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Sample records for achieve glycemic control

  1. Achieving glycemic control in special populations in hospital: perspectives in practice.

    PubMed

    Cheng, Alice Y Y

    2014-04-01

    Achieving and maintaining glycemic control in patients with diabetes admitted to hospital is challenging because of the many competing factors of nutrition, pharmacotherapy and other patient-related and systemic factors. For patients receiving enteral or parenteral feeding, eating irregularly or receiving glucocorticoid therapy, the challenges are even greater. The basic principles to follow when managing glycemia in these populations are as follows: 1) Recognition of those at risk for hyperglycemia; 2) frequent bedside glucose monitoring; 3) a proactive approach with routine insulin administration based on the predicted glucose patterns; 4) constant reassessment of the glycemic status and titration of the routine insulin accordingly. PMID:24690508

  2. Achieving glycemic control in young children with type 1 diabetes: approaches, pitfalls and new technologies.

    PubMed

    Gruppuso, Philip A

    2003-04-01

    Advances in technologies for insulin administrations, glucose monitoring, development of an artificial pancreas and cell-based therapy will ultimately have a profound effect on the lives of people wit diabetes. There is both current success and substantial promise, indicating that these approches may offer, for the first time, real potential for achieving euglycemia without hypoglycemia. Given the physiological and psychosocial impact of type 1 diabetes in young children, this group of patients and their parents stand to gain especially great benefit from these developments. However, the potential for improvements in the mangement of diabetes in young children based on available technologies should not be overlooked and should be effectively utilized as the standard for patient care. Only twenty years ago blood glucose reagent strips were first coming into routine use. Current meters have greatly reduced the amount of blood required ( now less than 1 microliter for many meters) and greatly imporved precision. The advent modified, recombinant insulins, which became available only in the last several years, allows for an insulin regimen to better match the absorption of dietary carbohydrate. All technologies have improved our ability to attain glycemic control, thereby reducing the risk of long-term complication in even our youngest patients. PMID:12751364

  3. Analysis of alternatives for insulinizing patients to achieve glycemic control and avoid accompanying risks of hypoglycemia

    PubMed Central

    GAO, JIALIN; XIONG, QIANYIN; MIAO, JUN; ZHANG, YAO; XIA, LIBING; LU, MEIQIN; ZHANG, BINHUA; CHEN, YUEPING; ZHANG, ANSU; YU, CUI; WANG, LI-ZHUO

    2015-01-01

    The aims of the present study were to explore the efficacy of glycemic control and the risks of hypoglycemia with different methods of insulin therapy, and to provide reference data for the clinical treatment of diabetes. In this retrospective study, hospitalized patients diagnosed with type 2 diabetes between March and December 2014, in the Department of Endocrinology in the First Affiliated Hospital of Wannan Medical College, were divided into three groups, including an intensive insulin analogue therapy group, a premixed insulin analogue treatment group and a premixed human insulin therapy group. The efficacy of glycemic control and the incidence of hypoglycemia were determined in each of the insulin treatment groups. Compared with the other treatment groups, the intensive insulin analogue therapy group was associated with superior blood glucose control, shorter time to reach standard insulin regimen, shorter hospitalization time, fewer fluctuations in blood glucose levels and lower insulin dosage on discharge from hospital. However, this treatment was also associated with a high risk of hypoglycemia. In conclusion, when combined with the effective prevention of hypoglycemia and appropriate nursing care (especially in hospital care), intensive insulin analogue therapy may provide the greatest benefit to patients. PMID:26137223

  4. Glycemic index, glycemic control and beyond.

    PubMed

    Derdemezis, Christos S; Lovegrove, Julie A

    2014-01-01

    It is currently estimated that over 370 million individuals have diabetes, making diabetes a major public health issue contributing significantly to global morbidity and mortality. The steep rise in diabetes prevalence over the past decades is attributable, in a large part, to lifestyle changes, with dietary habits and behaviour as significant contributors. Despite the relatively wide availability of antidiabetic medicine, it is lifestyle approaches that still remain the cornerstone of diabetes prevention and treatment. Glycemic index (GI) is a nutritional tool which represents the glycemic response to carbohydrate ingestion. In light of the major impact of nutrition on diabetes pathophysiology, with the rising need to combat the escalating diabetes epidemic, this review will focus on the role of GI in glycemic control, the primary target of diabetic treatment and beyond. The review will present the evidence relating GI and diabetes treatment and prevention, as well as weight loss, weight maintenance and cardiovascular disease risk factors. PMID:24040877

  5. Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options

    PubMed Central

    Du, Ye-Fong; Ou, Horng-Yih; Beverly, Elizabeth A; Chiu, Ching-Ju

    2014-01-01

    The prevalence of type 2 diabetes mellitus (T2DM) is increasing in the elderly. Because of the unique characteristics of elderly people with T2DM, therapeutic strategy and focus should be tailored to suit this population. This article reviews the guidelines and studies related to older people with T2DM worldwide. A few important themes are generalized: 1) the functional and cognitive status is critical for older people with T2DM considering their life expectancy compared to younger counterparts; 2) both severe hypoglycemia and persistent hyperglycemia are deleterious to older adults with T2DM, and both conditions should be avoided when determining therapeutic goals; 3) recently developed guidelines emphasize the avoidance of hypoglycemic episodes in older people, even in the absence of symptoms. In addition, we raise the concern of glycemic variability, and discuss the rationale for the selection of current options in managing this patient population. PMID:25429208

  6. [What glycemic control can be achieved in diabetic children and adolescents to avoid complications? Personal experience].

    PubMed

    Dorchy, H

    2006-01-01

    The principal aims of therapeutic management of the child, adolescent and adult with type 1 diabetes are to allow good quality of life and to avoid long-term complications by maintaining blood glucose concentrations close to the normal range and an HbA1c level under 7%. The number of daily insulin injections, 2 or > or =4 or pumps, by itself does not necessarily give better results, but the 4-injection regimen allows greater freedom, taking into account that the proper insulin adjustment is difficult before adolescence. Successful glycaemic control in young patients depends mainly on the quality and intensity of diabetes education. Any dogmatism must be avoided. Dietary recommendations issued over the last few years are the same for diabetic and nondiabetic individuals in order to avoid degenerative diseases. In the twice-daily injection regimen, the allocation of carbohydrates throughout the day is essential. Due to their pharmakokinetic characteristics, fast-acting and long-acting insulin analogues have specific indications in both the twice-daily injection regimen and the basal-bolus insulin therapy. They improve quality of life, without necessarily reducing HbA1c. In the two daily insulin injection regimen, fast-acting analogues are very useful to rapidly correct hyperglycaemia, to allow sleeping in and eating something sweet. In the basal-bolus regimen, long-acting analogues reduce nocturnal hypoglycaemias and improve fasting blood glucose. Clinical studies, conducted since the 1970s by our team, have demonstrated that screening for subclinical retinopathy (fluorescein angiography), neuropathy (conduction velocities), nephropathy (microalbuminuria), should be started at puberty and at least 3 years after the diagnosis of diabetes. The goal is to detect early abnormalities responsible for subclinical disorders that can be reversed by improved metabolic control, thus preventing the occurrence of irreversible potentially incapacitating lesions. This motivates

  7. Pharmacist Glycemic Control Team Improves Quality of Glycemic Control in Surgical Patients with Perioperative Dysglycemia

    PubMed Central

    Mularski, Karen SP; Yeh, Cynthia P; Bains, Jaspreet K; Mosen, David M; Hill, Ariel K; Mularski, Richard A

    2012-01-01

    Context: Perioperative hyperglycemia is a risk factor for increased morbidity and mortality. Improved glycemic control has been demonstrated to reduce surgical site infections, reduce perioperative morbidity, and reduce length of stay. However, safe and effective perioperative glycemic control can be limited by expert clinician availability. Objective: To improve quality by reliably providing safe and effective glycemic control to surgical patients with diabetes or stress hyperglycemia. Design: A designated group of pharmacists, the Glycemic Control Team (GCT), worked under protocol, on a consultation basis, to manage perioperative dysglycemia during hospitalization. We used a pre-post, observational study design to assess the effectiveness of the intervention and implementation of the GCT. Main Outcome Measures: The proportion of patients pre- and postintervention with good glycemic control and with hypoglycemia were measured and compared. We defined good glycemic control as having all, or all but one, point-of-care blood glucose values between 70–180 mg/dL in each 24-hour period. We defined hypoglycemia as having any point-of-care test glucose value <70mg/dL in any of the 3 days evaluated. Results: During the preimplementation period, 77.4% of postoperative patient days demonstrated good glycemic control. In the postimplementation period, this percentage increased to 90.3%. Over the same period, the rate of hypoglycemia decreased from 8.6% to 4.6%. Conclusion: Implementation of a pharmacist team to manage glycemic control in hospitalized, postoperative patients led to safer and better quality of glycemic care as measured by improved glycemic control and lower rates of hypoglycemia. PMID:22529756

  8. Practice of strict glycemic control in critically ill patients.

    PubMed

    Schultz, Marcus J; de Graaff, Mart J; Royakkers, Annic A N M; van Braam Houckgeest, Floris; van der Sluijs, Johannes P; Kieft, Hans; Spronk, Peter E

    2008-11-01

    Blood glucose control aiming at normoglycemia, frequently referred to as "strict glycemic control", decreases mortality and morbidity of critically ill patients. We searched the medical literature for export opinions, surveys, and clinical reports on blood glucose control in intensive care medicine. While strict glycemic control has been recommended standard of care for critically ill patients, the risk of severe hypoglycemia with strict glycemic control is frequently mentioned by experts. Some rationalize this risk, though others strongly point out the high incidence of hypoglycemia to be (one) reason not to perform strict glycemic control. Implementation of strict glycemic control is far from complete in intensive care units across the world. Frequently local guidelines accept higher blood glucose levels than those with strict glycemic control. Only a minority of retrieved manuscripts are on blood glucose regimens with the lower targets as with strict glycemic control. Hypoglycemia certainly is encountered with blood glucose control, in particular with strict glycemic control. Reports show intensive care-nurses can adequately and safely perform strict glycemic control. Implementation of strict glycemic control is far from complete, at least in part because of the feared risks of hypoglycemia. The preference for hyperglycemia over intermittent hypoglycemia is irrational, however, because there is causal evidence of harm for the former but only associative evidence of harm for the latter. For several reasons it is wise to have strict glycemic control being a nurse-based strategy. PMID:18971884

  9. Glycemic control and outcome related to cardiopulmonary bypass.

    PubMed

    Thiessen, Steven; Vanhorebeek, Ilse; Van den Berghe, Greet

    2015-06-01

    Perioperative hyperglycemia, aggravated by cardiopulmonary bypass, is associated with adverse outcome in adult and pediatric patients. Whereas hyperglycemia was originally perceived as an adaptive response to surgical stress, it is now clear that glycemic control is a strategy to reduce adverse outcomes after cardiac surgery and cardiopulmonary bypass. The optimal blood glucose target, whether or not glycemic control should be initiated already intraoperatively, and whether or not perioperative glucose administration affects the impact of glycemic control on ischemia-reperfusion damage remain open questions. Hypoglycemia, the risk of which is increased with glycemic control, is also associated with adverse outcomes. However, it remains controversial whether brief episodes of hypoglycemia, rapidly corrected during glycemic control, have adverse effects on outcome. This review gives an overview of the currently available literature on glycemic control during and after cardiac surgery and focuses on the indicated open questions about this intervention for this specific patient population. PMID:26060029

  10. Tight glycemic control in the ICU - is the earth flat?

    PubMed

    Steil, Garry M; Agus, Michael S D

    2014-01-01

    Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduction of continuous glucose monitoring (CGM). In this issue of Critical Care, a consensus panel provides a list of the research priorities they believe are needed for CGM to become routine practice in the ICU. We reflect on these recommendations and consider the implications for using CGM today. PMID:25041720

  11. Glycemic control indicators in patients with neonatal diabetes mellitus

    PubMed Central

    Suzuki, Shigeru; Koga, Masafumi

    2014-01-01

    Neonatal diabetes mellitus (NDM) is a type of diabetes mellitus caused by genetic abnormality which develops in insulin dependent state within 6 mo after birth. HbA1c is widely used in clinical practice for diabetes mellitus as the gold standard glycemic control indicator; however, fetal hemoglobin (HbF) is the main hemoglobin in neonates and so HbA1c cannot be used as a glycemic control indicator in NDM. Glycated albumin (GA), another glycemic control indicator, is not affected by HbF. We reported that GA can be used as a glycemic control indicator in NDM. However, it was later found that because of increased metabolism of albumin, GA shows an apparently lower level in relation to plasma glucose in NDM; measures to solve this problem were needed. In this review, we outlined the most recent findings concerning glycemic control indicators in neonates or NDM. PMID:24748932

  12. Is glycemic control of the critically ill cost-effective?

    PubMed

    Krinsley, James S

    2014-10-01

    Intensive monitoring of blood glucose levels and treatment of hyperglycemia have been associated with significant improvements in morbidity and mortality in the critically ill. In contrast to the large prospective and observational body of data relating glycemic control and clinical outcomes, the financial impact of glycemic control implementation has not been as well described. This article details data from interventional trials of intensive insulin therapy; investigations that relate dysglycemia to morbidity, particularly intensive care unit (ICU)-acquired infections and increased ICU length of stay; and evaluations of the attributable cost of nosocomial infection in order to construct a sensitivity analysis of the net economic impact of glycemic control. It concludes that glycemic control is associated with positive financial outcomes, even using very conservative assumptions, and provides the reader with an automated spreadsheet to estimate the financial implications of glycemic control using assumptions based on locally derived data. PMID:25502129

  13. Perioperative glycemic control: use of a hospital-wide protocol to safely improve hyperglycemia.

    PubMed

    Michaelian, Nancy; Joshi, Renu; Gillman, Ed; Kratz, Ronald; Helmuth, Amy; Zimmerman, Karen; Klahre, Denise; Warner, Sandy; McBride, Vickie; Bailey, M Judy; Houseal, Linda

    2011-08-01

    Perioperative hyperglycemia impairs immunity and contributes to increased susceptibility to infection, higher incidence of multiorgan dysfunction, and greater mortality. Strict glycemic control is associated with lower infection rates, decreased length of stay (LOS), and faster recovery. A protocol that standardized preoperative education, testing, and treatment of elevated blood glucose (BG) safely improved perioperative glycemic control. Preoperative average BG improved from 191 to 155 mg/dL (P=.016); postoperative average BG decreased from 189 to 168 mg/dL (P=.094). The percentage of patients presenting with BG greater than 180 mg/dL preoperatively and achieving BG less than 180 mg/DL postoperatively increased from 21% to 43% (P = .09). Even though some results were statistically non-significant, the data showed a trend toward improvement with the new protocol. Good perioperative glycemic control, without an increased risk of hypoglycemia, is achievable. PMID:21803272

  14. Nutrition Support Team-Led Glycemic Control Program for Critically Ill Patients.

    PubMed

    Dickerson, Roland N; Maish, George O; Minard, Gayle; Brown, Rex O

    2014-04-21

    Glycemic control is an important component of the metabolic management of the critically ill patient. Nutrition support teams are frequently challenged by complicated patients who exhibit multiple concurrent etiologies for hyperglycemia. Nutrition support teams can serve in a pivotal role in the development and evaluation of safe and effective techniques for achieving glycemic control. This review describes the efforts of a nutrition support team in achieving safe and effective glycemic control at their institution. Identification of target blood glucose concentration range, development, initiation, monitoring of a continuous intravenous insulin infusion algorithm, nursing adherence to the algorithm, modification of the algorithm based on the presence of conditions that alter insulin metabolism and glucose homeostasis, and transition of the patient who receives continuous enteral nutrition from a continuous intravenous insulin infusion to intermittent subcutaneous insulin therapy are discussed. PMID:24751550

  15. Stochastic Targeted (STAR) Glycemic Control: Design, Safety, and Performance

    PubMed Central

    Evans, Alicia; Le Compte, Aaron; Tan, Chia-Siong; Ward, Logan; Steel, James; Pretty, Christopher G; Penning, Sophie; Suhaimi, Fatanah; Shaw, Geoffrey M; Desaive, Thomas; Chase, J Geoffrey

    2012-01-01

    Introduction Tight glycemic control (TGC) has shown benefits but has been difficult to achieve consistently. STAR (Stochastic TARgeted) is a flexible, model-based TGC approach that directly accounts for intra- and interpatient variability with a stochastically derived maximum 5% risk of blood glucose (BG) below 72 mg/dl. This research assesses the safety, efficacy, and clinical burden of a STAR TGC controller modulating both insulin and nutrition inputs in virtual and clinical pilot trials. Methods Clinically validated virtual trials using data from 370 patients in the SPRINT (Specialized Relative Insulin and Nutrition Titration) study were used to design the STAR protocol and test its safety, performance, and required clinical effort prior to clinical pilot trials. Insulin and nutrition interventions were given every 1–3 h as chosen by the nurse to allow them to manage workload. Interventions were designed to maximize the overlap of the model-predicted (5–95th percentile) range of BG outcomes with the 72–117 mg/dl band and thus provide a maximum 5% risk of BG <72 mg/dl. Interventions were calculated using clinically validated computer models of human metabolism and its variability in critical illness. Carbohydrate intake (all sources) was selected to maximize intake up to 100% of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) goal (25 kg/kcal/h). Insulin doses were limited (8 U/h maximum), with limited increases based on current rate (0.5–2.0 U/h). Initial clinical pilot trials involved 3 patients covering ∼450 h. Approval was granted by the Upper South A Regional Ethics Committee. Results Virtual trials indicate that STAR provides similar glycemic control performance to SPRINT with 2–3 h (maximum) measurement intervals. Time in the 72–126 mg/dl and 72–145 mg/dl bands was equivalent for all controllers, indicating that glycemic outcome differences between protocols were only shifted in this range. Safety from

  16. Pollution by metals: Is there a relationship in glycemic control?

    PubMed

    González-Villalva, Adriana; Colín-Barenque, Laura; Bizarro-Nevares, Patricia; Rojas-Lemus, Marcela; Rodríguez-Lara, Vianey; García-Pelaez, Isabel; Ustarroz-Cano, Martha; López-Valdez, Nelly; Albarrán-Alonso, Juan Carlos; Fortoul, Teresa I

    2016-09-01

    There are evidences of environmental pollution and health effects. Metals are pollutants implicated in systemic toxicity. One of the least studied effects, but which is currently becoming more important, is the effect of metals on glycemic control. Metals have been implicated as causes of chronic inflammation and oxidative stress and are associated to obesity, hyperglycemia and even diabetes. Arsenic, iron, mercury, lead, cadmium and nickel have been studied as a risk factor for hyperglycemia and diabetes. There is another group of metals that causes hypoglycemia such as vanadium, chromium, zinc and magnesium by different mechanisms. Zinc, magnesium and chromium deficiency is associated with increased risk of diabetes. This review summarizes some metals involved in glycemic control and pretends to alert health professionals about considering environmental metals as an important factor that could explain the poor glycemic control in patients. Further studies are needed to understand this poorly assessed problem. PMID:27552445

  17. Type 2 diabetes mellitus, glycemic control, and cancer risk.

    PubMed

    Onitilo, Adedayo A; Stankowski, Rachel V; Berg, Richard L; Engel, Jessica M; Glurich, Ingrid; Williams, Gail M; Doi, Suhail A

    2014-03-01

    Type 2 diabetes mellitus is characterized by prolonged hyperinsulinemia, insulin resistance, and progressive hyperglycemia. Disease management relies on glycemic control through diet, exercise, and pharmacological intervention. The goal of the present study was to examine the effects of glycemic control and the use of glucose-lowering medication on the risk of breast, prostate, and colon cancer. Patients diagnosed with type 2 diabetes mellitus (N=9486) between 1 January 1995 and 31 December 2009 were identified and data on glycemic control (hemoglobin A1c, glucose), glucose-lowering medication use (insulin, metformin, sulfonylurea), age, BMI, date of diabetes diagnosis, insurance status, comorbidities, smoking history, location of residence, and cancer diagnoses were electronically abstracted. Cox proportional hazards regression modeling was used to examine the relationship between glycemic control, including medication use, and cancer risk. The results varied by cancer type and medication exposure. There was no association between glycemic control and breast or colon cancer; however, prostate cancer risk was significantly higher with better glycemic control (hemoglobin A1c ≤ 7.0%). Insulin use was associated with increased colon cancer incidence in women, but not with colon cancer in men or breast or prostate cancer risk. Metformin exposure was associated with reduced breast and prostate cancer incidence, but had no association with colon cancer risk. Sulfonylurea exposure was not associated with risk of any type of cancer. The data reported here support hyperinsulinemia, rather than hyperglycemia, as a major diabetes-related factor associated with increased risk of breast and colon cancer. In contrast, hyperglycemia appears to be protective in the case of prostate cancer. PMID:23962874

  18. Glycemic Control and the Risk of Tuberculosis: A Cohort Study

    PubMed Central

    Lai, Ting-Chun; Chiang, Chen-Yuan; Chan, Chang-Chuan; Lin, Hsien-Ho

    2016-01-01

    Background Diabetes is a well-known risk factor for tuberculosis (TB) and is increasingly prevalent in low- and middle-income countries, where the burden of TB is high. Glycemic control has the potential to modify the risk of TB. However, there are few studies on the association between glycemic control and TB risk, and the results are inconsistent. Methods and Findings We assembled a cohort using 123,546 individuals who participated in a community-based health screening service in northern Taiwan from 5 March 2005 to 27 July 2008. Glycemic control was measured using fasting plasma glucose (FPG) at the time of screening. The cohort was followed up to 31 December 2012 for the occurrence of TB by cross-matching the screening database to the national health insurance database. Multiple imputation was used to handle missing information. During a median follow-up of 4.6 y, 327 cases of TB occurred. In the multivariable Cox regression model, diabetic patients with poor glycemic control (FPG > 130 mg/dl) had a significantly higher hazard of TB (adjusted hazard ratio [aHR] 2.21, 95% CI 1.63–2.99, p < 0.001) compared to those without diabetes. The hazard of TB in diabetic patients with good glycemic control (FPG ≤ 130 mg/dl) did not differ significantly from that in nondiabetic individuals (aHR 0.69, 95% CI 0.35–1.36, p = 0.281). In the linear dose-response analysis, the hazard of TB increased with FPG (aHR 1.06 per 10-mg/dl increase in FPG, 95% CI 1.03–1.08, p < 0.001). Assuming the observed association between glycemic control and TB was causal, an estimated 7.5% (95% CI 4.1%–11.5%) of incident TB in the study population could be attributed to poor glycemic control. Limitations of the study include one-time measurement of fasting glucose at baseline and voluntary participation in the health screening service. Conclusions Good glycemic control could potentially modify the risk of TB among diabetic patients and may contribute to the control of TB in settings where

  19. Fathers’ Involvement in Preadolescents’ Diabetes Adherence and Glycemic Control*

    PubMed Central

    Rohan, Jennifer M.; Carle, Adam C.; Pendley, Jennifer Shroff; Delamater, Alan; Drotar, Dennis

    2011-01-01

    Objective To examine the relationship of paternal involvement in diabetes care with adherence and glycemic control. Methods One hundred and thirty-six mothers and fathers of preadolescents (aged 9–12 years) with type 1 diabetes reported on paternal involvement. Adherence was measured by interview and blood glucose meter downloads. Mothers’ and fathers’ ratings of paternal involvement in diabetes care were compared. We evaluated three structural equation models linking paternal involvement with adherence and glycemic control. Results Mothers and fathers reported similar amounts of paternal involvement, yet mothers rated paternal involvement as more helpful. The data supported a model indicating links between more paternal involvement and higher HbA1c and between lower adherence and higher HbA1c. Mediation and moderation models were not supported. Discussion Although paternal involvement was not directly associated with treatment adherence, it was associated with poorer glycemic control. Some fathers may increase their involvement in response to suboptimal glycemic outcomes. PMID:21515643

  20. A Mixed Methods Study Exploring the Factors and Behaviors That Affect Glycemic Control Following a Structured Education Program: The Irish DAFNE Study

    ERIC Educational Resources Information Center

    Casey, Dympna; O'Hara, Mary Clare; Meehan, Ben; Byrne, Molly; Dinneen, Sean F.; Murphy, Kathy

    2016-01-01

    Aim: To explain the factors affecting glycemic control (measured by HbA1c) following the Dose Adjustment for Normal Eating (DAFNE) program. Background: DAFNE is a structured education program designed to assist persons with type 1 diabetes mellitus achieve optimal glycemic control. However, not all participants reach this goal. Few studies…

  1. Determinants of Glycemic Control among Insulin Treated Diabetic Patients in Southwest Ethiopia: Hospital Based Cross Sectional Study

    PubMed Central

    Angamo, Mulugeta Tarekegn; Melese, Belete Habte; Ayen, Wubeante Yenet

    2013-01-01

    Background Good glycemic control reduces the risk of diabetic complications. Despite this, achieving good glycemic control remains a challenge in diabetic patients. The objective of this study is to identify determinants of glycemic control among insulin treated diabetic patients at Jimma University Hospital, Southwest Ethiopia. Methods Hospital-based cross-sectional study was conducted on systematically sampled 284 insulin-treated diabetic patients with a regular follow up. Data was collected by interviewing patients during hospital visits and reviewing respective databases of September 2010 to December 2011. Data collection took place from February 20 to May 20, 2012. Poor glycemic control was defined as fasting blood sugar (FBS) ≥126 mg/dL. Binary logistic regression analysis was conducted to identify predictors of poor glycemic control. Results Patients had a mean age of 41.37 (±15.08) years, 58.5% were males, the mean duration of insulin treatment was 4.9 (±5.1) years, 18.3% achieved good glycemic control (FBS≤126 mg/dL), 95% self-reported repeated use of disposable insulin syringe-needle and 48% correctly rotating insulin injection sites. Most (83.1%) of study participants had one or more complications. On multivariable logistic regression analyses, body weight of >70 Kg (AOR = 0.21; P<0.001), total daily dose of insulin ≤35 IU/day (AOR = 0.26; P<0.001), total daily dose variation without checking glycemic level (AOR = 3.39; P = 0.020), knowledge deficit about signs and symptoms of hyperglycemia (AOR = 3.60; P = 0.004), and non-adherence to dietary management (AOR = 0.35; P = 0.005) were independent predictors of poor glycemic control. Conclusions The proportion of patients with poor glycemic control was high, which resulted in the development of one or more complications regardless of duration on insulin treatment. Hence, appropriate management of patients focusing on the relevant associated factors and independent

  2. Overcoming barriers to glycemic control in African Americans with type-2 diabetes: benefits of insulin therapy.

    PubMed

    Marshall, Merville C

    2007-08-01

    A disproportionate number of African-American men and women are affected by obesity and diabetes. The documented rate of poor glycemic control in the African-American population may contribute to the high rate of morbidity and mortality due to diabetes observed in these patients. Since the benefits of strict glycemic control have been demonstrated in multiple large trials, the aim of treatment should be to achieve the goals set forth by the American Diabetes Association. Insulin remains an essential therapeutic agent for helping patients achieve glycemic control and preventing long-term comorbidities. However, barriers to insulin therapy exist for both the physician and patient. Strategies to counter this resistance include identifying barriers to treatment, restoring the patient's sense of control, utilizing simple regimens, and reviewing the benefits of insulin and the risk of hypoglycemia. In treating African-American patients with diabetes, providers of various racial and ethnic backgrounds may maximize treatment efficacy by attempting to understand and practice culturally competent care. PMID:17722663

  3. Improving Care in Older Patients with Diabetes: A Focus on Glycemic Control

    PubMed Central

    Lee, Eric A; Gibbs, Nancy E; Martin, John; Ziel, Fred; Polzin, Jennifer K; Palmer-Toy, Darryl

    2016-01-01

    Diabetes affects more than 25% of Americans older than age 65 years. The medical care of older patients must differ from the care of their younger counterparts. Older patients are at high risk of drug toxicity. A hemoglobin A1c (HbA1c) level less than 7.0% has historically been the goal of all patients with diabetes, regardless of age. Recent research has demonstrated that using medications to achieve such tight glycemic control is not necessary and is often not safe. This article discusses the seminal research findings that strongly suggest that HbA1c goals should be relaxed in older patients. The authors then recommend an age-specific and functionally appropriate HbA1c reference range for patients receiving medications to improve glycemic control. Other interventions are suggested that should make diabetes care safer in older patients receiving hypoglycemic medications. PMID:27352408

  4. Improving Care in Older Patients with Diabetes: A Focus on Glycemic Control.

    PubMed

    Lee, Eric A; Gibbs, Nancy E; Martin, John; Ziel, Fred; Polzin, Jennifer K; Palmer-Toy, Darryl

    2016-01-01

    Diabetes affects more than 25% of Americans older than age 65 years. The medical care of older patients must differ from the care of their younger counterparts. Older patients are at high risk of drug toxicity. A hemoglobin A1c (HbA1c) level less than 7.0% has historically been the goal of all patients with diabetes, regardless of age. Recent research has demonstrated that using medications to achieve such tight glycemic control is not necessary and is often not safe.This article discusses the seminal research findings that strongly suggest that HbA1c goals should be relaxed in older patients. The authors then recommend an age-specific and functionally appropriate HbA1c reference range for patients receiving medications to improve glycemic control. Other interventions are suggested that should make diabetes care safer in older patients receiving hypoglycemic medications. PMID:27352408

  5. Tight Glycemic Control and Cardiovascular Effects in Type 2 Diabetic Patients

    PubMed Central

    Moodahadu, Latha Subramanya; Dhall, Ruchi; Zargar, Abdul Hamid; Bangera, Sudhakar; Ramani, Lalitha; Katipally, Ramesh

    2014-01-01

    Diabetes Mellitus (DM) with poor glycemic control is one of the leading causes for cardiovascular mortality in diabetic patients. Tight glycemic control with glycosylated haemoglobin of <7 gms% is recommended as a routine and < 6.5 gms% is recommended for young and newly diagnosed diabetics. Treatment goal aims at achieving near normal blood glucose level, and directed at management of other co morbid conditions such as obesity, hypertension and dyslipidemia. Oral hypoglycemic agents are the preferred drugs, alone or in combination. Preference for glitazones is declining due to the increasing evidences of associated adverse events. Gliptins appear as promising agents with lesser tendency to cause hypoglycemia, but their long term safety and efficacy is yet to be established. We emphasize the role of preventive measures in prediabetics and in established DM, treatment should be individualized and customized to minimize hypoglycemic effects and to retain quality of life. PMID:25774253

  6. Short-term intensive glycemic control improves vibratory sensation in type 2 diabetes.

    PubMed

    Fujita, Yoshihito; Fukushima, Mitsuo; Suzuki, Haruhiko; Taniguchi, Ataru; Nakai, Yoshikatsu; Kuroe, Akira; Yasuda, Koichiro; Hosokawa, Masaya; Yamada, Yuichiro; Inagaki, Nobuya; Seino, Yutaka

    2008-04-01

    Strict long-term glycemic control has been reported to prevent or improve diabetic peripheral neuropathy, but the effects of short-term glycemic control have not been clarified in patients with type 2 diabetes. To investigate reversibility of impaired vibratory sensation by short-term glycemic control, we used the TM31 liminometer and C64 tuning fork methods to measure peripheral neuropathy. Thirty-one type 2 diabetes patients with poor glycemic control (HbA1c: 10.8+/-0.4%, mean+/-S.E.M., range from 7.9% to 16.2%) were administered strict glycemic control. Vibratory sensation before and after short-term glycemic control was evaluated, and the metabolic profile including plasma glucose, HbA1c, total cholesterol, HDL cholesterol, triglyceride, and free fatty acid (FFA) was measured. After 20.0+/-2.1 days of strict glycemic control, vibratory sensation improved significantly in both upper and lower extremities, assessed by TM31 liminometer and C64 tuning fork. Along with the improved glycemic control, lipid metabolism (total cholesterol, triglyceride and FFA) was significantly improved. Thus, short-term intensive glycemic control can improve vibratory sensation, metabolic changes in glucose and lipid metabolism being the factors responsible for improved of peripheral nerve function. PMID:18262304

  7. Intensive Glycemic Control in Cardiac Surgery.

    PubMed

    Tsai, Lillian L; Jensen, Hanna A; Thourani, Vinod H

    2016-04-01

    Hyperglycemia has been found to be associated with increased morbidity and mortality in surgical patients, yet, the optimal glucose management strategy during the perioperative setting remains undetermined. While much has been published about hyperglycemia and cardiac surgery, most studies have used widely varying definitions of hyperglycemia, methods of insulin administration, and the timing of therapy. This has only allowed investigators to make general conclusions in this challenging clinical scenario. This review will introduce the basic pathophysiology of hyperglycemia in the cardiac surgery setting, describe the main clinical consequences of operative hyperglycemia, and take the reader through the published material of intensive and conservative glucose management. Overall, it seems that intensive control has modest benefits with adverse effects often outweighing these advantages. However, some studies have indicated differing results for certain patient subgroups, such as non-diabetics with acute operative hyperglycemia. Future studies should focus on distinguishing which patient populations, if any, would optimally benefit from intensive insulin therapy. PMID:26879308

  8. Mobile Diabetes Intervention for Glycemic Control

    PubMed Central

    Sareh, Patricia L.; Shardell, Michelle L.; Terrin, Michael L.; Barr, Erik A.; Gruber-Baldini, Ann L.

    2014-01-01

    Of adults with type 2 diabetes, 84% take antihyperglycemic medication. Successful treatment requires active monitoring and medication dose adjustment by health providers. The objective of this study was to determine how a mobile-phone-based coaching system for diabetes management influences physician prescribing behavior. This secondary data analysis is based on a cluster randomized clinical trial that reported patients provided with mobile self-management had reduction in glycated hemoglobin (HbA1c) of 1.9% over 1 year, compared to 0.7% in control patients (P < .001). Participants were primary care patients with type 2 diabetes randomized at physician practice level into a control group (n = 55) and intervention group (n = 62). Main study measures were patients’ medication records (medication, dose, frequency, start and end date) abstracted at baseline and study end. Antihyperglycemic medications, including sulfonylureas or thiazolidinediones, and antihypertensive and antilipemic medications were analyzed. A higher percentage of patients in the intervention group had modification and intensification of incretin mimetics during the 1-year study period (9.7% vs 0.0% and 8.1% vs 0.0%, both P = .008). A higher percentage of patients in the intervention group had modification and intensification of metformin (24.2% vs 7.3%, P = .033). The overall difference in physician prescribing of oral antihyperglycemic medications was not statistically significant. Our results suggest mobile diabetes interventions can encourage physicians to modify and intensify antihyperglycemic medications in patients with type 2 diabetes. Differences in physician prescribing behavior were modest, and do not appear to be large enough to explain a 1.2% decrease in HbA1c. PMID:24876589

  9. Effect of Fructose on Glycemic Control in Diabetes

    PubMed Central

    Cozma, Adrian I.; Sievenpiper, John L.; de Souza, Russell J.; Chiavaroli, Laura; Ha, Vanessa; Wang, D. David; Mirrahimi, Arash; Yu, Matt E.; Carleton, Amanda J.; Di Buono, Marco; Jenkins, Alexandra L.; Leiter, Lawrence A.; Wolever, Thomas M.S.; Beyene, Joseph; Kendall, Cyril W.C.; Jenkins, David J.A.

    2012-01-01

    OBJECTIVE The effect of fructose on cardiometabolic risk in humans is controversial. We conducted a systematic review and meta-analysis of controlled feeding trials to clarify the effect of fructose on glycemic control in individuals with diabetes. RESEARCH DESIGN AND METHODS We searched MEDLINE, EMBASE, and the Cochrane Library (through 22 March 2012) for relevant trials lasting ≥7 days. Data were aggregated by the generic inverse variance method (random-effects models) and expressed as mean difference (MD) for fasting glucose and insulin and standardized MD (SMD) with 95% CI for glycated hemoglobin (HbA1c) and glycated albumin. Heterogeneity was assessed by the Cochran Q statistic and quantified by the I2 statistic. Trial quality was assessed by the Heyland methodological quality score (MQS). RESULTS Eighteen trials (n = 209) met the eligibility criteria. Isocaloric exchange of fructose for carbohydrate reduced glycated blood proteins (SMD −0.25 [95% CI −0.46 to −0.04]; P = 0.02) with significant intertrial heterogeneity (I2 = 63%; P = 0.001). This reduction is equivalent to a ∼0.53% reduction in HbA1c. Fructose consumption did not significantly affect fasting glucose or insulin. A priori subgroup analyses showed no evidence of effect modification on any end point. CONCLUSIONS Isocaloric exchange of fructose for other carbohydrate improves long-term glycemic control, as assessed by glycated blood proteins, without affecting insulin in people with diabetes. Generalizability may be limited because most of the trials were <12 weeks and had relatively low MQS (<8). To confirm these findings, larger and longer fructose feeding trials assessing both possible glycemic benefit and adverse metabolic effects are required. PMID:22723585

  10. Improved glycemic control in mice lacking Sglt1 and Sglt2.

    PubMed

    Powell, David R; DaCosta, Christopher M; Gay, Jason; Ding, Zhi-Ming; Smith, Melinda; Greer, Jennifer; Doree, Deon; Jeter-Jones, Sabrina; Mseeh, Faika; Rodriguez, Lawrence A; Harris, Angela; Buhring, Lindsey; Platt, Kenneth A; Vogel, Peter; Brommage, Robert; Shadoan, Melanie K; Sands, Arthur T; Zambrowicz, Brian

    2013-01-15

    Sodium-glucose cotransporter 2 (SGLT2) is the major, and SGLT1 the minor, transporter responsible for renal glucose reabsorption. Increasing urinary glucose excretion (UGE) by selectively inhibiting SGLT2 improves glycemic control in diabetic patients. We generated Sglt1 and Sglt2 knockout (KO) mice, Sglt1/Sglt2 double-KO (DKO) mice, and wild-type (WT) littermates to study their relative glycemic control and to determine contributions of SGLT1 and SGLT2 to UGE. Relative to WTs, Sglt2 KOs had improved oral glucose tolerance and were resistant to streptozotocin-induced diabetes. Sglt1 KOs fed glucose-free high-fat diet (G-free HFD) had improved oral glucose tolerance accompanied by delayed intestinal glucose absorption and increased circulating glucagon-like peptide-1 (GLP-1), but had normal intraperitoneal glucose tolerance. On G-free HFD, Sglt2 KOs had 30%, Sglt1 KOs 2%, and WTs <1% of the UGE of DKOs. Consistent with their increased UGE, DKOs had lower fasting blood glucose and improved intraperitoneal glucose tolerance than Sglt2 KOs. In conclusion, 1) Sglt2 is the major renal glucose transporter, but Sglt1 reabsorbs 70% of filtered glucose if Sglt2 is absent; 2) mice lacking Sglt2 display improved glucose tolerance despite UGE that is 30% of maximum; 3) Sglt1 KO mice respond to oral glucose with increased circulating GLP-1; and 4) DKO mice have improved glycemic control over mice lacking Sglt2 alone. These data suggest that, in patients with type 2 diabetes, combining pharmacological SGLT2 inhibition with complete renal and/or partial intestinal SGLT1 inhibition may improve glycemic control over that achieved by SGLT2 inhibition alone. PMID:23149623

  11. Indicators of glycemic control in patients with gestational diabetes mellitus and pregnant women with diabetes mellitus

    PubMed Central

    Hashimoto, Kunihiko; Koga, Masafumi

    2015-01-01

    Recently, it has become clear that mild abnormal glucose tolerance increases the incidence of perinatal maternal-infant complications, and so the definition and diagnostic criteria of gestational diabetes mellitus (GDM) have been changed. Therefore, in patients with GDM and pregnant women with diabetes mellitus, even stricter glycemic control than before is required to reduce the incidence of perinatal maternal-infant complications. Strict glycemic control cannot be attained without an indicator of glycemic control; this review proposes a reliable indicator. The gold standard indicator of glycemic control in patients with diabetes mellitus is hemoglobin A1c (HbA1c); however, we have demonstrated that HbA1c does not reflect glycemic control accurately during pregnancy because of iron deficiency. It has also become clear that glycated albumin, another indicator of glycemic control, is not influenced by iron deficiency and therefore might be a better indicator of glycemic control in patients with GDM and pregnant women with diabetes mellitus. However, large-population epidemiological studies are necessary in order to confirm our proposal. Here, we outline the most recent findings about the indicators of glycemic control during pregnancy including fructosamine and 1,5-anhydroglucitol. PMID:26240701

  12. Glycemic Control and Implant Stabilization in Type 2 Diabetes Mellitus

    PubMed Central

    Oates, T.W.; Dowell, S.; Robinson, M.; McMahan, C.A.

    2009-01-01

    Diabetes mellitus is considered a relative contra-indication for implant therapy. However, the effect of glycemic level on implant integration in persons with diabetes remains poorly understood. The hypothesis of this research was that poor glycemic control is directly related to short-term-impairment implant stabilization. This prospective clinical study evaluated 10 non-diabetic individuals (12 implants) and 20 persons with type 2 diabetes (30 implants). Glycated hemoglobin (HbA1c) levels ranged from 4.7-12.6%. Implant stability was assessed by resonance frequency analysis over 4 months following placement. Minimum stability levels were observed 2-6 weeks following placement for all 42 implants. Persons with HbA1c ≥ 8.1% had a greater maximum decrease in stability from baseline and required a longer time for healing, as indicated by return of stability level to baseline. This study demonstrates alterations in implant stability consistent with impaired implant integration for persons with type 2 diabetes mellitus in direct relation to hyperglycemic conditions. PMID:19407159

  13. Glycemic control in the burn intensive care unit: focus on the role of anemia in glucose measurement.

    PubMed

    Mann, Elizabeth A; Mora, Alejandra G; Pidcoke, Heather F; Wolf, Steven E; Wade, Charles E

    2009-11-01

    Glycemic control with intensive insulin therapy (IIT) has received widespread adoption secondary to findings of improved clinical outcomes and survival in the burn population. Severe burn as a model for trauma is characterized by a hypermetabolic state, hyperglycemia, and insulin resistance. In this article, we review the findings of a burn center research facility in terms of understanding glucose management. The conferred benefits from IIT, our findings of poor outcomes associated with glycemic variability, advantages from preserved diurnal variation of glucose and insulin, and impacts of glucometer error and hematocrit correction factor are discussed. We conclude with direction for further study and the need for a reliable continuous glucose monitoring system. Such efforts will further the endeavor for achieving adequate glycemic control in order to assess the efficacy of target ranges and use of IIT. PMID:20144386

  14. Benefits of Renin-Angiotensin Blockade on Retinopathy in Type 1 Diabetes Vary With Glycemic Control

    PubMed Central

    Harindhanavudhi, Tasma; Mauer, Michael; Klein, Ronald; Zinman, Bernard; Sinaiko, Alan; Caramori, M. Luiza

    2011-01-01

    OBJECTIVE Optimal glycemic control slows diabetic retinopathy (DR) development and progression and is the standard of care for type 1 diabetes. However, these glycemic goals are difficult to achieve and sustain in clinical practice. The Renin Angiotensin System Study (RASS) showed that renin-angiotensin system (RAS) blockade can slow DR progression. In the current study, we evaluate whether glycemic control influenced the benefit of RAS blockade on DR progression in type 1 diabetic patients. RESEARCH DESIGN AND METHODS We used RASS data to analyze the relationships between two-steps or more DR progression and baseline glycemic levels in 223 normotensive, normoalbuminuric type 1 diabetic patients randomized to receive 5 years of enalapril or losartan compared with placebo. RESULTS A total of 147 of 223 patients (65.9%) had DR at baseline (47 of 74 patients [63.5%] in placebo and 100 of 149 patients [67.1%] in the combined treatment groups [P = 0.67]). Patients with two-steps or more DR progression had higher baseline A1C than those without progression (9.4 vs. 8.2%, P < 0.001). There was no beneficial effect of RAS blockade (P = 0.92) in patients with baseline A1C ≤7.5%. In contrast, 30 of 112 (27%) patients on the active treatment arms with A1C >7.5% had two-steps or more DR progression compared with 26 of 56 patients (46%) in the placebo group (P = 0.03). CONCLUSIONS RAS blockade reduces DR progression in normotensive, normoalbuminuric type 1 diabetic patients with A1C >7.5%. Whether this therapy could benefit patients with A1C ≤7.5% will require long-term studies of much larger cohorts. PMID:21715517

  15. Are gastrointestinal symptoms related to diabetes mellitus and glycemic control?

    PubMed

    Koch, Christian A; Uwaifo, Gabriel I

    2008-09-01

    Many patients with diabetes mellitus suffer from upper and lower GI symptoms. The reported prevalence of these symptoms varies among different ethnic groups/populations. The natural history of GI symptoms as well as their pathogenesis in patients with diabetes remains poorly understood, although it is known that gastric emptying is influenced by hyperglycemia, euglycemia, and hypoglycemia. Poor glycemic control over a long period of time can lead to neuropathy and damage the vagus nerve, resulting in diabetic gastroparesis whose signs and symptoms vary in the individual patient. Gastroparesis can further worsen glycemic control by adversely altering the pharmacokinetics of orally administered hypoglycemic agents as well as by altering the delivery of diet-derived calories to intestines from which absorption, subsequently, determines incipient blood glucose, and thus effectiveness of various injectable antidiabetics including various insulins and related insulin analogs. As GI symptoms may overlap with other disorders, including functional dyspepsia, irritable bowel syndrome, and depression, it is important to have such patients/patients with diabetes undergo standardized testing for measuring gastric emptying. Certain medications including metformin, amylin analogues (i.e. pramlintide), glucagon-like peptide 1 analogs (i.e. exenatide, liraglutide), anticholinergic agents, antidepressants, calcium-channel blockers, and others may contribute to GI symptoms observed in patients with diabetes. Given the global diabetes pandemic, it is of utmost importance to not only diagnose and treat present patients with diabetes mellitus and its comorbidities, but also to help prevent the development of further disease burden by educating children and adolescents about healthy lifestyle modifications (avoidance of overeating, portion control, healthy food choices, increased physical and reduced sedentary activity), as changing behavior in adulthood has proven to be notoriously

  16. Glycemic control and diabetes management in hospitalized patients in Brazil

    PubMed Central

    2013-01-01

    Background The importance of tight blood glucose control among outpatients with diabetes mellitus is well established, however, the management of diabetes in the hospital setting is generally considered secondary in importance. This study sought to assess glycemic control and diabetes management in adult patients admitted to hospitals in Brazil. Methods A cross-sectional and nationwide survey was conducted from July 2010 to January 2012. Eligible cases were 18 years of age or older, had a diagnosis of diabetes and a hospitalization length of stay ≥72 hours. Socio-demographic information, hospitalization details, and data on diabetes diagnosis, management and treatment were collected for all patients by chart review. Information on all blood glucose (BG) readings for a maximum of 20 consecutive days of hospitalization was recorded for each patient. Results Overall, 2,399 patients were surveyed in 24 hospitals located in 13 cities from all five Brazilian regions. The prevalence of patients presenting hyperglycemic (BG >180 mg/dL) or hypoglycemic (BG <70 mg/dL) events was 89.4% and 30.9% in patients in general wards, and 88.2% and 27.7% in those in Intensive Care Units (ICUs), respectively. In addition, a BG measure >180 mg/dL was recorded in two-thirds of the patient-days. A high proportion of patients were treated with sliding-scale insulin regimen alone in the general wards (52.0%) and in the ICUs (69.2%), and only 35.7% and 3.9% received appropriate insulin therapy in general wards (basal + bolus insulin) and in ICUs (continuous IV insulin), respectively. Conclusions Inpatient glycemic control and diabetes management needs improvement. Opportunities to improve care in Brazilian hospitals include expanded use of intravenous insulin and subcutaneous basal-bolus insulin protocols, avoiding use of sliding-scale insulin alone, increased frequency of blood glucose monitoring, and institution wide quality improvement efforts targeting both physician and nursing

  17. Congestive Heart Failure and Diabetes: Balancing Glycemic Control with Heart Failure Improvement

    PubMed Central

    Nasir, Saifullah; Aguilar, David

    2012-01-01

    Diabetes and congestive heart failure (HF) commonly coexist in the same patient, and the presence of diabetes in HF patients is associated with increased adverse events compared to patients without diabetes. Recent guidelines regarding glycemic control stress individualization of glycemic therapy based on patient comorbid conditions and potential adverse effects of medical therapy. This balance in glycemic control may be particularly relevant in patients with diabetes and HF. In this review, we address data regarding the influence that certain HF medications may have on glycemic control. Despite potential modest changes in glycemic control, clinical benefits of proven pharmacologic HF therapies extend to patients with diabetes and HF. In addition, we review potential benefits and challenges associated with commonly used glycemic medications in HF patients. Finally, recent data and controversies on optimal glycemic targets in HF patients are discussed. Given the large number of patients with diabetes and HF and the health burden of these conditions, much needed future work is necessary to define the optimal glycemic treatment in HF patients with diabetes. PMID:23062568

  18. Creatine supplementation and glycemic control: a systematic review.

    PubMed

    Pinto, Camila Lemos; Botelho, Patrícia Borges; Pimentel, Gustavo Duarte; Campos-Ferraz, Patrícia Lopes; Mota, João Felipe

    2016-09-01

    The focus of this review is the effects of creatine supplementation with or without exercise on glucose metabolism. A comprehensive examination of the past 16 years of study within the field provided a distillation of key data. Both in animal and human studies, creatine supplementation together with exercise training demonstrated greater beneficial effects on glucose metabolism; creatine supplementation itself demonstrated positive results in only a few of the studies. In the animal studies, the effects of creatine supplementation on glucose metabolism were even more distinct, and caution is needed in extrapolating these data to different species, especially to humans. Regarding human studies, considering the samples characteristics, the findings cannot be extrapolated to patients who have poorer glycemic control, are older, are on a different pharmacological treatment (e.g., exogenous insulin therapy) or are physically inactive. Thus, creatine supplementation is a possible nutritional therapy adjuvant with hypoglycemic effects, particularly when used in conjunction with exercise. PMID:27306768

  19. Clinical review: Strict or loose glycemic control in critically ill patients - implementing best available evidence from randomized controlled trials

    PubMed Central

    2010-01-01

    Glycemic control aiming at normoglycemia, frequently referred to as 'strict glycemic control' (SGC), decreased mortality and morbidity of adult critically ill patients in two randomized controlled trials (RCTs). Five successive RCTs, however, failed to show benefit of SGC with one trial even reporting an unexpected higher mortality. Consequently, enthusiasm for the implementation of SGC has declined, hampering translation of SGC into daily ICU practice. In this manuscript we attempt to explain the variances in outcomes of the RCTs of SGC, and point out other limitations of the current literature on glycemic control in ICU patients. There are several alternative explanations for why the five negative RCTs showed no beneficial effects of SGC, apart from the possibility that SGC may indeed not benefit ICU patients. These include, but are not restricted to, variability in the performance of SGC, differences among trial designs, changes in standard of care, differences in timing (that is, initiation) of SGC, and the convergence between the intervention groups and control groups with respect to achieved blood glucose levels in the successive RCTs. Additional factors that may hamper translation of SGC into daily ICU practice include the feared risk of severe hypoglycemia, additional labor associated with SGC, and uncertainties about who the primarily responsible caregiver should be for the implementation of SGC. PMID:20550725

  20. Association between glycemic control and antidiabetic drugs in type 2 diabetes mellitus patients with cardiovascular complications

    PubMed Central

    Huri, Hasniza Zaman; Ling, Doris Yew Hui; Ahmad, Wan Azman Wan

    2015-01-01

    Purpose Cardiovascular disease (CVD) is a macrovascular complication in patients with type 2 diabetes mellitus (T2DM). To date, glycemic control profiles of antidiabetic drugs in cardiovascular (CV) complications have not been clearly elucidated. Therefore, this study was conducted retrospectively to assess the association of antidiabetic drugs and glycemic control with CV profiles in T2DM patients. The association of concurrent medications and comorbidities with glycemic control was also investigated. Methods A total of 220 T2DM patients from the University of Malaya Medical Centre, Malaysia, who had at least one CV complication and who had been taking at least one antidiabetic drug for at least 3 months, were included. The associations of antidiabetics, cardiovascular diseases, laboratory parameters, concurrent medications, comorbidities, demographics, and clinical characteristics with glycemic control were investigated. Results Sulfonylureas in combination (P=0.002) and sulfonylurea monotherapy (P<0.001) were found to be associated with good glycemic control, whereas insulin in combination (P=0.051), and combination biguanides and insulin therapy (P=0.012) were found to be associated with poor glycemic control. Stroke (P=0.044) was the only type of CVD that seemed to be significantly associated with good glycemic control. Other factors such as benign prostatic hyperplasia (P=0.026), elderly patients (P=0.018), low-density lipoprotein cholesterol levels (P=0.021), and fasting plasma glucose (P<0.001) were found to be significantly correlated with good glycemic control. Conclusion Individualized treatment in T2DM patients with CVDs can be supported through a better understanding of the association between glycemic control and CV profiles in T2DM patients. PMID:26316711

  1. [Dapagliflozin: Beyond glycemic control in the treatment of type 2 diabetes mellitus].

