 13 different primary health care units in both rural and urban environments. A sociodemographic questionnaire and two validated instruments, "Medical Term Recognition Test" and "Summary of Diabetes Self-Care Activities," were applied. The last value of hemoglobin A1c (HbA1c) and the number of chronic medications were collected from clinical records. Descriptive statistics and bivariate correlations were performed as well as multivariable linear regression to assess the association between HL and adherence to therapy. KEY RESULTS: Participants (n = 354) were on average age 63.67 ± 10.39 years, 57.1% male and 42.9% female, 68.4% with inadequate HL and an average HbA1c of 7 ± 1.18%. Better HL was correlated with higher adherence to the total of self-care activities, nonpharmacological therapy, and foot care. In multivariable linear regression analyses, better HL (ß = 0.176, p = .003), less than minimum wage (ß = -0.197, p = .001) and insulin therapy (ß = 0.272, p = .001) were independently associated with increased adherence to overall self-care activities. CONCLUSION: In a representative sample of people with T2DM in Portugal, HL was a key factor for greater adherence to demanding self-care activities. [HLRP: Health Literacy Research and Practice. 2024;8(4):e194-e203.].

Plain Language Summary In this multicentric, cross-sectional study in Portuguese primary care, we found that better health literacy was correlated with higher adherence to the self-care activities related to type 2 diabetes, and specifically with nonpharmacological therapy and foot care. Health literacy was a key factor for greater adherence to demanding diabetes self-care activities.

Association between self-care activities and glycemic control among patients with type 2 diabetes mellitus in Northwest Ethiopia general hospitals : a multicenter cross-sectional study.

Diabetes self-care activities are essential for achieving optimal glycemic control. However, little investigation has been conducted in Ethiopia to evaluate the relationship between the rate glycemic controland self-care activities among patients with type 2 diabetes mellitus (T2DM). Therefore, this study was conducted to assess self -care activities and their association with glycemic control among patients with T2DM in Northwest Ethiopia general hospitals. This multicenter cross-sectional study was conducted in Northwest Ethiopia general hospitals diabetic clinics. Diabetes self-care activities were measured using the Amharic version of the Summary of Diabetes Self-Care Activities (SDSCA-Amharic). Glycated hemoglobin (HbA1c) were used to assess the rate of glycemic control. A linear regression model was used to identify predictors of self-care activities and glycemic control. P-value of < 0.05 at 95% confidence interval (CI)  was considerd as statistically significant. Of 413 participants included in the final analysis, two-thirds (66.3%) had poor glycemic control, with a mean HbA1c of 7.94% (SD = 1.75). Blood glucose testing was the most important self-care activity domain for predicting better glycemic control [ß=-0.36, 95% CI (-0.48, -0.24); P = 0.0001] followed by diet [ß=-0.29, 95% CI (-0.39, -0.083); P = 0.0001], foot-care [ß=-0.28, 95% CI (-0.3, -0.061); P = 0.003], and physical activity [ß=-0.27, 95% CI (-0.29, -0.056); P = 0.004], respectively. Moreover, unable to read and write [ß = 0.72, 95% CI (0.57, 3.8); P = 0.037], overweight [ß = 0.32, 95% CI (0.011, 0.62); P = 0.042], obesity [ß = 0.67, 95% CI (0.39, 0.94); P = 0.0001], and low level of medication adherence [ß = 0.7, 95% CI (0.39, 1.1); P = 0.0001] were significant predictors of poor glycemic control.       Previous diabetes education [ß=-0.88, 95% CI (-1.2, -0.57); P=0.0001] was a significant predictor of good glycemic control. The prevalence of poor glycemic control and poor self-care activities were high among patients with T2DM. Self-care activities were independent predictors of glycemic control among patients with T2DM. Therefore, management interventions for patients with T2DM should focus on improving self-care activities and other predictor variables.

HbA1c comparable to fasting glucose in the external validation of the African Diabetes Risk Score and other established risk prediction models in Black South Africans.

