International Journal of Diabetes in Developing Countries最新文献

Background

Type 2 diabetes is a significant public health concern that affects over 537 million adults worldwide. Oral antidiabetic (OAD) failure can be a complex management issue in patients with type 2 diabetes. Insulin glargine U-300 is a newer type of basal insulin with more consistent pharmacological effects than traditional insulin glargine.

Objective

This study aimed to assess the safety and effectiveness of insulin glargine U-300 as compared to insulin glargine U-100 in Indian type 2 diabetes patients who had experienced OAD failure.

Methods

This is a record-based observational study conducted on type 2 diabetes patients who had experienced OAD failure.

Results

The study involved 389 cases (189 on insulin glargine U-300 and 200 on insulin glargine U-100). It was found that 56.6% and 58.1% of patients had reduced fasting glucose levels below 130 mg/dl after 1 month of treatment, and 78.8% and 76.1% had a reduction after 3 months following the use of insulin glargine U-300 and insulin glargine U-100, respectively. In patients on glargine U-300 and insulin glargine U-100, the mean fasting plasma glucose decreased from 241.05 ± 65.93 mg/dl at baseline to 142.61 ± 55.19 mg/dl (p < 0.05) and similarly from 250.68 ± 61.41 to 140.27 ± 48.29 mg/dl (p < 0.05) at the end of the first month, respectively. The incidence of hypoglycemia was comparatively fewer in patients using insulin glargine U-300 as compared to those using insulin glargine U-100 (8.1% vs. 6.7%, p < 0.05).

Conclusion

The results suggest that insulin glargine U-300 is an effective and safer treatment option than insulin glargine U-100 for Indian patients with OAD failure. These findings have the potential to improve the management of type 2 diabetes patients with OAD failure globally.

Abstract

Abstract

Abstract

Background

Essential hypertension is associated with increased risk for atherothrombotic disease.

Objective

The aims were to determine and compared the plasma concentration of von Willebrand Factor (vWF) and Plasminogen Activator Inhibitor type 1 (PAI-1) in hypertensive patients with and without atherothrombotic disease and the influence of antihypertensive treatment on those biomarkers.

Methods

Total of 341 individuals were included, 83 normotensive subjects and 258 hypertensive patients (43 with and 215 without atherothrombotic disease). The vWF and PAI-1 were measured by ELISA technique. Multivariate linear and quantile regression analysis were performed.

Results

There was higher vWF concentration (p < 0.001) and PAI-1 (p < 0.001) in hypertensive compared with normotensive individuals. The vWF level was correlated with hypertension, older age and glucose, explaining 26%, 70% and 86% of vWF variability. Increased PAI-1 levels were correlated with glucose, triglycerides, HbA1c, explaining 66%, 73% and 90% of variability. In contrast, lower PAI-1 concentration was determined by older age.

Conclusions

We found higher levels of vWF and PAI-1 in hypertensive patients, with highest concentration of vWF in patients with hypertension and thrombotic disease and the highest of PAI-1 in hypertensive patients without atherothrombotic disease. The lowest level of vWF was determined in patients with angiotensin II receptor blocker, and for the PAI-1 level in patients with calcium channel blocker medication. The lowest concentration of both biomarkers was present in patients who were treated with 3 or more drugs. Hypertension, older age, disorders in glucose and lipid metabolism were the main determinants of vWF and PAI-1 variability.