    PubMed

    Sanz-Serra, Pol; Pedro-Botet, Juan; Flores-Le Roux, Juana A; Benaiges, David; Chillarón, Juan J

    2015-01-01

    Patients with type 2 diabetes mellitus (T2DM) have a high or very high cardiovascular risk. The clinical practice guidelines focus on the need to achieve optimal glycemic control, and strategies for a multifactorial therapeutic approach have shown significant cardiovascular benefits in these patients. Inhibitors of sodium-glucose co-transporter 2 (SGLT-2) are a new class of orally administered drugs in the treatment of T2DM, which act by inhibiting reabsorption of glucose in the renal proximal tubule with consequent glycosuric effect and lowering of blood glucose. Dapagliflozin, SGLT-2 inhibitor marketed in Europe and Australia, has been shown to achieve glycosylated hemoglobin reductions similar to other oral agents, as well as beneficial effects on major comorbidities associated with T2DM. Therefore, it is considered of interest to review the clinical efficacy of this new oral hypoglycemic on glycemic control, risk of hypoglycemia, and its impact on body weight, blood pressure, lipid profile and renal function. PMID:25648671

  2. A Brief Adherence Intervention that Improved Glycemic Control: Mediation by Patterns of Adherence

    PubMed Central

    de Vries McClintock, Heather F.; Morales, Knashawn H.; Small, Dylan S.; Bogner, Hillary R.

    2014-01-01

    This study examined whether longitudinal adherence profiles mediated the relationship between a brief adherence intervention and glycemic control among patients with Type 2 diabetes. Adherence was assessed using the Medication Event Monitoring System (MEMS). Longitudinal analysis via growth curve mixture modeling was carried out to classify patients according to patterns of adherence to oral hypoglycemic agents. Hemoglobin A1c (HbA1c) assays were used to measure glycemic control as the clinical outcome. Across the whole sample, longitudinal adherence profiles mediated 35.2% (13.2%, 81.0%) of the effect of a brief adherence intervention on glycemic control (from odds ratio (OR) = 8.48, 95% CI (3.24, 22.2) to 4.00, 95% CI (1.34, 11.93)). Our results suggest that patients in the intervention had better glycemic control largely due to their greater likelihood of adherence to oral hypoglycemic agents. PMID:24913600

  3. Veganism Is a Viable Alternative to Conventional Diet Therapy for Improving Blood Lipids and Glycemic Control.

    PubMed

    Trepanowski, John F; Varady, Krista A

    2015-01-01

    The American Diabetes Association (ADA) and the National Cholesterol Education Program (NCEP) have each outlined a set of dietary recommendations aimed at improving glycemic control and blood lipids, respectively. However, traditional vegan diets (low-fat diets that proscribe animal product consumption) are also effective at improving glycemic control, and dietary portfolios (vegan diets that contain prescribed amounts of plant sterols, viscous fibers, soy protein, and nuts) are also effective at improving blood lipids. The purpose of this review was to compare the effects of traditional vegan diets and dietary portfolios with ADA and NCEP diets on body weight, blood lipids, blood pressure, and glycemic control. The main findings are that traditional vegan diets appear to improve glycemic control better than ADA diets in individuals with type 2 diabetes mellitus (T2DM), while dietary portfolios have been consistently shown to improve blood lipids better than NCEP diets in hypercholesterolemic individuals. PMID:24922183

  4. Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Almond consumption is associated with ameliorations in obesity, hyperlipidemia, hypertension, and hyperglycemia. The hypothesis of this 12-wk randomized crossover clinical trial was that almond consumption would improve glycemic control and decrease risk to cardiovascular disease in 20 Chinese type ...

  5. Clinical Outcomes of Metabolic Surgery: Efficacy of Glycemic Control, Weight Loss, and Remission of Diabetes.

    PubMed

    Schauer, Philip R; Mingrone, Geltrude; Ikramuddin, Sayeed; Wolfe, Bruce

    2016-06-01

    Since the 2007 Diabetes Surgery Summit in Rome, Italy, and the subsequent publishing of the world's first guidelines for the surgical treatment of type 2 diabetes (T2D), much new evidence regarding the efficacy and safety of metabolic surgery has emerged. Additional observational cohort studies support the superior effects of surgery over medical treatment with respect to glycemic control, weight loss, and even reduction in mortality and microvascular complications associated with T2D. Furthermore, new safety data suggest that the perioperative morbidity and mortality of metabolic surgery (5% and 0.3%, respectively) are now similar to that of common low-risk procedures, such as cholecystectomy and hysterectomy. The largest advance, however, has been the completion of 11 randomized controlled trials from around the globe that compare surgery with medical treatment of T2D. These studies with follow-up duration of 1-5 years involve nearly 800 patients without surgical mortality and with major complication rates of less than 5% and a reoperation rate of 8%. All but 1 of the 11 randomized controlled trials have shown the superiority of surgery over medical management at achieving remission or glycemic improvement. Surgery was also superior to medical treatment with respect to improving cardiovascular risk factors, such as weight loss and dyslipidemia, while reducing medication burden. This new efficacy and safety evidence should help guide physicians across the globe to the appropriate use of surgery as an effective treatment for patients suffering from T2D and obesity. PMID:27222548

  6. Glycemic control and antidiabetic drugs in type 2 diabetes mellitus patients with renal complications

    PubMed Central

    Huri, Hasniza Zaman; Lim, Lay Peng; Lim, Soo Kun

    2015-01-01

    Background Good glycemic control can delay the progression of kidney diseases in type 2 diabetes mellitus (T2DM) patients with renal complications. To date, the association between antidiabetic agents and glycemic control in this specific patient population is not well established. Purpose This study aimed to identify antidiabetic regimens as well as other factors that associated with glycemic control in T2DM patients with different stages of chronic kidney disease (CKD). Patients and methods This retrospective, cross-sectional study involved 242 T2DM inpatients and outpatients with renal complications from January 2009 to March 2014 and was conducted in a tertiary teaching hospital in Malaysia. Glycated hemoglobin (A1C) was used as main parameter to assess patients’ glycemic status. Patients were classified to have good (A1C <7%) or poor glycemic control (A1C ≥7%) based on the recommendations of the American Diabetes Association. Results Majority of the patients presented with CKD stage 4 (43.4%). Approximately 55.4% of patients were categorized to have poor glycemic control. Insulin (57.9%) was the most commonly prescribed antidiabetic medication, followed by sulfonylureas (43%). Of all antidiabetic regimens, sulfonylureas monotherapy (P<0.001), insulin therapy (P=0.005), and combination of biguanides with insulin (P=0.038) were found to be significantly associated with glycemic control. Other factors including duration of T2DM (P=0.004), comorbidities such as anemia (P=0.024) and retinopathy (P=0.033), concurrent medications such as erythropoietin therapy (P=0.047), α-blockers (P=0.033), and antigouts (P=0.003) were also correlated with A1C. Conclusion Identification of factors that are associated with glycemic control is important to help in optimization of glucose control in T2DM patients with renal complication. PMID:26300627

  7. Association between depression and glycemic control among type 2 diabetes patients in Lima, Peru

    PubMed Central

    Crispín‐Trebejo, Brenda; Bernabé‐Ortiz, Antonio

    2015-01-01

    Abstract Introduction There is limited and controversial information regarding the potential impact of depression on glycemic control. This study aims to evaluate the association between depression and poor glycemic control. In addition, the prevalence of depression and rates of poor glycemic control were determined. Methods Cross‐sectional study performed in the endocrinology unit of two hospitals of ESSALUD in Peru. The outcome of interest was poor glycemic control, evaluated by glycated hemoglobin (HbA1c: < 7% versus ≥ 7%), whereas the exposure of interest was depression defined as 15 or more points in the Patient Health Questionnaire‐9 tool. The association of interest was evaluated using Poisson regression models with robust standard errors reporting prevalence ratios (PR) and 95% confidence intervals (95% CI) adjusting for potential confounders. Results A total of 277 participants, 184 (66.4%) males, mean age 59.0 (SD: 4.8), and 7.1 (SD: 6.8) years of disease were analyzed. Only 31 participants (11.2%; 95% CI: 7.5%–14.9%) had moderately severe or severe depression, whereas 70 (25.3%; 95% CI 20.3%–30.8%) had good glycemic control. Depression increased the probability of having poor glycemic control (PR = 1.32; 95% CI 1.15–1.51) after adjusting for several potential confounders. Conclusions There is an association between depression and poor glycemic control among type 2 diabetes patients. Our results suggest that early detection of depression might be important to facilitate appropriate glycemic control and avoid further metabolic complications. PMID:26037488

  8. Postprandial blood glucose control in type 1 diabetes for carbohydrates with varying glycemic index foods.

    PubMed

    Hashimoto, Shogo; Noguchi, Claudia Cecilia Yamamoto; Furutani, Eiko

    2014-01-01

    Treatment of type 1 diabetes consists of maintaining postprandial normoglycemia using the correct prandial insulin dose according to food intake. Nonetheless, it is hardly achieved in practice, which results in several diabetes-related complications. In this study we present a feedforward plus feedback blood glucose control system that considers the glycemic index of foods. It consists of a preprandial insulin bolus whose optimal bolus dose and timing are stated as a minimization problem, which is followed by a postprandial closed-loop control based on model predictive control. Simulation results show that, for a representative carbohydrate intake of 50 g, the present control system is able to maintain postprandial glycemia below 140 mg/dL while preventing postprandial hypoglycemia as well. PMID:25571074

  9. Metabolic Management during Critical Illness: Glycemic Control in the ICU.

    PubMed

    Honiden, Shyoko; Inzucchi, Silvio E

    2015-12-01

    Hyperglycemia is a commonly encountered metabolic derangement in the ICU. Important cellular pathways, such as those related to oxidant stress, immunity, and cellular homeostasis, can become deranged with prolonged and uncontrolled hyperglycemia. There is additionally a complex interplay between nutritional status, ambient glucose concentrations, and protein catabolism. While the nuances of glucose management in the ICU have been debated, results from landmark studies support the notion that for most critically ill patients moderate glycemic control is appropriate, as reflected by recent guidelines. Beyond the target population and optimal glucose range, additional factors such as hypoglycemia and glucose variability are important metrics to follow. In this regard, new technologies such as continuous glucose sensors may help alleviate the risks associated with such glucose fluctuations in the ICU. In this review, we will explore the impact of hyperglycemia upon critical cellular pathways and how nutrition provided in the ICU affects blood glucose. Additionally, important clinical trials to date will be summarized. A practical and comprehensive approach to glucose management in the ICU will be outlined, touching upon important issues such as glucose variability, target population, and hypoglycemia. PMID:26595046

  10. Relationship between development of urethral stricture after transurethral resection of prostate and glycemic control

    PubMed Central

    Kumsar, Şükrü; Sağlam, Hasan Salih; Köse, Osman; Budak, Salih; Adsan, Oztuğ

    2014-01-01

    Objectives: The purpose of this study is to investigate the association of glycemic control prior to TUR-P and postoperative urethral stricture development. Materials and Methods: Of the 168 patients with a diagnosis of urethral stricture, who underwent internal urethrotomy in our hospital were retrospectively analyzed for this study. 98 patients who underwent monopolar TUR-P in our hospital previously and were developed urethral stricture were divided into two groups as diabetic and nondiabetic. Based on their HbA1c concentrations, diabetics were allocated to two groups with good (HbA1c ≤6.5%) or poor (HbA1c > 6,5%) glycemic control. Time to internal urethrotomy and the other operative parameters were compared among groups. Results: Time to internal urethrotomy after TUR-P was significantly shorter in diabetic patients with poor glycemic control than Group 1 and Group 2 (P = 0,02, P = 0,012) but no significant difference was found between Group 1 and Group 2 (P = 0,368). There was no significant difference in the mean diagnosed and resected prostate wight among groups There was no significant difference in the mean resection time and the mean time to urethral catheter removal among groups. Conclusions: Especially in poor glycemic control patients, urethral stricture development was seen in the early period after TUR-P. For this reason, in the elective TUR-P scheduled poor glycemic controlled patients the operation should be done after glycemic control. PMID:25371609

  11. Effect of current glycemic control on qualitative body composition in sedentary ambulatory Type 2 diabetics

    PubMed Central

    Solanki, Jayesh Dalpatbhai; Makwana, Amit H.; Mehta, Hemant B.; Kamdar, Panna; Gokhale, Pradnya A.; Shah, Chinmay J.

    2016-01-01

    Background: Obesity and Type 2 diabetes mellitus are on rise with cause–effect relationship. Diabetics monitor blood sugar, neglecting qualitative body composition, leaving residual threat of ectopic fat unattended. We tried to correlate glycemic triad with parameters of body composition derived objectively by bioelectrical impedance analysis (BIA). Materials and Methods: A sample of 78 under treatment sedentary Type 2 diabetics of either sex with known glycemic and lipidemic control from our city. Following baseline assessment measurement was done by instrument Omron Karada Scan (Model HBF-510, China) using the principle of tetra poplar BIA to derive parameters of body composition. We tried to correlate glycemic triad with these parameters, both directly as well as after defining them as per established cutoff norms. Results: We found poor glycemic control in the study group (20% for Hb1AC), high body mass index, subcutaneous fat, visceral fat (VF), total body fat (TBF), and lesser mass of skeletal muscle in Type 2 diabetics. However, there were small, insignificant, and inconsistent difference of these parameters while directly correlating with the fasting blood sugar, postprandial blood sugar, and glycosylated hemoglobin. On qualitative assessment, the impact of glycemic control as per standard norms, the risk of high VF, high TBF, low skeletal muscle mass was though high (between 1 and 2) in Type 2 diabetics with poor glycemic control as compared to good glycemics, but each strength lacks statistical significance. Conclusion: BIA reveals that Type 2 diabetics have more ectopic fat on expense of skeletal muscle that do not correlate with current glycemic status, both quantitatively and qualitatively. Measurement of body composition can be included and subjects can be motivated for lifestyle modification strategies while managing metabolic derangements of Type 2 diabetes. PMID:27185972

  12. Glycemic Control in a Clinic-Based Sample of Diabetics in M'Bour Senegal.

    PubMed

    BeLue, Rhonda; Ndiaye, Khadidiatou; NDao, Fatou; Ba, Fatou Niass Niang; Diaw, Mor

    2016-04-01

    Background Sub-Saharan Africa (SSA) including Senegal is faced with a significant and increasing burden of type 2 diabetes. However, little information is available about diabetes management among Senegalese diabetics.Purpose The current study aims to describe the level of glycemic control among a convenience sample of diabetics who receive care at the M'Bour Hospital in M'Bour, Senegal.Methods A total of 106 type 2 diabetic patients were recruited at the hospital complex of M'Bour, Senegal. Linear regression was employed to assess the relationship between clinical and sociodemographic factors and Hba1c.Results Only 24.8% of the sample had glycemic control, according to an Hba1c test. Participants who were diagnosed earlier were less likely to have diabetes control (mean = 7.8 years) compared with those who were diagnosed more recently (mean = 6.5 years);p< .05.Conclusions We found that glycemic control in our sample was suboptimal. Length of time with diabetes was one of the key factors related to glycemic control. Length of time with diabetes is negatively associated with glycemic control. Early diagnosis and early glycemic control are essential to long-term glycemic control screening, and early detection for diabetes is uncommon given the general lack of health insurance and most people paying out of pocket for medical care. In the absence of universal health insurance, public health programs that provide blood sugar screenings for high-risk individuals would provide preliminary indication of abnormal glucose; however, subsequent diagnostic testing and follow-up may still be cost prohibitive. PMID:27037142

  13. Combination therapy with insulin and oral agents: optimizing glycemic control in patients with type 2 diabetes mellitus.

    PubMed

    Yki-Järvinen, Hannele

    2002-01-01

    The United Kingdom Prospective Diabetes Study (UKPDS) showed that tight glycemic control with any of several therapeutic regimens has the potential to significantly reduce the risk for long-term microvascular complications of type 2 diabetes. An important question that remains to be answered is what is the best approach to optimizing glycemic control in patients with this disease. This article reviews results of studies in which insulin was used alone or in combination with oral antidiabetic agents for treatment of patients with type 2 diabetes. Analysis of comparative studies (13 in insulin-naive and 26 in previously insulin-treated patients) showed that combination therapy involving one to two insulin injections per day plus oral therapy is usually more effective than insulin monotherapy for achieving and maintaining glycemic control. Combination treatment for type 2 diabetes can be significantly improved by newly developed preparations that lack the major limitations of older products. Once-daily administration of isophane insulin (NPH insulin) is limited by a 15-18-h duration of action and a peak effect that occurs about 6 h after injection. Insulin glargine, a new insulin analogue developed using recombinant DNA technology, has a flat pharmacodynamic profile and a 24-h duration of action. Results from a recent comparative study indicate that insulin glargine plus oral therapy may provide better post-dinner glucose control as well as less symptomatic and nocturnal hypoglycemia than oral therapy combined with NPH insulin. The studies reviewed in the present article support the conclusion that combination therapy with insulin glargine combined with one or more oral antidiabetic agents may be the treatment of choice for achieving glycemic control in patients with type 2 diabetes. PMID:12324990

  14. Improvement of Glycemic Control in Insulin-Dependent Diabetics with Depression by Concomitant Treatment with Antidepressants.

    PubMed

    Radojkovic, Jana; Sikanic, Natasa; Bukumiric, Zoran; Tadic, Marijana; Kostic, Nada; Babic, Rade

    2016-01-01

    BACKGROUND It is still disputable whether negative effects of comorbid depression in diabetics can be diminished by successful treatment of depression. The primary aim of this study was to assess whether addition of antidepressants to existing insulin treatment would further improve glycemic control in these patients. A secondary objective was to assess whether such treatment impairs their lipid and inflammatory status. MATERIAL AND METHODS Total of 192 patients with poorly controlled diabetes (defined as HbA1c ≥8%) in the absence of any uncontrolled medical condition entered the 6-month run-in phase with optimization of diabetic therapy. Depression status was screened at the end of this phase by BDI-II depression testing. Patients with BDI-II ≥14 and psychiatric confirmation of depression (58 patients) entered the 6-month interventional phase with SSRI class antidepressants. RESULTS Fifty patients completed the study. During the run-in phase, HbA1c dropped from 10.0±1.8% to 8.5±1.2% (p<0.001), and during the interventional phase it dropped from 8.5±1.2% to 7.7±0.7% (p<0.001). BDI-II scores improved significantly from 30.4±13.2 to 23.5±11.0 (p=0.02) during the interventional phase. A positive linear correlation between improvement in depression scale and improvement in glycemic control was observed (R²=0.139, p=0.008). Lipid profile and inflammatory status did not change significantly during the interventional phase. CONCLUSIONS Patients with poorly controlled diabetes and comorbid depression might benefit from screening and treatment of depression with SSRI antidepressants by achieving an incremental effect on glycoregulation. This therapy did not have any adverse effects on lipid profile or inflammatory status. PMID:27329213

  15. Improvement of Glycemic Control in Insulin-Dependent Diabetics with Depression by Concomitant Treatment with Antidepressants

    PubMed Central

    Radojkovic, Jana; Sikanic, Natasa; Bukumiric, Zoran; Tadic, Marijana; Kostic, Nada; Babic, Rade

    2016-01-01

    Background It is still disputable whether negative effects of comorbid depression in diabetics can be diminished by successful treatment of depression. The primary aim of this study was to assess whether addition of antidepressants to existing insulin treatment would further improve glycemic control in these patients. A secondary objective was to assess whether such treatment impairs their lipid and inflammatory status. Material/Methods Total of 192 patients with poorly controlled diabetes (defined as HbA1c ≥8%) in the absence of any uncontrolled medical condition entered the 6-month run-in phase with optimization of diabetic therapy. Depression status was screened at the end of this phase by BDI-II depression testing. Patients with BDI-II ≥14 and psychiatric confirmation of depression (58 patients) entered the 6-month interventional phase with SSRI class antidepressants. Results Fifty patients completed the study. During the run-in phase, HbA1c dropped from 10.0±1.8% to 8.5±1.2% (p<0.001), and during the interventional phase it dropped from 8.5±1.2% to 7.7±0.7% (p<0.001). BDI-II scores improved significantly from 30.4±13.2 to 23.5±11.0 (p=0.02) during the interventional phase. A positive linear correlation between improvement in depression scale and improvement in glycemic control was observed (R2=0.139, p=0.008). Lipid profile and inflammatory status did not change significantly during the interventional phase. Conclusions Patients with poorly controlled diabetes and comorbid depression might benefit from screening and treatment of depression with SSRI antidepressants by achieving an incremental effect on glycoregulation. This therapy did not have any adverse effects on lipid profile or inflammatory status. PMID:27329213

  16. Effects of a Psychoeducational Group on Mood and Glycemic Control in Adults with Diabetes and Visual Impairments.

    ERIC Educational Resources Information Center

    Trozzolino, Linda; Thompson, Pamela S.; Tansman, Mara S.; Azen, Stanley P.

    2003-01-01

    This study evaluated the effectiveness of a 12-week psychoeducational group therapy program in improving mood and glycemic control in 48 adults with diabetes and visual impairments. Participants made statistically significant gains in glycemic control. There was a significant positive relationship between control and improvement in depression, but…

  17. Glycemic control in type 2 diabetes mellitus prevents coronary arterial wall infection

    PubMed Central

    Izadi, Morteza; Fazel, Mojgan; Karbasi-Afshar, Reza; Saadat, Seyed Hassan; Nasseri, Mohammad Hassan; Jonaidi-Jafari, Nematollah; Ranjbar, Reza; Kazemi-Saleh, Davood

    2014-01-01

    BACKGROUND Diabetes mellitus (DM) is a very well-known risk factor for development of atherosclerosis, and it has been hypothesized that poor glycemic control and hyperglycemia plays a major role in this process. In the current study, we aimed to evaluate the associates of poor glycemic control in Iranian patients who have already undergone coronary artery bypass grafting (CABG), with especial focus on the inhabitation of infectious agents within the coronary arterial wall. METHODS In January 2010, 52 consecutive patients with type 2 DM who undergone CABG at the Department of Cardiovascular Surgery of Baqiyatallah University of Medical Sciences (Tehran, Iran) were included into this cross-sectional study and biopsy specimens from their coronary plaques were taken and analyzed by polymerase chain reaction (PCR) methods for detecting Helicobacter species, cytomegalovirus (CMV) and Chlamydia pneumoniae, and their potential relation to the glycemic control status in these patients. RESULTS Compared to that in diabetic patients with mean fasting blood sugar (FBS) levels FBS < 126, atherosclerotic lesions in type 2 diabetic patients with poor glycemic control (FBS > 126) were significantly more likely to be positive for CMV PCR test (41% vs. 9%, respectively; P = 0.05). In laboratorial test results, mean triglyceride level was significantly higher among patients of poor glycemic control (168 ± 89 vs. 222 ± 125 mg/dl, respectively; P = 0.033). Hypertension was also significantly more prevalent in this population (73% vs. 36%, respectively; P = 0.034). CONCLUSION Type 2 diabetic patients with poor glycemic control can be at higher risk for developing CMV infection in their coronary arterial wall, which can promote atherosclerosis formation process in this patient population. According to the findings of this study, we recommend better control of serum glucose levels in type 2 diabetic patients to prevent formation/progression of atherosclerosis. PMID:25161684

  18. Ethnic Disparities in Glycemic Control Among Rural Older Adults with Type 2 Diabetes

    PubMed Central

    Quandt, Sara A.; Bell, Ronny A.; Snively, Beverly M.; Smith, Shannon L.; Stafford, Jeanette M.; Wetmore, Lindsay K.; Arcury, Thomas A.

    2006-01-01

    Glycemic control is a predictor of diabetes-related morbidity and mortality. However, little is known about how well older adults in rural communities, with limited access to self-care resources and specialty care practitioners, control their diabetes. Even less is known about whether minority, older, rural adults are at increased risk for poor glycemic control. We analyzed data from a cross-sectional survey of randomly selected older (≥65 years) adults with type 2 diabetes in rural North Carolina. Participants (N=693) were men and women from three ethnic groups: African American, Native American, and White. Capillary blood samples were collected for HbA1C analysis. HbA1C levels (<7%, 7%–<8%, and ≥8%) were compared across ethnic and gender groups. Two multiple logistic regression models (model 1: personal characteristics; model 2: personal and health characteristics) were used to evaluate potential predictors of HbA1C ≥7%. Overall, 36.4% had HbA1C ≥7%. Native Americans and African-American men had the highest proportion at levels of poor glycemic control (≥7%), and African-American women and White men had the lowest. In bivariate analysis, ethnicity, living arrangements, use of medications for diabetes, having a diabetes-related healthcare visit in the past year, and duration of diabetes were significantly associated with glycemic control. In multivariate analysis (model 1), being Native American, having low income without Medicaid, and being married were associated with poor glycemic control. Adding health characteristics (model 2), longer diabetes duration and diabetes medication therapy were significant predictors. These data indicate that older ethnic minorities in rural communities are at increased risk for diabetes complications and need diabetes management strategies to improve glycemic control. PMID:16259490

  19. Taking a Low Glycemic Index Multi-Nutrient Supplement as Breakfast Improves Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial

    PubMed Central

    Li, Di; Zhang, Peiwen; Guo, Honghui; Ling, Wenhua

    2014-01-01

    Dietary therapy is the mainstay of treatment for diabetes. This study examined the effect of a low glycemic index (GI) multi-nutrient supplement, consumed in place of breakfast, on glycemic control in patients with type 2 diabetes mellitus (T2DM). A total of 71 participants were randomized at a 2:1 ratio into either a breakfast replacement group or a normal breakfast group for a 12-week interventional study. The primary outcome measure was change in hemoglobin A1c (HbA1c). Nutrition status and somatometry were studied as secondary outcomes. The breakfast replacement group displayed a −0.2% absolute reduction in HbA1c (95% CI (confidence interval), −0.38% to −0.07%, p = 0.004), while the HbA1c of the control group increased 0.3% (95% CI, 0.1% to 0.5%, p = 0.005). The baseline Mini Nutritional Assessment score for both groups was 26.0 and no significant changes occurred following intervention. However, there was a statistically significant difference in body mass index between the treatment and control groups (p = 0.032) due to the weight gain in the control group (increased 0.5 kg, 95% CI was 0.2 to 0.9, p = 0.007). These data suggest that breakfast replacement with a low GI multi-nutrient supplement can improve glycemic and weight control in T2DM. PMID:25514391

  20. Taking a low glycemic index multi-nutrient supplement as breakfast improves glycemic control in patients with type 2 diabetes mellitus: a randomized controlled trial.

    PubMed

    Li, Di; Zhang, Peiwen; Guo, Honghui; Ling, Wenhua

    2014-12-01

    Dietary therapy is the mainstay of treatment for diabetes. This study examined the effect of a low glycemic index (GI) multi-nutrient supplement, consumed in place of breakfast, on glycemic control in patients with type 2 diabetes mellitus (T2DM). A total of 71 participants were randomized at a 2:1 ratio into either a breakfast replacement group or a normal breakfast group for a 12-week interventional study. The primary outcome measure was change in hemoglobin A1c (HbA1c). Nutrition status and somatometry were studied as secondary outcomes. The breakfast replacement group displayed a -0.2% absolute reduction in HbA1c (95% CI (confidence interval), -0.38% to -0.07%, p = 0.004), while the HbA1c of the control group increased 0.3% (95% CI, 0.1% to 0.5%, p = 0.005). The baseline Mini Nutritional Assessment score for both groups was 26.0 and no significant changes occurred following intervention. However, there was a statistically significant difference in body mass index between the treatment and control groups (p = 0.032) due to the weight gain in the control group (increased 0.5 kg, 95% CI was 0.2 to 0.9, p = 0.007). These data suggest that breakfast replacement with a low GI multi-nutrient supplement can improve glycemic and weight control in T2DM. PMID:25514391

  1. Food Insecurity and Glycemic Control Among Low-Income Patients With Type 2 Diabetes

    PubMed Central

    Seligman, Hilary K.; Jacobs, Elizabeth A.; López, Andrea; Tschann, Jeanne; Fernandez, Alicia

    2012-01-01

    OBJECTIVE To determine whether food insecurity—the inability to reliably afford safe and nutritious food—is associated with poor glycemic control and whether this association is mediated by difficulty following a healthy diet, diabetes self-efficacy, or emotional distress related to diabetes. RESEARCH DESIGN AND METHODS We used multivariable regression models to examine the association between food insecurity and poor glycemic control using a cross-sectional survey and chart review of 711 patients with diabetes in safety net health clinics. We then examined whether difficulty following a diabetic diet, self-efficacy, or emotional distress related to diabetes mediated the relationship between food insecurity and glycemic control. RESULTS The food insecurity prevalence in our sample was 46%. Food-insecure participants were significantly more likely than food-secure participants to have poor glycemic control, as defined by hemoglobin A1c ≥8.5% (42 vs. 33%; adjusted odds ratio 1.48 [95% CI 1.07–2.04]). Food-insecure participants were more likely to report difficulty affording a diabetic diet (64 vs. 49%, P < 0.001). They also reported lower diabetes-specific self-efficacy (P < 0.001) and higher emotional distress related to diabetes (P < 0.001). Difficulty following a healthy diet and emotional distress partially mediated the association between food insecurity and glycemic control. CONCLUSIONS Food insecurity is an independent risk factor for poor glycemic control in the safety net setting. This risk may be partially attributable to increased difficulty following a diabetes-appropriate diet and increased emotional distress regarding capacity for successful diabetes self-management. Screening patients with diabetes for food insecurity may be appropriate, particularly in the safety net setting. PMID:22210570

  2. Hope matters to the glycemic control of adolescents and young adults with type 1 diabetes.

    PubMed

    Santos, Fábio R M; Sigulem, Daniel; Areco, Kelsy C N; Gabbay, Monica A L; Dib, Sergio A; Bernardo, Viviane

    2015-05-01

    This study investigated the association of hope and its factors with depression and glycemic control in adolescents and young adults with type 1 diabetes. A total of 113 patients were invited to participate. Significant negative correlations were found between hope and HbA1c and also between hope and depression. Hope showed a significant association with HbA1c and depression in the stepwise regression model. Among the hope factors, "inner positive expectancy" was significantly associated with HbA1c and depression. This study supports that hope matters to glycemic control and depression. Intervention strategies focusing on hope should be further explored. PMID:25903254

  3. Interactions between Starch, Lipids, and Proteins in Foods: Microstructure Control for Glycemic Response Modulation.

    PubMed

    Parada, Javier; Santos, Jose L

    2016-10-25

    In real food, starch is usually forming part of a matrix with lipids and proteins. However, research on this ternary system and interactions between such food components has been scarce so far. The control of food microstructure is crucial to determine the product properties, including sensorial and nutritionals ones. This paper reviews the microstructural principles of interactions between starch, lipids, and proteins in foods as well as their effect on postprandial glycemic response, considering human intrinsic differences on postprandial glycemic responses. Several lines of research support the hypothesis that foods without rapidly digestible starch will not mandatorily generate the lowest postprandial glycemic response, highlighting that the full understanding of food microstructure, which modulates starch digestion, plays a key role on food design from a nutritional viewpoint. PMID:25831145

  4. Utility of different glycemic control metrics for optimizing management of diabetes

    PubMed Central

    Kohnert, Klaus-Dieter; Heinke, Peter; Vogt, Lutz; Salzsieder, Eckhard

    2015-01-01

    The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin (HbA1c). Despite its importance as an indicator for the development of diabetic complications, recent studies have revealed that this metric has some limitations; it conveys a rather complex message, which has to be taken into consideration for diabetes screening and treatment. On the basis of recent clinical trials, the relationship between HbA1c and cardiovascular outcomes in long-standing diabetes has been called into question. It becomes obvious that other surrogate and biomarkers are needed to better predict cardiovascular diabetes complications and assess efficiency of therapy. Glycated albumin, fructosamin, and 1,5-anhydroglucitol have received growing interest as alternative markers of glycemic control. In addition to measures of hyperglycemia, advanced glucose monitoring methods became available. An indispensible adjunct to HbA1c in routine diabetes care is self-monitoring of blood glucose. This monitoring method is now widely used, as it provides immediate feedback to patients on short-term changes, involving fasting, preprandial, and postprandial glucose levels. Beyond the traditional metrics, glycemic variability has been identified as a predictor of hypoglycemia, and it might also be implicated in the pathogenesis of vascular diabetes complications. Assessment of glycemic variability is thus important, but exact quantification requires frequently sampled glucose measurements. In order to optimize diabetes treatment, there is a need for both key metrics of glycemic control on a day-to-day basis and for more advanced, user-friendly monitoring methods. In addition to traditional discontinuous glucose testing, continuous glucose sensing has become a useful tool to reveal insufficient glycemic management. This new technology is particularly effective in patients with complicated diabetes and provides the opportunity to characterize

  5. Determinants of glycemic control in youth with type 2 diabetes at randomization in the TODAY study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The purpose of this study was to investigate insulin sensitivity and secretion indices and determinants of glycemic control in youth with recent-onset type 2 diabetes (T2DM) at randomization in the TODAY study, the largest study of youth with T2DM to date. We examined estimates of insulin sensitivit...

  6. Glycemic Control in a Clinic-Based Sample of Diabetics in M'Bour Senegal

    ERIC Educational Resources Information Center

    BeLue, Rhonda; Ndiaye, Khadidiatou; NDao, Fatou; Ba, Fatou Niass Niang; Diaw, Mor

    2016-01-01

    Background: Sub-Saharan Africa (SSA) including Senegal is faced with a significant and increasing burden of type 2 diabetes. However, little information is available about diabetes management among Senegalese diabetics. Purpose: The current study aims to describe the level of glycemic control among a convenience sample of diabetics who receive…

  7. Association of Exercise Stages of Change with Glycemic Control in Individuals with Type 2 Diabetes.

    ERIC Educational Resources Information Center

    Natarajan, Sundar; Clyburn, Ernest B.; Brown, Ronald T.

    2002-01-01

    Investigated the distribution of diabetic patients' stages of change to follow an exercise regimen, examining whether later stages of change were associated with better glycemic control. Data on participants from a primary care clinic (who were predominantly black, female, and indigent) indicated that over half of were in pre-contemplation,…

  8. Low Glycemic Index Carbohydrates versus All Types of Carbohydrates for Treating Diabetes in Pregnancy: A Randomized Clinical Trial to Evaluate the Effect of Glycemic Control

    PubMed Central

    Perichart-Perera, Otilia; Balas-Nakash, Margie; Rodríguez-Cano, Ameyalli; Legorreta-Legorreta, Jennifer; Parra-Covarrubias, Adalberto; Vadillo-Ortega, Felipe

    2012-01-01

    Background. Due to the higher prevalence of obesity and diabetes mellitus (DM), more pregnant women complicated with diabetes are in need of clinical care. Purpose. Compare the effect of including only low glycemic index (GI) carbohydrates (CHO) against all types of CHO on maternal glycemic control and on the maternal and newborn's nutritional status of women with type 2 DM and gestational diabetes mellitus (GDM). Methods. Women (n = 107, ≤29 weeks of gestation) were randomly assigned to one of two nutrition intervention groups: moderate energy and CHO restriction (Group 1: all types of CHO, Group 2: low GI foods). Results. No baseline differences in clinical data were observed. Capillary glucose concentrations throughout pregnancy were similar between groups. Fewer women in Group 2 exceeded weight gain recommendations. Higher risk of prematurity was observed in women in Group 2. No differences in glycemic control were observed between women with type 2 DM and those with GDM. Conclusions. Inclusion of low GI CHO as part of a comprehensive nutrition intervention is equally effective in improving glycemic control as compared to all types of CHO. This strategy had a positive effect in preventing excessive maternal weight gain but increased the risk of prematurity. PMID:23251152

  9. Effect of aerobic and anaerobic exercises on glycemic control in type 1 diabetic youths

    PubMed Central

    Lukács, Andrea; Barkai, László

    2015-01-01

    AIM: To evaluate the long-term effect of aerobic and/or anaerobic exercise on glycemic control in youths with type 1 diabetes. METHODS: Literature review was performed in spring and summer 2014 using PubMed/MEDLINE, Google Scholar, Scopus, and ScienceDirect with the following terms: aerobic, anaerobic, high-intensity, resistance, exercise/training, combined with glycemic/metabolic control, glycated haemoglobin A1c (HbA1c) and type 1 diabetes. Only peer-reviewed articles in English were included published in the last 15 years. It was selected from 1999 to 2014. Glycemic control was measured with HbA1c. Studies with an intervention lasting at least 12 wk were included if the HbA1c was measured before and after the intervention. RESULTS: A total of nine articles were found, and they were published between the years of 2002-2011. The sample size was 401 diabetic youths (166 males and 235 females) with an age range of 10-19 years except one study, in which the age range was 13-30 years. Study participants were from Australia, Tunisia, Lithuania, Taiwan, Turkey, Brazilia, Belgium, Egypt and France. Four studies were aerobic-based, four were combined aerobic and anaerobic programs, and one compared aerobic exercise to anaerobic one. Available studies had insufficient evidence that any type of exercise or combined training would clearly improve the glycemic control in type 1 diabetic youth. Only three (two aerobic-based and one combined) studies could provide a significant positive change in glycemic control. CONCLUSION: The regular physical exercise has several other valuable physiological and health benefits that justify the inclusion of exercise in pediatric diabetes treatment and care. PMID:25897363

  10. Association Between Cardiorespiratory Fitness and the Determinants of Glycemic Control Across the Entire Glucose Tolerance Continuum

    PubMed Central

    Malin, Steven K.; Karstoft, Kristian; Knudsen, Sine H.; Haus, Jacob M.; Laye, Matthew J.; Kirwan, John P.

    2015-01-01

    OBJECTIVE Cardiorespiratory fitness (VO2max) is associated with glycemic control, yet the relationship between VO2max and the underlying determinants of glycemic control is less clear. Our aim was to determine whether VO2max is associated with insulin sensitivity, insulin secretion, and the disposition index, a measure of compensatory pancreatic β-cell insulin secretion relative to insulin sensitivity, in subjects representing the entire range of the glucose tolerance continuum. RESEARCH DESIGN AND METHODS A cohort of subjects (N = 313) with heterogeneous age, sex, BMI, and glycemic control underwent measurements of body composition, HbA1c, fasting glucose, oral glucose tolerance (OGTT), and VO2max. OGTT-derived insulin sensitivity (SiOGTT), glucose-stimulated insulin secretion (GSISOGTT), and the disposition index (DIOGTT) (the product of SiOGTT and GSISOGTT) were measured, and associations between VO2max and these determinants of glycemic control were examined. RESULTS A low VO2max was associated with high HbA1c (r = −0.33), high fasting glucose (r = −0.34), high 2-h OGTT glucose (r = −0.33), low SiOGTT (r = 0.73), and high early-phase (r = −0.34) and late-phase (r = −0.36) GSISOGTT. Furthermore, a low VO2max was associated with low early- and late-phase DIOGTT (both r = 0.41). Interestingly, relationships between VO2max and either glycemic control or late-phase GSISOGTT deteriorated across the glucose tolerance continuum. CONCLUSIONS The association between poor cardiorespiratory fitness and compromised pancreatic β-cell compensation across the entire glucose tolerance continuum provides additional evidence highlighting the importance of fitness in protection against the onset of a fundamental pathophysiological event that leads to type 2 diabetes. PMID:25784661

  11. Prevalence of Asthma and Its Association With Glycemic Control Among Youth With Diabetes

    PubMed Central

    Black, Mary Helen; Anderson, Andrea; Bell, Ronny A.; Dabelea, Dana; Pihoker, Catherine; Saydah, Sharon; Seid, Michael; Standiford, Debra A.; Waitzfelder, Beth; Marcovina, Santica M.