BACKGROUND: The use of non-invasive risk scores to detect undiagnosed type 2 diabetes (T2D) ensures the restriction of invasive and costly blood tests to those most likely to be diagnosed with the disease. This study assessed and compared the performance of the African Diabetes Risk Score (ADRS) with three other diabetes risk prediction models for identifying screen-detected diabetes based on fasting plasma glucose (FPG) or glycated haemoglobin (HBA1c). METHODS: Age, sex, waist circumference, body mass index, blood pressure, history of diabetes and physical activity levels from the SA-NW-PURE study were used to externally validate the ADRS and other established risk prediction models. Discrimination was assessed and compared using C-statistics and nonparametric methods. Calibration was assessed using calibration plots, before and after recalibration. RESULTS: Nine hundred and thirty-seven participants were included; 14% had prevalent undiagnosed T2D according to FPG and 26% according to HbA1c. Discrimination was acceptable and was mostly similar between models for both diagnostic measures. The C-statistics for diagnosis by FPG ranged from 0.69 for the Simplified FINDRISC model to 0.77 for the ADRS model and 0.77 for the Simplified FINDRISC model to 0.79 for the ADRS model for diagnosis by HbA1c. Calibration ranged from acceptable to good, though over- and underestimation were present. All models improved significantly following recalibration. CONCLUSIONS: The models performed comparably, with the ADRS offering a non-invasive way to identify up to 79% of cases. Based on its ease of use and performance, the ADRS is recommended for screening for T2D in certain Black population groups in South Africa. HbA1c as a means of diagnosis also showed comparable performance with FPG. Therefore, further validation studies can potentially use HbA1c as the standard to compare to.

Effects of synbiotic supplementation on the components of metabolic syndrome in patients with schizophrenia: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Antipsychotic drugs may have adverse effects on the components of metabolic syndrome. Previous studies have shown that changes in the intestinal microbiome are associated with metabolic disturbances in patients with schizophrenia. The objective of this study was to determine the effects of synbiotics on the components of metabolic syndrome as primary outcomes in patients with schizophrenia. Secondary outcomes were HbA1c, insulin resistance, LDL-c, and anthropometric measurements. METHODS: In this double-blind, placebo-controlled trial, seventy patients with schizophrenia receiving antipsychotic drugs who had at least two criteria of metabolic syndrome were randomly divided into two groups to receive either two capsules of a synbiotic supplement or a placebo daily for 8 weeks. Anthropometric indices and biochemical parameters were measured at baseline and after the intervention. RESULTS: Fifty-five patients completed the study. The synbiotic supplement significantly decreased waist circumference and HbA1C compared to placebo (-2.66 ± 4.20 vs. 3.03 ± 4.50 and - 0.26 ± 0.54 vs. 0.20 ± 0.75, respectively). Although BMI did not change significantly in the synbiotic + antipsychotic group, it increased in the placebo + antipsychotic group (-0.37 ± 1.00 vs. 0.61 ± 1.09 P < 0.5). LDL-c and triglyceride (TG) levels decreased significantly in the synbiotic + antipsychotic group, but the change was not significantly different from that of the placebo + antipsychotic group. FBS, HDL-c, systolic and diastolic blood pressure, insulin resistance, and total cholesterol were not significantly different between the two groups after intervention. CONCLUSION: Synbiotic supplement may decrease waist circumference, HbA1c, LDL and TG and prevent BMI increase in patients receiving antipsychotic drugs. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT Number: IRCT20090901002394N45), Date: 26-12-2019.

The effects of supervised aerobic training on dyslipidaemia among diabetic older patients.