Graphical Abstract

Diabetic retinopathy (DR) is a leading cause of blindness among working-age adults worldwide. India is the diabetes capital of the world and one in five adults is said to have diabetes in India. With the increase in diabetes, there is an increasing burden of diabetic retinopathy (DR). All patients with diabetes have a risk of losing vision due to DR. The prevalence of diabetic retinopathy is 12.5%; out of which, 4% are said to have vision-threatening diabetic retinopathy (VTDR) The early stages of DR are symptomless, necessitating a proactive screening for an early detection of DR in all people with diabetes before they develop VTDR. This is a position statement jointly developed by RSSDI (Research Society for the Study of Diabetes in India) and VRSI (Vitreo Retinal Society of India) to provide guidelines for Physicians on DR screening in India. These guidelines emphasize the need for regular DR screening of all people with diabetes. It is recommended that the Physicians establish an effective DR screening model in their clinics, eg., a non-mydriatic fundus camera utilizing artificial intelligence (AI) algorithms for fundus photography to identify referral or non-referral DR. This will facilitate early detection and timely referral to an ophthalmologist thereby preventing VTDR. The need to create public awareness regarding blindness due to DR and a collaboration between Physicians and ophthalmologists for the management of diabetes, opportunistic screening of DR, and timely management of DR may play a crucial role in decreasing the burden of blindness secondary to diabetes.

Background

Time in range is a reliable measure of the risk of diabetes complications. High percentage of patients with diabetes fail to achieve the recommended time in range (TIR) target of 70–180 mg/dl (3.9–10 mmol/l) >70%.

Objective

This study aimed to identify factors influencing TIR prolongation.

Methods

Children aged 1–17 years with >1-year type 1 diabetes (T1D) duration, treated with continuous subcutaneous insulin infusion (CSII) ≥3 months, using continuous glucose monitoring (CGM) or intermittently scanned CGM (is-CGM) ≥1 month, and with a registration time >70% were included. Data were collected during routine diabetology visits at an outpatient clinic. Insulin pump and CGM or is-CGM reports in the most recent 14 days were recorded using a dedicated software. Legal caregivers were also asked to complete a questionnaire on how the patients use the insulin pump functions and eating habits.

Results

A sample of 110 patients was categorized into two groups: those with TIR >70% and TIR ≤70%. TIR >70% group presented with repeated hyperglycemia and a high glycemic variability coefficient of variation. We noted an acceptable hypoglycemia rate (3%), regardless of the TIR value. Patients with TIR >70% predominantly used predictive low glucose suspend system, maintained adequate intervals between insulin delivery and meal consumption, used the “bolus calculator” function, and more frequently created electronic reports.

Conclusions

Hyperglycemia and high glycemic variability prevent patients from achieving the target TIR. Advanced features in the CGM systems, premeal insulin bolus, and patients’ involvement in diabetes treatment are the main factors contributing to TIR prolongation.

Objective

This study evaluated the mortality risk factors in Iranian patients with diabetes mellitus (DM) and COVID-19-associated mucormycosis (CAM).

Methods

This retrospective study was conducted on confirmed CAM cases with DM. Only patients with a confirmed history of COVID-19 within the last 3 months were included. The patients were divided into the survived and deceased groups, and each group’s characteristics were studied and compared. Patients were also studied according to their DM status (known or unknown case).

Results

A total of 106 patients were included. The mortality rate was 25.5%. The most common underlying disease (hypertension, 41.5%) was significantly higher in the deceased group. Sixty-five patients (62.5%) were known cases of DM. The mean duration of DM was 12.46 years. There was a significant relationship between the DM history and mortality rate (84.6% vs. 15.4%, p = 0.007). The history of ICU admission was 8 times higher in unknown DM patients (p = 0.011, OR = 8.000, CI = 1.60–39.95). The mean HbA1C was significantly different in known DM cases (9.36 ± 2.03 vs. 8.02 ± 2.40, p = 0.004). The mean first day FBS, mean first BS in emergency room, and mean FBS on the first hospitalization week were 171, 202, and 167.2 mg/dL, respectively. Although mortality was significantly related to hyperglycemic state of fasting and non-fasting BS levels (p < 0.05), it was not related to HbA1C.

Conclusion

Patients with diabetes and COVID-19 had uncontrolled fasting and non-fasting glucose levels during mucormycosis episode. Hypertension, history of DM, and the lack of glucose control during recent hospitalization can be associated with a poor outcome.