    2011-01-01

    OBJECTIVE: To estimate the prevalence of asthma among youth with types 1 and 2 diabetes and examine associations between asthma and glycemic control. METHODS: This was a cross-sectional analysis of data from the SEARCH for Diabetes in Youth study, which included youth diagnosed with type 1 (n = 1683) and type 2 (n = 311) diabetes from 2002 through 2005. Asthma status and medications were ascertained from medical records and self-administered questionnaires, and glycemic control was assessed from hemoglobin A1c measured at the study visit. RESULTS: Prevalence of asthma among all youth with diabetes was 10.9% (95% confidence interval [CI]: 9.6%–12.3%). The prevalence was 10.0% (95% CI: 8.6%–11.4%) among youth with type 1 and 16.1% (95% CI: 12.0%–20.2%) among youth with type 2 diabetes and differed according to race/ethnicity. Among youth with type 1 diabetes, those with asthma had higher mean A1c levels than those without asthma, after adjustment for age, gender, race/ethnicity, and BMI (7.77% vs 7.49%; P = .034). Youth with asthma were more likely to have poor glycemic control, particularly those with type 1 diabetes whose asthma was not treated with pharmacotherapy, although this association was attenuated by adjustment for race/ethnicity. CONCLUSIONS: Prevalence of asthma may be elevated among youth with diabetes relative to the general US population. Among youth with type 1 diabetes, asthma is associated with poor glycemic control, especially if asthma is untreated. Specific asthma medications may decrease systemic inflammation, which underlies the complex relationship between pulmonary function, BMI, and glycemic control among youth with diabetes. PMID:21949144

  12. Effect of glycemic control on the risk of pancreatic cancer: A nationwide cohort study.

    PubMed

    Er, Kian-Ching; Hsu, Chen-Yang; Lee, Yi-Kung; Huang, Ming-Yuan; Su, Yung-Cheng

    2016-06-01

    Although the relationship between diabetes and pancreatic cancer has been studied, the effects of glycemic control on pancreatic cancer have never been evaluated. This study investigates the relationship between glycemic control and pancreatic cancer.Data from 1 million National Health Insurance beneficiaries were screened. The study cohort consisted of 46,973 diabetic patients and 652,142 nondiabetic subjects. Of the patients with diabetes, 1114 who had been admitted for hyperglycemic crisis episodes were defined as having poorly controlled diabetes. All adult beneficiaries were followed from January 1, 2005 to December 31, 2013, to determine whether pancreatic cancer was diagnosed. The Cox regression model was applied to compare the adjusted hazards for potential confounders.After controlling for age, sex, urbanization level, socioeconomic status, chronic liver disease, hypertension, coronary artery disease, hyperlipidemia, malignancies, smoking, chronic obstructive pulmonary disease, obesity, history of alcohol intoxication, chronic renal insufficiency, biliary tract disease, chronic pancreatitis, Charlson Comorbidity Index score, and high-dimensional propensity score, the adjusted hazard ratio of pancreatic cancer was 2.53 (95% confidence interval 1.96-3.26) in patients with diabetes. In diabetic patients with poor glycemic control, the hazard ratio of pancreatic cancer was significantly higher (hazard ratio 3.61, 95% confidence interval 1.34-9.78).This cohort study reveals a possible relationship between diabetes and pancreatic cancer. Moreover, poorly controlled diabetes may be associated with a higher possibility of pancreatic cancer. PMID:27311001

  13. Community Interventions to Improve Glycemic Control in African Americans With Type 2 Diabetes: A Systemic Review

    PubMed Central

    Smalls, Brittany L.; Walker, Rebekah J.; Bonilha, Heather S.; Campbell, Jennifer A.; Egede, Leonard E.

    2015-01-01

    Purpose: The purpose of this study was to conduct a systematic review of published community interventions to evaluate different components of community interventions and their ability to positively impact glycemic control in African Americans with T2DM. Methods: Medline, PsychInfo, and CINAHL were searched for potentially eligible studies published from January 2000 through January 2012. The following inclusion criteria were established for publications: (1) describe a community intervention, not prevention; (2) specifically indicate, in data analysis and results, the impact of the community intervention on African American adults, 18 years and older; (3) measure glycemic control (HbA1C) as an outcome measure; and (4) involve patients in a community setting, which excludes hospitals and hospital clinics. Results: Thirteen studies out of 9,233 articles identified in the search met the predetermined inclusion criteria. There were 5 randomized control trials and 3 reported improved glycemic control in the intervention group compared to the control group at the completion of the study. Of the 8 studies that were not randomized control trials, 6 showed a statistically significant change in HbA1C. Conclusion: In general, the community interventions assessed led to significant reductions in HbA1C in African Americans with type 2 diabetes. Community health workers did not have a greater impact on glycemic control in this sample. The findings of this study provides insight for designing community-based interventions in the future, such as including use of multiple delivery methods, consideration of mobile device software, nutritionist educator, and curriculum-based approaches. PMID:26156923

  14. Beyond Glycemic Control in Diabetes Mellitus: Effects of Incretin-Based Therapies on Bone Metabolism

    PubMed Central

    Ceccarelli, Elena; Guarino, Elisa G.; Merlotti, Daniela; Patti, Aurora; Gennari, Luigi; Nuti, Ranuccio; Dotta, Francesco

    2013-01-01

    Diabetes mellitus (DM) and osteoporosis (OP) are common disorders with a significant health burden, and an increase in fracture risk has been described both in type 1 (T1DM) and in type 2 (T2DM) diabetes. The pathogenic mechanisms of impaired skeletal strength in diabetes remain to be clarified in details and they are only in part reflected by a variation in bone mineral density. In T2DM, the occurrence of low bone turnover together with a decreased osteoblast activity and compromised bone quality has been shown. Of note, some antidiabetic drugs (e.g., thiazolidinediones, insulin) may deeply affect bone metabolism. In addition, the recently introduced class of incretin-based drugs (i.e., GLP-1 receptor agonists and DPP-4 inhibitors) is expected to exert potentially beneficial effects on bone health, possibly due to a bone anabolic activity of GLP-1, that can be either direct or indirect through the involvement of thyroid C cells. Here we will review the established as well as the putative effects of incretin hormones and of incretin-based drugs on bone metabolism, both in preclinical models and in man, taking into account that such therapeutic strategy may be effective not only to achieve a good glycemic control, but also to improve bone health in diabetic patients. PMID:23785355

  15. A RANDOMIZED CONTROLLED TRIAL OF RESISTANCE EXERCISE TRAINING TO IMPROVE GLYCEMIC CONTROL IN OLDER ADULTS WITH TYPE 2 DIABETES

    Technology Transfer Automated Retrieval System (TEKTRAN)

    OBJECTIVE-To determine the efficacy of high-intensity progressive resistance training (PRT) on glycemic control in older adults with type 2 diabetes. RESEARCH DESIGN AND METHODS-We performed a 16-week randomized controlled trial in 62 Latino older adults (40 women and 22 men; mean +/- SE age 66 +/...

  16. Association between Responsible Pet Ownership and Glycemic Control in Youths with Type 1 Diabetes.

    PubMed

    Maranda, Louise; Gupta, Olga T

    2016-01-01

    Type 1 diabetes mellitus (T1DM) a chronic characterized by an absolute insulin deficiency requires conscientious patient self-management to maintain glucose control within a normal range. Family cohesion and adaptability, positive coping strategies, social support and adequate self-regulatory behavior are found to favorably influence glycemic control. Our hypothesis was that the responsible care of a companion animal is associated with these positive attributes and correlated with the successful management of a chronic illness such as type 1 diabetes. We recruited 223 youths between 9 and 19 years of age from the Pediatric Diabetes clinic at the University of Massachusetts Medical School, reviewed the status of their glycemic control (using three consecutive A1c values) and asked them questions about the presence of a pet at home, and their level of involvement with its care. Multivariate analyses show that children who care actively for one or more pets at home are 2.5 times more likely to have control over their glycemic levels than children who do not care for a pet, adjusting for duration of disease, socio-economic status, age and self-management [1.1 to 5.8], pWald = 0.032. A separate model involving the care of a petdog only yielded comparable results (ORa = 2.6 [1.1 to 5.9], pWald = 0.023). PMID:27104736

  17. Association between Responsible Pet Ownership and Glycemic Control in Youths with Type 1 Diabetes

    PubMed Central

    2016-01-01

    Type 1 diabetes mellitus (T1DM) a chronic characterized by an absolute insulin deficiency requires conscientious patient self-management to maintain glucose control within a normal range. Family cohesion and adaptability, positive coping strategies, social support and adequate self-regulatory behavior are found to favorably influence glycemic control. Our hypothesis was that the responsible care of a companion animal is associated with these positive attributes and correlated with the successful management of a chronic illness such as type 1 diabetes. We recruited 223 youths between 9 and 19 years of age from the Pediatric Diabetes clinic at the University of Massachusetts Medical School, reviewed the status of their glycemic control (using three consecutive A1c values) and asked them questions about the presence of a pet at home, and their level of involvement with its care. Multivariate analyses show that children who care actively for one or more pets at home are 2.5 times more likely to have control over their glycemic levels than children who do not care for a pet, adjusting for duration of disease, socio-economic status, age and self-management [1.1 to 5.8], pWald = 0.032. A separate model involving the care of a petdog only yielded comparable results (ORa = 2.6 [1.1 to 5.9], pWald = 0.023). PMID:27104736

  18. Chronotype Is Independently Associated With Glycemic Control in Type 2 Diabetes

    PubMed Central

    Reutrakul, Sirimon; Hood, Megan M.; Crowley, Stephanie J.; Morgan, Mary K.; Teodori, Marsha; Knutson, Kristen L.; Van Cauter, Eve

    2013-01-01

    OBJECTIVE To examine whether chronotype and daily caloric distribution are associated with glycemic control in patients with type 2 diabetes independently of sleep disturbances. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes had a structured interview and completed questionnaires to collect information on diabetes history and habitual sleep duration, quality, and timing. Shift workers were excluded. A recently validated construct derived from mid-sleep time on weekends was used as an indicator of chronotype. One-day food recall was used to compute the temporal distribution of caloric intake. Hierarchical linear regression analyses controlling for demographic and sleep variables were computed to determine whether chronotype was associated with HbA1c values and whether this association was mediated by a higher proportion of caloric intake at dinner. RESULTS We analyzed 194 completed questionnaires. Multiple regression analyses adjusting for age, sex, race, BMI, insulin use, depressed mood, diabetes complications, and perceived sleep debt found that chronotype was significantly associated with glycemic control (P = 0.001). This association was partially mediated by a greater percentage of total daily calories consumed at dinner. CONCLUSIONS Later chronotype and larger dinner were associated with poorer glycemic control in patients with type 2 diabetes independently of sleep disturbances. These results suggest that chronotype may be predictive of disease outcomes and lend further support to the role of the circadian system in metabolic regulation. PMID:23637357

  19. DURATION-1: Exenatide Once Weekly Produces Sustained Glycemic Control and Weight Loss Over 52 Weeks

    PubMed Central

    Buse, John B.; Drucker, Daniel J.; Taylor, Kristin L.; Kim, Terri; Walsh, Brandon; Hu, Hao; Wilhelm, Ken; Trautmann, Michael; Shen, Larry Z.; Porter, Lisa E.

    2010-01-01

    OBJECTIVE In the Diabetes Therapy Utilization: Researching Changes in A1C, Weight and Other Factors Through Intervention with Exenatide Once Weekly (DURATION-1) study, the safety and efficacy of 30 weeks of treatment with the glucagon-like peptide-1 receptor agonist exenatide once weekly (exenatide QW; 2 mg) was compared with exenatide BID in 295 patients with type 2 diabetes. We now report the safety and efficacy of exenatide QW in 1) patients who continued treatment for an additional 22 weeks (52 weeks total) and 2) patients who switched from exenatide BID to exenatide QW after 30 weeks. RESEARCH DESIGN AND METHODS In this randomized, multicenter, comparator-controlled, open-label trial, 258 patients entered the 22-week open-ended assessment phase (n = 128 QW-only; n = 130 BID→QW). A1C, fasting plasma glucose (FPG), body weight, blood pressure, fasting lipids, safety, and tolerability were assessed. RESULTS Patients continuing exenatide QW maintained A1C improvements through 52 weeks (least squares mean −2.0% [95% CI −2.1 to −1.8%]). Patients switching from exenatide BID to exenatide QW achieved further A1C improvements; both groups exhibited the same A1C reduction and mean A1C (6.6%) at week 52. At week 52, 71 and 54% of all patients achieved A1C <7.0% and ≤6.5%, respectively. In both treatment arms, FPG was reduced by >40 mg/dl, and body weight was reduced by >4 kg after 52 weeks. Nausea occurred less frequently in this assessment period and was predominantly mild. No major hypoglycemia was observed. CONCLUSION Exenatide QW elicited sustained improvements in glycemic control and body weight through 52 weeks of treatment. Patients switching to exenatide QW experienced further improvements in A1C and FPG, with sustained weight loss. PMID:20215461

  20. α-2-Macroglobulin in Saliva Is Associated with Glycemic Control in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Aitken, Juan Pablo; Ortiz, Carolina; Morales-Bozo, Irene; Rojas-Alcayaga, Gonzalo; Baeza, Mauricio; Beltran, Caroll

    2015-01-01

    Background. Subjects with type 2 diabetes mellitus (DM2) require an adequate glycemic control to avoid diabetic complications. Currently, saliva biomarkers are used as a diagnostic tool and can be indicative of the degree of progression and control of various diseases. Several studies indicate that α-2-macroglobulin levels are elevated in diabetic patients. Methods. 120 subjects with DM2 were enrolled and classified into two groups according to their glycemic control (percentage of glycated hemoglobin-A1c (HbA1c), <7% adequate glycemic control group; >7% inadequate glycemic control group). The relationship between α-2-macroglobulin levels from saliva samples and HbA1c was subsequently evaluated. Results. We found a positive correlation between α-2-macroglobulin and HbA1c (r = 0.778 and P < 0.0001). Area under the receivers operating characteristic (ROC) curve of α-2-macroglobulin indicated a positive discrimination threshold of α-2-macroglobulin (AUC = 0.903, CI 95%: 0.847–0.959, P < 0.0001) to diagnose glycemic control. Conclusions. Our data strongly suggest that the level of saliva α-2-macroglobulin is an indicator for the degree of glycemic control in diabetic patients and represents a promising alternative method to evaluate this parameter. PMID:25821337

  1. Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis

    PubMed Central

    Houle, Janie; Lauzier-Jobin, François; Beaulieu, Marie-Dominique; Meunier, Sophie; Coulombe, Simon; Côté, José; Lespérance, François; Chiasson, Jean-Louis; Bherer, Louis; Lambert, Jean

    2016-01-01

    Objective The purpose of this study is to examine the contribution of health behaviors (self-management and coping), quality of care, and individual characteristics (depressive symptoms, self-efficacy, illness representations) as mediators in the relationship between socioeconomic status (SES) and glycemic control. Methods A sample of 295 adult patients with type 2 diabetes was recruited at the end of a diabetes education course. Glycemic control was evaluated through glycosylated hemoglobin (HbA1c). Living in poverty and education level were used as indicators of SES. Results Bootstrapping analysis showed that the significant effects of poverty and education level on HbA1c were mediated by avoidance coping and depressive symptoms. The representation that diabetes is unpredictable significantly mediated the relationship between living in poverty and HbA1c, while healthy diet mediated the relationship between education level and HbA1c. Conclusions To improve glycemic control among patients with low SES, professionals should regularly screen for depression, offering treatment when needed, and pay attention to patients' illness representations and coping strategies for handling stress related to their chronic disease. They should also support patients in improving their self-management skills for a healthy diet. PMID:27239316

  2. Potential mechanisms mediating improved glycemic control after bariatric/metabolic surgery.

    PubMed

    Yamamoto, Hiroshi; Kaida, Sachiko; Yamaguchi, Tsuyoshi; Murata, Satoshi; Tani, Masaji; Tani, Tohru

    2016-03-01

    Conservative medical treatment for morbid obesity generally fails to sustain weight loss. On the other hand, surgical operations, so-called bariatric surgery, have evolved due to their long-term effects. The global increase in the overweight population and the introduction of laparoscopic surgery have resulted in the use of bariatric surgery spreading quickly worldwide in recent years. Recent clinical evidence suggests that bariatric surgery not only reduces body weight, but also improves secondary serious diseases, including type 2 diabetes mellitus, in so-called metabolic surgery. Moreover, several potential mechanisms mediating the improvement in glycemic control after bariatric/metabolic surgery have been proposed based on the animal and human studies. These mechanisms include changes in the levels of gastrointestinal hormones, bacterial flora, bile acids, intestinal gluconeogenesis and gastrointestinal motility as well as adipose tissue and inflammatory mediators after surgery. The mechanisms underlying improved glycemic control are expected to accelerate the promotion of both metabolic and bariatric surgery. This article describes the current status of bariatric surgery worldwide and in Japan, reviews the accumulated data for weight loss and diabetic improvements after surgery and discusses the potential mechanisms mediating improved glycemic control. PMID:25700844

  3. Effect of the carbohydrate counting method on glycemic control in patients with type 1 diabetes

    PubMed Central

    2010-01-01

    Background The importance of achieving and maintaining an appropriate metabolic control in patients with type 1 diabetes mellitus (DM1) has been established in many studies aiming to prevent the development of chronic complications. The carbohydrate counting method can be recommended as an additional tool in the nutritional treatment of diabetes, allowing patients with DM1 to have more flexible food choices. This study aimed to evaluate the influence of nutrition intervention and the use of multiple short-acting insulin according to the carbohydrate counting method on clinical and metabolic control in patients with DM1. Methods Our sample consisted of 51 patients with DM1, 32 females, aged 25.3 ± 1.55 years. A protocol of nutritional status evaluation was applied and laboratory analysis was performed at baseline and after a three-month intervention. After the analysis of the food records, a balanced diet was prescribed using the carbohydrate counting method, and short-acting insulin was prescribed based on the total amount of carbohydrate per meal (1 unit per 15 g of carbohydrate). Results A significant decrease in A1c levels was observed from baseline to the three-month evaluation after the intervention (10.40 ± 0.33% and 9.52 ± 0.32%, respectively, p = 0.000). It was observed an increase in daily insulin dose after the intervention (0.99 ± 0.65 IU/Kg and 1.05 ± 0.05 IU/Kg, respectively, p = 0.003). No significant differences were found regarding anthropometric evaluation (BMI, waist, hip or abdominal circumferences and waist to hip ratio) after the intervention period. Conclusions The use of short-acting insulin based on the carbohydrate counting method after a short period of time resulted in a significant improvement of the glycemic control in patients with DM1 with no changes in body weight despite increases in the total daily insulin doses. PMID:20716374

  4. Non-High-Density Lipoprotein Cholesterol in Children with Diabetes: Proposed Treatment Recommendations Based on Glycemic Control, Body Mass Index, Age, Sex, and Generally Accepted Cut Points.

    PubMed

    Schwab, K Otfried; Doerfer, Jürgen; Hungele, Andreas; Scheuing, Nicole; Krebs, Andreas; Dost, Axel; Rohrer, Tilman R; Hofer, Sabine; Holl, Reinhard W

    2015-12-01

    Percentile-based non-high-density lipoprotein cholesterol levels were analyzed by glycemic control, weight, age, and sex of children with type 1 diabetes (n = 26,358). Ten percent of all children and 25% of overweight adolescent girls require both immediate lipid-lowering medication and lifestyle changes to achieve non-high-density lipoprotein cholesterol levels <120 mg/dL and cardiovascular risk reduction. PMID:26427965

  5. Evaluating the Effect of U-500 Insulin Therapy on Glycemic Control in Veterans With Type 2 Diabetes

    PubMed Central

    Nawarskas, Ann D.; Resch, Nina D.; Vigil, Justina M.

    2015-01-01

    IN BRIEF This article describes a single-center, retrospective chart review to determine the glycemic effect of converting from U-100 to U-500 regular insulin in veterans with type 2 diabetes and the effect of this change, if any, on the frequency of provider contacts. Results showed that U-500 insulin improved glycemic control without significantly increasing the risk of hypoglycemia or total daily insulin dose, even when follow-up contacts with providers were not structured or frequent. PMID:25653468

  6. Improved Glycemic Control and Vascular Function in Overweight and Obese Subjects by Glyoxalase 1 Inducer Formulation.

    PubMed

    Xue, Mingzhan; Weickert, Martin O; Qureshi, Sheharyar; Kandala, Ngianga-Bakwin; Anwar, Attia; Waldron, Molly; Shafie, Alaa; Messenger, David; Fowler, Mark; Jenkins, Gail; Rabbani, Naila; Thornalley, Paul J

    2016-08-01

    Risk of insulin resistance, impaired glycemic control, and cardiovascular disease is excessive in overweight and obese populations. We hypothesized that increasing expression of glyoxalase 1 (Glo1)-an enzyme that catalyzes the metabolism of reactive metabolite and glycating agent methylglyoxal-may improve metabolic and vascular health. Dietary bioactive compounds were screened for Glo1 inducer activity in a functional reporter assay, hits were confirmed in cell culture, and an optimized Glo1 inducer formulation was evaluated in a randomized, placebo-controlled crossover clinical trial in 29 overweight and obese subjects. We found trans-resveratrol (tRES) and hesperetin (HESP), at concentrations achieved clinically, synergized to increase Glo1 expression. In highly overweight subjects (BMI >27.5 kg/m(2)), tRES-HESP coformulation increased expression and activity of Glo1 (27%, P < 0.05) and decreased plasma methylglyoxal (-37%, P < 0.05) and total body methylglyoxal-protein glycation (-14%, P < 0.01). It decreased fasting and postprandial plasma glucose (-5%, P < 0.01, and -8%, P < 0.03, respectively), increased oral glucose insulin sensitivity index (42 mL ⋅ min(-1) ⋅ m(-2), P < 0.02), and improved arterial dilatation Δbrachial artery flow-mediated dilatation/Δdilation response to glyceryl nitrate (95% CI 0.13-2.11). In all subjects, it decreased vascular inflammation marker soluble intercellular adhesion molecule-1 (-10%, P < 0.01). In previous clinical evaluations, tRES and HESP individually were ineffective. tRES-HESP coformulation could be a suitable treatment for improved metabolic and vascular health in overweight and obese populations. PMID:27207552

  7. The role of parent-adolescent attachment in the glycemic control of adolescents with Type 1 diabetes: a pilot study.

    PubMed

    Rosenberg, Tziporah; Shields, Cleveland G

    2009-09-01

    This pilot study explored the associations between parent and adolescent reports of adolescent attachment and glycemic control in adolescents with Type 1 diabetes. We hypothesized that more secure attachment would correlate with more optimal diabetes control. Thirty-one families completed written self-report questionnaires about adolescent attachment, demographic data, and diabetes control. Adolescents and parents reported on their perceptions of adolescents' attachment to mothers and fathers. Mean HbA1c for the sample was 7.6% (SD = 1.14). Mothers' perceptions of adolescents' attachment were significantly correlated with adolescents' hemoglobin A1c (r = -.42, p = .022), indicating that maternal perceptions of more secure attachment was associated with better glycemic control. Neither fathers' perceptions nor adolescents' reports of attachment was significantly correlated with glycemic control. Attachment appears to be associated with glycemic control in this population though the mechanisms are unclear. Mothers' perceptions of attachment had the strongest associations with control, not adolescent reports. Further research is needed to understand the mechanisms through which parent reports of adolescent attachment are associated with glycemic control. PMID:19803618

  8. Endothelial Progenitor Cells Are Related to Glycemic Control in Children With Type 1 Diabetes Over Time

    PubMed Central

    Hörtenhuber, Thomas; Rami-Mehar, Birgit; Satler, Miriam; Nagl, Katrin; Höbaus, Clemens; Höllerl, Florian; Koppensteiner, Renate; Schernthaner, Guntram; Schober, Edith; Schernthaner, Gerit-Holger

    2013-01-01

    OBJECTIVE The risk of cardiovascular death before the age of 40 is 20-fold higher in patients with type 1 diabetes mellitus (T1DM). Endothelial progenitor cells (EPCs) predict cardiovascular morbidity and mortality in patients without diabetes. We hypothesized that EPCs are modified in children with T1DM and are related to characteristics of T1DM such as glycemic control. RESEARCH DESIGN AND METHODS Children (n = 190; 156 T1DM subjects and 34 control subjects) were included in an observational cohort study and matched for age and sex. EPCs were enumerated by flow cytometry at the beginning (cross-sectional) and 1 year later (longitudinal). To analyze changes of variables during the observation, Δ values were calculated. RESULTS EPCs were significantly reduced in T1DM children versus control subjects (609 ± 359 vs. 1,165 ± 484, P < 0.001). Multivariate regression modeling revealed that glycated hemoglobin A1c (HbA1c) was the strongest independent predictor of EPCs (β = −0.355, P < 0.001). Overall glycemic control at the beginning and end of study did not differ (7.8 ± 1.2 vs. 7.8 ± 1.2 relative %, P = NS), but we observed individual HbA1c changes of −4.30/+3.10 relative %. The strongest EPC increase was observed in the patients with the most favorable HbA1c lowering during the 1-year follow-up. Accordingly, the strongest EPC decrease was demonstrated in the patients with the strongest HbA1c worsening during the time period. CONCLUSIONS This is the first prospective study demonstrating diminished EPCs in children with T1DM. The association of better glycemic control with an increase in EPC numbers within 1 year suggests that a reduction of the high cardiovascular disease burden might be mediated likewise. PMID:23340890

  9. Effect of proton pump inhibitors on glycemic control in patients with diabetes

    PubMed Central

    Takebayashi, Kohzo; Inukai, Toshihiko

    2015-01-01

    Gastrin is a linear peptide hormone which is secreted mostly in the stomach pyloric antrum G cells. Although the main role of this hormone is the promotion of the secretion of gastric acid from the stomach parietal cells, gastrin can also behave as a growth factor and stimulate gastric cell proliferation. It is also reported that gastrin promotes β cell neogenesis in the pancreatic ductal complex, modest pancreatic β cell replication, and improvement of glucose tolerance in animal models, in which the remodeling of pancreatic tissues is promoted. These findings suggest the possibility that gastrin has the potential to promote an increase of β cell mass in pancreas, and therefore that gastrin may improve glucose tolerance. Proton pump inhibitors (PPIs) are wildly used clinically for the therapy of gastro-esophageal reflex disease, gastritis due to excess stomach acid, and gastric ulcers. PPIs indirectly elevate serum gastrin levels via a negative feedback effect. Recent evidence has revealed the beneficial effect of PPIs on glycemic control especially in patients with type 2 diabetes mellitus (T2DM), probably via the elevation of the levels of serum gastrin, although the detailed mechanism remains unclear. In addition, the beneficial effects of a combination therapy of gastrin or a PPI with a glucagon-like peptide-1 receptor agonist on glycemic control in animal models have been demonstrated. Although PPIs may be possible candidates for a new approach in the therapy of diabetes, a prospective, long-term, randomized, double-blind, placebo-controlled study is needed to establish the effect of PPIs on glycemic control in a large number of patients with T2DM. PMID:26322158

  10. Effect of Probiotics on Glycemic Control: A Systematic Review and Meta-Analysis of Randomized, Controlled Trials

    PubMed Central

    He, Jie; Chen, Fangyao; Chen, Rongping; Chen, Hong

    2015-01-01

    Background Previous clinical trials indicate that probiotic consumption may improve blood glucose control, however, results from randomized trials on glycemic control have been inconsistent. Objective To investigate the effects of probiotics on glycemic control in a systematic review and meta-analysis of randomized controlled trials. Data Sources PubMed, Embase, Cochrane Library, and Clinicaltrial.gov through October 2014. Data Extraction and Synthesis Two independent reviewers extracted relevant data and assessed study quality and risk of bias. Data were pooled using a random-effects model and expressed as mean differences (MD) with 95% CI. Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2). Results Seventeen randomized controlled trials were included, in which 17 fasting blood glucose (n = 1105), 11 fasting plasma insulin (n = 788), 8 homeostasis model assessment of insulin resistance (n = 635) comparisons were reported. Probiotic consumption, compared with placebo, significantly reduced fasting glucose (MD = -0.31 mmol/L; 95% CI 0.56, 0.06; p = 0.02), fasting plasma insulin (MD = -1.29 μU/mL; 95% CI -2.17, -0.41; p = 0.004), and HOMA-IR (MD = 0.48; 95% CI -0.83, -0.13; p = 0.007). Conclusions Probiotic consumption may improve glycemic control modestly. Modification of gut microbiota by probiotic supplementation may be a method for preventing and control hyperglycemia in clinical practice. PMID:26161741

  11. Degeneration of retinal ganglion cells in diabetic dogs and mice: Relationship to glycemic control and retinal capillary degeneration

    PubMed Central

    Howell, Scott J.; Mekhail, Mena N.; Azem, Rami; Ward, Nicole L.

    2013-01-01

    Purpose The purpose of this study was to investigate (i) the effect of diabetes on retinal ganglion cell death in diabetic dogs and mice, (ii) the effect of prolonged glycemic control on diabetes-induced death of retinal ganglion cells, (iii) whether retinal ganglion cell death in diabetes is associated with degeneration of retinal capillaries, and (iv) the effect of diet on diabetes-induced degeneration of retinal ganglion cells in mice. Methods Diabetes was induced in dogs using streptozotocin, and levels of glycemic control (good, moderate, and poor) were maintained for 5 years. Diabetes was studied in two mouse models (diabetes induced in C57Bl/6J mice using streptozotocin and spontaneously diabetic Ins2Akita mice). Retinal ganglion cell death was investigated by counting the number of axons from the ganglion cells in the optic nerve and with terminal transferase deoxyuridine triphosphate nick-end labeling and annexin V staining in mice. Results As reported previously, the development and severity of vascular lesions of diabetic retinopathy in diabetic dogs were strongly associated with glycemic control. Loss of retinal ganglion cells was extensive in dogs kept in poor glycemic control, and was essentially prevented in diabetic dogs kept in good glycemic control for the 5 years of study. In contrast, “moderate” glycemic control (intermediate between poor and good glycemic control) caused a significant increase in vascular pathology, but did not cause loss of retinal axons in the optic nerve. Using this validated optic nerve axon counting method, the two mouse models of diabetic retinopathy were studied to assess ganglion cell death. Despite 10 months of diabetes (a duration that has been shown to cause retinal capillary degeneration in both models), neither mouse model showed loss of optic nerve axons (thus suggesting no loss of retinal ganglion cells). Likewise, other parameters of cell death (terminal transferase deoxyuridine triphosphate nick

  12. The Association of Cognitive Function and Social Support with Glycemic Control in Adults with Diabetes

    PubMed Central

    Okura, Toru; Heisler, Michele; Langa, Kenneth M.

    2009-01-01

    OBJECTIVES To examine whether cognitive impairment among adults with diabetes is associated with worse glycemic control and to assess if level of social support for diabetes care modifies this relationship. DESIGN Cross-sectional analysis SETTING The 2003 Health and Retirement Study (HRS) Mail Survey on Diabetes and the 2004 wave of the HRS PARTICIPANTS Adults age > 50 with diabetes in the United States (N=1097, mean age=69.2) MEASUREMENTS Hemoglobin A1c (HbA1c) level, cognitive function measured with the 35-point HRS cognitive scale (HRS-cog), sociodemographic variables, duration of diabetes, depressed mood, social support for diabetes care, self-reported understanding score of diabetes knowledge, diabetes treatments, diabetes-related components of the Total Illness Burden Index, and functional limitations. RESULTS In an ordered logistic regression model for the three ordinal levels of HbA1c (<7.0, 7.0–7.9, ≥8.0 mg/dl), respondents with HRS-cog scores in the lowest quartile had significantly higher HbA1c levels compared to those in the highest cognitive quartile (adjusted odds ratio, 1.80; 95% confidence interval, 1.11–2.92). This association was modified by a high level of social support for diabetes care: among respondents in the lowest cognitive quartile, those with high levels of support had significantly lower odds of having higher HbA1c compared to those with low levels of support (1.11 vs. 2.87, p=0.016). CONCLUSION Although cognitive impairment was associated with worse glycemic control, higher levels of social support for diabetes care ameliorated this negative relationship. Identifying the level of social support available to cognitively-impaired adults with diabetes may help to target interventions for better glycemic control. PMID:19682129

  13. Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study

    PubMed Central

    Buhary, Badurudeen Mahmood; Almohareb, Ohoud; Aljohani, Naji; Alzahrani, Saad H.; Elkaissi, Samer; Sherbeeni, Suphia; Almaghamsi, Abdulrahman; Almalki, Mussa

    2016-01-01

    Context: Diabetes in pregnancy (DIP) is either pregestational or gestational. Aims: To determine the relationship between glycemic control and pregnancy outcomes in a cohort of DIP patients. Settings and Design: In this 12-month retrospective study, a total of 325 Saudi women with DIP who attended the outpatient clinics at a tertiary center Riyadh, Saudi Arabia, were included. Subjects and Methods: The patients were divided into two groups, those with glycated hemoglobin (HbA1c) ≤6.5% (48 mmol/mol) and those with glycated hemoglobin (HbA1c) above 6.5%. The two groups were compared for differences in maternal and fetal outcomes. Statistical Analysis Used: Independent Student's t-test and analysis of variance were performed for comparison of continuous variables and Chi-square test for frequencies. Odds ratio and 95% confidence intervals were calculated using logistic regression. Results: Patients with higher HbA1c were older (P = 0.0077), had significantly higher blood pressure, proteinuria (P < 0.0001), and were multiparous (P = 0.0269). They had significantly shorter gestational periods (P = 0.0002), more preterm labor (P < 0.0001), more perineal tears (P = 0.0406), more miscarriages (P < 0.0001), and more operative deliveries (P < 0.0001). Their babies were significantly of greater weight, had more Neonatal Intensive Care Unit (NICU) admissions, hypoglycemia, and macrosomia. Conclusions: Poor glycemic control during pregnancy is associated with adverse maternal and fetal outcomes (shortened gestational period, greater risk of miscarriage, increased likelihood of operative delivery, hypoglycemia, macrosomia, and increased NICU admission). Especially at risk are those with preexisting diabetes, who would benefit from earlier diabetes consultation and tighter glycemic control before conception. PMID:27366714

  14. Effect of Selenium Supplementation on Glycemic Control and Lipid Profiles in Patients with Diabetic Nephropathy.

    PubMed

    Bahmani, Fereshteh; Kia, Mahsa; Soleimani, Alireza; Asemi, Zatollah; Esmaillzadeh, Ahmad

    2016-08-01

    To our knowledge, data on the effects of selenium supplementation on glycemic control and lipid concentrations in patients with diabetic nephropathy (DN) are scarce. The current study was done to determine the effects of selenium supplementation on glycemic control and lipid concentrations in patients with DN. This was a randomized double-blind placebo-controlled clinical trial in which 60 patients with DN were randomly allocated into two groups to receive either 200 μg of selenium supplements (n = 30) or placebo (n = 30) daily for 12 weeks. Blood sampling was performed for the quantification of glycemic indicators and lipid profiles at the onset of the study and after 12 weeks of intervention. Selenium supplementation for 12 weeks resulted in a significant decrease in serum insulin levels (P = 0.01), homeostasis model of assessment-estimated insulin resistance (HOMA-IR) (P = 0.02), homeostasis model of assessment-estimated B cell function (HOMA-B) (P = 0.009) and a significant rise in plasma glutathione peroxidase (GPx) (P = 0.001) compared with the placebo. Taking selenium supplements had no significant effects on fasting plasma glucose (FPG), quantitative insulin sensitivity check index (QUICKI) and lipid profiles compared with the placebo. Overall, our study demonstrated that selenium supplementation for 12 weeks among patients with DN had beneficial effects on plasma GPx, serum insulin levels, HOMA-IR, and HOMA-B, while it did not affect FPG, QUICKI, and lipid profiles. PMID:26686847

  15. Role of Parenting Style in Achieving Metabolic Control in Adolescents With Type 1 Diabetes

    PubMed Central

    Shorer, Maayan; David, Ravit; Schoenberg-Taz, Michal; Levavi-Lavi, Ifat; Phillip, Moshe; Meyerovitch, Joseph

    2011-01-01

    OBJECTIVE To examine the role of parenting style in achieving metabolic control and treatment adherence in adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS Parents of 100 adolescents with type 1 diabetes completed assessments of their parenting style and sense of helplessness. Parents and patients rated patient adherence to the treatment regimen. Glycemic control was evaluated by HbA1c values. RESULTS An authoritative paternal parenting style predicted better glycemic control and adherence in the child; a permissive maternal parenting style predicted poor adherence. A higher sense of helplessness in both parents predicted worse glycemic control and lesser adherence to treatment. Parental sense of helplessness was a significant predictor of diabetes control after correcting for other confounders (patient age, sex, and treatment method). CONCLUSIONS An authoritative nonhelpless parenting style is associated with better diabetes control in adolescents. Paternal involvement is important in adolescent diabetes management. These results have implications for psychological interventions. PMID:21788643

  16. Chromium supplements for glycemic control in type 2 diabetes: limited evidence of effectiveness.

    PubMed

    Costello, Rebecca B; Dwyer, Johanna T; Bailey, Regan L

    2016-07-01

    Some adults with type 2 diabetes mellitus (T2DM) believe that chromium-containing supplements will help control their disease, but the evidence is mixed. This narrative review examines the efficacy of chromium supplements for improving glycemic control as measured by decreases in fasting plasma glucose (FPG) or hemoglobin A1c (HbA1c). Using systematic search criteria, 20 randomized controlled trials of chromium supplementation in T2DM patients were identified. Clinically meaningful treatment goals were defined as an FPG of ≤7.2 mmol/dL, a decline in HbA1c to ≤7%, or a decrease of ≥0.5% in HbA1c. In only a few randomized controlled trials did FPG (5 of 20), HbA1c (3 of 14), or both (1 of 14) reach the treatment goals with chromium supplementation. HbA1c declined by ≥0.5% in 5 of 14 studies. On the basis of the low strength of existing evidence, chromium supplements have limited effectiveness, and there is little rationale to recommend their use for glycemic control in patients with existing T2DM. Future meta-analyses should include only high-quality studies with similar forms of chromium and comparable inclusion/exclusion criteria to provide scientifically sound recommendations for clinicians. PMID:27261273

  17. Perioperative Glycemic Control in Plastic Surgery: Review and Discussion of an Institutional Protocol.

    PubMed

    Dortch, John D; Eck, Dustin L; Ladlie, Beth; TerKonda, Sarvam P

    2016-07-01

    Perioperative hyperglycemia is a well-known risk factor for surgical morbidity such as wound healing, infection, and prolonged hospitalization. This association has been reported for a number of surgical subspecialties, including plastic surgery. Specialty-specific guidelines have become increasingly available in the literature. Currently, glucose management guidelines for plastic surgery are lacking. Recognizing that multiple approaches exist for perioperative glucose, protocol-based models provide the necessary structure and guidance for approaching glycemic control. In this article, we review the influence of diabetes on outcomes in plastic surgery patients and propose a practical approach to perioperative blood glucose management based on current Endocrine Society and Mayo Clinic institutional guidelines. PMID:27301370

  18. Markedly Improved Glycemic Control in Poorly Controlled Type 2 Diabetes following Direct Acting Antiviral Treatment of Genotype 1 Hepatitis C

    PubMed Central

    Pashun, Raymond Anthony; Shen, Nicole T.; Jesudian, Arun

    2016-01-01

    Type 2 diabetes mellitus (T2DM) is often associated with hepatitis C virus (HCV) infection. Successful HCV treatment may improve glycemic control and potentially induce remission of T2DM. We report a case of an obese 52-year-old woman with mixed genotype 1a/1b HCV infection with compensated cirrhosis and a 10-year history of poorly controlled T2DM on insulin therapy. Following successful therapy with sofosbuvir, simeprevir, and ribavirin, her insulin requirements decreased and her glycosylated hemoglobin (HgA1c) normalized despite weight gain. This case suggests an association between HCV and T2DM and the potential for significant improvement in glycemic control with eradication of HCV. PMID:27293923

  19. Diabetes and cardiovascular disease: Changing the focus from glycemic control to improving the long-term survival

    PubMed Central

    Wang, Cecilia C. Low; Reusch, Jane EB

    2012-01-01

    Diabetes is the fifth leading cause of death worldwide and contributes to leading causes of death, cancer and cardiovascular disease including coronary heart disease, stroke, peripheral vascular disease and other vascular disease. While glycemic management remains a cornerstone of diabetes care, the co-management of hypertension, atherosclerosis, cardiovascular risk reduction and prevention of long-term consequences associated with diabetes are now well recognized as essential to improve long-term survival. Clinical trial evidence substantiates the importance of glycemic control, LDL-cholesterol lowering therapy, blood-pressure lowering, control of albuminuria, and comprehensive approaches targeting multiple risk factors to reduce cardiovascular risk. This article presents a review of the role of diabetes in pathogenesis of atherosclerosis and cardiac dysfunction, recent evidence regarding degree of glycemic control and mortality, and available evidence for a multi-faceted approach to improve long-term outcomes for patients. PMID:23062569

  20. Glycemic Control in US Immigrant and Nonimmigrant Black Youth with Type 1 Diabetes.

    PubMed

    Rebecca O'Connor, M; Dobra, A; Voss, J; Pihoker, C; Doorenbos, A

    2016-02-01

    Differences in glycemic control based on race have been reported in pediatric populations with type 1 diabetes (T1D). It is unknown if differences exist between pediatric populations within the same race classification. This retrospective study identified all immigrant and nonimmigrant Black youth diagnosed with T1D and treated at Seattle Children's Hospital from 2001 to 2011. Demographic characteristics and hemoglobin A1c (HbA1c) levels at 12, 24, and 36 months post diagnosis were obtained from existing medical records. Immigrant youth had lower mean HbA1c levels at all three time points. The ethnicity effect on mean HbA1c levels approached significance at 36 months. When comparing 12 and 36 months, the time effect was significant; the ethnicity effect approached significance. Clinically important differences may exist in glycemic control between pediatric populations with T1D from the same race classification. Additional work is needed to confirm these findings and determine potential causes. PMID:24452433

  1. Physical activity, glycemic control, and diabetic peripheral neuropathy: a national sample.

    PubMed

    Loprinzi, Paul D; Hager, Kathy K; Ramulu, Pradeep Y

    2014-01-01

    To determine if physical activity and/or blood glycohemoglobin (HbA1c) are associated with the prevalence of peripheral neuropathy (PN) in a representative population of diabetics. Three hundred thirty-nine diabetic participants (40-85 yrs) taking part in 2003-2004 National Health and Nutrition Examination Survey were studied. Participants were defined as having peripheral neuropathy if examination determined ≥1 insensate area in either foot. Moderate-to-vigorous physical activity (MVPA) was objectively-measured using accelerometry. After adjustments, MVPA was not significantly associated with PN (OR=1.16; 95% CI: 0.48-2.78), nor was HbA1c (OR=0.55; 95% CI: 0.28-1.04). However, there was evidence of statistical interaction (OR=0.24; 95% CI: 0.06-0.87) between MVPA and HbA1c status, showing that diabetics engaging in higher levels of MVPA and having normal HgbA1c levels were less likely to have PN than what would be expected based on the individual effects of MVPA and HbA1c alone. Although MVPA was not directly associated with PN, these findings suggest that proper physical activity, coupled with good glycemic control, is associated with less neuropathy. Future longitudinal studies are required to evaluate whether physical activity and improved glycemic control may help prevent or slow the progression of diabetic end-organ damage, particularly diabetic neuropathy. PMID:24090951

  2. The Potential for Glycemic Control Monitoring and Screening for Diabetes at Dental Visits Using Oral Blood

    PubMed Central

    Rosedale, Mary T.; Pesce, Michael A.; Rindskopf, David M.; Kaur, Navjot; Juterbock, Caroline M.; Wolff, Mark S.; Malaspina, Dolores; Danoff, Ann

    2015-01-01

    Objectives. We examined the potential for glycemic control monitoring and screening for diabetes in a dental setting among adults (n = 408) with or at risk for diabetes. Methods. In 2013 and 2014, we performed hemoglobin A1c (HbA1c) tests on dried blood samples of gingival crevicular blood and compared these with paired “gold-standard” HbA1c tests with dried finger-stick blood samples in New York City dental clinic patients. We examined differences in sociodemographics and diabetes-related risk and health care characteristics for 3 groups of at-risk patients. Results. About half of the study sample had elevated HbA1c values in the combined prediabetes and diabetes ranges, with approximately one fourth of those in the diabetes range. With a correlation of 0.991 between gingival crevicular and finger-stick blood HbA1c, measures of concurrence between the tests were extremely high for both elevated HbA1c and diabetes-range HbA1c levels. Persons already diagnosed with diabetes and undiagnosed persons aged 45 years or older could especially benefit from HbA1c testing at dental visits. Conclusions. Gingival crevicular blood collected at the dental visit can be used to screen for diabetes and monitor glycemic control for many at-risk patients. PMID:25713975

  3. Glycemic Control in Young Children with Diabetes: The Role of Parental Health Literacy

    PubMed Central

    Pulgarón, Elizabeth R.; Sanders, Lee M.; Patiño-Fernandez, Anna Maria; Wile, Diana; Sanchez, Janine; Rothman, Russell L.; Delamater, Alan

    2013-01-01

    Objective This cross sectional study examined the relationship between parental health literacy (HL), diabetes related numeracy, and parental perceived diabetes self-efficacy on glycemic control in a sample of young children with Type 1 DM. Methods Seventy primary caregivers of children (age 3–9 years) with Type 1 DM were recruited and surveyed at diabetes outpatient clinic visits. Patients’ medical histories were obtained by medical chart review. Results Parental diabetes related numeracy (r = −.52, p <.01), but not reading skills (r = −.25, p = NS) were inversely correlated with the child’s glycemic control (HbA1c). Parental perceived diabetes self-efficacy was also negatively correlated to their child’s HbA1c (r = −.47, p <.01). When numeracy and parental perceived diabetes self-efficacy were included as predictors of HbA1c, the model was significant (F = 12.93, p<.01) with both numeracy (β = − .46, p<.01) and parental perceived diabetes self-efficacy (β = − .36, p=.01) as significant predictors of HbA1c. Conclusions Data from this study highlight the importance of considering the role of parental numeracy, in health outcomes for children with Type 1 DM. Practice Implications: Practitioners should assess parental health literacy and consider intervention when needed. PMID:24091252

  4. Glycemic control in inpatients with diabetes following august changeover of trainee doctors in England.

    PubMed

    Rajendran, Rajesh; Jankovic, Dina; Rayman, Gerry

    2016-03-01

    The first Wednesday of August is the day of changeover of trainee doctors in England. It is widely perceived that inexperience and nonfamiliarity with the new hospital systems and policies in these first few weeks lead to increased medical errors, mismanagement, and mortality. The aim of this study was to analyze the impact of the August changeover of trainee doctors on inpatient glycemic control in a single English hospital. This is currently unknown in England. Overall, 16,870 patient-day capillary glucose reading measures in 2730 inpatients with diabetes were analyzed for 4 weeks before and after the changeover period for the years 2012, 2013, and 2014. Only inpatients hospitalized for longer than 1 day were included. Contrary to expectations, inpatient glycemic control did not worsen in the first 4 weeks after changeover compared to the preceding 4 weeks before changeover in the 3-year period. This may be due to forethought and planning by the deanery foundation school and the inpatient diabetes team in this hospital. PMID:26505469

  5. Patient complexity in quality comparisons for glycemic control: An observational study

    PubMed Central

    Safford, Monika M; Brimacombe, Michael; Zhang, Quanwu; Rajan, Mangala; Xie, Minge; Thompson, Wesley; Kolassa, John; Maney, Miriam; Pogach, Leonard

    2009-01-01

    Background Patient complexity is not incorporated into quality of care comparisons for glycemic control. We developed a method to adjust hemoglobin A1c levels for patient characteristics that reflect complexity, and examined the effect of using adjusted A1c values on quality comparisons. Methods This cross-sectional observational study used 1999 national VA (US Department of Veterans Affairs) pharmacy, inpatient and outpatient utilization, and laboratory data on diabetic veterans. We adjusted individual A1c levels for available domains of complexity: age, social support (marital status), comorbid illnesses, and severity of disease (insulin use). We used adjusted A1c values to generate VA medical center level performance measures, and compared medical center ranks using adjusted versus unadjusted A1c levels across several thresholds of A1c (8.0%, 8.5%, 9.0%, and 9.5%). Results The adjustment model had R2 = 8.3% with stable parameter estimates on thirty random 50% resamples. Adjustment for patient complexity resulted in the greatest rank differences in the best and worst performing deciles, with similar patterns across all tested thresholds. Conclusion Adjustment for complexity resulted in large differences in identified best and worst performers at all tested thresholds. Current performance measures of glycemic control may not be reliably identifying quality problems, and tying reimbursements to such measures may compromise the care of complex patients. PMID:19126229

  6. The Consumption of Bicarbonate-Rich Mineral Water Improves Glycemic Control.

    PubMed

    Murakami, Shinnosuke; Goto, Yasuaki; Ito, Kyo; Hayasaka, Shinya; Kurihara, Shigeo; Soga, Tomoyoshi; Tomita, Masaru; Fukuda, Shinji

    2015-01-01

    Hot spring water and natural mineral water have been therapeutically used to prevent or improve various diseases. Specifically, consumption of bicarbonate-rich mineral water (BMW) has been reported to prevent or improve type 2 diabetes (T2D) in humans. However, the molecular mechanisms of the beneficial effects behind mineral water consumption remain unclear. To elucidate the molecular level effects of BMW consumption on glycemic control, blood metabolome analysis and fecal microbiome analysis were applied to the BMW consumption test. During the study, 19 healthy volunteers drank 500 mL of commercially available tap water (TW) or BMW daily. TW consumption periods and BMW consumption periods lasted for a week each and this cycle was repeated twice. Biochemical tests indicated that serum glycoalbumin levels, one of the indexes of glycemic controls, decreased significantly after BMW consumption. Metabolome analysis of blood samples revealed that 19 metabolites including glycolysis-related metabolites and 3 amino acids were significantly different between TW and BMW consumption periods. Additionally, microbiome analysis demonstrated that composition of lean-inducible bacteria was increased after BMW consumption. Our results suggested that consumption of BMW has the possible potential to prevent and/or improve T2D through the alterations of host metabolism and gut microbiota composition. PMID:26798400

  7. The Consumption of Bicarbonate-Rich Mineral Water Improves Glycemic Control

    PubMed Central

    Murakami, Shinnosuke; Goto, Yasuaki; Ito, Kyo; Hayasaka, Shinya; Kurihara, Shigeo; Soga, Tomoyoshi; Tomita, Masaru; Fukuda, Shinji

    2015-01-01

    Hot spring water and natural mineral water have been therapeutically used to prevent or improve various diseases. Specifically, consumption of bicarbonate-rich mineral water (BMW) has been reported to prevent or improve type 2 diabetes (T2D) in humans. However, the molecular mechanisms of the beneficial effects behind mineral water consumption remain unclear. To elucidate the molecular level effects of BMW consumption on glycemic control, blood metabolome analysis and fecal microbiome analysis were applied to the BMW consumption test. During the study, 19 healthy volunteers drank 500 mL of commercially available tap water (TW) or BMW daily. TW consumption periods and BMW consumption periods lasted for a week each and this cycle was repeated twice. Biochemical tests indicated that serum glycoalbumin levels, one of the indexes of glycemic controls, decreased significantly after BMW consumption. Metabolome analysis of blood samples revealed that 19 metabolites including glycolysis-related metabolites and 3 amino acids were significantly different between TW and BMW consumption periods. Additionally, microbiome analysis demonstrated that composition of lean-inducible bacteria was increased after BMW consumption. Our results suggested that consumption of BMW has the possible potential to prevent and/or improve T2D through the alterations of host metabolism and gut microbiota composition. PMID:26798400

  8. Glycemic Control Modifies Difference in Mortality Risk Between Hemodialysis and Peritoneal Dialysis in Incident Dialysis Patients With Diabetes

    PubMed Central

    Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-01-01

    Abstract Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A1c (HbA1c) and dialysis modalities for patient survival (P for interaction = 0.004), subjects were stratified into good and poor glycemic control groups (HbA1c< or ≥8.0%). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.47–0.90, P = 0.01; patients with available HbA1c [n = 773], HR = 0.64, 95% CI = 0.46–0.91, P = 0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA1c <8.0%, HR = 0.59, 95% CI = 0.37–0.94, P = 0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA1c ≥8.0%, HR = 1.21, 95% CI = 0.46–2.76, P = 0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes

  9. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis

    PubMed Central

    Barnard, Neal D.; Levin, Susan M.; Watanabe, Mitsuhiro

    2014-01-01

    Introduction Previous studies have suggested an association between vegetarian diets and improvements in glycemic control in diabetes, although this relationship is not well established. No meta-analysis of these studies has been performed. Methods To conduct a systematic review and meta-analysis of controlled clinical trials examining the association between vegetarian diets and glycemic control in type 2 diabetes. Data source: The electronic databases Medline, Web of Science, Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials were searched for articles published in any language through December 9, 2013. Study selection: The following criteria were used for study inclusion: (I) age of participants >20 years; (II) vegetarian diet as intervention; (III) mean difference in hemoglobin A1c (HbA1c) and/or fasting blood glucose levels used as outcomes; and (IV) controlled trials, duration ≥4 weeks. Exclusion criteria were: (I) not an original investigation; (II) duplicate samples; (III) diabetes other than type 2; (IV) multiple interventions; and (V) uncontrolled studies. Data extraction and synthesis: The data collected included study design, baseline population characteristics, dietary data, and outcomes. Data were pooled using a random-effects model. Main outcomes and measures: Differences in HbA1c and fasting blood glucose levels associated with vegetarian diets were assessed. Results Of 477 studies identified, six met the inclusion criteria (n=255, mean age 42.5 years). Consumption of vegetarian diets was associated with a significant reduction in HbA1c [−0.39 percentage point; 95% confidence interval (CI), −0.62 to −0.15; P=0.001; I2=3.0; P for heterogeneity =0.389], and a non-significant reduction in fasting blood glucose concentration (−0.36 mmol/L; 95% CI, −1.04 to 0.32; P=0.301; I2=0; P for heterogeneity =0.710), compared with consumption of comparator diets. Conclusions Consumption of vegetarian diets is

  10. RELATIONSHIP BETWEEN GLYCEMIC CONTROL AND GASTRIC EMPTYING IN POORLY CONTROLLED TYPE 2 DIABETES

    PubMed Central

    Bharucha, Adil E.; Kudva, Yogish; Basu, Ananda; Camilleri, Michael; Low, Phillip A.; Vella, Adrian; Zinsmeister, Alan R.