BACKGROUND: Higher prevalence rates of diabetes and its complications have been reported among individuals with poor physical activity and a sedentary lifestyle. This study explored the influence of six months of moderate-intensity supervised aerobic training on the serum lipid profile, hs-CRP level, and variable-related correlations in prediabetic and type 2 diabetes patients (T2DM). DESIGN: The study was based on a two-arm parallel group pretest‒posttest comparative design. METHODS: A total of 50 subjects who were diagnosed with diabetes for more than five years and aged 30-70 years were included in this study. The subjects were classified into two groups on the basis of their glycated haemoglobin (HbA1c%) values: Group 1 (patients with the prediabetes; HbA1c % ≤ 6.5, n = 25) and Group 2 (patients with the T2DM; HbA1c % ≥ 6.5, n = 25). Blood sugar, HbA1c %, insulin, lipid profile, and highly sensitive CRP (hs-CRP) were measured via colorimetric and immunoassay techniques at baseline and six months postintervention with moderate aerobic exercise. RESULTS: The results revealed that participation in moderate aerobic training interventions for six months resulted in a significant reduction in BMI, fasting blood sugar, glycosylated haemoglobin, hs-CRP, and lipid profile parameters such as T-Cholest, TG, and LDL-C as well as significant improvement in the level of insulin with a reduction in the values of HOMA-IR towards normal values in the patients with prediabetes (P < 0.01) in group 1 and patients with diabetes in group 2 (P < 0.001). The change in VO2max with good physical fitness significantly improved with the exercise program after six months. The reduced levels of hs-CRP, HOMA-IR, and lipid profile and improved levels of insulin were significantly positively correlated with the levels of glycated haemoglobin (HbA1c%) in the patients with prediabetes (P < 0.01) and those with diabetes (P < 0.001) following six months of moderate aerobic training interventions. Moreover, hs-CRP was positively correlated with T-Cholest, TG, and LDL-C (p = 0.01) and negatively correlated with HDL-C. The data revealed improved glycemic control factors, lipid profiles, and hs-CRP levels as cardio-predictive markers in patients with both prediabetes and diabetes as well. These findings suggest that the anti-inflammatory effect of physical activity gained from moderate exercise training for six months may counteract increased cardiovascular complications associated with increased CRP levels and lipid profiles in prediabetes and T2DM patients. CONCLUSIONS: Moderate aerobic training for six months favourably affects glycemic parameters, lipid profiles, and inflammatory hs-CRP indicators and improves VO2max, an indicator of physical fitness, in prediabetic and diabetic patients. The data obtained suggest the positive effect of moderate exercise training as a protective modulator of cardiovascular disorders, including the dyslipidaemic profile, glycaemic control, and hs-CRP inflammatory markers, in prediabetes and T2DM patients. Thus, regular exercise, owing to its anti-inflammatory effects and ability to improve cardiorespiratory fitness, lipid profiles, blood glucose levels, and insulin resistance, may help reduce the severity of cardiovascular diseases in prediabetes and T2DM patients and healthy controls. TRIAL REGISTRATION: Retrospectively registered with ClinicalTrials.gov PRS under trial identifier ID: NCT06246435 dated 30/01/2024.

A Case of Neonate Hypoglycemia.

BACKGROUND: There has been no unified definition for neonatal hypoglycemia. Generally, neonatal hypoglycemia is diagnosed when the whole blood glucose concentration is below 2.2 mmol/L. The reasons are numerous. This case report presents an instance of a newborn with extremely low blood glucose levels immediately after birth from a diabetic mother, referred to as the "Infants of Diabetic Mothers", providing a practical case reference for early monitoring and timely intervention for Infants of Diabetic Mothers (IDMs). METHODS: The glucose concentrations in whole blood and serum were measured using a fingerstick glucometer and a fully automatic biochemical analyzer, respectively. The levels of insulin and C-peptide were detected using a fully automatic chemiluminescence method. The glycated hemoglobin was measured using a glycated hemoglobin analyzer. RESULTS: The mother's blood glucose value before delivery was 8.28 mmol/L. After delivery, the fingerstick blood glucose and serum glucose concentrations of the newborn were 2.6 mmol/L and 0.11 mmol/L, respectively. The levels of insulin and C-peptide were 805.55 pmol/L and 2,312.64 pmol/L, respectively. The value of glycated hemoglobin was 7.5%. Intravenous nutrition with a 100 mL of 10% glucose at an infusion rate of 12.7 mL/d was maintained. Then, 10% glucose was given to the neonate at an infusion rate of 7.7 mL/minute for 30 minutes. Eventually, the blood glucose levels were raised to 5.2 mmol/L. CONCLUSIONS: Diabetes has a profound impact on both the mother and the newborn. Close monitoring and timely intervention are necessary to reduce neonatal complications and promote longterm healthy growth and development.