    2014-01-01

    Background & Aims Acute hyperglycemia delays gastric emptying in patients with diabetes. However, it is not clear whether improved control of glycemia affects gastric emptying in these patients. We investigated whether overnight and short-term (6 months) improvements in control of glycemia affect gastric emptying. Methods We studied 30 patients with poorly controlled type 2 diabetes (levels of glycated hemoglobin >9%). We measured gastric emptying using the [13C]-spirulina platensis breath test on the patients’ first visit (visit 1), after overnight administration of insulin or saline, 1 week later (visit 2), and 6 months after intensive therapy for diabetes. We also measured fasting and post-prandial plasma levels of C-peptide, GLP1, and amylin, as well as autonomic functions. Results At visit 1, gastric emptying was normal in 10 patients, delayed in 14, and accelerated in 6; 6 patients had gastrointestinal symptoms; vagal dysfunction was associated with delayed gastric emptying (P<.05). Higher fasting blood levels of glucose were associated with shorter half-times of gastric emptying (thalf) at visits 1 (r= −0.46, P=.01) and 2 (r= −0.43, P=.02). Although blood levels of glucose were lower after administration of insulin (132±7 mg/dl) than saline (211±15 mg/dl; P=0.0002), gastric emptying thalf was not lower after administration of insulin, compared with saline. After 6 months of intensive therapy, levels of glycated hemoglobin decreased from 10.6%±0.3% to 9%±0.4% (P=.0003), but gastric emptying thalf did not change (92±8 min before, 92±7 min after). Gastric emptying did not correlate with plasma levels of GLP1 and amylin. Conclusions Two-thirds of patients with poorly-controlled type 2 diabetes have mostly asymptomatic yet abnormal gastric emptying. Higher fasting blood levels of glucose are associated with faster gastric emptying. Overnight and sustained (6 months) improvements in glycemic control do not affect gastric emptying. PMID:25041866

  11. THE CONTENT OF MICROELEMENTS IN BLOOD SERUM AND ERYTHROCYTES IN CHILDREN WITH DIABETES MELLITUS TYPE I DEPENDING ON LEVEL OF GLYCEMIC CONTROL.

    PubMed

    Gluschenko, N; Vasylyshyn, Kh; Roschupkin, A; Lekishvili, S; Gladchenko, O

    2016-01-01

    The aim of this paper is to investigate the content of chromium, cobalt and nickel in serum and erythrocytes in children with type 1 diabetes mellitus, depending on the level of glycemic control. The study was conducted on 68 children with type 1 diabetes mellitus. The patients were divided into four groups based on glycemic control. Group I was composed of 9 children with optimal level of glycemic control. Group II - 25 children with suboptimal level of glycemic control. Group III - 34 children with a high risk to life level of glycemic control. Group IV (control group) consisted of 30 healthy children. Compensation state of type 1 diabetes was evaluated according to ISPAD (Consensus for the Management of Type 1 Diabetes Mellitus in Children and Adolescens 2000). The content of trace elements in biological agents was determined by atomic absorbtion spectrophotometry method with C-115M1 mass-spectrophotometer, manufactured by «Selmi» enterprise (Ukraine). It is found that there is a decrease in serum concentrations of chromium and erythrocyte content of cobalt in patients with optimal level of glycemic control. The deficiency of chromium is accompanied by the deficiency of cobalt in patients with suboptimal level of glycemic control. The lower levels of cobalt and nickel are recorded simultaneously, but there is theexcess of chromium in the erythrocytes of these patients. Patients, who suffer from 1 type diabetes mellitus and high risk for life level of glycemic control have considerable polideficiency of cobalt, nickel and chromium in serum.The increasing level of chromium was recorded only in the erythrocytes. The level of glycemic control and the duration of 1 type diabetes mellitus are important in the forecasting of the development of chronic diabetic complications. It is found that the duration of 1 type diabetes mellitus influences the levels of cobalt and nickel in serum mostly, while the level of glycemic control influences the chromium content. PMID

  12. Impact of Glycemic Control on Healthcare Resource Utilization and Costs of Type 2 Diabetes: Current and Future Pharmacologic Approaches to Improving Outcomes

    PubMed Central

    Banerji, Mary Ann; Dunn, Jeffrey D.

    2013-01-01

    . Conclusions As the prevalence of type 2 diabetes and its associated comorbidities grows, healthcare costs will continue to increase, indicating a need for better approaches to achieve glycemic control and manage comorbid conditions. Drug therapies are needed that enhance patient adherence and persistence levels far above levels reported with currently available drugs. Improvements in adherence to treatment guidelines and greater rates of lifestyle modifications also are needed. A serious unmet need exists for greatly improved patient outcomes, more effective and more tolerable drugs, as well as marked improvements in adherence to treatment guidelines and drug therapy to positively impact healthcare costs and resource use. PMID:24991370

  13. Efficacy of bromocriptine on glycemic and metabolic control of prediabetic patients

    PubMed Central

    Khalilzade, Saied Hossein; Aminorroaya, Ashraf; Hovsepain, Silva; Amini, Masoud

    2015-01-01

    Background: It is suggested that bromocriptine could be effective in treatment of prediabetic patients and, consequently, in preventing type 2 diabetes (T2DM). In this study, we investigated the effectiveness of bromocriptine on glycemic and metabolic control of prediabetic patients. Materials and Methods: In this double-blind, placebo controlled trial study, prediabetic patients diagnosed during Isfahan Diabetes Prevention Project (IDPP) were enrolled. They randomized in two bromocriptine (2.5 mg) and placebo-treated groups, for 12 weeks. After physical examination, fasting plasma glucose (FPG), HbA1c, Insulin, cholesterol, HDL-c, and triglyceride were measured and glucose tolerance test (OGTT) was performed. HOMA-IR and LDL-c were calculated. The mean of the data were compared in the bromocriptine and placebo treated groups, before and after intervention by intention to treat analysis using mixed effect model. P values < 0.05 were considered, statistically, significant. Results: In this study, 53 prediabetic patients (27 in the bromocriptine group and 26 in the placebo group) were treated. There were no differences between data of two groups at baseline (P > 0.05). The mean body mass index, systolic blood pressure, fasting plasma glucose and glucose of 30 min, 60 min, 120 min of post OGTT, HbA1c, insulin, HOMA-IR, lipid profile did not change, significantly, in both bromocriptine and placebo-treated groups after 12 weeks (P > 0.05). However, diastolic blood pressure (P = 0.02) and the area under the curve of glucose (P = 0.045) were decreased in the bromocriptine-treated group. Conclusion: Bromocriptine did not have significant effect on glycemic control of prediabetic patients. Further studies, with bigger sample size are recommended. PMID:26918235

  14. Do Perceptions of Empowerment Affect Glycemic Control and Self-Care Among Adults with Type 2 Diabetes?

    PubMed Central

    D’Souza, Melba Sheila; Karkada, Subrahmanya Nairy; Hanrahan, Nancy P.; Venkatesaperumal, Ramesh; Amirtharaj, Anandhi

    2015-01-01

    Background: The Arab adult with T2DM is understudied with less known facts about the perception of empowerment and its relationship with self-care and glycemic control. Purpose: The purpose of this study was to determine the extent to which perception of empowerment by Arab adults living with Type 2 Diabetes Mellitus (T2DM) was associated with better glycemic control and self-care management. Methods: A cross-sectional descriptive study was led among 300 Arab adults living in Oman with T2DM in an outpatient diabetes clinic. The Diabetes Empowerment Scale (DES), glycosylated haemaglobin (HbA1c) and Body mass index was assessed. The DES was found to be valid and reliable for the population. ANOVA, Regression analysis, and Structural equation modeling was used for analysis. Results: The composite score and three subscales of DES were a significant and strong predictor of good glycemic control among Omani adults with T2DM (p<0.001). Age, education, duration of DM, prior DM education program and medications were significantly associated with DES. Conclusion: Diabetes nurse educators engaged in the care of adults with T2DM should assess self-empowerment and tailor interventions to increase empowerment for better glycemic control. Patient empowerment plays an essential role in maintaining self-care behaviours and HbA1c. PMID:26156908

  15. Impact of psychological stress caused by the Great East Japan Earthquake on glycemic control in patients with diabetes.

    PubMed

    Fujihara, K; Saito, A; Heianza, Y; Gibo, H; Suzuki, H; Shimano, H; Saito, K; Kodama, S; Yamada, N; Sone, H

    2012-10-01

    We examined the relationship between psychological stress and the worsening of glycemic control in diabetic patients at the time of the Great East Japan Earthquake. HbA1c levels in diabetic patients before and after the disaster were evaluated with the General Health Questionnaire (GHQ) and other questions including those on changes in diet, exercise, psychological stress and drug intake in 320 consecutive diabetic patients who had been followed in a diabetes clinic. Logistic regression analysis revealed that the total GHQ scores (odds ratio [OR] 1.03 [95% confidence interval 1.01-1.06]; p<0.01) and interruption of drug intake (OR 4.48 [1.57-12.7]; p=0.01) were independently associated with worsening of glycemic control defined as an increase in the HbA1c level equal to or greater than 0.5%. Among the scores on the GHQ, those for somatic symptoms (OR 1.18 [1.01-1.38]; p=0.03) and sleep disturbances or anxiety (OR 1.26 [1.08-1.46]; p<0.01) were independently associated with glycemic control. These results suggest that psychological stress during a disaster has independent effects on worsening of glycemic control. PMID:22851189

  16. Glycemic control and nerve conduction abnormalities in non-insulin-dependent diabetic subjects.

    PubMed

    Graf, R J; Halter, J B; Pfeifer, M A; Halar, E; Brozovich, F; Porte, D

    1981-03-01

    The influence of therapy of hyperglycemia on the progression of diabetic neuropathy is unclear. We studied variables of glycemia and motor and sensory nerve conduction velocity in a group of 18 non-insulin-dependent diabetic subjects before and after institution of diabetes therapy. Diabetes therapy significantly reduced variables of glycemia after 1, 3, 6, and 12 months. Conduction velocity of the median motor nerve was improved from baseline at each time tested during treatment. In addition, peroneal and tibial motor nerve conduction velocities improved in patients whose levels of hyperglycemia were lowered. Moreover, extent of improvement of conduction velocity of some motor nerves was related to the degree of reduction of hyperglycemia. Sensory nerve conduction velocity was not altered by diabetes therapy. These findings support the hypothesis of a metabolic component to diabetic neuropathy and suggest that optimal glycemic control may be beneficial to patients with this disorder. PMID:7013592

  17. The importance of postprandial glycemic control: optimizing add-on therapy to basal insulin.

    PubMed

    Shaefer, Charles F; Anderson, John

    2016-01-01

    Diabetes, mainly type 2 diabetes mellitus (T2DM), is associated with a growing clinical and economic burden in the United States, which is expected to increase in association with an aging population. Sufficient glycemic control in patients with T2DM, in order to reduce the risk of micro- and macrovascular complications associated with diabetes, is mediated by lifestyle modifications and a regimen of increasingly intensive antidiabetes drugs. Several treatments and strategies are available for primary care physicians to select from when choosing the most appropriate therapy for their individual patients with T2DM, but, ultimately, due to the progressive nature of the disease, most of these patients will require insulin therapy to maintain glycemic control. Regimens containing basal and postprandial insulins are widely used, but there is still widespread reluctance to initiate insulin treatment due to fear of weight gain and hypoglycemia. Furthermore, as patients approach recommended glycated hemoglobin targets, postprandial hyperglycemia becomes the main contributor to hyperglycemic exposure, necessitating the timely initiation of prandial treatment. Finally, insulin treatment can be limited by factors like the number of injections, mealtime restrictions, complex titration algorithms and patient adherence. Recent developments in antidiabetes drug research have brought more convenient basal and postprandial regimens closer. Clinical evaluation of the efficacy and safety of basal insulins plus add-on glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has yielded promising results. Primary care physicians are continually challenged to optimize insulin treatment strategies to maximize patient outcomes. Emerging strategies such as long-acting basal insulin analogs and short-acting GLP-1 RAs are particularly appealing to address this challenge. PMID:26548422

  18. Association of Diabetic Neuropathy with Duration of Type 2 Diabetes and Glycemic Control

    PubMed Central

    Asad, Ambreen; Waqas, Ahmed; Ali, Nazia; Nisar, Anam; Qayyum, Mohsin A; Maryam, Hafsa; Javaid, Mohsin; Jamil, Mohsin

    2015-01-01

    Introduction: Diabetes mellitus is associated with severe microvascular and macrovascular complications with major implications for public health. Diabetic neuropathy is a very problematic complication of diabetes mellitus. It is associated with severe morbidity, mortality, and a huge economic burden. The present study was designed with two aims: 1) to analyze the association of diabetic neuropathy with the glycemic index (levels of fasting blood glucose, random blood glucose, and Hb1Ac) in patients with Type 2 diabetes, and 2) to analyze the association of diabetic neuropathy with time passed since the diagnosis of diabetes. Methods: This case-control study was undertaken between June 2013 and February 2015 in the Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, Pakistan. Type 2 diabetics with an age range of 30-60 years were recruited from outpatient departments of AFIRM, Rawalpindi. Data were collected and recorded on a form with four sections recording the following: 1) demographics of patients and number of years passed since diagnosis of diabetes; 2) clinical examination for touch, pressure, power, pain, vibration, and ankle reflex; 3) nerve conduction studies for motor components of the common peroneal nerve and tibial nerve and the sensory component of median nerve and sural nerve; 4) glycemic index, including fasting blood glucose levels (BSF), random blood glucose (BSR) levels, and HbA1c levels. Data were analyzed in SPSS v. 20. Chi-square and phi statistics and logistic regression analysis were run to analyze associations between diabetic neuropathy and time passed since diagnosis of diabetes and glycemic index. Results: In total, 152 patients were recruited. One-half of those patients had neuropathy (76 patients) and the other half (76 patients) had normal nerve function. The mean (standard deviation [SD]) duration of diabetes was nine years (6.76), BSF levels 7.98 mmol/l (2.18), BSR 9.5 mmol/l (3.19), and HbA1c 6.5% (2

  19. Differential Effect of Race, Education, Gender, and Language Discrimination on Glycemic Control in Adults with Type 2 Diabetes

    PubMed Central

    Brice Reynolds, D.; Walker, Rebekah J.; Campbell, Jennifer A.

    2015-01-01

    Abstract Background: Discrimination has been linked to negative health outcomes, but little research has investigated different types of discrimination to determine if some have a greater impact on outcomes. We examined the differential effect of discrimination based on race, level of education, gender, and language on glycemic control in adults with type 2 diabetes. Patients and Methods: Six hundred two patients with type 2 diabetes from two adult primary care clinics in the southeastern United States completed validated questionnaires. Questions included perceived discrimination because of race/ethnicity, level of education, sex/gender, or language. A multiple linear regression model assessed the differential effect of each type of perceived discrimination on glycemic control while adjusting for relevant covariates, including race, site, gender, marital status, duration of diabetes, number of years in school, number of hours worked per week, income, and health status. Results: The mean age was 61.5 years, and the mean duration of diabetes was 12.3 years. Of the sample, 61.6% were men, and 64.9% were non-Hispanic black. In adjusted models, education discrimination remained significantly associated with glycemic control (β=0.47; 95% confidence interval, 0.03, 0.92). Race, gender and language discrimination were not significantly associated with poor glycemic control in either unadjusted or adjusted analyses. Conclusions: Discrimination based on education was found to be significantly associated with poor glycemic control. The findings suggest that education discrimination may be an important social determinant to consider when providing care to patients with type 2 diabetes and should be assessed separate from other types of discrimination, such as that based on race. PMID:25549154

  20. The impact of measurement frequency on the domains of glycemic control in the critically ill--a Monte Carlo simulation.

    PubMed

    Krinsley, James S; Bruns, David E; Boyd, James C

    2015-03-01

    The role of blood glucose (BG) measurement frequency on the domains of glycemic control is not well defined. This Monte Carlo mathematical simulation of glycemic control in a cohort of critically ill patients modeled sets of 100 patients with simulated BG-measuring devices having 5 levels of measurement imprecision, using 2 published insulin infusion protocols, for 200 hours, with 3 different BG-measurement intervals-15 minutes (Q15'), 1 hour (Q1h), and 2 hours (Q2h)-resulting in 1,100,000 BG measurements for 3000 simulated patients. The model varied insulin sensitivity, initial BG value and rate of gluconeogenesis. The primary outcomes included rates of hyperglycemia (BG > 180 mg/dL), hypoglycemia (BG < 70 and 40 mg/dL), proportion of patients with elevated glucose variability (within-patient coefficient of variation [CV] > 20%), and time in range (BG ranges 80-150 mg/dL and 80-180 mg/dL). Percentages of hyperglycemia, hypoglycemia at both thresholds, and patients with elevated glucose variability as well as time outside glycemic targets were substantially higher in simulations with measurement interval Q2h compared to those with measurement interval Q1h and moderately higher in simulations with Q1h than in those with Q15'. Higher measurement frequency mitigated the deleterious effect of high measurement imprecision, defined as CV ≥ 15%. This Monte Carlo simulation suggests that glycemic control in critically ill patients is more optimal with a BG measurement interval no longer than 1h, with further benefit obtained with use of measurement interval of 15'. These findings have important implications for the development of glycemic control standards. PMID:25568143

  1. Glycemic Control in Kenyan Children and Adolescents with Type 1 Diabetes Mellitus

    PubMed Central

    Ngwiri, Thomas; Were, Fred; Predieri, Barbara; Ngugi, Paul; Iughetti, Lorenzo

    2015-01-01

    Background. Type 1 diabetes mellitus (T1DM) is the most common endocrine disorder in children and adolescents worldwide. While data about prevalence, treatment, and complications are recorded in many countries, few data exist for Sub-Saharan Africa. The aim of this study was to determine the degree of control in patients with T1DM aged 1–19 years over a 6-month period in 3 outpatient Kenyan clinics. It also sought to determine how control was influenced by parameters of patient and treatment. Methods. Eighty-two children and adolescents with T1DM were included in the study. Clinical history regarding duration of illness, type and dose of insulin, and recent symptoms of hypoglycemia/hyperglycemia were recorded. Glycaemia, HbA1c, and ketonuria were tested. HbA1c of 8.0% and below was defined as the cut-off for acceptable control. Results. The median HbA1c for the study population was 11.1% (range: 6.3–18.8). Overall, only 28% of patients had reasonable glycemic control as defined in this study. 72% therefore had poor control. It was also found that age above 12 years was significantly associated with poor control. Conclusions. African children and with T1DM are poorly controlled particularly in adolescents. Our data strongly support the necessity of Kenya children to receive more aggressive management and follow-up. PMID:26494998

  2. Long term Glycemic Control Using Polymer Encapsulated, Human Stem-Cell Derived β-cells in Immune Competent mice

    PubMed Central

    Vegas, Arturo J.; Veiseh, Omid; Gürtler, Mads; Millman, Jeffrey R.; Pagliuca, Felicia W.; Bader, Andrew R.; Doloff, Joshua C.; Li, Jie; Chen, Michael; Olejnik, Karsten; Tam, Hok Hei; Jhunjhunwala, Siddharth; Langan, Erin; Aresta-Dasilva, Stephanie; Gandham, Srujan; McGarrigle, James; Bochenek, Matthew A.; Hollister-Lock, Jennifer; Oberholzer, Jose; Greiner, Dale L.; Weir, Gordon C.; Melton, Douglas A.; Langer, Robert; Anderson, Daniel G.

    2016-01-01

    The transplantation of glucose-responsive, insulin-producing cells offers the potential for restoring glycemic control in diabetic patients1. Pancreas transplantation and the infusion of cadaveric islets are currently implemented clinically2, but are limited by the adverse effects of lifetime immunosuppression and the limited supply of donor tissue3. The latter concern may be addressed by recently described glucose responsive mature β-cells derived from human embryonic stem cells; called SC-β, these cells may represent an unlimited human cell source for pancreas replacement therapy4. Strategies to address the immunosuppression concern include immunoisolation of insulin-producing cells with porous biomaterials that function as an immune barrier5,6. However, clinical implementation has been challenging due to host immune responses to implant materials7. Here, we report the first long term glycemic correction of a diabetic, immune-competent animal model with human SC-β cells. SC-β cells were encapsulated with alginate-derivatives capable of mitigating foreign body responses in vivo, and implanted into the intraperitoneal (IP) space of streptozotocin-treated (STZ) C57BL/6J mice. These implants induced glycemic correction until removal at 174 days without any immunosuppression. Human C-peptide concentrations and in vivo glucose responsiveness demonstrate therapeutically relevant glycemic control. Implants retrieved after 174 days contained viable insulin-producing cells. PMID:26808346

  3. Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort

    PubMed Central

    Pop-Busui, Rodica; Lu, Jiang; Lopes, Neuza; Jones, Teresa L. Z.

    2009-01-01

    We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass-Angioplasty-Revascularization-Investigation-2-Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing versus insulin-providing treatments for diabetes. 2368 patients with type 2 diabetes and CAD were evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression, adjusted for multiple covariates including age, sex, HbA1c, diabetes duration. 51% BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR1.57, 1.15, 2.13). Patients on sulfonylurea or combination of sulfonylurea/metformin/TZD had marginally higher rates of DPN than the metformin/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN. PMID:19335534

  4. Peri-procedural Glycemic Control in Patients with Diabetes Mellitus Undergoing Coronary Angiography with Possible Percutaneous Coronary Intervention

    PubMed Central

    Shah, Binita; Berger, Jeffrey S.; Amoroso, Nicholas S.; Mai, Xingchen; Lorin, Jeffrey D.; Danoff, Ann; Schwartzbard, Arthur Z.; Lobach, Iryna; Guo, Yu; Feit, Frederick; Slater, James; Attubato, Michael J.; Sedlis, Steven P.

    2014-01-01

    Peri-procedural hyperglycemia is an independent predictor of mortality in patients undergoing percutaneous coronary intervention (PCI). However, peri-procedural management of blood glucose is not standardized. The effects of routinely continuing long-acting glucose-lowering medications prior to coronary angiography with possible PCI on peri-procedural glycemic control have not been investigated. Patients with diabetes mellitus (DM) (n=172) were randomized to continue (Continue group; n=86) or hold (Hold group; n=86) their clinically prescribed long-acting glucose-lowering medications prior to procedure. The primary endpoint was glucose level on procedural access. In a subset of patients (no DM group, n=25, Continue group, n=25, and Hold group, n=25), selected measures of platelet activity that change acutely were assessed. Patients with DM randomized to the Continue group had lower blood glucose levels on procedural access compared with those randomized to the Hold group (117 [97–151] vs 134 [117–172] mg/dL, p=0.002). There were 2 hypoglycemic events in the Continue group and none in the Hold group, and no adverse events in either group. Selected markers of platelet activity differed across the no DM, Continue, and Hold groups (leukocyte platelet aggregates: 8.1% [7.2–10.4], 8.7% [6.9–11.4], 10.9% [8.6–14.7], p=0.007; monocyte platelet aggregates: 14.0% [10.3–16.3], 20.8% [16.2–27.0], 22.5% [15.2–35.4], p<0.001; soluble p-selectin: 51.9ng/mL [39.7–74.0], 59.1ng/mL [46.8–73.2], 72.2ng/mL [58.4–77.4], p=0.014). In conclusion, routinely continuing clinically prescribed long-acting glucose-lowering medications prior to coronary angiography with possible PCI helps achieve peri-procedural euglycemia, appears safe, and should be considered as a strategy for achieving peri-procedural glycemic control. PMID:24630791

  5. Level of sustained glycemic control and associated factors among patients with diabetes mellitus in Ethiopia: a hospital-based cross-sectional study

    PubMed Central

    Abebe, Solomon Mekonnen; Berhane, Yemane; Worku, Alemayehu; Alemu, Shitaye; Mesfin, Nebiyu

    2015-01-01

    Background The level of sustained glycemic control in patients with diabetes mellitus (DM) is a major determinant of the occurrence of both acute and chronic complications. However, information about the level of glycemic control among patients in the follow-up care at the University of Gondar Referral Hospital is scanty. The study assessed the degree of glycemic control and associated factors among diabetic patients in the study area. Method A hospital-based cross-sectional study was conducted at the University of Gondar Referral Hospital. All diabetic patients aged ≥18 years who visited the Diabetes Clinic in January and February 2013 for follow-up medical evaluation and medication participated in the study. Patients with glycosylated hemoglobin test (HbA1c) of ≥7% were classified as having a poor level of glycemic control. Propensity score was used to estimate the treatment effect. Multivariable logistic regression analysis was applied to determine the associated factors. Result Two hundred and fifty three (64.7%) of the 391 diabetic patients included in the study had a poor level of glycemic control, as evidenced by HbA1c ≥7%. Poor glycemic control was much higher among Type 1 patients (82.9%) compared with Type 2 patients (57.5%). Being on insulin treatment (AOR =2.51; 95% CI =1.25, 5.04) and reporting poor medication adherence (AOR =3.19; 95% CI =1.76, 5.80) were found to be associated with poor glycemic control among Type 2 DM patients. High waist circumference was inversely associated with a poor level of glycemic control in Type 1 DM patients (AOR =0.05; 95% CI =0.01, 0.85). Conclusion The proportion of diabetic patients with a poor level of glycemic control is high. We recommend a comprehensive intervention to improve the overall treatment adherence with special attention to DM patients receiving insulin. PMID:25657591

  6. Diabetes Care, Glycemic Control, Complications, and Concomitant Autoimmune Diseases in Children with Type 1 Diabetes in Turkey: A Multicenter Study

    PubMed Central

    Şimşek, Damla Gökşen; Aycan, Zehra; Özen, Samim; Çetinkaya, Semra; Kara, Cengiz; Abalı, Saygın; Demir, Korcan; Tunç, Özgül; Uçaktürk, Ahmet; Asar, Gülgün; Baş, Firdevs; Çetinkaya, Ergun; Aydın, Murat; Karagüzel, Gülay; Orbak, Zerrin; Orbak, Zerrin; Şıklar, Zeynep; Altıncık, Ayça; Ökten, Ayşenur; Özkan, Behzat; Öçal, Gönül; Semiz, Serap; Arslanoğlu, İlknur; Evliyaoğlu, Olcay; Bundak, Rüveyde; Darcan, Şükran

    2013-01-01

    Objective: Epidemiologic and clinical features of type 1 diabetes mellitus (T1DM) may show substantial differences among countries. The primary goal in the management of T1DM is to prevent micro- and macrovascular complications by achieving good glycemic control. The present study aimed to assess metabolic control, presence of concomitant autoimmune diseases, and of acute and long-term complications in patients diagnosed with T1DM during childhood and adolescence. The study also aimed to be a first step in the development of a national registry system for T1DM, in Turkey. Methods: Based on hospital records, this cross-sectional, multicenter study included 1 032 patients with T1DM from 12 different centers in Turkey, in whom the diagnosis was established during childhood. Epidemiological and clinical characteristics of the patients were recorded. Metabolic control, diabetes care, complications, and concomitant autoimmune diseases were evaluated. Results: Mean age, diabetes duration, and hemoglobin A1c level were 12.5±4.1 years, 4.7±3.2 years, and 8.5±1.6%, respectively. Acute complications noted in the past year included ketoacidosis in 5.2% of the patients and severe hypoglycemia in 4.9%. Chronic lymphocytic thyroiditis was noted in 12%, Graves’ disease in 0.1%, and celiac disease in 4.3% of the patients. Chronic complications including neuropathy, retinopathy, and persistent microalbuminuria were present in 2.6%, 1.4%, and 5.4% of the patients, respectively. Diabetic nephropathy was not present in any of the patients. Mean diabetes duration and age of patients with neuropathy, retinopathy and microalbuminuria were significantly different from the patients without these long-term complications (p<0.01). A significant difference was found between pubertal and prepubertal children in terms of persistent microalbuminuria and neuropathy (p=0.02 and p<0.001, respectively). Of the patients, 4.4% (n:38) were obese and 5% had short stature; 17.4% of the patients had

  7. Social Support Groups in the Maintenance of Glycemic Control after Community-Based Intervention

    PubMed Central

    Zhang, Guangxing; Hughes, Claire; Kehauoha, Bridget Puni; Sinclair, Ka‘imi A.

    2016-01-01

    Native Hawaiians and other Pacific Islanders (NH/PI; e.g., Samoan and Chuukese) have higher type 2 diabetes prevalence compared to other groups in Hawai‘i. Partners in Care (PIC), a culturally tailored, community-based, diabetes self-management education intervention (DSME), is effective at improving participants' glycemic control and self-care behaviors. Maintenance of improvements is challenging. Diabetes-related social support groups (SSG) are a promising maintenance component for DSME. This study examined the effects of a diabetes-specific SSG component relative to a control group, after the receipt of the 3-month PIC intervention, which was delivered to 47 adult NH/PI with type 2 diabetes. Participants were then randomized to either a 3-month, 6-session SSG or a control group. Hemoglobin A1c (HbA1c), blood pressure, triglycerides, cholesterol, and diabetes self-management knowledge and behaviors were assessed at baseline, 3 months, and 6 months. Results indicated significant improvements in HbA1c, diabetes-related self-management knowledge, and behaviors from baseline to 3-month assessment. However, no differences between the SSG and control group from 3-month to 6-month assessment suggest that all participants were able to maintain initial improvements. The SSG group had a significant decrease in systolic blood pressure from 3-month to 6-month assessment while the control group did not. Study limitations and future directions are discussed. PMID:27563680

  8. Social Support Groups in the Maintenance of Glycemic Control after Community-Based Intervention.

    PubMed

    Ing, Claire Townsend; Zhang, Guangxing; Dillard, Adrienne; Yoshimura, Sheryl R; Hughes, Claire; Palakiko, Donna-Marie; Kehauoha, Bridget Puni; Sinclair, Ka'imi A; Kaholokula, Joseph Keawe'aimoku

    2016-01-01

    Native Hawaiians and other Pacific Islanders (NH/PI; e.g., Samoan and Chuukese) have higher type 2 diabetes prevalence compared to other groups in Hawai'i. Partners in Care (PIC), a culturally tailored, community-based, diabetes self-management education intervention (DSME), is effective at improving participants' glycemic control and self-care behaviors. Maintenance of improvements is challenging. Diabetes-related social support groups (SSG) are a promising maintenance component for DSME. This study examined the effects of a diabetes-specific SSG component relative to a control group, after the receipt of the 3-month PIC intervention, which was delivered to 47 adult NH/PI with type 2 diabetes. Participants were then randomized to either a 3-month, 6-session SSG or a control group. Hemoglobin A1c (HbA1c), blood pressure, triglycerides, cholesterol, and diabetes self-management knowledge and behaviors were assessed at baseline, 3 months, and 6 months. Results indicated significant improvements in HbA1c, diabetes-related self-management knowledge, and behaviors from baseline to 3-month assessment. However, no differences between the SSG and control group from 3-month to 6-month assessment suggest that all participants were able to maintain initial improvements. The SSG group had a significant decrease in systolic blood pressure from 3-month to 6-month assessment while the control group did not. Study limitations and future directions are discussed. PMID:27563680

  9. Glycemic penalty index for adequately assessing and comparing different blood glucose control algorithms

    PubMed Central

    Van Herpe, Tom; De Brabanter, Jos; Beullens, Martine; De Moor, Bart; Van den Berghe, Greet

    2008-01-01

    Introduction Blood glucose (BG) control performed by intensive care unit (ICU) nurses is becoming standard practice for critically ill patients. New (semi-automated) 'BG control' algorithms (or 'insulin titration' algorithms) are under development, but these require stringent validation before they can replace the currently used algorithms. Existing methods for objectively comparing different insulin titration algorithms show weaknesses. In the current study, a new approach for appropriately assessing the adequacy of different algorithms is proposed. Methods Two ICU patient populations (with different baseline characteristics) were studied, both treated with a similar 'nurse-driven' insulin titration algorithm targeting BG levels of 80 to 110 mg/dl. A new method for objectively evaluating BG deviations from normoglycemia was founded on a smooth penalty function. Next, the performance of this new evaluation tool was compared with the current standard assessment methods, on an individual as well as a population basis. Finally, the impact of four selected parameters (the average BG sampling frequency, the duration of algorithm application, the severity of disease, and the type of illness) on the performance of an insulin titration algorithm was determined by multiple regression analysis. Results The glycemic penalty index (GPI) was proposed as a tool for assessing the overall glycemic control behavior in ICU patients. The GPI of a patient is the average of all penalties that are individually assigned to each measured BG value based on the optimized smooth penalty function. The computation of this index returns a number between 0 (no penalty) and 100 (the highest penalty). For some patients, the assessment of the BG control behavior using the traditional standard evaluation methods was different from the evaluation with GPI. Two parameters were found to have a significant impact on GPI: the BG sampling frequency and the duration of algorithm application. A higher BG

  10. Colonic Fermentation of Unavailable Carbohydrates from Unripe Banana and its Influence over Glycemic Control.

    PubMed

    Dan, Milana C T; Cardenette, Giselli H L; Sardá, Fabiana A H; Giuntini, Eliana Bistriche; Bello-Pérez, Luis Arturo; Carpinelli, Ângelo R; Lajolo, Franco M; Menezes, Elizabete Wenzel

    2015-09-01

    The aim of this study was to evaluate the effect of the colonic fermentation of unavailable carbohydrates from unripe banana (mass - UBM - and starch - UBS) over parameters related to glucose and insulin response in rats. Wistar male rats were fed either a control diet, a UBM diet (5 % resistant starch - RS) or a UBS diet (10 % RS) for 28 days. In vivo (oral glucose tolerance test) and in vitro (cecum fecal fermentation, pancreatic islet insulin secretion) analyses were performed. The consumption of UBM and UBS diets by Wistar rats for 28 days improved insulin/glucose ratio. Also, pancreatic islets isolated from the test groups presented significant lower insulin secretion compared to the control group, when the same in vitro glucose stimulation was done. Total short chain fatty acids produced were higher in both experimental groups in relation to the control group. These findings suggest that UBM and UBS diets promote colonic fermentation and can influence glycemic control, improving insulin sensitivity in rats. PMID:26092708

  11. Cadmium Level, Glycemic Control, and Indices of Renal Function in Treated Type II Diabetics: Implications for Polluted Environments

    PubMed Central

    Anetor, John I.; Uche, Chukwuemelie Z.; Ayita, Emmanuel B.; Adedapo, Solomon K.; Adeleye, Jokotade O.; Anetor, Gloria O.; Akinlade, Sola K.

    2016-01-01

    Cadmium (Cd) has recently emerged as a major concern not only in environmental toxicology but also in metabolic diseases such as diabetes mellitus and its complications. Conflicting data aside, these studies have not been examined in a clinical population undergoing management as well as possible modulation by the prominent metabolic antagonist of Cd such as zinc (Zn). This study examined the relationship between cadmium levels, glycemic control, and renal pathology in established type II diabetic patients with focus on populations exposed to modern environmental health hazards (MEHHs). Sixty-five participants, consisting of 45 type-2 diabetics and 20 non-diabetics were enrolled for the study, mean age 61.51 ± 5.27 years. Glycated hemoglobin (HbA1c) was used to classify them into three sub-groups: (A) good glycemic control (44.4%), (B) fair glycemic control (24.4%), and (C) poor glycemic control (31.1%). Plasma levels of glucose, Cd, Zn, HbA1c, creatinine, urinary creatinine, microalbuminuria, and estimated glomerular filtration rate (eGFR) were determined in all participants using standard methods. Fasting plasma glucose was higher in diabetics than in non-diabetics (p = 0.000) as well as Zn level, though not significantly. Interestingly, Cd level, Cd/Zn ratio, and urinary creatinine were significantly lower in diabetics than in non-diabetics. The group with poor glycemic control (C) had significantly higher Cd level compared to the one with good glycemic control (group A). The renal function revealed that microalbuminuria and urinary albumin/creatinine ratio (UACR) was significantly higher in diabetics than in non-diabetics, while eGFR was found to be similar in both diabetics and non-diabetics. UACR inversely correlated with Cd level, while plasma creatinine level positively correlated with Cd but not significantly. Correlation between Cd and HbA1c revealed non-significant inverse correlation (r = −0.007; p > 0.05), while Zn showed a

  12. Cadmium Level, Glycemic Control, and Indices of Renal Function in Treated Type II Diabetics: Implications for Polluted Environments.

    PubMed

    Anetor, John I; Uche, Chukwuemelie Z; Ayita, Emmanuel B; Adedapo, Solomon K; Adeleye, Jokotade O; Anetor, Gloria O; Akinlade, Sola K

    2016-01-01

    Cadmium (Cd) has recently emerged as a major concern not only in environmental toxicology but also in metabolic diseases such as diabetes mellitus and its complications. Conflicting data aside, these studies have not been examined in a clinical population undergoing management as well as possible modulation by the prominent metabolic antagonist of Cd such as zinc (Zn). This study examined the relationship between cadmium levels, glycemic control, and renal pathology in established type II diabetic patients with focus on populations exposed to modern environmental health hazards (MEHHs). Sixty-five participants, consisting of 45 type-2 diabetics and 20 non-diabetics were enrolled for the study, mean age 61.51 ± 5.27 years. Glycated hemoglobin (HbA1c) was used to classify them into three sub-groups: (A) good glycemic control (44.4%), (B) fair glycemic control (24.4%), and (C) poor glycemic control (31.1%). Plasma levels of glucose, Cd, Zn, HbA1c, creatinine, urinary creatinine, microalbuminuria, and estimated glomerular filtration rate (eGFR) were determined in all participants using standard methods. Fasting plasma glucose was higher in diabetics than in non-diabetics (p = 0.000) as well as Zn level, though not significantly. Interestingly, Cd level, Cd/Zn ratio, and urinary creatinine were significantly lower in diabetics than in non-diabetics. The group with poor glycemic control (C) had significantly higher Cd level compared to the one with good glycemic control (group A). The renal function revealed that microalbuminuria and urinary albumin/creatinine ratio (UACR) was significantly higher in diabetics than in non-diabetics, while eGFR was found to be similar in both diabetics and non-diabetics. UACR inversely correlated with Cd level, while plasma creatinine level positively correlated with Cd but not significantly. Correlation between Cd and HbA1c revealed non-significant inverse correlation (r = -0.007; p > 0.05), while Zn showed a

  13. Effect of glycemic control on corneal nerves and peripheral neuropathy in streptozotocin-induced diabetic C57Bl/6J mice

    PubMed Central

    Yorek, Matthew S.; Obrosov, Alexander; Shevalye, Hanna; Lupachyk, Sergey; Harper, Matthew M.; Kardon, Randy H.; Yorek, Mark A.

    2016-01-01

    We sought to determine the impact that duration of hyperglycemia and control has on corneal nerve fiber density in relation to standard diabetic neuropathy endpoints. Control and streptozotocin-diabetic C57Bl/6J mice were analyzed after 4, 8, 12 and 20 weeks. For the 20 week time point five groups of mice were compared: control, untreated diabetic, and diabetic treated with insulin designated as having either poor glycemic control, good glycemic control or poor glycemic control switched to good glycemic control. Hyperglycemia was regulated by use of insulin releasing pellets. Loss of corneal nerves in the sub-epithelial nerve plexus or corneal epithelium progressed slowly in diabetic mice requiring 20 weeks to reach statistical significance. In comparison, slowing of motor and sensory nerve conduction velocity developed rapidly with significant difference compared to control mice observed after 4 and 8 weeks of hyperglycemia, respectively. In diabetic mice with good glycemic control average blood glucose levels over the 20 week experimental period were lowered from 589 ± 2 to 251 ± 9 mg/dl. All diabetic neuropathy endpoints examined were improved in diabetic mice with good glycemic control compared to untreated diabetic mice. However, good control of blood glucose was not totally sufficient in preventing diabetic neuropathy. PMID:25403729

  14. Poor glycemic control as a reason for referral of diabetes patients to specialists in Israel

    PubMed Central

    Fogelman, Yacov; Karkabi, Khaled; Goldfracht, Margalit

    2016-01-01

    Aims/introduction Family physicians face the dilemma of when to refer patients with diabetes to specialists. This study examined attitudes of family physicians to referring patients with poor glucose control to diabetes specialists. Materials and methods At continuous medical education courses, family physicians were asked to respond anonymously, as to whether they generally manage the diabetes of their patients, and specifically those with poor glycemic control (HbA1c>9.0%). Results Of 470 respondents, 426 (90%) reported that they generally manage their patients’ diabetes; 202 (43%) reported that they manage the diabetes of patients with HbA1c>9.0%. Board certification in family medicine and affiliation to a health maintenance organization, but not sex, age, years of professional experience, or the proportion of patients with diabetes at their clinics, were associated with referral practices. Conclusions Family medicine residency and organizational support appear to promote treatment by family physicians of patients with poorly controlled diabetes in the primary care setting. PMID:27124172

  15. Severe Type 2 Diabetes Induces Reversible Modifications of Endothelial Progenitor Cells Which are Ameliorate by Glycemic Control

    PubMed Central

    De Pascale, Maria Rosaria; Bruzzese, Giuseppe; Crimi, Ettore; Grimaldi, Vincenzo; Liguori, Antonio; Brongo, Sergio; Barbieri, Michelangela; Picascia, Antonietta; Schiano, Concetta; Sommese, Linda; Ferrara, Nicola; Paolisso, Giuseppe; Napoli, Claudio

    2016-01-01

    Background Circulating endothelial progenitors cells (EPCs) play a critical role in neovascularization and endothelial repair. There is a growing evidence that hyperglycemia related to Diabetes Mellitus (DM) decreases EPC number and function so promoting vascular complications. Aim of the Study This study investigated whether an intensive glycemic control regimen in Type 2 DM can increase the number of EPCs and restores their function. Methods Sixty-two patients with Type 2 DM were studied. Patients were tested at baseline and after 3 months of an intensive regimen of glycemic control. The Type 2 DM group was compared to control group of subjects without diabetes. Patients with Type 2 DM (mean age 58.2±5.4 years, 25.6% women, disease duration of 15.4±6.3 years) had a baseline HgA1c of 8.7±0.5% and lower EPC levels (CD34+/KDR+) in comparison to healthy controls (p<0.01). Results The intensive glycemic control regimen (HgA1c decreased to 6.2±0.3%) was coupled with a significant increase of EPC levels (mean of 18%, p<0.04 vs. baseline) and number of EPCs CFUs (p<0.05 vs. baseline). Conclusion This study confirms that number and bioactivity of EPCs are reduced in patients with Type 2 DM and, most importantly, that the intensive glycemic control in Type 2 DM promotes EPC improvement both in their number and in bioactivity. PMID:27426095

  16. Chronic Illness with Complexity: Implications for Performance Measurement of Optimal Glycemic Control

    PubMed Central

    Helmer, Drew; Rajan, Mangala; Tseng, Chin-Lin; Pogach, Leonard; Sambamoorthi, Usha

    2007-01-01

    OBJECTIVE To evaluate the association between chronic illness with complexity (CIC) and optimal glycemic control. PARTICIPANTS Cross-sectional and longitudinal analyses of Diabetes Epidemiologic Cohort database of Veterans Health Administration (VHA) users with diabetes, less than 75 years old, with HbA1c tests in fiscal year (FY) 1999 and 2000, alive at FY2000 end (N = 95,423). DESIGN/MEASUREMENTS Outcomes were HbA1c < 7% in each FY. CIC included three domains: nondiabetes physical illness, diabetes-related, and mental illness/substance abuse conditions. Other independent variables included age, gender, race, marital status, VHA priority status, and diabetes severity. Longitudinal analyses were restricted to patients with HbA1c ≥ 7% in FY1999 and included hospitalizations between final HbA1c’s in FY1999 and FY2000. Multiple logistic regressions examined associations between CIC categories and HbA1c. RESULTS In FY1999, 33% had HbA1c <7%. In multivariate analyses, patients with nondiabetes physical illness and mental illness/substance abuse were more likely to have HbA1c <7% in FY1999 [adjusted odds ratios for cancer (AOR), 1.31; 95% CI (1.25–1.37); mental illness only, 1.18; 95% CI (1.14–1.22)]. Those with diabetes-related complications were less likely to have HbA1c <7% in FY1999. Associations generally held in FY2000. However, conditions in the mental illness/substance abuse complexity domain were less strongly associated with HbA1c <7%. Macrovascular-related hospitalizations were positively associated with HbA1c <7% [AOR, 1.41; 95% CI (1.34–1.49)]. CONCLUSIONS The association between CIC and HbA1c <7% is heterogeneous and depends on the domain of complexity. The varying associations of CIC categories with optimal glycemic control suggest the need for appropriate risk adjustment when using HbA1c <7% as a valid performance measure for diabetes quality of care. PMID:18026810

  17. Sleep in Adolescents and Young Adults with Type 1 Diabetes: Associations with Diabetes Management and Glycemic Control

    PubMed Central

    Jaser, Sarah S.; Ellis, Deborah

    2016-01-01

    Objective To describe sleep in adolescents and young adults with type 1 diabetes and explore the association between sleep disturbances, diabetes management and glycemic control. Methods Adolescents with type 1 diabetes (n = 159, mean age = 16.4, 43% female, 69% white, mean A1C = 9.3%) completed the Pittsburgh Sleep Quality Index to assess sleep quantity and quality and sleep disturbances. Frequency of blood glucose monitoring (meter downloads) was used as a measure of diabetes management. Results Average sleep duration was 7.4 hours, below the recommended duration for this age. Adolescents using insulin pumps reported fewer sleep disturbances and longer sleep duration than those on injections, and older adolescents reported less sleep than younger adolescents. Poorer sleep duration was related to poorer diabetes management and better self-reported sleep quality was associated with better glycemic control for males but not for females. Conclusions Assessing for and treating sleep disturbances in adolescents may improve diabetes management. PMID:27081578

  18. Convergence of Continuous Glucose Monitoring and In-Hospital Tight Glycemic Control: Closing the Gap between Caregivers and Industry

    PubMed Central

    Miller, Michaela; Skladany, Matthew J.; Ludwig, Christopher R.; Guthermann, Joshua S.

    2007-01-01

    The convergence of continuous glucose monitoring (CGM) and tight glycemic control protocols is approaching. As with the diffusion of any innovative technology, there will be challenges that will likely delay widespread adoption. With the objective of assessing the current mindset of health care professionals toward CGM adoption in the hospital intensive care unit (ICU) setting and resulting implications to industry, Boston Biomedical Consultants surveyed >60 U.S. ICU managers and nurses during Spring 2007. The underlying sentiment expressed by survey respondents toward CGM was positive, with many citing potential benefits of CGM adoption, such as labor savings, improved glycemic control, and assistance with insulin dosing. While the demand for CGM in the hospital clearly exists, early stage product acceptance will remain limited given the substantial education, market development, and economic hurdles. PMID:19885164

  19. The role of genetic factors and kidney and liver function in glycemic control in type 2 diabetes patients on long-term metformin and sulphonylurea cotreatment.

    PubMed

    Klen, Jasna; Goričar, Katja; Janež, Andrej; Dolžan, Vita

    2014-01-01

    This study investigated the influence of genetic polymorphisms of metformin transporters on long-term glycemic control and lipid status in type 2 diabetes patients in the everyday clinical setting. In total 135 patients treated with combination of metformin and sulphonylurea for at least 6 months were genotyped for SLC22A1 rs628031 and SLC47A1 rs2289669 polymorphisms. Relatively good blood glucose control with median HbA1c 6.9 (6.4-7.6) % was achieved on prescribed metformin dosage of 2550 (2000-2550) mg per day. Only 28 (20.7%) patients experienced mild hypoglycemia events, while no severe hypoglycemia events were observed. Most patients had normal or mildly impaired renal function. Parameters indicating renal function were not correlated with fasting glucose, HbA1c, or lipid parameters. Rs628031 and rs2289669 had minor allele frequencies of 0.385 and 0.355, respectively, and were not associated with HbA1c levels. Rs628031 was marginally associated with risk for hypoglycemia events (P = 0.046; OR = 0.51; 95% CI 0.26-0.99), while significant correlation was observed between rs2289669 and total cholesterol levels (P = 0.018). In conclusion, in patients on long-term metformin and sulphonylurea combination treatment, metformin transporters polymorphisms do not play a major role in glycemic control; however, they may influence lipid status. PMID:25025077

  20. Impact of Glycemic Control and Metformin Use on the Recurrence and Progression of Non-Muscle Invasive Bladder Cancer in Patients with Diabetes Mellitus

    PubMed Central

    2016-01-01

    The purpose of the present study was to determine the potential relationships of glycemic control and use of metformin with non-muscle invasive bladder cancer characteristics. We reviewed data from 645 patients with non-muscle invasive bladder cancer between January 2004 and May 2015. We analyzed the association of pre and post-operative glycemic control and use of metformin with clinical characteristics of bladder tumors. We also analyzed the association of glycemic control and use of metformin with recurrence-free and progression-free survivals. Diabetes mellitus patients showed decreased recurrence-free survival (hazard ratio 1.42; 95% confidence interval 1.1–1.9; P = 0.021) and progression-free survival (hazard ratio 1.79; 95% confidence interval 1.1–2.8; P = 0.013). Diabetes mellitus patients with a HbA1c ≥ 7.0% demonstrated a higher rate of progression (P = 0.026). Kaplan-Meier analysis showed that progression-free survival rate was associated with poor baseline glycemic control (P = 0.026) and post-operative glycemic control (P = 0.025). However, use of metformin had no impact on the recurrence (P = 1.00) and progression (P = 0.282). In conclusion, poor baseline and post-operative glycemic control was related with shorter progression-free survival of patients with non-muscle invasive bladder cancer. Use of metformin had no impact on the recurrence and progression. Therefore, tight glycemic control and close follow-up for bladder tumor may be beneficial in patients with poor glycemic control. PMID:27510392

  1. Computer decision support software safely improves glycemic control in the burn intensive care unit: a randomized controlled clinical study

    PubMed Central

    Mann, Elizabeth A.; Jones, John A.; Wolf, Steven E.; Wade, Charles E.

    2011-01-01

    Objective The optimal method for glycemic control in the critically burned patient is unknown. The purpose of this randomized controlled study was to determine the safety and efficacy of computer decision support software (CDSS) to control serum glucose concentration in a burn intensive care unit. Methods Eighteen adult burn/trauma patients receiving continuous insulin infusion were initially randomized to receive glucose management via a traditional paper-based protocol (PP) or a computer protocol (CP) for 72 hours, then crossed over to the alternate method for an additional 72 hours. Results Time in target glucose range (80-110 mg/dl) was higher in the CP group (47 ± 17% versus 41 ± 16.6%; p ≤ 0.05); time over target range was not significantly reduced in the CP group (49 ± 17.8% versus 54 ± 17.1; p = 0.08); and no difference was noted in time under target range of 80 mg/dl (CP 4.5 ± 2.8, PP 4.8 ± 3.3%; p = 0.8), under 60 mg/dl (p = 0.7), and under 40 mg/dl (p = 1.0). Severe hypoglycemic events (< 40 mg/dl) did not differ from the CP group compared to historical controls for patients receiving no insulin (p = 0.6). More glucose measurements were performed in the CP group (p = 0.0003), and nursing staff compliance with CP recommendations was greater (p < 0.0001). Conclusions Glycemic control using CDSS is safe and effective for the critically burned patient. Time in target range improved without increase in hypoglycemic events. CDSS enhanced consistency in practice, providing standardization among nursing staff. PMID:21240001

  2. Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control

    PubMed Central

    Betônico, Carolina C R; Titan, Silvia M O; Correa-Giannella, Maria Lúcia C; Nery, Márcia; Queiroz, Márcia

    2016-01-01

    The purpose of this study was to evaluate the therapeutic options for diabetes treatment and their potential side effects, in addition to analyzing the risks and benefits of tight glycemic control in patients with diabetic kidney disease. For this review, a search was performed using several pre-defined keyword combinations and their equivalents: “diabetes kidney disease” and “renal failure” in combination with “diabetes treatment” and “oral antidiabetic drugs” or “oral hypoglycemic agents.” The search was performed in PubMed, Endocrine Abstracts and the Cochrane Library from January 1980 up to January 2015. Diabetes treatment in patients with diabetic kidney disease is challenging, in part because of progression of renal failure-related changes in insulin signaling, glucose transport and metabolism, favoring both hyperglycemic peaks and hypoglycemia. Additionally, the decline in renal function impairs the clearance and metabolism of antidiabetic agents and insulin, frequently requiring reassessment of prescriptions. The management of hyperglycemia in patients with diabetic kidney disease is even more difficult, requiring adjustment of antidiabetic agents and insulin doses. The health team responsible for the follow-up of these patients should be vigilant and prepared to make such changes; however, unfortunately, there are few guidelines addressing the nuances of the management of this specific population. PMID:26872083

  3. Mobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants.

    PubMed

    Nundy, Shantanu; Dick, Jonathan J; Chou, Chia-Hung; Nocon, Robert S; Chin, Marshall H; Peek, Monica E

    2014-02-01

    Even with the best health care available, patients with chronic illnesses typically spend no more than a few hours a year in a health care setting, while their outcomes are largely determined by their activities during the remaining 5,000 waking hours of the year. As a widely available, low-cost technology, mobile phones are a promising tool to use in engaging patients in behavior change and facilitating self-care between visits. We examined the impact of a six-month mobile health (mHealth) demonstration project among adults with diabetes who belonged to an academic medical center's employee health plan. In addition to pre-post improvements in glycemic control (p=0.01) and patients' satisfaction with overall care (p=0.04), we observed a net cost savings of 8.8 percent. Those early results suggest that mHealth programs can support health care organizations' pursuit of the triple aim of improving patients' experiences with care, improving population health, and reducing the per capita cost of health care PMID:24493770

  4. Niclosamide ethanolamine improves blood glycemic control and reduces hepatic steatosis in mice

    PubMed Central

    Tao, Hanlin; Zhang, Yong; Zeng, Xiangang; Shulman, Gerald I.; Jin, Shengkan

    2014-01-01

    Type 2 diabetes (T2D) has reached an epidemic level globally. Most current treatments ameliorate the hyperglycemic symptom but are not effective in correcting the underlying cause. One important causal factor of T2D is ectopic accumulation of lipid in organs such as liver and muscle. Mitochondrial uncoupling, which reduces cellular energy efficiency and increases lipid oxidation, represents an appealing therapeutic strategy. The challenge, however, is to discover safe mitochondrial uncouplers for practical use. Niclosamide is an FDA approved anthelmintic drug that uncouples mitochondria of parasitic worms. Here we show that niclosamide ethanolamine salt (NEN) uncouples mammalian mitochondria at upper nanomolar concentrations. Oral NEN increases energy expenditure and lipid metabolism in mice. It is efficacious in preventing and treating high-fat diet (HFD) induced hepatic steatosis and insulin resistance. Moreover, it improves glycemic control and delays disease progression of the db/db mice. Given the well- documented safety profile of NEN, our study provides a potentially practical pharmacological embodiment of a new strategy for treating T2D. PMID:25282357

  5. Preserving Mafa Expression in Diabetic Islet β-Cells Improves Glycemic Control in Vivo*

    PubMed Central

    Matsuoka, Taka-aki; Kaneto, Hideaki; Kawashima, Satoshi; Miyatsuka, Takeshi; Tochino, Yoshihiro; Yoshikawa, Atsushi; Imagawa, Akihisa; Miyazaki, Jun-ichi; Gannon, Maureen; Stein, Roland; Shimomura, Iichiro

    2015-01-01

    The murine Mafa transcription factor is a key regulator of postnatal islet β-cell activity, affecting insulin transcription, insulin secretion, and β-cell mass. Human MAFA expression is also markedly decreased in islet β-cells of type 2 diabetes mellitus (T2DM) patients. Moreover, levels are profoundly reduced in db/db islet β-cells, a mouse model of T2DM. To examine the significance of this key islet β-cell-enriched protein to glycemic control under diabetic conditions, we generated transgenic mice that conditionally and specifically produced Mafa in db/db islet β-cells. Sustained expression of Mafa resulted in significantly lower plasma glucose levels, higher plasma insulin, and augmented islet β-cell mass. In addition, there was increased expression of insulin, Slc2a2, and newly identified Mafa-regulated genes involved in reducing β-cell stress, like Gsta1 and Gckr. Importantly, the levels of human GSTA1 were also compromised in T2DM islets. Collectively, these results illustrate how consequential the reduction in Mafa activity is to islet β-cell function under pathophysiological conditions. PMID:25645923

  6. Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control.

    PubMed

    Betônico, Carolina C R; Titan, Silvia M O; Correa-Giannella, Maria Lúcia C; Nery, Márcia; Queiroz, Márcia

    2016-01-01

    The purpose of this study was to evaluate the therapeutic options for diabetes treatment and their potential side effects, in addition to analyzing the risks and benefits of tight glycemic control in patients with diabetic kidney disease. For this review, a search was performed using several pre-defined keyword combinations and their equivalents: "diabetes kidney disease" and "renal failure" in combination with "diabetes treatment" and "oral antidiabetic drugs" or "oral hypoglycemic agents." The search was performed in PubMed, Endocrine Abstracts and the Cochrane Library from January 1980 up to January 2015. Diabetes treatment in patients with diabetic kidney disease is challenging, in part because of progression of renal failure-related changes in insulin signaling, glucose transport and metabolism, favoring both hyperglycemic peaks and hypoglycemia. Additionally, the decline in renal function impairs the clearance and metabolism of antidiabetic agents and insulin, frequently requiring reassessment of prescriptions. The management of hyperglycemia in patients with diabetic kidney disease is even more difficult, requiring adjustment of antidiabetic agents and insulin doses. The health team responsible for the follow-up of these patients should be vigilant and prepared to make such changes; however, unfortunately, there are few guidelines addressing the nuances of the management of this specific population. PMID:26872083

  7. PERCEIVED WEIGHT DISCRIMINATION AMPLIFIES THE LINK BETWEEN CENTRAL ADIPOSITY AND NONDIABETIC GLYCEMIC CONTROL (HBA1C)

    PubMed Central

    Tsenkova, Vera K.; Carr, Deborah; Schoeller, Dale A.; Ryff, Carol D.

    2010-01-01

    Background While the preclinical development of type 2 diabetes is partly explained by obesity and central adiposity, psychosocial research has shown that chronic stressors such as discrimination have health consequences as well. Purpose We investigated the extent to which the well-established effects of obesity and central adiposity on nondiabetic glycemic control (indexed by HbA1c) were moderated by a targeted psychosocial stressor linked to weight: perceived weight discrimination. Methods Data came from the nondiabetic subsample (n=938) of the Midlife in the United States (MIDUS II) survey. Results Body mass index (BMI), waist-to-hip ratio, and waist circumference were linked to significantly higher HbA1c (p < .001). Multivariate-adjusted models showed that weight discrimination exacerbated the effects of waist-to-hip ratio on HbA1c ( p < .05), such that people who had higher WHR and reported weight discrimination had the highest HbA1c levels. Conclusions Understanding how biological and psychosocial factors interact at nondiabetic levels to increase vulnerability could have important implications for public health and education strategies. Effective strategies may include targeting sources of discrimination, rather than solely targeting health behaviors and practices of overweight and obese persons. PMID:21136227

  8. Alexithymia in patients with type 2 diabetes mellitus: the role of anxiety, depression, and glycemic control

    PubMed Central

    Avci, Dilek; Kelleci, Meral

    2016-01-01

    Objective This study was aimed at determining the prevalence of alexithymia in patients with type 2 DM and the factors affecting it. Methods This cross-sectional study was conducted with 326 patients with type 2 DM. Study data were collected with the Personal Information Form, Toronto Alexithymia Scale, and Hospital Anxiety and Depression Scale. Glycemic control was assessed by glycated haemoglobin (HbA1c) results. The analysis was performed using descriptive statistics, chi-square test, Pear-son’s correlation, and logistic regression analysis. Results Of the patients, 37.7% were determined to have alexithymia. A significant relationship was determined between alexithymia and HbA1c, depression, and anxiety. According to binary logistic regression analyses, alexithymia was 2.63 times higher among those who were in a paid employment than those who were not, 2.09 times higher among those whose HbA1c levels were ≥7.0% than those whose HbA1c levels were <7.0%, 3.77 times higher among those whose anxiety subscale scores were ≥11 than those whose anxiety subscale scores were ≤10, and 2.57 times higher among those whose depression subscale scores were ≥8 than those whose depression subscale scores were ≤7. Conclusion In this study, it was determined that two out of every five patients with DM had alexithymia. Therefore, their treatment should be arranged to include mental health care services. PMID:27499615

  9. Smoking, Central Adiposity, and Poor Glycemic Control Increase Risk of Hearing Impairment

    PubMed Central

    Cruickshanks, Karen J.; Nondahl, David M.; Dalton, Dayna S.; Fischer, Mary E.; Klein, Barbara E.K.; Klein, Ronald; Nieto, F. Javier; Schubert, Carla R.; Tweed, Ted S.

    2015-01-01

    Objectives To determine associations between smoking, adiposity, diabetes, and other cardiovascular disease (CVD) risk factors and the 15-yr incidence of hearing impairment (HI). Design The Epidemiology of Hearing Loss Study (EHLS) is a longitudinal population-based cohort study (1993–95 to 2009–2010). Setting Beaver Dam, WI. Participants Participants in the Beaver Dam Eye Study (1988–90; residents of Beaver Dam, WI ages 43–84 years in 1987–88) were eligible for the EHLS. There were 1925 participants with normal hearing at baseline. Measurements 15-year cumulative incidence of HI (pure-tone average (PTA) of hearing thresholds at 0.5, 1, 2 and 4 kHz > 25 decibels Hearing Level (dB HL) in either ear). Cigarette smoking, exercise, and other factors were ascertained by questionnaire. Blood pressure, waist circumference, body mass index and glycosylated hemoglobin were measured. Results Follow-up examinations (≥1) were obtained from 87.2% (n=1678; mean baseline age 61 years). The 15-year cumulative incidence of HI was 56.8%. Adjusting for age and sex, current smoking (Hazard Ratio (HR) =1.31, p=0.048), education (<16 yrs; HR=1.35, p=0.01), waist circumference (HR=1.08 per 10 cm, p=0.017), and poorly controlled diabetes (HR=2.03, p=0.048) were associated with increased risk of HI. Former smokers and people with better controlled diabetes were not at increased risk. Conclusion Smoking, central adiposity and poorly controlled diabetes predicted incident HI. These well-known CVD risk factors, suggest vascular changes may contribute to HI in aging. Interventions targeting reductions in smoking and adiposity, and improved glycemic control in people with diabetes, may help to prevent or delay the onset of HI. PMID:25953199

  10. Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus.

    PubMed

    Taylor, G W; Burt, B A; Becker, M P; Genco, R J; Shlossman, M; Knowler, W C; Pettitt, D J

    1996-10-01

    This study tested the hypothesis that severe periodontitis in persons with non-insulin-dependent diabetes mellitus (NIDDM) increases the risk of poor glycemic control. Data from the longitudinal study of residents of the Gila River Indian Community were analyzed for dentate subjects aged 18 to 67, comprising all those: 1) diagnosed at baseline with NIDDM (at least 200 mg/dL plasma glucose after a 2-hour oral glucose tolerance test); 2) with baseline glycosylated hemoglobin (HbA1) less than 9%; and 3) who remained dentate during the 2-year follow-up period. Medical and dental examinations were conducted at 2-year intervals. Severe periodontitis was specified two ways for separate analyses: 1) as baseline periodontal attachment loss of 6 mm or more on at least one index tooth; and 2) baseline radiographic bone loss of 50% or more on at least one tooth. Clinical data for loss of periodontal attachment were available for 80 subjects who had at least one follow-up examination, 9 of whom had two follow-up examinations at 2-year intervals after baseline. Radiographic bone loss data were available for 88 subjects who had at least one follow-up examination, 17 of whom had two follow-up examinations. Poor glycemic control was specified as the presence of HbA, of 9% or more at follow-up. To increase the sample size, observations from baseline to second examination and from second to third examinations were combined. To control for non-independence of observations, generalized estimating equations (GEE) were used for regression modeling. Severe periodontitis at baseline was associated with increased risk of poor glycemic control at follow-up. Other statistically significant covariates in the GEE models were: 1) baseline age; 2) level of glycemic control at baseline; 3) having more severe NIDDM at baseline; 4) duration of NIDDM; and 5) smoking at baseline. These results support considering severe periodontitis as a risk factor for poor glycemic control and suggest that

  11. Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort.

    PubMed

    Pop-Busui, Rodica; Lu, Jiang; Lopes, Neuza; Jones, Teresa L Z

    2009-03-01

    We evaluated the associations between glycemic therapies and prevalence of diabetic peripheral neuropathy (DPN) at baseline among participants in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial on medical and revascularization therapies for coronary artery disease (CAD) and on insulin-sensitizing vs. insulin-providing treatments for diabetes. A total of 2,368 patients with type 2 diabetes and CAD was evaluated. DPN was defined as clinical examination score >2 using the Michigan Neuropathy Screening Instrument (MNSI). DPN odds ratios across different groups of glycemic therapy were evaluated by multiple logistic regression adjusted for multiple covariates including age, sex, hemoglobin A1c (HbA1c), and diabetes duration. Fifty-one percent of BARI 2D subjects with valid baseline characteristics and MNSI scores had DPN. After adjusting for all variables, use of insulin was significantly associated with DPN (OR = 1.57, 95% CI: 1.15-2.13). Patients on sulfonylurea (SU) or combination of SU/metformin (Met)/thiazolidinediones (TZD) had marginally higher rates of DPN than the Met/TZD group. This cross-sectional study in a cohort of patients with type 2 diabetes and CAD showed association of insulin use with higher DPN prevalence, independent of disease duration, glycemic control, and other characteristics. The causality between a glycemic control strategy and DPN cannot be evaluated in this cross-sectional study, but continued assessment of DPN and randomized therapies in BARI 2D trial may provide further explanations on the development of DPN. PMID:19335534

  12. Supported Telemonitoring and Glycemic Control in People with Type 2 Diabetes: The Telescot Diabetes Pragmatic Multicenter Randomized Controlled Trial

    PubMed Central

    Wild, Sarah H.; Hanley, Janet; Lewis, Stephanie C.; McKnight, John A.; Padfield, Paul L.; Parker, Richard A.; Pinnock, Hilary; Sheikh, Aziz; McKinstry, Brian

    2016-01-01

    Background Self-monitoring of blood glucose among people with type 2 diabetes not treated with insulin does not appear to be effective in improving glycemic control. We investigated whether health professional review of telemetrically transmitted self-monitored glucose results in improved glycemic control in people with poorly controlled type 2 diabetes. Methods and Findings We performed a randomized, parallel, investigator-blind controlled trial with centralized randomization in family practices in four regions of the United Kingdom among 321 people with type 2 diabetes and glycated hemoglobin (HbA1c) >58 mmol/mol. The supported telemonitoring intervention involved self-measurement and transmission to a secure website of twice-weekly morning and evening glucose for review by family practice clinicians who were not blinded to allocation group. The control group received usual care, with at least annual review and more frequent reviews for people with poor glycemic or blood pressure control. HbA1c assessed at 9 mo was the primary outcome. Intention-to-treat analyses were performed. 160 people were randomized to the intervention group and 161 to the usual care group between June 6, 2011, and July 19, 2013. HbA1c data at follow-up were available for 146 people in the intervention group and 139 people in the control group. The mean (SD) HbA1c at follow-up was 63.0 (15.5) mmol/mol in the intervention group and 67.8 (14.7) mmol/mol in the usual care group. For primary analysis, adjusted mean HbA1c was 5.60 mmol/mol / 0.51% lower (95% CI 2.38 to 8.81 mmol/mol/ 95% CI 0.22% to 0.81%, p = 0·0007). For secondary analyses, adjusted mean ambulatory systolic blood pressure was 3.06 mmHg lower (95% CI 0.56–5.56 mmHg, p = 0.017) and mean ambulatory diastolic blood pressure was 2.17 mmHg lower (95% CI 0.62–3.72, p = 0.006) among people in the intervention group when compared with usual care after adjustment for baseline differences and minimization strata. No significant

  13. Acute effects of dietary glycemic index on antioxidant capacity in nutrient-controlled feeding study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Oxidative stress, caused by an imbalance between antioxidant capacity and reactive oxygen species, may be an early event in a metabolic cascade elicited by a high glycemic index (GI) diet, ultimately increasing the risk for cardiovascular disease and diabetes. We conducted a feeding study to evalua...

  14. Effects of diets differing in glycemic index and glycemic load on cardiovascular risk factors: review of randomized controlled-feeing trials

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Despite a considerable amount of data available on the relationship between dietary glycemic index (GI) or load (GL) and cardiovascular disease (CVD) risk factors, in aggregate, the area remains unsettled. The aim of the present review was to summarize the effect of diets differing in GI/GL on CVD r...

  15. Acute Inactivity Impairs Glycemic Control but Not Blood Flow to Glucose Ingestion

    PubMed Central

    Reynolds, Leryn J; Credeur, Daniel P; Holwerda, Seth W; Leidy, Heather J; Fadel, Paul J; Thyfault, John P

    2014-01-01

    Purpose Insulin-stimulated increases in skeletal muscle blood flow play a role in glucose disposal. Indeed, 7 days of aerobic exercise in type 2 diabetes patients increased blood flow responses to an oral glucose tolerance test (OGTT) and improved glucose tolerance. More recent work suggests that reduced daily physical activity impairs glycemic control (GC) in healthy individuals. Herein, we sought to determine if an acute reduction in daily activity (from >10,000 to <5,000 steps/day) for 5 days (RA5) in healthy individuals reduced insulin-stimulated blood flow and GC in parallel and if a 1 day return to activity (RTA1) improved these outcomes. Methods OGTTs were performed as a stimulus to increase insulin in 14 healthy, recreationally active men (24±1.1 yrs) at baseline, RA5, and RTA1. Measures of insulin sensitivity (Matsuda index) and femoral and brachial artery blood flow were made during the OGTT. Free living measures of GC including peak postprandial glucose (peak PPG) were also made via continuous glucose monitoring. Results Femoral and brachial artery blood flow increased during the OGTT but neither was significantly impacted by changes in physical activity (p>0.05). However, insulin sensitivity was decreased by RA5 (11.3±1.5 to 8.0±1.0; p<0.05). Likewise, free living GC measures of peak post prandial blood glucose (113±3 to 123±5 mg/dL; p<0.05) was significantly increased at RA5. Interestingly, insulin sensitivity and GC as assessed by peak PPG were not restored after RTA1 (p>0.05). Conclusions Thus, acute reductions in physical activity impaired GC and insulin sensitivity; however blood flow responses to an OGTT were not affected. Further, a 1 day return to activity was not sufficient to normalize GC following 5 days of reduced daily physical activity. PMID:25207931

  16. Glycemic variability: Clinical implications

    PubMed Central

    Satya Krishna, Surabhi Venkata; Kota, Sunil K.; Modi, Kirtikumar D.

    2013-01-01

    Glycemic control and its benefits in preventing microvascular diabetic complications are convincingly proved by various prospective trials. Diabetes control and complications trial (DCCT) had reported variable glycated hemoglobin (HbA1C) as a cause of increased microvascular complications in conventional glycemic control group versus intensive one. However, in spite of several indirect evidences, its link with cardiovascular events or macrovascular complications is still not proved. Glycemic variability (GV) is one more tool to explain relation between hyperglycemia and increased cardiovascular risk in diabetic patients. In fact GV along with fasting blood sugar, postprandial blood sugar, HbA1C, and quality of life has been proposed to form glycemic pentad, which needs to be considered in diabetes management. Postprandial spikes in blood glucose as well as hypoglycemic events, both are blamed for increased cardiovascular events in Type 2 diabetics. GV includes both these events and hence minimizing GV can prevent future cardiovascular events. Modern diabetes management modalities including improved sulfonylureas, glucagon like peptide-1 (GLP-1)-based therapy, newer basal insulins, and modern insulin pumps address the issue of GV effectively. This article highlights mechanism, clinical implications, and measures to control GV in clinical practice. PMID:23961476

  17. Effects of a low-carbohydrate diet on glycemic control in outpatients with severe type 2 diabetes

    PubMed Central

    Haimoto, Hajime; Sasakabe, Tae; Wakai, Kenji; Umegaki, Hiroyuki

    2009-01-01

    We previously demonstrated that a loosely restricted 45%-carbohydrate diet led to greater reduction in hemoglobin A1c (HbA1c) compared to high-carbohydrate diets in outpatients with mild type 2 diabetes (mean HbA1c level: 7.4%) over 2 years. To determine whether good glycemic control can be achieved with a 30%-carbohydrate diet in severe type 2 diabetes, 33 outpatients (15 males, 18 females, mean age: 59 yrs) with HbA1c levels of 9.0% or above were instructed to follow a low-carbohydrate diet (1852 kcal; %CHO:fat:protein = 30:44:20) for 6 months in an outpatient clinic and were followed to assess their HbA1c levels, body mass index and doses of antidiabetic drugs. HbA1c levels decreased sharply from a baseline of 10.9 ± 1.6% to 7.8 ± 1.5% at 3 months and to 7.4 ± 1.4% at 6 months. Body mass index decreased slightly from baseline (23.8 ± 3.3) to 6 months (23.5 ± 3.4). Only two patients dropped out. No adverse effects were observed except for mild constipation. The number of patients on sulfonylureas decreased from 7 at baseline to 2 at 6 months. No patient required inpatient care or insulin therapy. In summary, the 30%-carbohydrate diet over 6 months led to a remarkable reduction in HbA1c levels, even among outpatients with severe type 2 diabetes, without any insulin therapy, hospital care or increase in sulfonylureas. The effectiveness of the diet may be comparable to that of insulin therapy. PMID:19419563

  18. Effect of pharmacist-led patient education on glycemic control of type 2 diabetics: a randomized controlled trial

    PubMed Central

    Farsaei, Shadi; Sabzghabaee, Ali Mohammad; Zargarzadeh, Amir Hooshang; Amini, Massoud

    2011-01-01

    BACKGROUND: This study was conducted to evaluate the effect of a clinical pharmacist-led patient education program for type 2 diabetic patients at Isfahan Endocrine & Metabolism Research Center (IEMRC) from April 2008 to January 2009. METHODS: In a randomized controlled clinical trial, a total of 172 patients with uncontrolled type 2 diabetes were selected and randomly allocated into control and intervention groups. After taking informed written consent, the intervention group received an educational program about oral anti-hyperglycemic medications, adherence, diabetes dairy log and pill box usage. Patient's glycemic control in the intervention group was followed for three months through either telephone or face to face interviews with the pharmacist. Fasting blood glucose and HbA1c were measured at the start and end of the pharmacistled drug education program for both intervention and control groups. RESULTS: After a three months follow-up, mean fasting blood glucose and HbA1c of the patients in the intervention group decreased significantly compared to control group (p < 0.001). CONCLUSIONS: This study demonstrates an improvement in diabetes management of type 2 diabetics by involving a pharmacist in the multidisciplinary teams in the outpatient clinics. The results suggest the benefits of adding adherence education to the diabetic education programs. PMID:21448382

  19. Peer Support Training Improved the Glycemic Control, Insulin Management, and Diabetic Behaviors of Patients with Type 2 Diabetes in Rural Communities of Central China: A Randomized Controlled Trial

    PubMed Central

    Deng, Kaiqin; Ren, Yanlei; Luo, Zhongmei; Du, Kun; Zhang, Xiaoqin; Zhang, Qiong

    2016-01-01

    Background The efficacy of peer support in Chinese diabetes patients is still uncertain. The purpose of this study was to observe the effects of a peer support program on the outcomes of patients with type 2 diabetes who received community-based insulin therapy in rural communities of central China. Material/Methods Two hundred and eight eligible patients with type 2 diabetes were randomly assigned into the traditional training group (control group, n=111) and peer support intervention group (peer group, n=97) between June 2013 and January 2014 in 2 rural communities of Jingzhou area, China. Both groups received 3-month traditional training, followed by another 4-month traditional training or peer support training, respectively. At baseline and 7 months after treatment, the blood glycemic level was evaluated by biochemical detection. Capacities of self-management and knowledge related to insulin usage were assessed by questionnaire survey. Results Ninety-seven and ninety patients completed this study in the control group and peer group, respectively. There was no significant difference in age, gender, diabetes duration, insulin usage time, and complications between the 2 groups at baseline (P>0.05). Compared with the control group, peer group patients achieved a more significant decrease in blood glycosylated hemoglobin levels (P<0.05), increase in knowledge related to insulin usage, and increase of diabetes self-management ability (P<0.05). Conclusions Peer support intervention effectively improves outcomes of patients with type 2 diabetes in rural communities of central China. PMID:26808489

  20. Poor glycemic control is associated with the risk of subclinical hypothyroidism in patients with type 2 diabetes mellitus

    PubMed Central

    Cho, Jae Ho; Kim, Ho Jin; Lee, Jun Ho; Park, Il Rae; Moon, Jun Sung; Yoon, Ji Sung; Lee, In-Kyu; Won, Kyu Chang; Lee, Hyoung Woo

    2016-01-01

    Background/Aims: Overt hypothyroidism is frequently found in patients with type 2 diabetes mellitus (T2DM), but it remains unknown the relationship between subclinical hypothyroidism (SCH) and T2DM. We attempt to evaluate the difference in prevalence of SCH between patients with T2DM and general population, and the association between SCH and glycemic control status ofdiabetic patients. Methods: This was cross-sectional study. Total 8,528 subjects who visited for health check-up were recruited. SCH was defined as an elevated level of serum thyroid stimulating hormone (> 4.0 mIU/L) with a normal level of free thyroxine. T2DM group was categorized into three groups by glycosylated hemoglobin (HbA1c): < 7% (reference), ≥ 7% and < 9%, ≥ 9%. Results: Finally, 7,966 subjects were included. The prevalence of SCH was not different between healthy controls and subjects with T2DM (8.1% vs. 7.4%, p = 0.533; in men, 5.7% vs. 5.1%, p = 0.573; in women, 10.9% vs. 11.7%, p = 0.712), but it was increased with highest HbA1c group more than well controlled group, especially in women. The risk of SCH was increased by group with poorer glycemic control; the odds ratio for HbA1c ≥ 9% compared to < 7% was 2.52 (95% confidence interval [CI], 1.09 to 5.86; p = 0.031), and 4.58 (95% CI, 1.41 to 14.87; p = 0.011) in women, but not significant in men. Conclusions: The prevalence of SCH was similar between T2DM and healthy group. Poor glycemic control in T2DM was obviously associated with the risk of SCH, especially in elderly women. These results suggest SCH as comorbidity may be considered in elderly women with poor glycemic control. PMID:27271351

  1. Association between Poor Glycemic Control, Impaired Sleep Quality, and Increased Arterial Thickening in Type 2 Diabetic Patients

    PubMed Central

    Yoda, Koichiro; Inaba, Masaaki; Hamamoto, Kae; Yoda, Maki; Tsuda, Akihiro; Mori, Katsuhito; Imanishi, Yasuo; Emoto, Masanori; Yamada, Shinsuke

    2015-01-01

    Objective Poor sleep quality is an independent predictor of cardiovascular events. However, little is known about the association between glycemic control and objective sleep architecture and its influence on arteriosclerosis in patients with type-2 diabetes mellitus (DM). The present study examined the association of objective sleep architecture with both glycemic control and arteriosclerosis in type-2 DM patients. Design Cross-sectional study in vascular laboratory. Methods The subjects were 63 type-2 DM inpatients (M/F, 32/31; age, 57.5±13.1) without taking any sleeping promoting drug and chronic kidney disease. We examined objective sleep architecture by single-channel electroencephalography and arteriosclerosis by carotid-artery intima-media thickness (CA-IMT). Results HbA1c was associated significantly in a negative manner with REM sleep latency (interval between sleep-onset and the first REM period) (β=-0.280, p=0.033), but not with other measurements of sleep quality. REM sleep latency associated significantly in a positive manner with log delta power (the marker of deep sleep) during that period (β=0.544, p=0.001). In the model including variables univariately correlated with CA-IMT (REM sleep latency, age, DM duration, systolic blood pressure, and HbA1c) as independent variables, REM sleep latency (β=-0.232, p=0.038), but not HbA1c were significantly associated with CA-IMT. When log delta power was included in place of REM sleep latency, log delta power (β=-0.257, p=0.023) emerged as a significant factor associated with CA-IMT. Conclusions In type-2 DM patients, poor glycemic control was independently associated with poor quality of sleep as represented by decrease of REM sleep latency which might be responsible for increased CA-IMT, a relevant marker for arterial wall thickening. PMID:25875738

  2. Restoration of Glycemic Control in Patients with Type 2 Diabetes Following Bariatric Surgery is Associated with Reduction in Microparticles

    PubMed Central

    Cheng, V.; Kashyap, S.R.; Schauer, P.R.; Kirwan, J.P.; McCrae, K.R.

    2011-01-01

    Background Microparticles bud from cellular elements during inflammation and are associated with vascular dysfunction related to type 2 diabetes. Although weight loss is known to reduce inflammation, the metabolic effects of bariatric surgery on microparticle concentration and composition are not known. Objectives To determine the effect of bariatric surgery on microparticle concentration and correlate these changes with clinical parameters. Setting Multispecialty group practice Methods We studied 14 obese subjects with type 2 diabetes two weeks before and at one and 12 months following bariatric surgery. Nine of the patients underwent Roux-en-Y gastric bypass and 5 received gastric restrictive surgery. Results One month following surgery, body mass index was reduced by ~10%, glycemic control improved dramatically (P < 0.01), and there was a >60% reduction in endothelial, platelet microparticles and CRP levels (P < 0.05). Tissue factor microparticles reduced by 40% ( p = 0.1). Twelve months following surgery, BMI was reduced by ~20%, glycemic control was maintained (P < 0.01), and there was a >50% reduction in monocyte microparticles compared to pre-surgery. The reduction in monocyte microparticles one month after surgery was strongly associated with the reduction in hemoglobin A1c (P < 0.05). The reduction in monocyte microparticles 12 months following surgery correlated strongly with the reduction in body mass index (P < 0.05). Conclusion The reduction in microparticles after bariatric surgery in patients with type 2 diabetes reflects an attenuation of inflammation and this mechanism may contribute to normalization of glycemic control. PMID:22093380

  3. The impact of knowledge about diabetes, resilience and depression on glycemic control: a cross-sectional study among adolescents and young adults with type 1 diabetes

    PubMed Central

    2013-01-01

    Background The purpose of this study is to evaluate the relationship between glycemic control and the factors of knowledge about diabetes, resilience, depression and anxiety among Brazilian adolescents and young adults with type 1 diabetes. Methods This cross-sectional study included 85 adolescents and young adults with type 1 diabetes, aged between 11–22 years, with an average age of 17.7 ± 3.72 years. Glycemic control degree was evaluated through HbA1c. To assess psychosocial factors, the following questionnaires were used: resilience (Resilience Scale, RS) and anxiety and depression (Hospital Anxiety and Depression Scale, HADS). The Diabetes Knowledge Assessment Scale (DKNA) was used to assess knowledge about diabetes. Results Significant correlations were found between HbA1c and resilience, anxiety and depression. Multiple linear regression analysis revealed that the only variable which presented significant association with the value of HbA1c was depression. Conclusions Depression has a significant association with higher HbA1c levels, as demonstrated in a regression analysis. The results suggest that depression, anxiety and resilience should be considered in the design of a multidisciplinary approach to type 1 diabetes, as these factors were significantly correlated with glycemic control. Glycemic control was not correlated with knowledge of diabetes, suggesting that theoretical or practical understanding of this disease is not by itself significantly associated with appropriate glycemic control (HbA1c ≤ 7.5%). PMID:24289093

  4. Dyadic measures of the parent-child relationship during the transition to adolescence and glycemic control in children with type 1 diabetes.

    PubMed

    Anderson, Barbara J; Holmbeck, Grayson; Iannotti, Ronald J; McKay, Siripoom V; Lochrie, Amanda; Volkening, Lisa K; Laffel, Lori

    2009-06-01

    To identify aspects of family behavior associated with glycemic control in youth with type 1 diabetes mellitus during the transition to adolescence, the authors studied 121 9- to 14-year-olds (M = 12.1 yrs) and their parents, who completed the Diabetes Family Conflict Scale (DFCS) and the Diabetes Family Responsibility Questionnaire (DFRQ). From the DFRQ, the authors derived 2 dyadic variables, frequency of agreement (exact parent and child concurrence about who was responsible for a task) and frequency of discordance (opposite parent and child reports about responsibility). The authors divided the cohort into Younger (n = 57, M = 10.6 yrs) and Older (n = 64, M = 13.5 yrs) groups. Family conflict was significantly related to glycemic control in the entire cohort and in both the Younger and Older groups. However, only in the Younger group was Agreement related to glycemic control, with higher Agreement associated with better glycemic control. Findings suggest that Agreement about sharing of diabetes responsibilities may be an important target for family-based interventions aiming to optimize glycemic control in preteen youth. PMID:19630455

  5. A Comparison of Continuous Subcutaneous Insulin Infusion vs. Multiple Daily Insulin Injection in Children with Type I Diabetes in Kuwait: Glycemic Control, Insulin Requirement, and BMI

    PubMed Central

    Mousa, Mohammad; Al-Mahdi, Maria; Al-Sanaa, Hala; Al-Kandari, Hessa

    2015-01-01

    Objective Continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDI) are two methods currently used to manage type I diabetes mellitus (T1DM). Here we compare our experiences with CSII and MDI in a large cohort of pediatric patients in Kuwait. Methods Data on 326 patients with T1DM who were started on CSII between 2007 and 2012 were retrospectively compared with those of 326 patients on MDI. They were matched for sex, age at diagnosis, T1DM duration, glycemic control, insulin requirement, and body mass index (BMI). Data were collected at baseline and every three months and included glycated hemoglobin (HbA1c), insulin dose, and adverse events (severe hypoglycemia, diabetic ketoacidosis, and skin problems). Results The main reason for switching to CSII was to achieve better glycemic control (37%), followed by reducing hypoglycemia, and improving the quality of life (13.3% each). Although HbA1c decrease was most significant in the first year, it continued to be significantly lower in the CSII group compared to the MDI throughout the study period. Total daily insulin requirements were significantly lower in the CSII group. BMI increased in both groups, but the difference was significant only at the end of the fifth year. There was no significant change in the rate of diabetic ketoacidosis in either group. The CSII patients had more severe hypoglycemic episodes at baseline; however, it significantly decreased throughout the study period. Only five patients discontinued CSII therapy and two of these restarted within three months. Conclusion CSII is a safe intensive insulin therapy in youngsters with T1DM and achieved markedly fewer severe hypoglycemic episodes and lower daily insulin requirements PMID:26421114

  6. Study of Adiponectin Level in Diabetic Adolescent Girls in Relation to Glycemic Control and Complication of Diabetes

    PubMed Central

    Dayem, Soha M. Abd El; Nazif, Hayam K.; EI-Kader, Mona Abd; El-Tawil, Maha

    2015-01-01

    AIM: To study the relation between adiponectin level with glycemic control and complication of diabetes. PATIENTS AND METHODS: The study included 40 female adolescent type 1 diabetic patients and 40 healthy volunteers of the same age and sex. Blood sample was taken for assessment of glycosylated hemoglobin, lipid profile and adiponectine. Urine sample was taken for assessment of albumin/creatinine ratio. RESULTS: Diabetic patients had a significantly higher diastolic blood pressure, triglyceride, total cholesterol, LDL and adiponectin than controls. Patients with diabetes complication had a significant lower BMI and HDL. On the other hand, they had higher disease duration, total cholesterol, HbA1, albumin/creatinine ratio and adiponectin. Patients with microalbuminuria had a lower BMI, higher disease duration, diastolic blood pressure and adiponectin. Patients with diabetic retinopathy had higher disease duration, insulin dose, HbA1, microalbuminuria and adiponectin. Adiponectin in diabetic patients had a significant negative correlation with BMI and positive correlation with systolic blood pressure and microlabuminuria. CONCLUSION: Serum adiponectin level is high in adolescent type 1 diabetic girls. It can be used as a predictor of diabetes complications rather than a sensitive biochemical marker for glycemic control.

  7. EFFECT OF HIGH-DOSE VITAMIN D REPLETION ON GLYCEMIC CONTROL IN AFRICAN AMERICAN MEN WITH PREDIABETES AND HYPOVITAMINOSIS D

    PubMed Central

    Barengolts, Elena; Manickam, Buvana; Eisenberg, Yuval; Akbar, Arfana; Kukreja, Subhash; Ciubotaru, Irina

    2016-01-01

    Objective This double blind, randomized, controlled trial evaluated 12 months high dose vitamin D2 supplementation for improving insulin sensitivity, secretion and glycemic status. Methods African American men with prediabetes (A1C 5.7 – 6.4%), hypovitaminosis D (25OHD 5 – 29 ng/ml), and prevalent medical problems were supplemented with vitamin D3 (400 IU/day) and then randomized to weekly placebo or vitamin D2 (50,000 IU). The primary outcome was the change in oral glucose insulin sensitivity (OGIS, from oral glucose tolerance test) after 12 months of treatment. Secondary outcomes included other glycemic indices, A1C and incident diabetes. Results Baseline characteristics were similar in vitamin D-supplemented (n = 87) and placebo (n = 86) subjects completing the trial with average concentrations 14.4 ng/ml, 362 and 6.1% for 25OHD, OGIS and A1C, respectively. After 12 months vitamin D-supplemented group had a change in serum 25OHD +35 vs +6 ng/ml for placebo, p<0.001; OGIS +7.8 vs −16.0 for placebo, p = 0.026; and A1C −0.01 vs +0.01% for placebo, p = 0.66; while 10% in both groups progressed to diabetes. A post hoc analysis of participants with baseline impaired fasting glucose showed that more subjects in the vitamin D subgroup (31.6%) than placebo (8.3%) returned to normal glucose tolerance, but the difference did not reach significance (p=0.13). Conclusion The trial does not provide evidence that 12 months of high-dose D2 repletion improves clinically relevant glycemic outcomes in subjects with prediabetes and hypovitaminosis D (NCT01375660). PMID:25716637

  8. Inflammatory biomarkers in type 2 diabetic patients: effect of glycemic control and impact of ldl subfraction phenotype

    PubMed Central

    2014-01-01

    Background Type 2 diabetes mellitus (T2D) is associated with higher cardiovascular risk partly related to an increase in inflammatory parameters. The aim of this study was to determine the association of inflammatory biomarkers with low-density lipoprotein (LDL) subfraction phenotype and glycemic control in subjects with T2D and poor glycemic control. Methods A cross-sectional study was performed comparing 122 subjects with T2D (59 ± 11 years old, body mass index 30.2 ± 5.6 kg/m2) with 54 control subjects. Patients with T2D were classified according to their LDL subfraction phenotype and inflammatory biomarkers (C-reactive protein, Interleukin-6, Interleukin-8, Transforming growth factor β1, Monocyte chemotactic protein 1, Leptin, Adiponectin) were evaluated according to the degree of glycemic control, LDL phenotype and other clinical characteristics. Forty-two subjects with T2D were studied before and after 3 months of improving glycemic control by different strategies. Results Patients with T2D had higher C-reactive protein (CRP) and monocyte chemotactic protein-1 (MCP1) levels and lower adiponectin concentration, compared to controls. T2D subjects with body mass index ≥ 30 kg/m2 had higher CRP levels (5.2 ± 4.8 mg/l vs 3.7 ± 4.3 mg/l; p < 0.05). The presence of LDL phenotype B was related to higher levels of transforming growth factor-β1 (TGF-β1) (53.92 ± 52.82 ng/l vs 31.35 ± 33.74 ng/l; p < 0.05) and lower levels of adiponectin (3663 ± 3044 ng/l vs 2723 ± 1776 ng/l; p < 0.05). The reduction of HbA1c from 9.5 ± 1.8% at baseline to 7.4 ± 0.8% was associated with a significant reduction of TGF-β1 (41.86 ± 32.84 ng/l vs 26.64 ± 26.91 ng/l; p = 0.02). Conclusions Subjects with T2D, especially those with LDL phenotype B and obesity, have higher levels of inflammatory biomarkers. Improvement of glycemic control reduces TGF-β1 levels, which may contribute partly to its renoprotective

  9. Night eating in patients with type 2 diabetes. Associations with glycemic control, eating patterns, sleep, and mood.

    PubMed

    Hood, Megan M; Reutrakul, Sirimon; Crowley, Stephanie J

    2014-08-01

    Night eating is a complex behavior associated with disruptions in eating, sleep, and mood regulation. While night eating has been associated with alterations in neuroendocrine functioning, night eating and Night Eating Syndrome (NES) are not well understood in patients with prevalent metabolic conditions, such as diabetes. In this study, 194 adults with Type 2 diabetes completed questionnaires assessing night eating symptoms as well as eating, sleep, and depressive symptoms. Glycemic control data, as measured by hemoglobin A1c (HbA1c), were gathered from patient medical charts. Results indicated that 7% of participants met criteria for NES. Increased symptoms of night eating were associated with poorer glycemic control and disruptions in eating, sleep, and mood, including significantly increased likelihood of having HbA1c levels >7% and endorsing clinical levels of depressive symptoms. Increasing understanding of the relationship between night eating and metabolic and psychosocial functioning in patients with diabetes may provide new avenues for treatment of these patients. PMID:24751916

  10. Glycemic Control Modifies Difference in Mortality Risk Between Hemodialysis and Peritoneal Dialysis in Incident Dialysis Patients With Diabetes: Results From a Nationwide Prospective Cohort in Korea.

    PubMed

    Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-03-01

    Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A1c (HbA1c) and dialysis modalities for patient survival (P for interaction = 0.004), subjects were stratified into good and poor glycemic control groups (HbA1c< or ≥8.0%). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.47-0.90, P = 0.01; patients with available HbA1c [n = 773], HR = 0.64, 95% CI = 0.46-0.91, P = 0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA1c <8.0%, HR = 0.59, 95% CI = 0.37-0.94, P = 0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA1c ≥8.0%, HR = 1.21, 95% CI = 0.46-2.76, P = 0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes. PMID:26986162

  11. Randomized, double-blind, placebo-controlled, clinical study on the effect of Diabetinol® on glycemic control of subjects with impaired fasting glucose

    PubMed Central

    Evans, Malkanthi; Judy, William V; Wilson, Dale; Rumberger, John A; Guthrie, Najla

    2015-01-01

    Background This study investigated the efficacy of Diabetinol® in people with diabetes on medication but not meeting the American Association of Clinical Endocrinologists and American Diabetes Association glycemic, blood pressure, and lipid targets. Subjects and methods Fifty subjects, aged 18–75 years, with fasting blood glucose ≤15.4 mmol/L, hemoglobin A1c levels ≤12%, and a body mass index between 25 and 40 kg/m2, were enrolled in a 24-week, randomized, double-blind, placebo-controlled, parallel study. Diabetinol® or placebo was administered as 2×525 mg capsules/day. Results In the Diabetinol® group, 14.3% versus 0% in the placebo group, 33.3% versus 15.4% in placebo, 20.0% versus 12.5% in placebo, and 83.3% versus 60% in placebo achieved the American Association of Clinical Endocrinologists and American Diabetes Association targets for hemoglobin A1c, low-density lipoprotein, total cholesterol, and systolic blood pressure, respectively. There was no difference in the maximum concentration (Cmax) of serum glucose or area under the curve (AUC)0–240 minutes. The time to Cmax was longer for participants on Diabetinol® than placebo group at week 12 (P=0.01). Fasting blood glucose increased from baseline to week 24 in both groups; however, this increase was 14.3 mg/dL lower in the Diabetinol® group versus placebo. The Diabetinol® group showed an increase of 5.53 mg/dL in fasting insulin at week 12 (P=0.09) and 3.2 mg/dL at week 24 (P=0.41) over and above the placebo group. A decrease of 1.5% in total cholesterol, 5.8% in low-density lipoprotein, and a 1.6% increase in high-density lipoprotein concentrations were seen in the Diabetinol® group. Diabetinol® improved 6-month oral glucose tolerance test and 2-hour postprandial glucose profiles in participants between 40 and 60 years of age. Conclusion The current study suggests a role for Diabetinol® as an adjunctive therapy for glycemic maintenance and for decreasing the risk of diabetes

  12. Evaluation of Glycemic Control in Type 2 Diabetes Mellitus using Cytomorphometry of Buccal Cells and Correlation with Glycosylated Hemoglobin

    PubMed Central

    Karthik, K Raghavendhar; Malathi, N; Poornima, K; Prakash, Sunil; Kadhiresan, R; Arunmozhi, U

    2015-01-01

    Background: To study cytological alterations in the exfoliated buccal cells of diabetic patients. To analyze the cytomorphometric findings in the smears of uncontrolled and controlled diabetic patients and compare it with that of normal healthy controls. To establish a correlation between cytomorphometric changes and glycosylated hemoglobin (HbA1c) in diabetics and normal controls, for evaluation of glycemic control. Materials and Methods: The study was carried out in 40 confirmed diabetic patients from a hospital out-patient diabetic ward and 20 healthy individuals as controls (Group A: n = 20), in Chennai. Specific exclusion criteria were used to select the study group from a larger group of subjects. Based on HbA1c values, the diabetic patients were categorized into Group B = Controlled diabetics (n = 20) (HbA1c <7%) and Group C = Uncontrolled diabetics (n = 20) (HbA1c >9%). After informed consent, buccal smear was collected from clinically normal appearing mucosa and stained with papanicoloau (PAP) stain. Cytomorphometric analysis of selective PAP stained cells was done using image analysis software, Image Pro Plus 5.5 (Olympus) and parameters determined were average cytoplasmic area (CA), average nuclear area (NA) and cytoplasmic:nuclear (C: N) ratio for an average of 50 cells/patient. Results: Comparing the average NA among three groups, an increase through Group A, B, C, with a maximum significance between Group C and A was seen. The average C: N ratio showed a statistically significant difference between all three groups. Significant correlation existed between the HbA1c values and both the C: N ratio and average NA in all the three groups. Conclusions: Cytomorphometric analysis of buccal smears using the C: N ratio alteration as a reliable criteria, may serve as yet another non-invasive tool for screening programs for diabetic detection. And the technique may possibly be used also for evaluation of glycemic control in known diabetics. PMID:25859101

  13. Continuous Glucose Monitors and the Burden of Tight Glycemic Control in Critical Care: Can They Cure the Time Cost?

    PubMed Central

    Signal, Matthew; Pretty, Christopher G.; Chase, J. Geoffrey; Le Compte, Aaron; Shaw, Geoffrey M.

    2010-01-01

    Background Tight glycemic control (TGC) in critical care has shown distinct benefits but has also proven to be difficult to obtain. The risk of severe hypoglycemia (<40 mg/dl) raises significant concerns for safety. Added clinical burden has also been an issue. Continuous glucose monitors (CGMs) offer frequent automated measurement and thus the possibility of using them for early detection and intervention of hypoglycemic events. Additionally, regular measurement by CGM may also be able to reduce clinical burden. Aim An in silico study investigates the potential of CGM devices to reduce clinical effort in a published TGC protocol. Methods This study uses retrospective clinical data from the Specialized Relative Insulin Nutrition Titration (SPRINT) TGC study covering 20 patients from a benchmark cohort. Clinically validated metabolic system models are used to generate a blood glucose (BG) profile for each patient, resulting in 33 continuous, separate BG episodes (6881 patient hours). The in silico analysis is performed with three different stochastic noise models: two Gaussian and one first-order autoregressive. The noisy, virtual CGM BG values are filtered and used to drive the SPRINT TGC protocol. A simple threshold alarm is used to trigger glucose interventions to avert potential hypoglycemia. The Monte Carlo method was used to get robust results from the stochastic noise models. Results Using SPRINT with simulated CGM noise, the BG time in an 80–110 mg/dl band was reduced no more than 4.4% to 45.2% compared to glucometer sensors. Antihypoglycemic interventions had negligible effect on time in band but eliminated all recorded hypoglycemic episodes in these simulations. Assuming 4–6 calibration measurements per day, the nonautomated clinical measurements are reduced from an average of 16 per day to as low as 4. At 2.5 min per glucometer measurement, a daily saving of ∼25–30 min per patient could potentially be achieved. Conclusions This paper has analyzed

  14. Association Between Specific Depression Symptoms and Glycemic Control Among Patients With Comorbid Type 2 Diabetes and Provisional Depression

    PubMed Central

    Czech, Stephanie J.; Orsillo, Susan M.; Pirraglia, Paul A.; English, Thomas M.; Connell, Alexa J.

    2015-01-01

    Objective: To determine whether specific depression symptoms are associated with glycemic control independent of potential demographic and clinical covariates among primary care patients with comorbid type 2 diabetes and provisional threshold or subthreshold depression. Method: We examined a convenience sample of patients diagnosed with type 2 diabetes and provisional threshold or subthreshold depression (N = 82) at 2 family health centers. Cases were identified using a population-based registry of patients diagnosed with type 2 diabetes (ICD-9 codes 250.00 for controlled type 2 diabetes and 250.02 for uncontrolled type 2 diabetes). Data from patients with a primary care provider appointment from the beginning of April 2011 through the end of June 2012 and with at least one 9-item Patient Health Questionnaire (PHQ-9) depression screener and a glycated hemoglobin A1c (HbA1c) laboratory test between 2 weeks before and 10 weeks after PHQ-9 screening were eligible for inclusion. We defined provisional threshold or subthreshold depression using PHQ-9 scoring criteria, which were designed to yield provisional diagnostic information about major depressive disorder based on DSM-5 diagnostic criteria. Results: Patients reporting higher severity of sleep problems on the PHQ-9 had significantly higher HbA1c levels (mean = 8.48, SD = 2.17) compared to patients reporting lower severity or absence of this symptom (mean = 7.19, SD = 1.34, t48.88 = −3.13, P = .003). Problems with sleep contributed unique variance on glycemic control (β = 0.27, P = .02) when controlling for potential clinical and demographic covariates, with those reporting more sleep difficulties having higher HbA1c levels. Conclusions: For patients with type 2 diabetes and provisional threshold or subthreshold depression, it may be prudent to aggressively address sleep problems as a potential mechanism toward improving diabetes control. PMID:26835160

  15. Association between glycemic control and morning blood surge with vascular endothelial dysfunction in type 2 diabetes mellitus patients

    PubMed Central

    Nuthalapati, Rama Kumari; Indukuri, Bhaskara Raju

    2016-01-01

    Objective: Morning blood pressure surge (MBPS) is an independent predictor of cardiovascular events. However, little is known about the association between glycemic control and MBPS, and its effect on vascular injury in patients with type 2 diabetes mellitus (T2DM). The current study examined the association between glycemic control and MBPS and the involvement of MBPS in the development of vascular dysfunction in T2DM patients. Materials and Methods: One hundred and twenty-two consecutive T2DM outpatients from the Department of Cardiology and Endocrinology were enrolled in this study. We did MBPS in T2DM patients, 85 (male) (69.7%) patients and 37 (female) patients (30.3%); mean age 60.1 ± 9.39; (n = 122) using 24 h ambulatory blood pressure monitoring and assessed vascular function by brachial artery flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD). Results: The correlation between MBPS and various clinical variables were examined by single regression analysis in all subjects. MBPS showed significant and positive correlation with pulse rate (P = 0.01), fasting blood sugar (P = 0.002), and postprandial blood sugar (P = 0.05). To further confirm the association of insulin resistance (IR) with MBPS in T2DM patients, we examined the correlation between homeostasis model assessment-IR (HOMA-IR), an established marker of IR and MBPS in diabetic (DM) patients who were not taking insulin no significant association with MBPS in T2DM patients (P = 0.41), angiotensin-converting enzyme/angiotensin receptor blocker (P = 0.07). We examined the relationship between MBPS and vascular injury by measuring endothelium-dependent FMD and endothelium-independent NMD in T2DM patients. Among the various traditional risk factors for atherosclerosis such as DM duration (P = 0.04), platelet reactivity (P = 0.04) and morning surge (P = 0.002) emerged as significant factors. HOMA-IR was a negative correlation with FMD. Conclusions: The current study demonstrated that

  16. Effects of subtracting sitting versus adding exercise on glycemic control and variability in sedentary office workers.

    PubMed

    Blankenship, Jennifer M; Granados, Kirsten; Braun, Barry

    2014-11-01

    Recent evidence suggests that, like adding exercise, reducing sitting time may improve cardiometabolic health. There has not been a direct comparison of the 2 strategies with energy expenditure held constant. The purpose of this study was to compare fasting and postmeal glucose and insulin concentrations in response to a day with frequent breaks from sitting but no exercise versus considerable sitting plus moderate exercise. Ten sedentary overweight/obese office workers were tested in 3 conditions: (i) walking per activity guidelines (AGW): sitting for majority of workday with a 30 min pre-lunch walk; (ii) frequent long breaks (FLB): no structured exercise but frequent breaks from sitting during workday with energy expenditure matched to AGW; and (iii) frequent short breaks (FSB): number of breaks matched to FLB, but duration of breaks were shorter. Plasma glucose and insulin areas under the curve were measured in response to a meal tolerance test (MTT) at the end of the workday and interstitial glucose was evaluated throughout the day and overnight using continuous glucose monitoring. Using repeated-measures linear mixed models, area under the curve of plasma glucose or insulin after the MTT was not different between conditions. Glycemic variability was lower in FLB compared with AGW (p < 0.05), and nocturnal duration of elevated glucose (>7.8 mmol/L) was shorter after FLB (2.5 ± 2.5 min) than AGW (32.7 ± 16.4 min) or FSB (45.6 ± 29.6 min, p = 0.05). When energy expenditure was matched, breaks from sitting approximated the effects of moderate-intensity exercise on postmeal glucose and insulin responses and more effectively constrained glycemic variability. PMID:25166626

  17. Adenovirus 36 Attenuates Weight Loss from Exercise but Improves Glycemic Control by Increasing Mitochondrial Activity in the Liver

    PubMed Central

    Ye, Michael B.; Park, Sooho; Kim, In-Beom; Nam, Jae-Hwan

    2014-01-01

    Human adenovirus type 36 (Ad36) as an obesity agent induces adiposity by increasing glucose uptake and promoting chronic inflammation in fat tissues; in contrast, exercise reduces total body fat and inflammation. Our objective was to determine the association between Ad36 and the effects of exercise on inflammation and glycemic control. In the human trials (n = 54), Korean children (aged 12–14 years) exercised for 60 min on three occasions each week for 2 months. We compared the body mass index (BMI) Z-scores before and after exercise. C57BL/6 mice were infected with Ad36 and Ad2 as a control, and these mice exercised for 12 weeks postinfection. After the exercise period, we determined the serum parameters and assessed the presence of inflammation and the mitochondrial function in the organs. Ad36-seropositive children who were subjected to a supervised exercise regimen had high BMI Z-scores whereas Ad36-seronegative children had lower scores. Similarly, Ad36-infected mice were resistant to weight loss and exhibited chronic inflammation of their adipose tissues despite frequent exercise. However, Ad36 combined with exercise reduced the levels of serum glucose, nonesterified fatty acids, total cholesterol, and insulin in virus-infected mice. Interestingly, virus infection increased the mitochondrial function in the liver, as demonstrated by the numbers of mitochondria, cytochrome c oxidase activity, and transcription of key mitochondrial genes. Therefore Ad36 counteracts the weight-loss effect of exercise and maintains the chronic inflammatory state, but glycemic control is improved by exercise synergistically because of increased mitochondrial activity in the liver. PMID:25479564

  18. Effects of exercise on glycemic control in type 2 diabetes mellitus in Koreans: the fifth Korea National Health and Nutrition Examination Survey (KNHANES V)

    PubMed Central

    Park, Ji-Hye; Lee, Young-Eun

    2015-01-01

    [Purpose] The aim of this study was to investigate the effect of exercise on glycemic control using data from fifth Korea National Health and Nutrition Examination Survey and to provide appropriate exercise guidelines for patients with type 2 diabetes mellitus in Korea. [Subjects and Methods] We selected 1,328 patients from the fifth Korea National Health and Nutrition Examination Survey database who had type 2 diabetes and ranged in age from 30 to 90 years. Statistical analyses included χ2 tests, multiple linear regression, and logistic regression. [Results] Factors found to be significantly related to glycemic control included income level, physical activity based on intensity of aerobic exercise, use of diabetes medicine, presence of hypertension, duration of diabetes, and waist circumference. In addition, engaging in combined low- and moderate-intensity aerobic exercise when adjusted for resistance exercise was found to lower the risk of glycemic control failure. [Conclusion] Patients with type 2 diabetes mellitus in Korea should engage in combined low- and moderate-intensity aerobic exercise such as walking for 30 minutes or more five times a week. Physical activity is likely to improve glycemic control and thus prevent the acute and chronic complications of diabetes mellitus. PMID:26696738

  19. Four-year change in cardiorespiratory fitness and influence on glycemic control in adults with Type 2 diabetes in a randomized trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    OBJECTIVE To examine an intensive lifestyle intervention (ILI) compared with diabetes support and education (DSE) on 4-year change in fitness and physical activity (PA), and to examine the effect of change in fitness and PA, adjusting for potential confounders, on glycemic control in the Look AHEAD ...

  20. Effect of metformin added to insulin on glycemic control among overweight/obese adolescents with type 1 diabetes: A randomized clinical trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Previous studies assessing the effect of metformin on glycemic control in adolescents with type 1 diabetes have produced inconclusive results. To assess the efficacy and safety of metformin as an adjunct to insulin in treating overweight adolescents with type 1 diabetes. Multicenter (26 pediatric en...

  1. Four-Point Preprandial Self-Monitoring of Blood Glucose for the Assessment of Glycemic Control and Variability in Patients with Type 2 Diabetes Treated with Insulin and Vildagliptin

    PubMed Central

    Tura, Andrea; Farngren, Johan; Schweizer, Anja; Foley, James E.; Pacini, Giovanni; Ahrén, Bo

    2015-01-01

    The study explored the utility of four-point preprandial glucose self-monitoring to calculate several indices of glycemic control and variability in a study adding the DPP-4 inhibitor vildagliptin to ongoing insulin therapy. This analysis utilized data from a double-blind, randomized, placebo-controlled crossover study in 29 patients with type 2 diabetes treated with vildagliptin or placebo on top of stable insulin dose. During two 4-week treatment periods, self-monitoring of plasma glucose was undertaken at 4 occasions every day. Glucose values were used to assess several indices of glycemic control quality, such as glucose mean, GRADE, M-VALUE, hypoglycemia and hyperglycemia index, and indices of glycemic variability, such as standard deviation, CONGA, J-INDEX, and MAGE. We found that vildagliptin improved the glycemic condition compared to placebo: mean glycemic levels, and both GRADE and M-VALUE, were reduced by vildagliptin (P < 0.01). Indices also showed that vildagliptin reduced glycemia without increasing the risk for hypoglycemia. Almost all indices of glycemic variability showed an improvement of the glycemic condition with vildagliptin (P < 0.02), though more marked differences were shown by the more complex indices. In conclusion, the study shows that four-sample preprandial glucose self-monitoring is sufficient to yield information on the vildagliptin effects on glycemic control and variability. PMID:26587020

  2. Successful Implementation of a Perioperative Glycemic Control Protocol in Cardiac Surgery: Barrier Analysis and Intervention Using Lean Six Sigma

    PubMed Central

    Martinez, Elizabeth A.; Chavez-Valdez, Raul; Holt, Natalie F.; Grogan, Kelly L.; Khalifeh, Katherine W.; Slater, Tammy; Winner, Laura E.; Moyer, Jennifer; Lehmann, Christoph U.

    2011-01-01

    Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period. PMID:22091218

  3. The Negative Effects of Obesity and Poor Glycemic Control on Cognitive function: A Proposed Model for Possible Mechanisms

    PubMed Central

    Alosco, Michael L.; Gunstad, John

    2016-01-01

    Obesity has reached epidemic proportions and is a contributor to many adverse health outcomes, including increased risk for dementia and adverse structural and functional brain changes. Milder forms of cognitive impairment in multiple domains can also be found in obese individuals of all ages that are believed to stem from brain abnormalities long prior to onset of neurological conditions such as dementia. However, the mechanisms for adverse brain changes and subsequent cognitive dysfunction in obesity are complex and poorly understood. This paper proposes a possible etiological model for obesity associated cognitive impairment with emphasis on the role of poor glycemic control and conditions like type 2 diabetes mellitus. Clinical implications associated with treatment of obesity in persons with cognitive deficits in addition to the cognitive promoting effects of weight loss surgery are also discussed. PMID:24752836

  4. Zinc transporter gene expression and glycemic control in post-menopausal women with Type 2 diabetes mellitus.

    PubMed

    Foster, Meika; Chu, Anna; Petocz, Peter; Samman, Samir

    2014-10-01

    Type 2 diabetes mellitus (DM) is associated often with underlying zinc deficiency and nutritional supplements such as zinc may be of therapeutic benefit in the disease. In a randomized, double-blind, placebo-controlled, 12-week trial in postmenopausal women (n=48) with Type 2 DM we investigated the effects of supplementation with zinc (40mg/d) and flaxseed oil (FSO; 2g/d) on the gene expression of zinc transporters (ZnT1, ZnT5, ZnT6, ZnT7, ZnT8, Zip1, Zip3, Zip7, and Zip10) and metallothionein (MT-1A, and MT-2A), and markers of glycemic control (glucose, insulin, glycosylated hemoglobin [HbA1c]). The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. No significant effects of zinc or FSO supplementation were observed on glycemic marker concentrations, HOMA-IR or fold change over 12 weeks in zinc transporter and metallothionein gene expression. In multivariate analysis, the change over 12 weeks in serum glucose concentrations (P=0.001) and HOMA-IR (P=0.001) predicted the fold change in Zip10. In secondary analysis, marginal statistical significance was observed with the change in both serum glucose concentrations (P=0.003) and HOMA-IR (P=0.007) being predictive of the fold change in ZnT6. ZnT8 mRNA expression was variable; HbA1c levels were higher (P=0.006) in participants who exhibited ZnT8 expression compared to those who did not. The significant predictive relationships between Zip10, ZnT6, serum glucose and HOMA-IR are preliminary, as is the relationship between HbA1c and ZnT8; nevertheless the observations support an association between Type 2 DM and zinc homeostasis that requires further exploration. PMID:25156968

  5. Long-term glycemic control using polymer-encapsulated human stem cell-derived beta cells in immune-competent mice.

    PubMed

    Vegas, Arturo J; Veiseh, Omid; Gürtler, Mads; Millman, Jeffrey R; Pagliuca, Felicia W; Bader, Andrew R; Doloff, Joshua C; Li, Jie; Chen, Michael; Olejnik, Karsten; Tam, Hok Hei; Jhunjhunwala, Siddharth; Langan, Erin; Aresta-Dasilva, Stephanie; Gandham, Srujan; McGarrigle, James J; Bochenek, Matthew A; Hollister-Lock, Jennifer; Oberholzer, Jose; Greiner, Dale L; Weir, Gordon C; Melton, Douglas A; Langer, Robert; Anderson, Daniel G

    2016-03-01

    The transplantation of glucose-responsive, insulin-producing cells offers the potential for restoring glycemic control in individuals with diabetes. Pancreas transplantation and the infusion of cadaveric islets are currently implemented clinically, but these approaches are limited by the adverse effects of immunosuppressive therapy over the lifetime of the recipient and the limited supply of donor tissue. The latter concern may be addressed by recently described glucose-responsive mature beta cells that are derived from human embryonic stem cells (referred to as SC-β cells), which may represent an unlimited source of human cells for pancreas replacement therapy. Strategies to address the immunosuppression concerns include immunoisolation of insulin-producing cells with porous biomaterials that function as an immune barrier. However, clinical implementation has been challenging because of host immune responses to the implant materials. Here we report the first long-term glycemic correction of a diabetic, immunocompetent animal model using human SC-β cells. SC-β cells were encapsulated with alginate derivatives capable of mitigating foreign-body responses in vivo and implanted into the intraperitoneal space of C57BL/6J mice treated with streptozotocin, which is an animal model for chemically induced type 1 diabetes. These implants induced glycemic correction without any immunosuppression until their removal at 174 d after implantation. Human C-peptide concentrations and in vivo glucose responsiveness demonstrated therapeutically relevant glycemic control. Implants retrieved after 174 d contained viable insulin-producing cells. PMID:26808346

  6. Effect of Replacing Animal Protein with Plant Protein on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Viguiliouk, Effie; Stewart, Sarah E.; Jayalath, Viranda H.; Ng, Alena Praneet; Mirrahimi, Arash; de Souza, Russell J.; Hanley, Anthony J.; Bazinet, Richard P.; Blanco Mejia, Sonia; Leiter, Lawrence A.; Josse, Robert G.; Kendall, Cyril W.C.; Jenkins, David J.A.; Sievenpiper, John L.

    2015-01-01

    Previous research on the effect of replacing sources of animal protein with plant protein on glycemic control has been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of this replacement on glycemic control in individuals with diabetes. We searched MEDLINE, EMBASE, and Cochrane databases through 26 August 2015. We included RCTs ≥ 3-weeks comparing the effect of replacing animal with plant protein on HbA1c, fasting glucose (FG), and fasting insulin (FI). Two independent reviewers extracted relevant data, assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2-statistic). Thirteen RCTs (n = 280) met the eligibility criteria. Diets emphasizing a replacement of animal with plant protein at a median level of ~35% of total protein per day significantly lowered HbA1c (MD = −0.15%; 95%-CI: −0.26, −0.05%), FG (MD = −0.53 mmol/L; 95%-CI: −0.92, −0.13 mmol/L) and FI (MD = −10.09 pmol/L; 95%-CI: −17.31, −2.86 pmol/L) compared with control arms. Overall, the results indicate that replacing sources of animal with plant protein leads to modest improvements in glycemic control in individuals with diabetes. Owing to uncertainties in our analyses there is a need for larger, longer, higher quality trials. Trial Registration: ClinicalTrials.gov registration number: NCT02037321. PMID:26633472

  7. Adding glimepiride to current insulin therapy increases high-molecular weight adiponectin levels to improve glycemic control in poorly controlled type 2 diabetes

    PubMed Central

    2014-01-01

    Background To observe the efficacy and safety of adding glimepiride to established insulin therapy in poorly controlled type 2 diabetes (T2D) and to assess the relationship of changes in the serum high-molecular weight (HMW) adiponectin levels and glycemic control after glimepiride treatment. Methods Fifty-six subjects with poorly controlled insulin-treated T2D were randomly assigned to either the glimepiride-added group (the group A, n = 29) or the insulin-increasing group (the group B, n = 27) while continuing current insulin-based therapy. Glycosylated hemoglobin (HbA1c) value, daily insulin dose, body weight, waist circumference, plasma lipid concentration, serum HMW adiponectin level and the number of hypoglycemic events were evaluated before and after treatment. Results At the end of study, insulin doses were significantly reduced, and the mean HbA1c, fasting blood glucose (FBG) and 2-hour postprandial blood glucose (P2BG) were improved greater in the group A compared with the group B. The serum HMW adiponectin levels were significantly increased in the group A compared with the group B. Most importantly, we found that changes in HbA1c were inversely correlated with changes in serum HMW adiponectin in the group A (r = −0.452, p = 0.02). Conclusions Adding glimepiride to current insulin treatment led to better improvement in glycemic control with a significant smaller daily insulin dose, and the increases in the serum HMW adiponectin levels may directly contribute to improvement glycemic control. PMID:24650537

  8. The effects of the king oyster mushroom Pleurotus eryngii (higher Basidiomycetes) on glycemic control in alloxan-induced diabetic mice.

    PubMed

    Li, Jian-Ping; Lei, Ya-li; Zhan, Huan

    2014-01-01

    The purpose of this study is to investigate the effects of Pleurotus eryngii on glycemic metabolism. Alloxan-induced hyperglycemic mice were used to study the effects of P. eryngii on blood glucose, glycohemoglobin, insulin secretion, damaged pancreatic β-cells, total antioxidant status (TAOS), and hepatic glycogen in hyperglycemic mice. Sixty diabetic mice were divided equally into 5 groups: the alloxan (AX)-induced hyperglycemic group, the AX and glibenclamide (GLI)-treated group, the AX and P. eryngii extracts (PEEs) 50-treated group (PEE 50 mg/kg), the AX and PEE100-treated group (PEE 100 mg/kg), and the AX and PEE200-treated group (PEE 200 mg/kg). The other 12 normal mice were injected intravenously with the normal saline and used as the control group. After PEE (100 and 200 mg/kg) was orally administered to the mice over 5 weeks, blood glucose and HbAlc were significantly decreased in AX-induced hyperglycemic mice (P < 0.05 and P < 0.01, respectively), whereas the level of insulin secretion was markedly elevated in (P < 0.05). The pancreatic β-cells damaged by AX partially and gradually recovered after PPE extract was administered to the hyperglycemic mice for 35 days. In addition, PEE treatment gradually increased the body weight and significantly increased the concentration of hepatic glycogen in hyperglycemic mice (P < 0.05). The results suggest that the action of PPE on glycemic metabolism occurs via increasing glycogen and insulin concentrations as well as recovering injured β-cells and reducing free radical damage. PPE may become a new potential hypoglycemic food for hyperglycemic people. PMID:24941163

  9. Effect of Tree Nuts on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Dietary Trials

    PubMed Central

    Viguiliouk, Effie; Kendall, Cyril W. C.; Blanco Mejia, Sonia; Cozma, Adrian I.; Ha, Vanessa; Mirrahimi, Arash; Jayalath, Viranda H.; Augustin, Livia S. A.; Chiavaroli, Laura; Leiter, Lawrence A.; de Souza, Russell J.; Jenkins, David J. A.; Sievenpiper, John L.

    2014-01-01

    Background Tree nut consumption has been associated with reduced diabetes risk, however, results from randomized trials on glycemic control have been inconsistent. Objective To provide better evidence for diabetes guidelines development, we conducted a systematic review and meta-analysis of randomized controlled trials to assess the effects of tree nuts on markers of glycemic control in individuals with diabetes. Data Sources MEDLINE, EMBASE, CINAHL, and Cochrane databases through 6 April 2014. Study Selection Randomized controlled trials ≥3 weeks conducted in individuals with diabetes that compare the effect of diets emphasizing tree nuts to isocaloric diets without tree nuts on HbA1c, fasting glucose, fasting insulin, and HOMA-IR. Data Extraction and Synthesis Two independent reviewer’s extracted relevant data and assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% CI’s. Heterogeneity was assessed (Cochran Q-statistic) and quantified (I2). Results Twelve trials (n = 450) were included. Diets emphasizing tree nuts at a median dose of 56 g/d significantly lowered HbA1c (MD = −0.07% [95% CI:−0.10, −0.03%]; P = 0.0003) and fasting glucose (MD = −0.15 mmol/L [95% CI: −0.27, −0.02 mmol/L]; P = 0.03) compared with control diets. No significant treatment effects were observed for fasting insulin and HOMA-IR, however the direction of effect favoured tree nuts. Limitations Majority of trials were of short duration and poor quality. Conclusions Pooled analyses show that tree nuts improve glycemic control in individuals with type 2 diabetes, supporting their inclusion in a healthy diet. Owing to the uncertainties in our analyses there is a need for longer, higher quality trials with a focus on using nuts to displace high-glycemic index carbohydrates. Trial Registration ClinicalTrials.gov NCT01630980 PMID:25076495

  10. A Novel Behavioral Intervention in Adolescents with Type 1 Diabetes Mellitus Improves Glycemic Control: Preliminary Results from a Pilot Randomized Control Trial

    PubMed Central

    Maranda, Louise; Lau, May; Stewart, Sunita M; Gupta, Olga T

    2015-01-01

    Purpose The purpose of this study is to develop and pilot an innovative behavioral intervention in adolescents with type 1 diabetes mellitus (T1DM) incorporating structured care of a pet to improve glycemic control. Methods Twenty-eight adolescents with A1C > 8.5% (69 mmol/mol) were randomly assigned to either the intervention group (care of a Betta splendens pet fish) or the control group (usual care). Adolescents in the intervention group were given instructions to associate daily and weekly fish care duties with diabetes self-management tasks including blood glucose testing and parent-adolescent communication. Results After 3 months the participants in the intervention group exhibited a statistically significant decrease in A1C levels (−0.5%) compared to their peers in the control group who had an increase in A1C levels (0.8%)(p = 0.04). The younger adolescents (ages 10–13) demonstrated a greater response to the intervention which was statistically significant (−1.5% vs. 0.6%, p = 0.04) compared with the older adolescents (ages 14–17). Conclusions Structured care of a pet fish can improve glycemic control in adolescents with T1DM, likely by providing cues to perform diabetes self-management behaviors. PMID:25614529

  11. Sodium–glucose cotransporter-2 inhibitor combination therapy to optimize glycemic control and tolerability in patients with type 2 diabetes: focus on dapagliflozin–metformin

    PubMed Central

    Schwartz, Stanley S; Katz, Arie

    2016-01-01

    In type 2 diabetes (T2D), early combination therapy using agents that target a number of the underlying pathophysiologic defects contributing to hyperglycemia may improve patient outcomes. For many patients, the combination of metformin with a sodium–glucose cotransporter-2 (SGLT-2) inhibitor may be a good option because these agents have complementary mechanisms of action, neutral-to-positive effects on body weight, and a low risk of hypoglycemia. This review focuses on the combination of metformin with dapagliflozin, a member of the SGLT-2 inhibitor class of antidiabetes agents. In clinical trials, the combination of dapagliflozin with metformin produced significant and sustained reductions in glycated hemoglobin and body weight in a broad range of adult patients with T2D, including those initiating pharmacotherapy and those with more advanced disease. These reductions were accompanied by modest decreases in blood pressure. Dapagliflozin as add-on therapy to metformin was well tolerated and associated with low rates of hypoglycemia. Genital infections and, in some studies, urinary tract infections were more frequent with dapagliflozin than with placebo. Early combination therapy with dapagliflozin and metformin may be a safe and appropriate treatment option that enables patients with T2D to achieve individualized glycemic goals as either initial combination therapy in treatment-naïve patients or as dapagliflozin add-on in patients inadequately controlled with metformin therapy. PMID:27042132

  12. Sodium-glucose cotransporter-2 inhibitor combination therapy to optimize glycemic control and tolerability in patients with type 2 diabetes: focus on dapagliflozin-metformin.

    PubMed

    Schwartz, Stanley S; Katz, Arie

    2016-01-01

    In type 2 diabetes (T2D), early combination therapy using agents that target a number of the underlying pathophysiologic defects contributing to hyperglycemia may improve patient outcomes. For many patients, the combination of metformin with a sodium-glucose cotransporter-2 (SGLT-2) inhibitor may be a good option because these agents have complementary mechanisms of action, neutral-to-positive effects on body weight, and a low risk of hypoglycemia. This review focuses on the combination of metformin with dapagliflozin, a member of the SGLT-2 inhibitor class of antidiabetes agents. In clinical trials, the combination of dapagliflozin with metformin produced significant and sustained reductions in glycated hemoglobin and body weight in a broad range of adult patients with T2D, including those initiating pharmacotherapy and those with more advanced disease. These reductions were accompanied by modest decreases in blood pressure. Dapagliflozin as add-on therapy to metformin was well tolerated and associated with low rates of hypoglycemia. Genital infections and, in some studies, urinary tract infections were more frequent with dapagliflozin than with placebo. Early combination therapy with dapagliflozin and metformin may be a safe and appropriate treatment option that enables patients with T2D to achieve individualized glycemic goals as either initial combination therapy in treatment-naïve patients or as dapagliflozin add-on in patients inadequately controlled with metformin therapy. PMID:27042132

  13. Are differences between patient and provider explanatory models of diabetes associated with patient self-management and glycemic control?

    PubMed

    Weller, Susan C; Baer, Roberta D; de Alba Garcia, Javier Garcia; Salcedo Rocha, Ana L

    2013-11-01

    In this study we test whether differences between patient and provider explanatory models of diabetes affect self-management and glucose control in type 2 diabetes patients. Diabetic patients (n=60) and family practice physicians (n=39) in Guadalajara, Mexico, responded to a structured explanatory model interview (130 questions on causes, symptoms, and treatments). A cultural consensus analysis indicated a widely shared model among physicians and provided a single shared set of answers to the questions. Patient-provider congruence in beliefs was assessed by comparing each patient's responses with the physician answer set. Congruence in beliefs predicted self-management behaviors (r=0.27, p=.03), more than educational level (r=0.16, p=.23), but was not predictive of A1C (r=0.12, p=.40). Differences between patient and physician explanatory models can adversely affect patient-directed activities and may indirectly affect glycemic control by affecting self-management. These differences may be due to low patient educational level and resulting problems in understanding biomedical approaches to diabetes. PMID:24185147

  14. Effects of Encapsulated Propolis on Blood Glycemic Control, Lipid Metabolism, and Insulin Resistance in Type 2 Diabetes Mellitus Rats

    PubMed Central

    Li, Yajing; Chen, Minli; Xuan, Hongzhuan; Hu, Fuliang

    2012-01-01

    The present study investigates the encapsulated propolis on blood glycemic control, lipid metabolism, and insulin resistance in type 2 diabetes mellitus (T2DM) rats. The animal characteristics and biological assays of body weight, fasting blood glucose (FBG), fasting serum insulin (FINS), insulin act index (IAI), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured and euglycemic hyperinsulinemic glucose clamp technique were used to determine these effects. Our findings show that oral administration of encapsulated propolis can significantly inhibit the increasing of FBG and TG in T2DM rats and can improve IAI and M value in euglycemic hyperinsulinemic clamp experiment. There was no significant effects on body weight, TC, HDL-C, and LDL-C in T2DM rats treated with encapsulated propolis. In conclusion, the results indicate that encapsulated propolis can control blood glucose, modulate lipid metabolism, and improve the insulin sensitivity in T2DM rats. PMID:21716678

  15. A Pilot Food Bank Intervention Featuring Diabetes-Appropriate Food Improved Glycemic Control Among Clients In Three States.

    PubMed

    Seligman, Hilary K; Lyles, Courtney; Marshall, Michelle B; Prendergast, Kimberly; Smith, Morgan C; Headings, Amy; Bradshaw, Georgiana; Rosenmoss, Sophie; Waxman, Elaine

    2015-11-01

    Food insecurity--defined as not having adequate quantity and quality of food at all times for all household members to have an active, healthy life--is a risk factor for poor diabetes control, yet few diabetes interventions address this important factor. Food pantries, which receive food from food banks and distribute it to clients in need, may be ideal sites for diabetes self-management support because they can provide free diabetes-appropriate food to people in low-income communities. Between February 2012 and March 2014, we enrolled 687 food pantry clients with diabetes in three states in a six-month pilot intervention that provided them with diabetes-appropriate food, blood sugar monitoring, primary care referral, and self-management support. Improvements were seen in pre-post analyses of glycemic control (hemoglobin A1c decreased from 8.11 percent to 7.96 percent), fruit and vegetable intake (which increased from 2.8 to 3.1 servings per day), self-efficacy, and medication adherence. Among participants with elevated HbA1c (at least 7.5 percent) at baseline, HbA1c improved from 9.52 percent to 9.04 percent. Although food pantries are nontraditional settings for diabetes support, this pilot study suggests a promising health promotion model for vulnerable populations. Policies supporting such interventions may be particularly effective because of food pantries' food access and distribution capacity. PMID:26526255

  16. Correlation Between Glycemic Control and the Incidence of Peritoneal and Catheter Tunnel and Exit-Site Infections in Diabetic Patients Undergoing Peritoneal Dialysis

    PubMed Central

    Rodríguez-Carmona, Ana; Pérez-Fontán, Miguel; López-Muñiz, Andrés; Ferreiro-Hermida, Tamara; García-Falcón, Teresa

    2014-01-01

    ♦ Background: Diabetes mellitus, especially if complicated by poor glycemic control, portends an increased risk of infection. The significance of this association in the case of diabetic patients undergoing peritoneal dialysis (PD) has not been assessed. ♦ Methods: Using a retrospective observational design, we analyzed the association between glycemic control at the start of PD (estimated from glycosylated hemoglobin levels) and the risk of peritoneal and catheter tunnel and exit-site infections during follow-up in 183 incident patients on PD. We used the median value of glycosylated hemoglobin to classify patients into good (group A) or poor (group B) glycemic control groups. We applied multivariate strategies of analysis to control for other potential predictors of PD-related infection. ♦ Results: Groups A and B differed significantly in age, dialysis vintage, use of insulin, and rate of Staphylococcus aureus carriage. Neither the incidence (0.60 episodes in group A vs 0.56 episodes in group B per patient-year) nor the time to a first peritoneal infection (median: 42 months vs 38 months) differed significantly between the study groups. In contrast, group B had a significantly higher incidence of catheter tunnel and exit-site infections (0.23 episodes vs 0.12 episodes per patient-year) and shorter time to a first infection episode (64 months vs 76 months, p = 0.004). The difference persisted in multivariate analysis (adjusted hazard ratio: 2.65; 95% confidence interval: 1.13 to 6.05; p = 0.013). We observed no differences between the study groups in the spectrum of causative organisms or in the outcomes of PD-related infections. ♦ Conclusions: Poor glycemic control is a consistent predictor of subsequent risk of catheter tunnel and exit-site infection, but not of peritoneal infection, among diabetic patients starting PD therapy. PMID:23818005

  17. Impact of Intensive Glycemic Control on the Incidence of Atrial Fibrillation and Associated Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus (from the ACCORD Study)

    PubMed Central

    Fatemi, Omid; Yuriditsky, Eugene; Tsioufis, Costas; Tsachris, Demetrios; Morgan, Timothy; Basile, Jan; Bigger, Thomas; Cushman, William; Goff, David; Soliman, Elsayed Z.; Thomas, Abraham; Papademetriou, Vasilios

    2014-01-01

    Atrial fibrillation (AF) is prevalent among individuals with type 2 diabetes mellitus (DM), and is associated with markers of poor glycemic control; however the impact of glycemic control on incident AF and outcomes is unknown. We sought to prospectively evaluate if intensive glycemic control in individuals with DM impacts incident AF, and to evaluate morbidity and mortality among individuals with DM and incident AF. We studied 10,082 individuals with DM from the ACCORD cohort in a randomized, double-blind fashion. Participants were randomized to an intensive therapeutic strategy targeting a glycated hemoglobin level of <6.0%, or a standard strategy targeting a glycated hemoglobin of 7.0-7.9%. Incident AF occurred in 159 patients (1.58%) over the follow-up period at a rate of 5.9/1,000 person-years in the intensive-therapy group, and a rate of 6.37/1,000 person-years in the standard-therapy group (p=0.52). In a multivariate model, predictors of incident AF were age, weight, diastolic blood pressure, heart rate, and heart failure history. Patients with DM and new-onset AF had a HR of 2.65 for all-cause mortality (95% CI 1.8-3.86, p<0.0001), HR of 2.1 for myocardial infarction (95% CI 1.33-3.31, p=0.0015), and HR of 3.80 for development of heart failure (95% CI 2.48-5.84, p<0.0001). In conclusion, intensive glycemic control did not impact rate of new-onset AF. Patients with DM and incident AF had an increased risk for morbidity and mortality as compared to those without AF. PMID:25159234

  18. Profiles and Factors Associated with Poor Glycemic Control Among Inpatients with Diabetes Mellitus Type 2 as a Primary Diagnosis in a Teaching Hospital

    PubMed Central

    Ismail, Aniza; Suddin, Leny Suzana; Sulong, Saperi; Ahmed, Zafar; Kamaruddin, Nor Azmi; Sukor, Norlela

    2016-01-01

    Context: Diabetes mellitus is a growing health problem in most countries. In Malaysia, there was an increase in prevalence over the years. This makes diabetes also a growing concern in Malaysia, which warrants strengthening of the prevention and control programme. Aims: This paper aims to describe the profiles of diabetes mellitus type 2 in tertiary setting and to identify the risk factors for high level of HbA1c among the study population. The findings will give a glimpse on current status of diabetes in our country and may reflect the achievement of the country in combating this disease. Settings and Design: A cross-sectional study was conducted in UKM Medical Centre. Methods and Material: Medical records of patient with E11 ICD-10 code were collected using Case Report Form. Statistical Analysis Used: Descriptive analysis done of mean and median while test of association were done using Spearman correlation and logistic regression. Results: The results showed that majority of inpatients of DMT2 showed mean age of 58.8 + 12.6 years and most were males (56.7%) with secondary level of education (41.7%). Median duration of disease was 12.0 + 11.0 years with median HbA1c level of 8.9 ± 4.4%. Only small proportion of patients achieved the desired level of HbA1c <6.5% (21.3%) and significant association was found with tertiary level of education [AOR = 0.10, 95%CI = 0.01-0.96] and with type of anti-diabetic therapy [AOR = 15.90, 95%CI=1;2.03-124.30]. Conclusions: In conclusion, diabetes mellitus type 2 inpatients still showed unsatisfactory glycemic control and holistic approach using health education should be advocated continuously in the future in view of education being one of the predictors for the good HbA1c outcome. PMID:27385874

  19. Short- and Longterm Glycemic Control of Streptozotocin-Induced Diabetic Rats Using Different Insulin Preparations.

    PubMed

    Luippold, Gerd; Bedenik, Jessica; Voigt, Anke; Grempler, Rolf

    2016-01-01

    The chemical induction of diabetes with STZ has gained popularity because of the relative ease of rendering normal animals diabetic. Insulin substitution is required in STZ-rats in long-term studies to avoid ketoacidosis and consequently loss of animals. Aim of the present studies was to test different insulin preparations and different ways of administration in their ability to reduce blood glucose in STZ-induced diabetic rats. Single dosing of the long-acting insulin analogue glargine was able to dose-dependently reduce blood glucose over 4 h towards normoglycemia in STZ-treated rats. However, this effect was not sustained until 8 h post injection. A more sustained glucose-lowering effect was achieved using insulin-releasing implants. In STZ-rats, 1 insulin implant moderately lowered blood glucose levels 10 days after implantation, while 2 implants induced normoglycemia over the whole day. According to the glucose-lowering effect 1 as well as 2 insulin implants significantly reduced HbA1c measured after 26 days of implantation. In line with the improved glucose homeostasis due to the implants, urinary glucose excretion was also blunted in STZ-treated rats with 2 implants. Since diabetic nephropathy is one of the complications of longterm diabetes, renal function was characterized in the STZ-rat model. Increases in creatinine clearance and urinary albumin excretion resemble early signs of diabetic nephropathy. These functional abnormalities of the kidney could clearly be corrected with insulin-releasing implants 27 days after implantation. The data show that diabetic STZ-rats respond to exogenous insulin with regard to glucose levels as well as kidney parameters and a suitable dose of insulin implants for glucose control was established. This animal model together with the insulin dosing regimen is suitable to address diabetes-induced early diabetic nephropathy and also to study combination therapies with insulin for the treatment of type 1 diabetes. PMID:27253523

  20. Short- and Longterm Glycemic Control of Streptozotocin-Induced Diabetic Rats Using Different Insulin Preparations

    PubMed Central

    Luippold, Gerd; Bedenik, Jessica; Voigt, Anke; Grempler, Rolf

    2016-01-01

    The chemical induction of diabetes with STZ has gained popularity because of the relative ease of rendering normal animals diabetic. Insulin substitution is required in STZ-rats in long-term studies to avoid ketoacidosis and consequently loss of animals. Aim of the present studies was to test different insulin preparations and different ways of administration in their ability to reduce blood glucose in STZ-induced diabetic rats. Single dosing of the long-acting insulin analogue glargine was able to dose-dependently reduce blood glucose over 4 h towards normoglycemia in STZ-treated rats. However, this effect was not sustained until 8 h post injection. A more sustained glucose-lowering effect was achieved using insulin-releasing implants. In STZ-rats, 1 insulin implant moderately lowered blood glucose levels 10 days after implantation, while 2 implants induced normoglycemia over the whole day. According to the glucose-lowering effect 1 as well as 2 insulin implants significantly reduced HbA1c measured after 26 days of implantation. In line with the improved glucose homeostasis due to the implants, urinary glucose excretion was also blunted in STZ-treated rats with 2 implants. Since diabetic nephropathy is one of the complications of longterm diabetes, renal function was characterized in the STZ-rat model. Increases in creatinine clearance and urinary albumin excretion resemble early signs of diabetic nephropathy. These functional abnormalities of the kidney could clearly be corrected with insulin-releasing implants 27 days after implantation. The data show that diabetic STZ-rats respond to exogenous insulin with regard to glucose levels as well as kidney parameters and a suitable dose of insulin implants for glucose control was established. This animal model together with the insulin dosing regimen is suitable to address diabetes-induced early diabetic nephropathy and also to study combination therapies with insulin for the treatment of type 1 diabetes. PMID:27253523

  1. Effects of Low Glycemic Index Diets on Gestational Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Clinical Trials.

    PubMed

    Wei, Jinhua; Heng, Weijun; Gao, Jianbo

    2016-05-01

    Studies of the effects of low glycemic index (LGI) diets on gestational diabetes mellitus (GDM) have reported conflicting findings.The aim of the study was to evaluate the results of randomized controlled trials (RCTs) that investigated the effects of LGI diets with and without added dietary fiber (DF) on maternal and neonatal outcomes in GDM patients.We searched the MEDLINE, EMBASE, EBSCO, Springer, Ovid, and Cochrane Library databases for studies of the effects of LGI diets in GDM patients. We performed a meta-analysis of the effects of the LGI diets with and without added dietary fiber (DF) on GDM outcomes. Risk ratios (RR) and 95% confidence intervals (CIs) were calculated using random- and fixed-effects models.Five RCTs involving 302 participants were included in our meta-analysis. No statistically significant differences in the risks of cesarean section delivery, large for gestational age, and small for gestational age were observed. The risk of macrosomia in the LGI groups was significantly lower (RR = 0.27; 95% CI: 0.10-0.71; P = 0.008) than that in the control groups. Our subgroup analysis of the effects of DF showed that LGI diets with an increased level of DF, relative to the control diet, reduced the risk of macrosomia beyond that of the LGI diets alone (RR: 0.17 vs 0.47, respectively). The subgroup analysis also showed that LGI diets in which the level of DF was approximately equivalent to that in the control diets significantly reduced the risk of insulin usage (RR = 0.69; 95% CI: 0.52-0.92; P = 0.01).The LGI diets reduced the risk of macrosomia in GDM patients, and LGI diets with added DF reduced the risk of macrosomia further. The LGI diets with levels of DF approximately equivalent to that in the control diets reduced the risk of insulin usage in GDM patients. PMID:27258511

  2. Relationships of illness representation, diabetes knowledge, and self-care behaviour to glycemic control in incarcerated persons with diabetes.

    PubMed

    Reagan, Louise A; Walsh, Stephen J; Shelton, Deborah

    2016-09-12

    Purpose The purpose of this paper is to examine relationships of self-care behavior, illness representation and diabetes knowledge with A1C (level of glycemic control) in 124 incarcerated persons. Design/methodology/approach Using a cross-sectional design, summary scores and items from the self-care inventory revised, brief illness perception questionnaire and the spoken knowledge for low literacy in diabetes were evaluated using linear regression to assess their relationship to A1C. Findings Metabolic control was suboptimal for the majority of inmates with diabetes. The final regression model was statistically significant ( F (3, 120)=9.51, p=0.001, R(2)=19.2 percent). Higher log10 HbA1C (A1C) was associated with lower personal control beliefs ( B=-0.007, t (122)=-2.42, p=<0.02), higher self-report of diabetes understanding ( B=0.009, t (122)=3.12, p=0.00) and using insulin ( B=0.062, t (122)=2.45, p=0.02). Research limitations/implications Similar to findings with community dwelling participants, enhancing diabetes personal control beliefs among inmates may lead to lower A1C. Social implications Highly structured environments with limited options for self-care, personal choices and readily available health care may give some incarcerated persons with diabetes no motivation to improve diabetes control even if they have an understanding of what to do. Originality/value While there is abundant research in the community describing how these factors influence A1C levels, research of this nature with incarcerated persons with diabetes is limited. Findings will inform diabetes programming during incarceration to better prepare inmates for reentry. PMID:27548018

  3. Plasma Proteins Modified by Advanced Glycation End Products (AGEs) Reveal Site-specific Susceptibilities to Glycemic Control in Patients with Type 2 Diabetes.

    PubMed

    Greifenhagen, Uta; Frolov, Andrej; Blüher, Matthias; Hoffmann, Ralf

    2016-04-29

    Protein glycation refers to the reversible reaction between aldoses (or ketoses) and amino groups yielding relatively stable Amadori (or Heyns) products. Consecutive oxidative cleavage reactions of these products or the reaction of amino groups with other reactive substances (e.g. α-dicarbonyls) yield advanced glycation end products (AGEs) that can alter the structures and functions of proteins. AGEs have been identified in all organisms, and their contents appear to rise with some diseases, such as diabetes and obesity. Here, we report a pilot study using highly sensitive and specific proteomics approach to identify and quantify AGE modification sites in plasma proteins by reversed phase HPLC mass spectrometry in tryptic plasma digests. In total, 19 AGE modification sites corresponding to 11 proteins were identified in patients with type 2 diabetes mellitus under poor glycemic control. The modification degrees of 15 modification sites did not differ among cohorts of normoglycemic lean or obese and type 2 diabetes mellitus patients under good and poor glycemic control. The contents of two amide-AGEs in human serum albumin and apolipoprotein A-II were significantly higher in patients with poor glycemic control, although the plasma levels of both proteins were similar among all plasma samples. These two modification sites might be useful to predict long term, AGE-related complications in diabetic patients, such as impaired vision, increased arterial stiffness, or decreased kidney function. PMID:26933035

  4. Differences in hospital glycemic control and insulin requirements in patients recovering from critical illness and those without prior critical illness

    PubMed Central

    Miller, April D; Phillips, Leslie M; Schulz, Richard M; Bookstaver, P Brandon; Rudisill, Celeste N

    2010-01-01

    Introduction Hospital patients recovering from critical illness on general floors often receive insulin therapy based on protocols designed for patients admitted directly to general floors. The objective of this study is to compare glycemic control and insulin dosing in patients recovering from critical illness and those without prior critical illness. Methods Medical record review of blood glucose measurements and insulin dosing in 25 patients under general ward care while transitioning from the intensive care unit (transition group) and 25 patients admitted directly to the floor (direct floor group). Results Average blood glucose did not differ significantly between groups (transition group 9.49 mmol/L, direct floor group 9.6 mmol/L; P = 0.83). Significant differences in insulin requirements were observed between groups with average daily doses of 55.9 units in patients transitioning from the intensive care unit (ICU) versus 25.6 units in the direct floor group (P = 0.004). Conclusions Patients recovering from critical illness required significantly larger doses of insulin than those patients admitted directly to the floor. Managing insulin therapy in patients transitioning from the ICU may require greater insulin doses. PMID:22291498

  5. Targeted plasma metabolome response to variations in dietary glycemic load in a randomized, controlled, crossover feeding trial in healthy adults

    PubMed Central

    Barton, Sally; Navarro, Sandi L.; Buas, Matthew F.; Y, Schwarz; Gu, Haiwei; Djukovic, Danijel; Raftery, Daniel; Kratz, Mario; Neuhouser, Marian L.; Lampe, Johanna W.

    2015-01-01

    Low versus high glycemic load (GL) diet patterns are inversely associated with obesity and chronic diseases such as cancer and cardiovascular disease. These associations persist beyond the protection afforded by increased fiber alone, representing an important gap in our understanding of the metabolic effects of GL. We conducted a randomized, controlled, crossover feeding trial of two 28-day diet periods of high and low GL. Using LC-MS, targeted metabolomics analysis of 155 metabolites was performed on plasma samples from 19 healthy adults aged 18-45 years. Fourteen metabolites differed significantly between diets (P<0.05), with kynurenate remaining significant after Bonferroni correction (P<4×10-4). Metabolites with the largest difference in abundance were kynurenate and trimethylamine-N-oxide (TMAO), both significantly higher after consumption of the low GL diet. Partial least squares-discriminant analysis showed clear separation between the two diets; however no specific pathway was identified in pathway analyses. We found significant differences in 14 plasma metabolites suggesting a differing metabolic response to low and high GL diets. Kynurenate is associated with reduced inflammation, and may be one mechanism through which protective effects of a low GL diet are manifested and warrants further evaluation. This trial was registered at clinicaltrials.gov as NCT00622661. PMID:26165375

  6. The potent synergistic effects of the combination of liraglutide and canagliflozin on glycemic control and weight loss

    PubMed Central

    Bell, David S.H.

    2014-01-01

    Patient: Male, 57 Final Diagnosis: Diabetes mellitus type 2 Symptoms: Weight loss Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Unusual or unexpected effect of treatment Background: Studies of the efficacy of the combination of the incretin mimetic liraglutide and the SGLT2 inhibitor canagliflozin or indeed studies of the combination of any incretin mimetic with an SGLT2 inhibitor have neither been performed nor published. Pharmacologically, the combination of an incretin-mimetic and an SGLT2-receptor blocker should result in a more significant weight loss and a greater reduction in postprandial glucose and HbA1c. Case Report: An insulin-dependent type 2 diabetic patient with multiple diabetic complications was placed on the combination of liraglutide and canagliflozin and 4 weeks later was able to discontinue insulin. In addition, in spite of discontinuing insulin, his HbA1c dropped from 7.0% to 6.8%, and he had reductions in body (weight from 247 to 218 lbs), BMI (from 34 to 29.5 Kg/m2), waist circumference (from 47 to 44 ½ inches), and neck circumference (from 19 ½ to 18 ¼ inches). Conclusions: The combination of an SGLT2 inhibitor and an incretin mimetic/analog results in improved glycemic control accompanied by significant weight loss. This combination needs to be studied in a prospective randomized trial because the effect of each of the components of this combination is synergistically magnified by the addition of the partner drug. PMID:24753783

  7. Targeted plasma metabolome response to variations in dietary glycemic load in a randomized, controlled, crossover feeding trial in healthy adults.

    PubMed

    Barton, Sally; Navarro, Sandi L; Buas, Matthew F; Schwarz, Yvonne; Gu, Haiwei; Djukovic, Danijel; Raftery, Daniel; Kratz, Mario; Neuhouser, Marian L; Lampe, Johanna W

    2015-09-01

    Low versus high glycemic load (GL) diet patterns are inversely associated with obesity and chronic diseases such as cancer and cardiovascular disease. These associations persist beyond the protection afforded by increased fiber alone, representing an important gap in our understanding of the metabolic effects of GL. We conducted a randomized, controlled, crossover feeding trial of two 28-day diet periods of high and low GL. Using LC-MS, targeted metabolomics analysis of 155 metabolites was performed on plasma samples from 19 healthy adults aged 18-45 years. Fourteen metabolites differed significantly between diets (P < 0.05), with kynurenate remaining significant after Bonferroni correction (P < 4 × 10(-4)). Metabolites with the largest difference in abundance were kynurenate and trimethylamine-N-oxide (TMAO), both significantly higher after consumption of the low GL diet. Partial least squares-discriminant analysis showed clear separation between the two diets; however no specific pathway was identified in pathway analyses. We found significant differences in 14 plasma metabolites suggesting a differing metabolic response to low and high GL diets. Kynurenate is associated with reduced inflammation, and may be one mechanism through which protective effects of a low GL diet are manifested and warrants further evaluation. This trial was registered at clinicaltrials.gov as NCT00622661. PMID:26165375

  8. BIOMONITORING TO ACHIEVE CONTROL OF TOXIC EFFLUENTS

    EPA Science Inventory

    This 48 - page Technology Transfer Report provides a case study of how water quality-based toxicity control procedures can be combined with chemical analyses and biological stream surveys to achieve more effective water pollution control. t describes how regulatory agencies used ...

  9. Salacia reticulata improves serum lipid profiles and glycemic control in patients with prediabetes and mild to moderate hyperlipidemia: a double-blind, placebo-controlled, randomized trial.

    PubMed

    Shivaprasad, H N; Bhanumathy, M; Sushma, G; Midhun, T; Raveendra, K R; Sushma, K R; Venkateshwarlu, K

    2013-06-01

    The present randomized, double-blind, placebo-controlled study evaluated the efficacy and safety of Salacia reticulata leaves and root bark extracts in 29 patients with prediabetes and mild to moderate hyperlipidemia. Patients received either Salacia extracts (500 mg/day) or placebo along with therapeutic lifestyle changes for a period of 6 weeks. Efficacy was evaluated in terms of change in lipid profile and glycemic levels. The safety and tolerability was evaluated by a physical examination and clinical laboratory evaluations. Improvements in lipid profiles and glycemic levels were observed in Salacia extract-treated groups when compared to placebo at week 6. A statistical significant reduction was observed in low-density lipoprotein cholesterol and fasting blood sugar (FBS) levels at week 3 and 6 when treated with root bark extract. The leaves extract-treated group showed statistically significant reduction in FBS levels at week 6 only. No adverse events occurred and all safety parameters were within normal ranges during the study. This study revealed that treatment with S. reticulata was safe and well-tolerated and may be beneficial in the management of prediabetes and mild to moderate hyperlipidemia. PMID:23767865

  10. Chemical Composition and the Effect of Walnut Hydrosol on Glycemic Control of Patients With Type 1 Diabetes

    PubMed Central

    Moravej, Hossein; Salehi, Alireza; Razavi, Zahra; Moein, Mahmood Reza; Etemadfard, Hamed; Karami, Forough; Ghahremani, Forough

    2016-01-01

    Background Walnut hydrosol (WH) is used extensively by Iranian people with diabetes in order to control blood sugar (BS). There are few data regarding the effect of walnut on controlling diabetes. Objectives A pilot study to determine the efficacy and safety of WH in patients with type 1 diabetes. Materials and Methods Eight patients with diabetes mellitus (DM) type 1 were enrolled in the study. They did not use any medicine except insulin. They were advised to drink 250 mL WH after meals twice a day for four weeks. Their BS level was measured and their insulin dose was changed according to their BS. After four weeks, they discontinued WH use and their BS level was checked for two weeks. Descriptive statistics was used to analyze the data. Also, the essential oil of the sample was extracted using a liquid extractor and then analysis of the constituents was performed. Results The average daily BS level and insulin dose decreased in seven subjects. Two subjects developed generalized pruritic erythematous skin rash. One patient presented hypoglycemic coma. She had no other coma risk factor. Seven compounds were identified in the walnut essential oil and the rate of monoterpenoid and sesquiterpenes hydrocarbons were 53.45% and 5.95%, respectively. The main constituents of the oil were carvacrol (33.21%), thymol (16%) and homoveratrole (15.83%). Conclusions WH may control the glycemic level in people with diabetes, but it may be associated with minor and major side effects. Further in vitro studies, using these seven compounds, are recommended to determine the efficacy and complications of WH in people with diabetes. PMID:27335580

  11. Differences in glycemic control across world regions: a post-hoc analysis in patients with type 2 diabetes mellitus on dual antidiabetes drug therapy

    PubMed Central

    Brath, H; Paldánius, P M; Bader, G; Kolaczynski, W M; Nilsson, P M

    2016-01-01

    Objective: This post-hoc analysis of the EDGE (Effectiveness of Diabetes control with vildaGliptin and vildagliptin/mEtformin) study assessed inter-regional differences in baseline characteristics and response to treatment intensification with dual oral antidiabetes drugs (OADs) in patients with type 2 diabetes mellitus (T2DM). Methods: Patients with T2DM inadequately controlled with first-line monotherapy were assigned to receive a dipeptidyl peptidase-4 (DPP-4) inhibitor, vildagliptin, or comparator OADs as add-on dual therapy. The primary effectiveness end point (PEP) was achieving glycated hemoglobin (HbA1c) reduction >0.3% without hypoglycemia, peripheral edema, discontinuation owing to gastrointestinal events or weight gain ⩾5% at 12 months. The secondary effectiveness end point (SEP) was achieving HbA1c of <7% without hypoglycemia or weight gain ⩾3% at 12 months. Results: Baseline characteristics of patients (N=43 791), including mean HbA1c (8.2%), varied across regions. Baseline age (62.3 years) and T2DM duration (6.3 years) were greater in patients from Europe than those from India and the Middle East (age: 51.8 and 52.1 years; T2DM duration: 4.3 and 4.2 years, respectively). The probability of achieving PEP with dual therapy was higher in India (odds ratio (OR): 1.5), Latin America (OR: 1.2) and Middle East (OR: 2.0) than in Europe (OR: 0.8) and East Asia (OR: 0.3). Achievement of SEP in patients receiving dual therapy was greater in Latin America (OR: 1.7) and Middle East (OR: 1.7). Vildagliptin add-on therapy allowed more patients to achieve SEP across regions. Women aged ⩾45 years less often attained glycemic target (HbA1c<7%) without significant weight gain ⩾5% compared with women aged <45 years (OR: 0.876, 95% confidence interval: 0.774, 0.992; P=0.037). Conclusions: Baseline HbA1c and T2DM duration differed considerably across all regions. Treatment intensification with second OAD, particularly with a DPP-4 inhibitor vildagliptin, resulted

  12. Exenatide once weekly treatment maintained improvements in glycemic control and weight loss over 2 years

    PubMed Central

    2011-01-01

    Background The once-weekly (QW) formulation of the glucagon-like peptide-1 receptor agonist exenatide has been demonstrated to improve A1C, fasting plasma glucose (FPG), body weight, serum lipid profiles, and blood pressure in patients with type 2 diabetes through 52 weeks of treatment. In this report, we describe the 2-year results of the open-label, open-ended extension to the DURATION-1 trial of exenatide QW for type 2 diabetes. Methods A 2-stage protocol was used: patients received either exenatide QW (2 mg) or exenatide twice daily for 30 weeks (5 μg for the first 4 weeks and 10 μg thereafter), followed by 1.5 years of treatment with exenatide QW (2 mg), for a total of 2 years (104 weeks) of exenatide treatment. Of the 295 (intent-to-treat [ITT]) patients who entered the trial, 73% (n = 216) completed 2 years of treatment (completer population). Baseline characteristics (mean ± SE) for these patients were: A1C, 8.2 ± 0.1%; FPG, 168.4 ± 43.0 mg/dL; body weight, 101.1 ± 18.7 kg; and diabetes duration, 7 ± 5 years. Results In the completer population, significant improvements (LS mean ± SE [95% CI]) were maintained after 2 years of treatment in A1C (-1.71 ± 0.08% [-1.86 to -1.55%]), FPG (-40.1 ± 2.9 mg/dL [-45.7 to -34.5 mg/dL]), and body weight (-2.61 ± 0.52 kg [-3.64 to -1.58 kg]) compared with baseline. The percentages of patients who achieved an A1C of <7.0% and ≤6.5% at 2 years were 60% and 39%, respectively. A significant reduction in systolic blood pressure (SBP; -3.0 ± 1.0 mmHg [-4.9 to -1.1 mmHg]) was maintained through 2 years of treatment. Serum lipid profiles were also significantly improved, including triglycerides (geometric LS mean change from baseline, -15 ± 2.7% [-21% to -10%]), total cholesterol (-8.6 ± 2.8 mg/dL [-14.0 to -3.1 mg/dL]), and low-density lipoproteins (-4.5 ± 2.2 mg/dL [-8.9 to -0.01 mg/dL]). Changes in A1C, body weight, FPG, SBP, and lipids in the ITT population were similar to those seen in the completer

  13. Effect of blood pressure and glycemic control on the plasma cell-free DNA in hemodialysis patients

    PubMed Central

    Jeong, Da Wun; Moon, Ju-Young; Choi, Young-Wook; Moon, Haena; Kim, Kipyo; Lee, Yu-Ho; Kim, Se-Yeun; Kim, Yang-Gyun; Jeong, Kyung-Hwan; Lee, Sang-Ho

    2015-01-01

    Background The plasma levels of cell-free DNA (cfDNA) are known to be elevated under inflammatory or apoptotic conditions. Increased cfDNA levels have been reported in hemodialysis (HD) patients. The aim of this study was to investigate the clinical significance of cfDNA in HD patients. Methods A total of 95 patients on HD were enrolled. We measured their predialysis cfDNA levels using real-time EIF2C1 gene sequence amplification and analyzed its association with certain clinical parameters. Results The mean plasma cfDNA level in the HD patients was 3,884 ± 407 GE/mL, and the mean plasma cfDNA level in the control group was 1,420 ± 121 GE/mL (P < 0.05). Diabetic patients showed higher plasma cfDNA levels compared with nondiabetic patients (P < 0.01). Patients with cardiovascular complications also showed higher plasma cfDNA levels compared with those without cardiovascular complication (P < 0.05). In univariable analysis, the cfDNA level was associated with 3-month mean systolic blood pressure (SBP), white blood cell, serum albumin, creatinine (Cr), normalized protein catabolic rate in HD patients. In diabetic patients, it was significantly correlated with SBP, hemoglobin A1c, and serum albumin. In multivariate analysis, SBP was the independent determinant for the cfDNA level. In diabetic patients, cfDNA level was independently associated with hemoglobin A1c and SBP. Conclusions In patients with HD, cfDNA is elevated in diabetic patients and patients with cardiovascular diseases. Uncontrolled hypertension and poor glycemic control are independent determinants for the elevated cfDNA. Our data suggest that cfDNA might be a marker of vascular injury rather than proinflammatory condition in HD patients. PMID:26779422

  14. Achievements of schistosomiasis control in China.

    PubMed

    Yuan, Hongchang; Jiang, Qingwu; Zhao, Genming; He, Na

    2002-01-01

    The control of schistosomiasis has been spectacularly successful in terms of controlling endemicity and severity of the disease during the last 50 years. It can be categorized into two stages. From 1955 through 1980, the transmission-control strategy had been widely and successfully carried out. By the end of 1980, the epidemic of schistosomiasis was successfully circumscribed in certain core regions including areas at the middle and low reaches of the Yangtze River and some mountainous areas in Sichuan and Yunnan provinces, where control of schistosomiasis had been demonstrated to be very difficult to be sustained. Therefore, since 1980, schistosomiasis control in China has been modified to employ a stepwise strategy, based on which morbidity control has been given priorities and if possible transmission control has been pursued. However, since snail-ridden areas remain unchanged so far, reinfections occur frequently. This necessitates a maintenance phase to consolidate the achievements in the control of schistosomiasis. In the mean time, we are challenged with some environmental, social and economical changes in terms of controlling schistosomiasis. Successfully controlling schistosomiasis in China is still a long-term task but will be achieved without doubt along with the economic development and the promotion of living and cultural standard of people. PMID:12426618

  15. Effects of a Multispecies Probiotic Mixture on Glycemic Control and Inflammatory Status in Women with Gestational Diabetes: A Randomized Controlled Clinical Trial

    PubMed Central

    Saremi, Sadaf; Jafarnejad, Farzan; Arab, Arman

    2016-01-01

    Objective. This trial aims to examine the effects of a Probiotic Mixture (VSL#3) on glycemic status and inflammatory markers, in women with GDM. Materials and Methods. Over a period of 8 weeks, 82 women with gestational diabetes were randomly assigned to either an intervention group (n = 41) which were given VSL#3 capsule or to a control group which were given placebo capsule (n = 41). Fasting plasma glucose, homeostatic model assessment of insulin resistance, glycosylated hemoglobin, high-sensitivity C-reactive protein, tumor necrosis factor-α, interleukin-6, Interferon gamma, and interleukin-10 were measured before and after the intervention. Results. After 8 wk of supplementation FPG, HbA1c, HOMA-IR, and insulin levels remained unchanged in the probiotic and placebo groups. The comparison between the two groups showed no significant differences with FPG and HbA1c, but there were significant differences in insulin levels and HOMA-IR (16.6 ± 5.9; 3.7 ± 1.5, resp.). Unlike the levels of IFN-g (19.21 ± 16.6), there was a significant decrease in levels of IL-6 (3.81 ± 0.7), TNF-α (3.10 ± 1.1), and hs-CRP (4927.4 ± 924.6). No significant increase was observed in IL-10 (3.11 ± 5.7) in the intervention group as compared with the control group. Conclusions. In women with GDM, supplementation with probiotics (VSL#3) may help to modulate some inflammatory markers and may have benefits on glycemic control. PMID:27429803

  16. Effect of two dietary fibers on satiety and glycemic parameters: a randomized, double-blind, placebo-controlled, exploratory study

    PubMed Central

    2014-01-01

    Background Dietary carbohydrates may affect metabolic and physiologic parameters. The present study evaluated whether a combination of two dietary fibers, oligofructose (OFS) and pectin (P), altered satiety and glycemic parameters. The primary objective of this study was to determine whether dietary supplementation for 3 weeks with OFS + P would produce a greater reduction in energy intake of an ad libitum test meal compared to control. Methods This was a single center, randomized, double-blind, placebo-controlled, parallel group study in overweight and obese, otherwise healthy, subjects (N = 96). There were two OFS + P treatment groups: high-dose (30 g/d), low-dose (15 g/d), and a control group (maltodextrin 15 g/d). Energy intake, appetite measures based on Satiety Labeled Intensity Magnitude (SLIM) scale, fasting and post-prandial glucose, and insulin levels and body weight were measured at baseline and at the end of 3 weeks. Adverse events and gastrointestinal tolerability of the treatments were also assessed. Results An analysis of covariance (ANCOVA) performed on the primary endpoint change from baseline in energy intake, showed no statistically significant difference in energy intake among the three treatment groups (p = 0.5387). The LS mean changes (SE) in energy intake from baseline to week 3 were −58.3 (42.4) kilocalories (kcal) for the high dose group, −74.2 (43.6) kcal for the low dose group, and −9.0 (42.9) kcal for the control group. For the pairwise comparisons of OFS + P doses and control, confidence intervals were constructed around the difference in LS mean changes. All study products were generally well tolerated. Conclusion There was a directional benefit in ad libitum energy intake for both OFS + P doses compared to control, with a greater reduction in kilocalories in the low dose comparison, but the reductions were not significant. Further studies are warranted. Clinical trial registration GSK Clinical Study

  17. Vagal Blocking Improves Glycemic Control and Elevated Blood Pressure in Obese Subjects with Type 2 Diabetes Mellitus

    PubMed Central

    Shikora, S.; Toouli, J.; Herrera, M. F.; Kulseng, B.; Zulewski, H.; Brancatisano, R.; Kow, L.; Pantoja, J. P.; Johnsen, G.; Brancatisano, A.; Tweden, K. S.; Knudson, M. B.; Billington, C. J.

    2013-01-01

    Background. An active device that downregulates abdominal vagal signalling has resulted in significant weight loss in feasibility studies. Objective. To prospectively evaluate the effect of intermittent vagal blocking (VBLOC) on weight loss, glycemic control, and blood pressure (BP) in obese subjects with DM2. Methods. Twenty-eight subjects were implanted with a VBLOC device (Maestro Rechargeable System) at 5 centers in an open-label study. Effects on weight loss, HbA1c, fasting blood glucose, and BP were evaluated at 1 week to 12 months. Results. 26 subjects (17 females/9 males, 51 ± 2 years, BMI 37 ± 1 kg/m2, mean ± SEM) completed 12 months followup. One serious adverse event (pain at implant site) was easily resolved. At 1 week and 12 months, mean excess weight loss percentages (% EWL) were 9 ± 1% and 25 ± 4% (P < 0.0001), and HbA1c declined by 0.3 ± 0.1% and 1.0 ± 0.2% (P = 0.02, baseline 7.8 ± 0.2%). In DM2 subjects with elevated BP (n = 15), mean arterial pressure reduced by 7 ± 3 mmHg and 8 ± 3 mmHg (P = 0.04, baseline 100 ± 2 mmHg) at 1 week and 12 months. All subjects MAP decreased by 3 ± 2 mmHg (baseline 95 ± 2 mmHg) at 12 months. Conclusions. VBLOC was safe in obese DM2 subjects and associated with meaningful weight loss, early and sustained improvements in HbA1c, and reductions in BP in hypertensive DM2 subjects. This trial is registered with ClinicalTrials.gov NCT00555958. PMID:23984050

  18. Prolonged leucine supplementation does not augment muscle mass or affect glycemic control in elderly type 2 diabetic men.

    PubMed

    Leenders, Marika; Verdijk, Lex B; van der Hoeven, Letty; van Kranenburg, Janneau; Hartgens, Fred; Wodzig, Will K W H; Saris, Wim H M; van Loon, Luc J C

    2011-06-01

    The loss of muscle mass with aging has been, at least partly, attributed to a blunted muscle protein synthetic response to food intake. Leucine coingestion has been reported to stimulate postprandial insulin release and augment postprandial muscle protein accretion. We assessed the clinical benefits of 6 mo of leucine supplementation in elderly, type 2 diabetes patients. Sixty elderly males with type 2 diabetes (age, 71 ± 1 y; BMI, 27.3 ± 0.4 kg/m(2)) were administered 2.5 g L-leucine (n = 30) or a placebo (n = 30) with each main meal during 6 mo of nutritional intervention (7.5 g/d leucine or placebo). Body composition, muscle fiber characteristics, muscle strength, glucose homeostasis, and basal plasma amino acid and lipid concentrations were assessed prior to, during, and after intervention. Lean tissue mass did not change or differ between groups and at 0, 3, and 6 mo were 61.9 ± 1.1, 62.2 ± 1.1, and 62.0 ± 1.0 kg, respectively, in the leucine group and 62.2 ± 1.3, 62.2 ± 1.3, and 62.2 ± 1.3 kg in the placebo group. There also were no changes in body fat percentage, muscle strength, and muscle fiber type characteristics. Blood glycosylated hemoglobin did not change or differ between groups and was 7.1 ± 0.1% in the leucine group and 7.2 ± 0.2% in the placebo group. Consistent with this, oral glucose insulin sensitivity and plasma lipid concentrations did not change or differ between groups. We conclude that prolonged leucine supplementation (7.5 g/d) does not modulate body composition, muscle mass, strength, glycemic control, and/or lipidemia in elderly, type 2 diabetes patients who habitually consume adequate dietary protein. PMID:21525248

  19. Oxamate Improves Glycemic Control and Insulin Sensitivity via Inhibition of Tissue Lactate Production in db/db Mice

    PubMed Central

    Ye, Weiran; Zheng, Yijia; Zhang, Shanshan; Yan, Li; Cheng, Hua; Wu, Muchao

    2016-01-01

    Oxamate (OXA) is a pyruvate analogue that directly inhibits the lactate dehydrogenase (LDH)-catalyzed conversion process of pyruvate into lactate. Earlier and recent studies have shown elevated blood lactate levels among insulin-resistant and type 2 diabetes subjects and that blood lactate levels independently predicted the development of incident diabetes. To explore the potential of OXA in the treatment of diabetes, db/db mice were treated with OXA in vivo. Treatment of OXA (350–750 mg/kg of body weight) for 12 weeks was shown to decrease body weight gain and blood glucose and HbA1c levels and improve insulin secretion, the morphology of pancreatic islets, and insulin sensitivity in db/db mice. Meanwhile, OXA reduced the lactate production of adipose tissue and skeletal muscle and serum lactate levels and decreased serum levels of TG, FFA, CRP, IL-6, and TNF-α in db/db mice. The PCR array showed that OXA downregulated the expression of Tnf, Il6, leptin, Cxcr3, Map2k1, and Ikbkb, and upregulated the expression of Irs2, Nfkbia, and Pde3b in the skeletal muscle of db/db mice. Interestingly, LDH-A expression increased in the islet cells of db/db mice, and both treatment of OXA and pioglitazone decreased LDH-A expression, which might be related to the improvement of insulin secretion. Taken together, increased lactate production of adipose tissue and skeletal muscle may be at least partially responsible for insulin resistance and diabetes in db/db mice. OXA improved glycemic control and insulin sensitivity in db/db mice primarily via inhibition of tissue lactate production. Oxamic acid derivatives may be a potential drug for the treatment of type 2 diabetes. PMID:26938239

  20. Effect of natural honey from Ilam and metformin for improving glycemic control in streptozotocin-induced diabetic rats

    PubMed Central

    Nasrolahi, Ozra; Heidari, Reza; Rahmani, Fatima; Farokhi, Farah

    2012-01-01

    Objective(s): Diabetes mellitus is a public health problem and one of the five leading causes of death globally. In the present study, the effect of Metformin with natural honey was investigated on glycemia in the Streptozotocin-induced diabetic rats. Materials and Methods: Thirty Wistar male rats were randomly divided into six groups including C: non diabetic rats received distilled water, CH: non diabetic rats received honey, CD: diabetic rats administered with distilled water, DM: Metformin treated diabetic rats, DH: honey treated diabetic rats, and DMH: diabetic rats treated with a combination of Metformin and natural honey. Diabetes was induced by a single dose of Streptozotocin (65 mg/kg; i.p.). The animals were treated by oral gavage once daily for four weeks. At the end of the treatment period, the animals were sacrificed and their blood samples collected. Amount of glucose, triglyceride (TG), total cholesterol (TC), HDL cholesterol, LDL cholesterol, VLDL cholesterol, total bilirubin, and albumin were determined in serum. Results: Group CD: showed hyperglycemia (252.2±4.1 mg/dl), while level of blood glucose was significantly (p<0.01) reduced in groups DH (124.2±2.7 mg/dl), DM (108.0±3.4 mg/dl), and DMH (115.4±2.1 mg/dl). Honey in combination with Metformin significantly (p<0.01) reduced level of bilirubin but Metformin alone did not reduce bilirubin. Honey alone and in combination with Metformin also significantly reduced triglycerides, total cholesterol, LDL, VLDL and increased HDL, but Metformin did not reduced triglycerides and increased HDL. Conclusion: The results of the present study demonstrated that consuming natural honey with Metformin improves glycemic control and is more useful than consuming Metformin alone. The higher therapeutic effect of Ilam honey on lipid abnormalities than Tualang honey was also evident. PMID:25050251

  1. Glycemic Targets in Diabetes Care: Emerging Clarity after Accord

    PubMed Central

    Buse, John B.

    2015-01-01

    Through the 1990s convincing evidence emerged from studies involving relatively recent onset diabetes that glycemic control achieving glycated hemoglobin A1c levels of approximately 7% was associated with improved microvascular outcomes. Based on advocacy groups' statements encouraging lower targets and recognition of cardiovascular disease as the leading cause of death in diabetes, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was funded in 1999 to explore more intensive targets and techniques in the treatment of type 2 diabetes. Most surprisingly, intensive management targeting normal levels of glycemia was associated with increased mortality and the ACCORD trial was terminated early in 2008. Post hoc analyses have allowed the emergence of some clarity around the role of glycemic management and targets in diabetes care and are the subject of this review. PMID:26330660

  2. Diabetes-related complications, glycemic control, and falls in older adults

    PubMed Central

    Schwartz, Ann V.; Vittinghoff, Eric; Sellmeyer, Deborah E.; Feingold, Kenneth R.; de Rekeneire, Nathalie; Strotmeyer, Elsa S.; Shorr, Ronald. I.; Vinik, Aaron I.; Odden, Michelle C.; Park, Seok Won; Faulkner, Kimberly A.; Harris, Tamara B.

    2008-01-01

    BACKGROUND Older adults with type 2 diabetes are more likely to fall but little is known about risk factors for falls in this population. We determined if diabetes-related complications or treatments are associated with fall risk in older diabetic adults. METHODS In the Health, Aging, and Body Composition cohort of well-functioning older adults, participants reported falls in the previous year at annual visits. Odds ratios for more frequent falls among 446 diabetic participants whose mean age was 73.6 years, with an average follow-up of 4.9 years, were estimated with continuation ratio models. RESULTS In the first year, 23% reported falling; 22, 26, 30, and 31% fell in subsequent years. In adjusted models, reduced peroneal nerve response amplitude (OR=1.50; 95% CI 1.07, 2.12, worst quartile vs others), higher cystatin-C, a marker of reduced renal function, (OR=1.38; 95% CI 1.11, 1.71, for 1SD increase), poorer contrast sensitivity (OR=1.41; 95% CI 0.97, 2.04, worst quartile vs others), and low A1C in insulin users (OR = 4.36; 95% CI 1.32, 14.46, A1C≤6% vs >8%) were associated with fall risk. In those using oral hypoglycemic medications but not insulin, low A1C was not associated with fall risk (OR = 1.29; 95% CI 0.65, 2.54, A1C≤6% vs >8%). Adjustment for physical performance explained some, but not all, of these associations. CONCLUSIONS In older diabetic adults, reducing diabetes-related complications may prevent falls. Achieving lower A1C levels with oral hypoglycemic medications was not associated with more frequent falls, but, among those using insulin, A1C ≤6% increased fall risk. PMID:18056893

  3. Effects of a palatinose-based liquid diet (Inslow) on glycemic control and the second-meal effect in healthy men.

    PubMed

    Arai, Hidekazu; Mizuno, Akira; Sakuma, Masae; Fukaya, Makiko; Matsuo, Kaoru; Muto, Kazusa; Sasaki, Hajime; Matsuura, Motoi; Okumura, Hisami; Yamamoto, Hironori; Taketani, Yutaka; Doi, Toshio; Takeda, Eiji

    2007-01-01

    Postprandial hyperglycemia induces prolonged hyperinsulinemia, which is a risk factor for type 2 diabetes mellitus. Foods with a low glycemic index blunt the rapid rise in postprandial plasma glucose and insulin levels. We herein investigated the effects of a novel, palatinose-based liquid diet (Inslow, Meiji Dairy Products, Tokyo, Japan) on postprandial plasma glucose and insulin levels and on the rate of substrate oxidation in 7 healthy men. Furthermore, to examine the effects of Inslow on the second-meal effect, we quantified our subjects' postprandial plasma glucose, insulin, and free fatty acid levels for up to 7 hours after they ingested a breakfast containing Inslow or control formula, followed by a standard lunch 5 hours later. Our results showed that peak plasma glucose and insulin levels 30 minutes after Inslow loading were lower than after control formula loading. Postprandial fat oxidation rates in the Inslow group were higher than in the control formula group (P < .05). In the second-meal effect study, plasma glucose and insulin levels after lunch in the Inslow group were lower than in the control formula group (P < .01), although the peak levels in these groups were not different. The free fatty acid concentration in the Inslow group immediately before lunch was significantly lower than in the control formula group (P < .05). In conclusion, consumption of Inslow at breakfast appears to improve patient glycemic control by reducing their postprandial plasma glucose and insulin levels after lunch (second-meal effect). PMID:17161233

  4. Effect of Artemisia dracunculus Administration on Glycemic Control, Insulin Sensitivity, and Insulin Secretion in Patients with Impaired Glucose Tolerance.

    PubMed

    Méndez-Del Villar, Miriam; Puebla-Pérez, Ana M; Sánchez-Peña, María J; González-Ortiz, Luis J; Martínez-Abundis, Esperanza; González-Ortiz, Manuel

    2016-05-01

    To evaluate the effect of Artemisia dracunculus on glycemic control, insulin sensitivity, and insulin secretion in patients with impaired glucose tolerance (IGT). A randomized, double blind, placebo-controlled clinical trial was performed in 24 patients with diagnosis of IGT. Before and after the intervention, glucose and insulin levels were measured every 30 min for 2 h after a 75-g dextrose load, along with glycated hemoglobin A1c (A1C) and lipid profile. Twelve patients received A. dracunculus (1000 mg) before breakfast and dinner for 90 days; the remaining 12 patients received placebo. Area under the curve (AUC) of glucose and insulin, total insulin secretion, first phase of insulin secretion, and insulin sensitivity were calculated. Wilcoxon signed-rank, Mann-Whitney U, and chi-square tests were used for statistical analyses. The institutional ethics committee approved the protocol. After A. dracunculus administration, there were significant decreases in systolic blood pressure (SBP; 120.0 ± 11.3 vs. 113.0 ± 11.2 mmHg, P < .05), A1C (5.8 ± 0.3 vs. 5.6% ± 0.4%, P < .05), AUC of insulin (56,136.0 ± 27,426.0 vs. 44,472.0 ± 23,370.0 pmol/L, P < .05), and total insulin secretion (0.45 ± 0.23 vs. 0.35 ± 0.18, P < .05), with a significant increase in high-density lipoprotein cholesterol (HDL-C) (1.3 ± 0.3 vs. 1.4 ± 0.3 mmol/L, P < .05). There were no significant differences after placebo administration. A. dracunculus administration for 90 days in patients with IGT significantly decreased SBP, A1C, AUC of insulin, and total insulin secretion with a significant increase in HDL-C levels. PMID:27097076

  5. Effects of regular exercise on obesity and type 2 diabete mellitus in Korean children: improvements glycemic control and serum adipokines level

    PubMed Central

    Lee, Sung Soo; Kang, Sunghwun

    2015-01-01

    [Purpose] The aim of the study was to clarify the effects of regular exercise on lipid profiles and serum adipokines in Korean children. [Subjects and Methods] Subjects were divided into controls (n=10), children who were obese (n=10), and children with type 2 diabetes mellitus (n=10). Maximal oxygen uptake (VO2max), body composition, lipid profiles, glucagon, insulin and adipokines (leptin, resistin, visfatin and retinol binding protein 4) were measured before to and after a 12-week exercise program. [Results] Body weight, body mass index, and percentage body fat were significantly higher in the obese and diabetes groups compared with the control group. Total cholesterol, triglycerides, low-density lipoprotein cholesterol and glycemic control levels were significantly decreased after the exercise program in the obese and diabetes groups, while high-density lipoprotein cholesterol levels were significantly increased. Adipokines were higher in the obese and diabetes groups compared with the control group prior to the exercise program, and were significantly lower following completion. [Conclusion] These results suggest that regular exercise has positive effects on obesity and type 2 diabetes mellitus in Korean children by improving glycemic control and reducing body weight, thereby lowering cardiovascular risk factors and adipokine levels. PMID:26180345

  6. Inpatient Diabetes Education Is Associated With Less Frequent Hospital Readmission Among Patients With Poor Glycemic Control

    PubMed Central

    Healy, Sara J.; Black, Dawn; Harris, Cara; Lorenz, Andrew; Dungan, Kathleen M.

    2013-01-01

    OBJECTIVE To explore the relationship between inpatient diabetes education (IDE) and hospital readmissions in patients with poorly controlled diabetes. RESEARCH DESIGN AND METHODS Patients with a discharge diagnosis of diabetes (ICD-9 code 250.x) and HbA1c >9% who were hospitalized between 2008 and 2010 were retrospectively identified. All-cause first readmissions were determined within 30 days and 180 days after discharge. IDE was conducted by a certified diabetes educator or trainee. Relationships between IDE and hospital readmission were analyzed with stepwise backward logistic regression models. RESULTS In all, 2,265 patients were included in the 30-day analysis and 2,069 patients were included in the 180-day analysis. Patients who received IDE had a lower frequency of readmission within 30 days than did those who did not (11 vs. 16%; P = 0.0001). This relationship persisted after adjustment for sociodemographic and illness-related factors (odds ratio 0.66 [95% CI 0.51–0.85]; P = 0.001). Medicaid insurance and longer stay were also independent predictors in this model. IDE was also associated with reduced readmissions within 180 days, although the relationship was attenuated. In the final 180-day model, no IDE, African American race, Medicaid or Medicare insurance, longer stay, and lower HbA1c were independently associated with increased hospital readmission. Further analysis determined that higher HbA1c was associated with lower frequency of readmission only among patients who received a diabetes education consult. CONCLUSIONS Formal IDE was independently associated with a lower frequency of all-cause hospital readmission within 30 days; this relationship was attenuated by 180 days. Prospective studies are needed to confirm this association. PMID:23835695

  7. Effect of tighter glycemic control on cardiac function, exercise capacity, and muscle strength in heart failure patients with type 2 diabetes: a randomized study

    PubMed Central

    Nielsen, Roni; Wiggers, Henrik; Thomsen, Henrik Holm; Bovin, Ann; Refsgaard, Jens; Abrahamsen, Jan; Møller, Niels; Bøtker, Hans Erik; Nørrelund, Helene

    2016-01-01

    Objectives In patients with type 2 diabetes (T2D) and heart failure (HF), the optimal glycemic target is uncertain, and evidence-based data are lacking. Therefore, we performed a randomized study on the effect of optimized glycemic control on left ventricular function, exercise capacity, muscle strength, and body composition. Design and methods 40 patients with T2D and HF (left ventricular ejection fraction (LVEF) 35±12% and hemoglobin A1c (HbA1c) 8.4±0.7% (68±0.8 mmol/mol)) were randomized to either 4-month optimization (OPT group) or non-optimization (non-OPT group) of glycemic control. Patients underwent dobutamine stress echocardiography, cardiopulmonary exercise test, 6 min hall-walk test (6-MWT), muscle strength examination, and dual X-ray absorptiometry scanning at baseline and at follow-up. Results 39 patients completed the study. HbA1c decreased in the OPT versus the non-OPT group (8.4±0.8% (68±9 mmol/mol) to 7.6±0.7% (60±7 mmol/mol) vs 8.3±0.7% (67±10 mmol/mol) to 8.4±1.0% (68±11 mmol/mol); p<0.001). There was no difference between the groups with respect to changes in myocardial contractile reserve (LVEF (p=0.18)), oxygen consumption (p=0.55), exercise capacity (p=0.12), and 6-MWT (p=0.84). Muscle strength decreased in the non-OPT compared with the OPT group (37.2±8.1 to 34.8±8.3 kg vs 34.9±10.2 to 35.4±10.7 kg; p=0.01), in line with a non-significant decrease in lean (p=0.07) and fat (p=0.07) tissue mass in the non-OPT group. Hypoglycemia and fluid retention did not differ between groups. Conclusions 4 months of optimization of glycemic control was associated with preserved muscle strength and lean body mass in patients with T2D and HF compared with lenient control, and had no deleterious effect on left ventricular contractile function and seemed to be safe. Trial registration number NCT01213784; pre-results. PMID:27158520

  8. The association between quality of life, depressive symptoms and glycemic control in a group of type 2 diabetes patients: comment on Papelbaum et al.

    PubMed

    Horvath, Zsuzsanna; de Lijster, Jasmijn; Kupper, Nina

    2011-07-01

    This comment on the article: "The association between quality of life, depressive symptoms and glycemic control in a group of type 2 diabetes patients" by Papelbaum et al. was aimed to provide some critical remarks concerning the focus of the results section which showed significant discrepancies compared to the introduction and the research question. In addition, we would like to exhort the authors for a more comprehensive approach and for a more complete and congruent description of their results, in order to avoid misunderstanding. PMID:21440947

  9. Health-Care Costs, Glycemic Control and Nutritional Status in Malnourished Older Diabetics Treated with a Hypercaloric Diabetes-Specific Enteral Nutritional Formula

    PubMed Central

    Sanz-Paris, Alejandro; Boj-Carceller, Diana; Lardies-Sanchez, Beatriz; Perez-Fernandez, Leticia; Cruz-Jentoft, Alfonso J.

    2016-01-01

    Diabetes-specific formulas are an effective alternative for providing nutrients and maintaining glycemic control. This study assesses the effect of treatment with an oral enteral nutrition with a hypercaloric diabetes-specific formula (HDSF) for one year, on health-care resources use, health-care costs, glucose control and nutritional status, in 93 type-2 diabetes mellitus (T2DM) malnourished patients. Changes in health-care resources use and health-care costs were collected the year before and during the year of intervention. Glucose status and nutritional laboratory parameters were analyzed at baseline and one-year after the administration of HDSF. The administration of HDSF was significantly associated with a reduced use of health-care resources, fewer hospital admissions (54.7%; p < 0.001), days spent at hospital (64.1%; p < 0.001) and emergency visits (57.7%; p < 0.001). Health-care costs were reduced by 65.6% (p < 0.001) during the intervention. Glycemic control (short- and long-term) and the need of pharmacological treatment did not change, while some nutritional parameters were improved at one year (albumin: +10.6%, p < 0.001; hemoglobin: +6.4%, p = 0.026). In conclusion, using HDSF in malnourished older type-2 diabetic patients may allow increasing energy intake while maintaining glucose control and improving nutritional parameters. The use of health-care resources and costs were significantly reduced during the nutritional intervention. PMID:27005661

  10. Health-Care Costs, Glycemic Control and Nutritional Status in Malnourished Older Diabetics Treated with a Hypercaloric Diabetes-Specific Enteral Nutritional Formula.

    PubMed

    Sanz-Paris, Alejandro; Boj-Carceller, Diana; Lardies-Sanchez, Beatriz; Perez-Fernandez, Leticia; Cruz-Jentoft, Alfonso J

    2016-03-01

    Diabetes-specific formulas are an effective alternative for providing nutrients and maintaining glycemic control. This study assesses the effect of treatment with an oral enteral nutrition with a hypercaloric diabetes-specific formula (HDSF) for one year, on health-care resources use, health-care costs, glucose control and nutritional status, in 93 type-2 diabetes mellitus (T2DM) malnourished patients. Changes in health-care resources use and health-care costs were collected the year before and during the year of intervention. Glucose status and nutritional laboratory parameters were analyzed at baseline and one-year after the administration of HDSF. The administration of HDSF was significantly associated with a reduced use of health-care resources, fewer hospital admissions (54.7%; p < 0.001), days spent at hospital (64.1%; p < 0.001) and emergency visits (57.7%; p < 0.001). Health-care costs were reduced by 65.6% (p < 0.001) during the intervention. Glycemic control (short- and long-term) and the need of pharmacological treatment did not change, while some nutritional parameters were improved at one year (albumin: +10.6%, p < 0.001; hemoglobin: +6.4%, p = 0.026). In conclusion, using HDSF in malnourished older type-2 diabetic patients may allow increasing energy intake while maintaining glucose control and improving nutritional parameters. The use of health-care resources and costs were significantly reduced during the nutritional intervention. PMID:27005661

  11. Polyphenols and Glycemic Control

    PubMed Central

    Kim, Yoona; Keogh, Jennifer B.; Clifton, Peter M.

    2016-01-01

    Growing evidence from animal studies supports the anti-diabetic properties of some dietary polyphenols, suggesting that dietary polyphenols could be one dietary therapy for the prevention and management of Type 2 diabetes. This review aims to address the potential mechanisms of action of dietary polyphenols in the regulation of glucose homeostasis and insulin sensitivity based on in vitro and in vivo studies, and to provide a comprehensive overview of the anti-diabetic effects of commonly consumed dietary polyphenols including polyphenol-rich mixed diets, tea and coffee, chocolate and cocoa, cinnamon, grape, pomegranate, red wine, berries and olive oil, with a focus on human clinical trials. Dietary polyphenols may inhibit α-amylase and α-glucosidase, inhibit glucose absorption in the intestine by sodium-dependent glucose transporter 1 (SGLT1), stimulate insulin secretion and reduce hepatic glucose output. Polyphenols may also enhance insulin-dependent glucose uptake, activate 5′ adenosine monophosphate-activated protein kinase (AMPK), modify the microbiome and have anti-inflammatory effects. However, human epidemiological and intervention studies have shown inconsistent results. Further intervention studies are essential to clarify the conflicting findings and confirm or refute the anti-diabetic effects of dietary polyphenols. PMID:26742071

  12. Polyphenols and Glycemic Control.

    PubMed

    Kim, Yoona; Keogh, Jennifer B; Clifton, Peter M

    2016-01-01

    Growing evidence from animal studies supports the anti-diabetic properties of some dietary polyphenols, suggesting that dietary polyphenols could be one dietary therapy for the prevention and management of Type 2 diabetes. This review aims to address the potential mechanisms of action of dietary polyphenols in the regulation of glucose homeostasis and insulin sensitivity based on in vitro and in vivo studies, and to provide a comprehensive overview of the anti-diabetic effects of commonly consumed dietary polyphenols including polyphenol-rich mixed diets, tea and coffee, chocolate and cocoa, cinnamon, grape, pomegranate, red wine, berries and olive oil, with a focus on human clinical trials. Dietary polyphenols may inhibit α-amylase and α-glucosidase, inhibit glucose absorption in the intestine by sodium-dependent glucose transporter 1 (SGLT1), stimulate insulin secretion and reduce hepatic glucose output. Polyphenols may also enhance insulin-dependent glucose uptake, activate 5' adenosine monophosphate-activated protein kinase (AMPK), modify the microbiome and have anti-inflammatory effects. However, human epidemiological and intervention studies have shown inconsistent results. Further intervention studies are essential to clarify the conflicting findings and confirm or refute the anti-diabetic effects of dietary polyphenols. PMID:26742071

  13. Malaria control: achievements, problems and strategies.

    PubMed

    Nájera, J A

    2001-06-01

    Even if history has not always been the Magistra vitae, Cicero expected it to be, it should provide, as Baas said, a mirror in which to observe and compare the past and present in order to draw therefrom well-grounded conclusions for the future. Based on this belief, this paper aims to provide an overview of the foundations and development of malaria control policies during the XX century. It presents an analysis of the conflicting tendencies which shaped the development of these policies and which appear to have oscillated between calls for frontal attack in an all-out campaign and calls for sustainable gains, even if slow. It discusses the various approaches to the control of malaria, their achievements and their limitations, not only to serve as a background to understand better the foundations of current policies, but also to prevent that simplistic generalisations may again lead to exaggerated expectations and disillusion. The first part of the paper is devoted to the development of malaria control during the first half of the century, characterised by the ups and downs in the reliance on mosquito control as the control measure applicable everywhere. The proliferation of "man-made-malaria", which accompanied the push for economic development in most of the endemic countries, spurred the need for control interventions and, while great successes were obtained in many specific projects, the general campaigns proposed by the enthusiasts of vector control faced increasing difficulties in their practical implementation in the field. Important events, which may be considered representative of this period are, on the campaign approach, the success of Gorgas in the Panama Canal, but also the failure of the Mian Mir project in India; while on the developmental approach, the Italian and Dutch schools of malariology, the Tennessee Valley and the development of malaria sanitation, included the so called species sanitation. The projection of these developments to a global

  14. Glycemic Responses, Appetite Ratings and Gastrointestinal Hormone Responses of Most Common Breads Consumed in Spain. A Randomized Control Trial in Healthy Humans

    PubMed Central

    Gonzalez-Anton, Carolina; Rico, Maria C.; Sanchez-Rodriguez, Estefania; Ruiz-Lopez, Maria D.; Gil, Angel; Mesa, Maria D.

    2015-01-01

    The present study was carried out to determine the glycemic index (GI), glycemic load (GL), insulinemic index (InI), appetite ratings and postprandial plasma concentrations of gastrointestinal hormones related to the control of food intake after the ingestion of the five most common breads consumed in Spain with different compositions and manufacturing processes. Twenty-two healthy adults participated in a randomized crossover study. The breads tested were Ordinary, Precooked-Frozen, Candeal-flour, Alfacar whites and Wholemeal. All breads portions were calculated to supply 50 g of available carbohydrates. In addition, 50 g of glucose was used as a reference. A linear mixed-effects model was used to compare data calculated for all breads with glucose load. The GI value varied from 61 for the Wholemeal, to Alfacar 68, Ordinary 76, and 78 and 86 for the Precooked-Frozen and Candeal-flour breads, respectively. Wholemeal and Alfacar had lower GI than glucose. All tested breads had a lower GL (ranged 9 to 18) compared with glucose. Wholemeal GL was similar to Alfacar, but lower than the other white breads. InI were significantly lower for all breads (ranged 68 to 73) compared with glucose, and similar among them. The intake of the Wholemeal bread led to a higher release of gastric inhibitory polypeptide compared with the Ordinary and Precooked breads and to a higher release of pancreatic polypeptide compared with the Precooked-Frozen bread. All breads affected appetite ratings similarly. In conclusion, based on GL, the Wholemeal bread would be expected to exert a favorable glycemic response. PMID:26024293

  15. Salmonella Abscess of the Anterior Chest Wall in a Patient With Type 2 Diabetes and Poor Glycemic Control: A Case Report.

    PubMed

    Chiao, Hao-Yu; Wang, Chi-Yu; Wang, Chih-Hsin

    2016-03-01

    Salmonella can cause extra-intestinal focal infections as well as gastrointestinal problems. A few cases of Salmonella skin and soft tissue infection have been documented in immunocompromised patients such as persons with type 2 diabetes and poor glycemic control. A case study is presented of a 30-year-old man with a 10-year history of poorly controlled (HbA1C 11.7%) diabetes mellitus who presented with a ruptured nodule resulting in a wound with signs of infection over his anterior chest region of 1-month duration. He had been taking amoxycillin/clavulanate for the week previous to presentation at the authors' facility. Following sharp debridement, the ulcerative wound deteriorated and a chest wall abscess developed. Bacterial culture results were positive for Salmonella group D, resistant to ampicillin and susceptible to ceftriaxone and ciprofloxacin. The patient underwent surgical debridement, resulting in a wound 7 cm x 4 cm, and was provided ceftriaxone 2.0 g intravenously daily along with insulin therapy. After surgical debridement, a local rotational flap was created for wound closure and reconstruction. The patient was discharged 1 week later on oral antibiotic therapy for 1 week. His wound was completely healed without recurrence at his 4-month follow-up. For this patient, addressing glycemic issues, identifying the infectious organism, and providing appropriate therapy, radical debridement, and flap surgery helped heal an advanced soft tissue infection. In immunocompromised patients with skin or soft tissue infections, the presence of Salmonella should be considered. PMID:26978859

  16. Glycemic Control among U.S. Hispanics/Latinos with Diabetes from the HCHS/SOL Sociocultural Ancillary Study: Do Structural and Functional Social Support Play a Role?

    PubMed Central

    Fortmann, Addie L.; Roesch, Scott C.; Penedo, Frank J.; Isasi, Carmen R.; Carnethon, Mercedes R.; Corsino, Leonor; Schneiderman, Neil; Daviglus, Martha L.; Teng, Yanping; Giachello, Aida; Gonzalez, Franklyn; Gallo, Linda C.

    2014-01-01

    Background Social support is one potential source of health-related resiliency in Hispanics with diabetes. Purpose This study examined relationships of structural (i.e., social integration) and functional (i.e., perceived) social support with glycemic control (glycosylated hemoglobin; HbA1c) in the Hispanic Community Health Study/Study of Hispanics (HCHS/SOL) Sociocultural Ancillary Study. Methods This study included 766 men and women representing multiple Hispanic ethnic backgrounds, aged 18-74 years, with diagnosed diabetes who completed fasting blood draw, medication review, and measures of sociodemographic factors, medical history, structural support (Cohen Social Network Index), and functional support (Interpersonal Support Evaluation List-12). Results After adjusting for sociodemographic covariates and medication, a one standard deviation increase in functional support was related to an 0.18 % higher HbA1c (p = 0.04). A similar trend was observed for structural support; however, this effect was non-significant in adjusted models. Conclusion Greater functional support was associated with poorer glycemic control in Hispanics. PMID:25107503

  17. Efficacy and Acceptability of Glycemic Control of Glucagon-Like Peptide-1 Receptor Agonists among Type 2 Diabetes: A Systematic Review and Network Meta-Analysis

    PubMed Central

    Li, Zhixia; Zhang, Yuan; Quan, Xiaochi; Yang, Zhirong; Zeng, Xiantao; Ji, Linong

    2016-01-01

    Objective To synthesize current evidence of the impact of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on hypoglycemia, treatment discontinuation and glycemic level in patients with type 2 diabetes. Design Systematic review and network meta-analysis. Data Sources Literature search (Medline, Embase, the Cochrane library), website of clinical trial, bibliographies of published systematic reviews. Eligibility Criteria Randomized controlled trials with available data comparing GLP-1 RAs with placebo or traditional anti-diabetic drugs in patients with type 2 diabetes. Data Synthesis Traditional pairwise meta-analyses within DerSimonian-Laird random effects model and network meta-analysis within a Bayesian framework were performed to calculate odds ratios for the incidence of hypoglycemia, treatment discontinuation, HbA1c<7.0% and HbA1c<6.5%. Ranking probabilities for all treatments were estimated to obtain a treatment hierarchy using the surface under the cumulative ranking curve (SUCRA) and mean ranks. Results 78 trials with 13 treatments were included. Overall, all GLP-1 RAs except for albiglutide increased the risk of hypoglycemia when compared to placebo. Reduction in the incidence of hypoglycemia was found for all GLP-1 RAs versus insulin (except for dulaglutide) and sulphonylureas. For the incidence of treatment discontinuation, increase was found for exenatide, liraglutide, lixisenatide and taspoglutide versus placebo, insulin and sitagliptin. For glycemic level, decrease was found for all GLP-1 RAs versus placebo. Dulaglutide, exenatide long-acting release (exe_lar), liraglutide and taspoglutide had significant lowering effect when compared with sitagliptin (HbA1c<7.0%) and insulin (HbA1c<6.5%). Finally, according to SUCRAs, placebo, thiazolidinediones and albiglutide had the best decrease effect on hypoglycemia; sulphanylureas, sitagliptin and insulin decrease the incidence of treatment discontinuation most; exe_lar and dulaglutide had the highest

  18. Real-world evaluation of glycemic control among patients with type 2 diabetes mellitus treated with canagliflozin versus dipeptidyl peptidase-4 inhibitors.

    PubMed

    Thayer, Sarah; Chow, Wing; Korrer, Stephanie; Aguilar, Richard

    2016-06-01

    Objective To evaluate glycemic control among patients with type 2 diabetes mellitus (T2DM) treated with canagliflozin (CANA) vs. dipeptidyl peptidase-4 (DPP-4) inhibitors. Methods Using integrated claims and lab data from a US health plan of commercial and Medicare Advantage enrollees, this matched-control cohort study assessed adult T2DM patients receiving treatment with CANA or DPP-4 inhibitors (1 April 2013-31 December 2013). Cohorts were chosen hierarchically; the first pharmacy claim for CANA was identified as the index date; then the first pharmacy claim for a DPP-4 inhibitor was identified and index date set. Eligible patients had 6 months of continuous health plan enrollment before the index date (baseline) and 9 months after (follow-up) and no evidence of index drug in baseline. Patients were matched 1:1 using propensity score matching. Changes in glycated hemoglobin (HbA1c) and percentages of patients with HbA1c <8% and <7% during the follow-up were evaluated. Results The matched CANA and DPP-4 inhibitor cohorts (53.2% treated with sitagliptin) included 2766 patients each (mean age: 55.7 years). Among patients with baseline and follow-up HbA1c results, mean baseline HbA1c values were similar, 8.62% and 8.57% (p = 0.615) for the CANA (n = 729) and DPP-4 inhibitor (n = 710) cohorts, respectively. Change in HbA1c was greater among patients in the CANA cohort than for those in the DPP-4 inhibitor cohort (-0.92% vs. -0.63%, p < 0.001), and also among the subset of patients with baseline HbA1c ≥7% (-1.07% [n = 624] vs. -0.79% [n = 603], p = 0.004). During follow-up, greater percentages of the CANA cohort relative to the DPP-4 inhibitor cohort achieved HbA1c of <8% (66.0% vs. 58.6%, p = 0.004) and <7% (35.4% vs. 29.9%, p = 0.022). Limitations This study was observational and residual confounding remains a possibility. Conclusions In this real-world study of patients with T2DM, CANA use was associated with greater HbA1c

  19. Effects of an aquatic physical exercise program on glycemic control and perinatal outcomes of gestational diabetes: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Gestational diabetes mellitus (GDM) is increasing worldwide and has been associated with adverse perinatal outcomes and high risk for chronic disease both for the mother and for the child. Physical exercise is feasible for diabetic pregnant women and contributes to better glycemic control and to a decrease in adverse perinatal outcomes. However, there are no randomized controlled trials (RCT) assessing the effects of aquatic physical exercise on GDM control and adverse maternal and fetal outcomes. Methods/Design An RCT will be conducted at Instituto de Medicina Integral Prof Fernando Figueira (IMIP), Brazil. A total of 72 pregnant women will be studied; 36 gestational diabetics will undergo an aquatic physical exercise program in a thermal pool, 3 times per week over 2 months. The primary endpoint will be glucose level control and use of insulin; secondary endpoints will be the following maternal and fetal outcomes: weight gain during pregnancy, blood pressure, pre-eclampsia diagnosis, intrauterus growth restriction, preterm birth, Cesarean section, macrosomia and maternal or neonatal intensive care admission. Endpoints between intervention and control group will analyzed by t test for unpaired data and χ2 test, and the level of significance will set at <0.05. Discussion The physical proprieties of water make aquatic exercises ideal for pregnant women. An aquatic physical exercise program developed for GDM women will be trialed in a thermal pool and under the supervision of physiotherapist to ensure compliance. It is expected that this study will provide evidence as to the effect of aquatic physical exercise on GDM control. Trial registration ClinicalTrial.gov, NCT01940003. PMID:24245914

  20. Enriching the Hierarchical Model of Achievement Motivation: Autonomous and Controlling Reasons Underlying Achievement Goals

    ERIC Educational Resources Information Center

    Michou, Aikaterini; Vansteenkiste, Maarten; Mouratidis, Athanasios; Lens, Willy

    2014-01-01

    Background: The hierarchical model of achievement motivation presumes that achievement goals channel the achievement motives of need for achievement and fear of failure towards motivational outcomes. Yet, less is known whether autonomous and controlling reasons underlying the pursuit of achievement goals can serve as additional pathways between…

  1. The DAILY (Daily Automated Intensive Log for Youth) trial: a wireless, portable system to improve adherence and glycemic control in youth with diabetes.

    PubMed

    Kumar, Vikram S; Wentzell, Katherine J; Mikkelsen, Tarjei; Pentland, Alex; Laffel, Lori M

    2004-08-01

    Blood glucose (BG) monitoring (BGM) is an important component of diabetes management. New wireless technologies may facilitate BGM and help to optimize glycemic control. We evaluated an integrated wireless approach with and without a motivational game in youth with diabetes. Forty youth, 8-18 years old, each received a handheld device fitted with a wireless modem and diabetes data management software, plus a wireless-enabled BG monitor. Half were randomized to receive the new technologies along with an integrated motivational game in which the participants would guess a BG level following collection of three earlier readings (Game Group). BG data, insulin doses, and carbohydrate intake were displayed graphically prior to the glucose estimation. The other group received the new technologies alone (Control Group). Both groups were instructed to perform BGM four times daily and transmit their data to a central server via the wireless modem. Feasibility of implementation and outcomes were ascertained after 4 weeks. Ninety-three percent of participants successfully transmitted their data wirelessly to the server. The Game Group transmitted significantly more glucose values than the Control Group (P < 0.001). The Game Group also had significantly less hyperglycemia (glucose >/=13.9 mmol/L or >/=250 mg/dL) than the Control Group (P < 0.001). Youth in the Game Group displayed a significant increase in diabetes knowledge over the 4-week trial (P < 0.005). Finally, there was a trend for more youth in the Game Group to maintain hemoglobin A1C values glycemic control. PMID:15320998

  2. Effect of a Brown Rice Based Vegan Diet and Conventional Diabetic Diet on Glycemic Control of Patients with Type 2 Diabetes: A 12-Week Randomized Clinical Trial

    PubMed Central

    Lee, Yu-Mi; Kim, Se-A; Lee, In-Kyu; Kim, Jung-Guk; Park, Keun-Gyu; Jeong, Ji-Yun; Jeon, Jae-Han; Shin, Ji-Yeon; Lee, Duk-Hee

    2016-01-01

    Objective Several intervention studies have suggested that vegetarian or vegan diets have clinical benefits, particularly in terms of glycemic control, in patients with type 2 diabetes (T2D); however, no randomized controlled trial has been conducted in Asians who more commonly depend on plant-based foods, as compared to Western populations. Here, we aimed to compare the effect of a vegan diet and conventional diabetic diet on glycemic control among Korean individuals. Materials and Methods Participants diagnosed with T2D were randomly assigned to follow either a vegan diet (excluding animal-based food including fish; n = 46) or a conventional diet recommended by the Korean Diabetes Association 2011 (n = 47) for 12 weeks. HbA1c levels were measured at weeks 0, 4, and 12, and the primary study endpoint was the change in HbA1c levels over 12 weeks. Results The mean HbA1c levels at weeks 0, 4, and 12 were 7.7%, 7.2%, and 7.1% in the vegan group, and 7.4%, 7.2%, and 7.2% in the conventional group, respectively. Although both groups showed significant reductions in HbA1C levels, the reductions were larger in the vegan group than in the conventional group (-0.5% vs. -0.2%; p-for-interaction = 0.017). When only considering participants with high compliance, the difference in HbA1c level reduction between the groups was found to be larger (-0.9% vs. -0.3%). The beneficial effect of vegan diets was noted even after adjusting for changes in total energy intake or waist circumference over the 12 weeks. Conclusion Both diets led to reductions in HbA1c levels; however, glycemic control was better with the vegan diet than with the conventional diet. Thus, the dietary guidelines for patients with T2D should include a vegan diet for the better management and treatment. However, further studies are needed to evaluate the long-term effects of a vegan diet, and to identify potential explanations of the underlying mechanisms. Trial Registration CRiS KCT0001771 PMID:27253526

  3. Insulin glargine maintains equivalent glycemic control and better lipometabolic control than NPH insulin in type 1 diabetes patients who missed a meal.

    PubMed

    Rosak, C; Jung, R; Hofmann, U

    2008-08-01

    Our goal was to investigate blood glucose and lipometabolism control in type 1 diabetes patients who missed breakfast and the accompanying insulin injection of NPH insulin (NPH) or insulin glargine (glargine) as part of a basal-bolus regimen. This was a multi-center, open-label, controlled study in adults (> or =18 years) with HbA (1c)< or =11.5% on insulin therapy with NPH as basal insulin. Patients were randomized to receive prandial insulin plus either bedtime glargine (n=28) or NPH (n=32). Insulin was titrated to target fasting blood glucose levels 80-130 mg/dl at 06:00-07:00. Patients had no intake of insulin or food between 22:00 and 12:00 the next day. The change in blood glucose levels (07:00-11:00) was similar (27.5 mg/dl vs. 35.4 mg/dl), but the mean blood glucose level was higher with glargine vs. NPH at 22:00 (158.2 mg/dl vs. 130.2 mg/dl). During the period without insulin or food intake, blood glucose decreased with glargine (-25.8 mg/dl) and increased with NPH (+9.1 mg/dl; p=0.0284). Nonesterified fatty acid (07:00 and 09:00-12:00) and beta-hydroxybutyrate (07:00 and 10:00-12:00) levels were lower with glargine vs. NPH (both p<0.05). For patients who miss a morning meal, glargine is associated with maintained glycemic and lipometabolic control compared with NPH insulin. PMID:18493882

  4. Assessment of Lung Function by Spirometry and Diffusion Study and Effect of Glycemic Control on Pulmonary Function in Type 2 Diabetes Mellitus Patients of the Eastern India

    PubMed Central

    Uz-Zaman, Salim; Singhamahapatra, Anilbaran; Dey, Pranab Kumar; Roy, Anindya; Roy, Kaushik; Roy (Basu), Kakali

    2014-01-01

    Introduction: There are so many complications involving eyes, kidneys, lungs and nerves associated with diabetes. But, pulmonary complications are poorly characterized among eastern Indian diabetic populations. Aims and Objectives: To assess pulmonary function in patients with type 2 diabetes mellitus. To find out correlation of the pulmonary functions test variables with Glycemic control. Materials and Methods: Total of 60 type 2 diabetes patient of age between 35-55 y and same number of age and sex matched apparently healthy control individual were included in the present study. All subjects were evaluated for PFT by flow sensitive spirometer (RMS HELIOS-401), the spirometric parameters were measured as a percentage of predicted and DLCO (by single breath technique). HBA1c of all cases were measured and they were grouped according to HBA1c level (Group-a =>7%, Group-b =6%-7%, Group-c =<6%). Results: Significant differences in the spirometric parameters (FVC, FEV1/FVC) and diffusion capacity (DLCO% and DL/VA%) existed between cases and controls. There was a significant decrease in FVC, DLCO and DL/VA and significant increase in FEV1/FVC in that groups having HBA1c level >7% than the other groups. FEV1, FVC, DLCO, and DL/VA were negatively correlated with HbA1c where as FEV1/FVC has positive association with HbA1c. Conclusion: Significant deterioration of lung function and diffusing capacity was observed in type 2 diabetes patients with poor glycemic control. PMID:25584206

  5. Reported Benefits of Insulin Therapy for Better Glycemic Control in Type 2 Diabetic Patients—Is This Applicable in Saudi Patients?

    PubMed Central

    AlSaggaf, Wafaa; Asiri, Mohammed; Ajlan, Balgees; Afif, Alaa Bin; Khalil, Roaa; Salman, Anas Bin; Alghamdi, Ahmed; Bashawieh, Osama; Alamoudi, Atheer; Aljahdali, Abeer; Aljahdali, Nouf; Patwa, Hussam; Bakhaidar, Mohammed; Bahijri, Suhad M.; Ahmed, Maimoona; Al-Shali, Khalid; Bokhari, Samia; Alhozali, Amani; Borai, Anwar; Ajabnoor, Ghada; Tuomilehto, Jaakko

    2016-01-01

    AIM To compare the effect of different treatment regimens (oral hypoglycemic agents [OHGs], insulin therapy, and combination of both) on glycemic control and other cardiometabolic risk factors in type 2 diabetes mellitus (T2DM) patients in Saudi. SUBJECTS AND METHODS Patients with T2DM, but no serious diabetic complications, were randomly recruited from the diabetes clinics at two large hospitals in Jeddah, Saudi Arabia, during June 2013 to July 2014. Only those without change in treatment modality for the last 18 months were included. Blood pressure and anthropometric measurements were measured. Treatment plan was recorded from the patients’ files. Fasting blood sample was obtained to measure glucose, HbA1c, and lipid profile. RESULTS A total of 197 patients were recruited; 41.1% were men and 58.9% were women. The mean (±SD) age was 58.5 ± 10.5 years. Most patients (60.7%) were on OHGs, 11.5% on insulin therapy, and 27.7% were using a combination of insulin and OHGs. The mean HbA1c was lower in patients using OHGs only, compared with means in those using insulin, or combined therapy in patients with disease duration of ≤10 years (P = 0.001) and also in those with a longer duration of the disease (P < 0.001). A lower mean diastolic and systolic blood pressure was found among patients on insulin alone (P < 0.01). No significant differences were found in lipid profiles among the groups. CONCLUSION Insulin therapy, without adequate diabetes education, fails to control hyperglycemia adequately in Saudi T2DM patients. There is a challenge to find out reasons for poor control and the ways as to how to improve glycemic control in T2DM. PMID:27330334

  6. Glycemic control and nutritional strategies in the cardiothoracic surgical intensive care unit--2010: state of the art.

    PubMed

    Mechanick, Jeffrey I; Scurlock, Corey

    2010-01-01

    Patients in the cardiothoracic surgical intensive care unit are generally critically ill and undergoing a systemic inflammatory response to cardiopulmonary bypass, ischemia/reperfusion, and hypothermia. This presents several metabolic challenges: hyperglycemia in need of intensive insulin therapy, catabolism, and uncertain gastrointestinal tract function in need of nutritional strategies. Currently, there are controversies surrounding the standard use of intensive insulin therapy and appropriate glycemic targets as well as the use of early enteral nutrition ± parenteral nutrition. In this review, an approach for intensive metabolic support in the cardiothoracic surgical intensive care unit is presented incorporating the most recent clinical evidence. This approach advocates an IIT blood glucose target of 80-110 mg/dL if, it can be implemented safely, with early nutrition support (using parenteral nutrition as needed) to prevent a critical energy debt. PMID:21167457

  7. Sodium glucose co-transporter 2 inhibitors for glycemic control in type 2 diabetes mellitus: Quality of reporting of randomized controlled trials

    PubMed Central

    Mittal, Niti; Mittal, Rakesh; Kumar, Harish; Medhi, Bikash

    2016-01-01

    Background: Sodium glucose co-transporter 2 inhibitors represent a novel class of antidiabetic drugs. The reporting quality of the trials evaluating the efficacy of these agents for glycemic control in type 2 diabetes mellitus has not been explored. Our aim was to assess the reporting quality of such randomized controlled trials (RCTs) and to identify the predictors of reporting quality. Materials and Methods: A systematic literature search was conducted for RCTs published till 12 June 2014. Two independent investigators carried out the searches and assessed the reporting quality on three parameters: Overall quality score (OQS) using Consolidated Standards of Reporting Trials (CONSORT) 2010 statement, Jadad score and intention to treat analysis. Inter-rater agreements were compared using Cohen's weighted kappa statistic. Multivariable linear regression analysis was used to identify the predictors. Results: Thirty-seven relevant RCTs were included in the present analysis. The median OQS was 17 with a range from 8 to 21. On Jadad scale, the median score was three with a range from 0 to 5. Complete details about allocation concealment and blinding were present in 21 and 10 studies respectively. Most studies lacked an elaborate discussion on trial limitations and generalizability. Among the factors identified as significantly associated with reporting quality were the publishing journal and region of conduct of RCT. Conclusions: The key methodological items remain poorly reported in most studies. Strategies like stricter adherence to CONSORT guidelines by journals, access to full trial protocols to gain valuable information and full collaboration among investigators and methodologists might prove helpful in improving the quality of published RCT reports. PMID:26955572

  8. Patient-Centered Community Diabetes Education Program Improves Glycemic Control in African-American Patients with Poorly Controlled Type 2 Diabetes: Importance of Point of Care Metabolic Measurements.

    PubMed

    Gaillard, Trudy; Amponsah, Grace; Osei, Kwame

    2015-07-01

    African-Americans with type 2 diabetes (T2DM) have higher morbidity and mortality partly attributed to poor glucose control and lack of formal diabetes self-management education and support (DSMES) programs compared to Whites. Therefore, the objective of this study was to compare the clinical and metabolic parameters during DSMES vs. standard care in African-Americans with T2DM attending primary care inner city clinics. We recruited 124 African-American patients with T2DM, randomized into Group 1-DSMES (n = 58) and Group 2-standard care group (n = 38) for 6 months. Body weight, blood pressure, random blood sugars and point-of-care (POC) hemoglobin A1C (A1C) and lipids/lipoproteins were measured at 0, 3, and 6 months. At 6 months, Group 1 had significant reduction in A1C (8.2 ± 1.4% vs. 7.5 ± 1.5%, p = 0.02) and random glucose (190.4 ± 77.6 vs. 160.6 ± 59.8 mg/dl, p = 0.03). However, there were no changes in body weight, blood pressure, or lipids/lipoprotein levels. We found no significant changes in the clinical/metabolic parameters in Group 2. We concluded that DSMES, supplemented with POC testing, was associated with significant improvements in glycemic control without changes in body weight, blood pressure, or lipids/lipoproteins. We recommend the inclusion of DSMES with POC testing in managing African-American patients with T2DM attending inner city primary care clinics. PMID:26371360

  9. Effect of scaling and root planing on serum interleukin-10 levels and glycemic control in chronic periodontitis and type 2 diabetes mellitus

    PubMed Central

    Acharya, Anirudh Balakrishna; Thakur, Srinath; Muddapur, Mahadevayya Veerayya

    2015-01-01

    Aim: Chronic periodontal disease (CPD) and type 2 diabetes mellitus (T2DM) share common pathogenic pathways involving the cytokine network resulting in increased susceptibility to both diseases, leading to increased inflammatory destruction, insulin resistance, and poor glycemic control. Periodontal treatment may improve glycemic control. The aim of this study was to evaluate the effect of scaling and root planing (SRP) of T2DM patients with CPD on hyperglycemia and the levels of serum interleukin-10 (IL-10). Materials and Methods: Forty-five subjects were divided into three groups comprising 15 subjects each as Group 1 (healthy controls), Group 2 (CPD patients), and Group 3 (T2DM patients with CPD). Plaque index, gingival index (GI), probing pocket depths (PPD), clinical attachment loss (AL), bleeding on probing (BoP), random blood sugar, glycosylated hemoglobin (HbA1C), and serum IL-10 were measured at baseline; SRP was performed on Groups 2 and 3 and the selected parameters recorded again at 6 months. Results: Statistically significant (P < 0.05) differences were observed in the variables at baseline and 6 months after SRP between the three groups using one-way ANOVA. The paired samples t-test for PPD and AL in Group 3 was statistically significant. Group 3 revealed positive correlations between PPD and HbA1C, BoP and IL-10, respectively, at 6 months and a predictable association of HbA1C with PPD and GI, and IL-10 levels with BoP, respectively, at 6 months. Conclusion: Scaling and root planing is effective in reducing blood glucose levels in T2DM patient with pocket depths and effective in elevating systemic IL-10 levels in CPD patients and CPD patients with T2DM. PMID:26015670

  10. Serum 1,5-Anhydroglucitol Concentrations Are a Reliable Index of Glycemic Control in Type 2 Diabetes With Mild or Moderate Renal Dysfunction

    PubMed Central

    Kim, Won Jun; Park, Cheol-Young; Lee, Kyu-Beck; Park, Se Eun; Rhee, Eun Jung; Lee, Won Young; Oh, Ki Won; Park, Sung Woo

    2012-01-01

    OBJECTIVE To assess the relationship between 1,5-anhydroglucitol (AG) levels, which are a marker of glycemic control, and stages of chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS This was a cross-sectional study with 269 subjects with type 2 diabetes who were divided into four groups based on estimated glomerular filtration rate (eGFR) using Modification of Diet in Renal Disease (eGFRMDRD) formula: 57 in control, 111 in CKD stages 1–2, 78 in stage 3, and 23 in stages 4–5. RESULTS The study groups differed significantly with respect to 1,5-AG and fasting plasma glucose (FPG), age, duration of diabetes, blood pressure, HDL, and percentage of antihypertension or antidyslipidemia medication use. Stepwise multivariate regression analyses showed that 1,5-AG levels in the control group, the CKD stages 1–2 group, and the CKD stage 3 group could be explained by HbA1c, age, duration of diabetes, FPG, and antihypertension medication. However, eGFRMDRD was the only independent determinant of 1,5-AG levels in CKD stages 4–5. Logarithmic transformed 1,5-AG values (ln[1,5-AG]) had significant inverse correlations with HbA1c and FPG levels for CKD stages 1–2 and CKD stage 3 (all P < 0.001). However, associations between ln(1,5-AG) and HbA1c or FPG were insignificant for CKD stages 4–5 (P = 0.274 and P = 0.080, respectively). CONCLUSIONS This study demonstrated that 1,5-AG levels do not appear to be influenced by mild or moderate renal dysfunction, suggesting it is a reliable glycemic marker in type 2 diabetes with CKD stages 1–3. PMID:22210564

  11. Effects of Glycemic Control on Bone Turnover in Older Mexican Americans with Type 2 Diabetes: Data from the Cameron County Hispanic Cohort in Texas

    NASA Technical Reports Server (NTRS)

    Rianon, N.; Smith, S. M.; Lee, M.; Musgrave, P.; Nader, S.; Khosla, S.; Ambrose, C.; McCormick, J.; Fisher-Hoch, S.

    2016-01-01

    High bone turnover, evidenced by high serum osteocalcin (OC) concentration, is indicated as risk of fracture in old age. However, low bone turnover has been reported in patients with type 2 diabetes (T2D) who also have high fracture risk. Poor glycemic control indicated by higher glycated hemoglobin levels (HbA1c) has been associated with lower serum OC in older Caucasian and Asian patients with T2D. There remains a gap in knowledge about effects of T2D on bone turnover status in Hispanic populations. We report bone turnover in association with glycemic control in 72 older (greater than or equal to 50 years) men (N=21) and women (N=51) from the Cameron County Hispanic Cohort (CCHC) in Texas. Prevalence of T2D is about 30 percent in this cohort who live in health disparity due to poor access to health care. Separate multivariable linear regression models were conducted to determine association between high/diabetic levels of HbA1c (less than 6.5 normal versus greater than or equal to 6.5 high) and serum OC after controlling for age, body mass index (BMI, greater than 30 obese versus less than 30 non-obese), visceral fat, femoral neck BMD and serum concentrations of creatinine, calcium, and vitamin D for men and women. Interaction effects were assessed while developing final multivariable model to identify factors that modify the association between HbA1c and OC. Subjects were 66 plus or minus 9 (mean plus or minus Standard Deviation) years for men and 67 plus or minus 8 years for women. HbA1c was 8.0 plus or minus 2.0 for men and 7.8 plus or minus 2.0 for women. There were no significant differences for BMI, femoral neck BMD, serum calcium or 25-hydroxyvitamin D concentrations between men and women. High HbA1c was significantly associated with lower OC levels in men in both age groups (mean difference in OC between high vs. low HbA1c [95 percent confidence interval] for older group (greater than or equal to 65 years) was minus 9.51 (minus 16.36 to minus 2.65) and

  12. The hypoglycemic effect of pumpkin seeds, Trigonelline (TRG), Nicotinic acid (NA), and D-Chiro-inositol (DCI) in controlling glycemic levels in diabetes mellitus.

    PubMed

    Adams, Gary G; Imran, Shahwar; Wang, Sheng; Mohammad, Abubaker; Kok, M Samil; Gray, David A; Channell, Guy A; Harding, Stephen E

    2014-01-01

    In the contemporary society, diabetes mellitus is considered as a common, growing, serious, costly, and potentially preventable public health problem. It is forecasted that in 2030, the number of people with diabetes will go up from 117 million in 2000 to 366 million in 2030. The prevalence of diabetes will place a huge burden on health and financial structures of countries, and these will impact on individuals, as well as families and nations. Polysaccharides, para-aminobenzoic acid, fixed oils, sterol, proteins, and peptides are biologically active ingredients, which are found in pumpkins. The chemicals within pumpkins such as the fruit pulp, oil from ungerminated seeds, and protein from germinated seeds have hypoglycemic properties. Preliminary investigation showed that pumpkin seeds, and the macromolecules, therein, such as Trigonelline (TRG), Nicotinic acid (NA), and D-chiro-inositol (DCI), possess hypoglycemic properties and could assist in maintaining glycemic control. PMID:24564589

  13. Clinical significance of barriers to blood glucose control in type 2 diabetes patients with insufficient glycemic control

    PubMed Central

    Suzuki, Takeo; Takei, Ryoko; Inoguchi, Toyoshi; Sonoda, Noriyuki; Sasaki, Shuji; Kaise, Toshihiko; Takayanagi, Ryoichi

    2015-01-01

    Background The purpose of this study was to assess actual barriers to blood glucose control in patients with type 2 diabetes mellitus and to investigate barrier-related factors in an exploratory manner. Methods This cross-sectional study assessed patients with type 2 diabetes mellitus treated as outpatients at medical institutions within Fukuoka Prefecture, Japan. Barriers to blood glucose control were examined in patients with glycated hemoglobin ≥6.9% using a nine-item questionnaire. Answers were also obtained from physicians in charge of the patients for seven of nine questions. Results Seven hundred and thirteen patients answered the questionnaire. Many physicians and patients described barriers that involved difficulty in complying with diet therapy. For six of the seven barriers, patient awareness was lower than physician awareness. Patient-reported lack of concern for diabetes mellitus was more prevalent among patients with macrovascular complications. Patients who reported difficulty in compliance with exercise therapy and fear of hypoglycemia were more likely to suffer from microvascular complications. Conclusion For many of the barriers to blood glucose control, patients were less aware than physicians, suggesting that we need to take action to raise patient awareness. Of interest are the observations that the relevant barriers differed for macrovascular and microvascular complications and that the relationship between presence of macrovascular complications and lack of concern about diabetes mellitus. PMID:26170633

  14. A proprietary alpha-amylase inhibitor from white bean (Phaseolus vulgaris): a review of clinical studies on weight loss and glycemic control.

    PubMed

    Barrett, Marilyn L; Udani, Jay K

    2011-01-01

    Obesity, and resultant health hazards which include diabetes, cardiovascular disease and metabolic syndrome, are worldwide medical problems. Control of diet and exercise are cornerstones of the management of excess weight. Foods with a low glycemic index may reduce the risk of diabetes and heart disease as well as their complications. As an alternative to a low glycemic index diet, there is a growing body of research into products that slow the absorption of carbohydrates through the inhibition of enzymes responsible for their digestion. These products include alpha-amylase and glucosidase inhibitors. The common white bean (Phaseolus vulgaris) produces an alpha-amylase inhibitor, which has been characterized and tested in numerous clinical studies. A specific and proprietary product named Phase 2® Carb Controller (Pharmachem Laboratories, Kearny, NJ) has demonstrated the ability to cause weight loss with doses of 500 to 3000 mg per day, in either a single dose or in divided doses. Clinical studies also show that Phase 2 has the ability to reduce the post-prandial spike in blood glucose levels. Experiments conducted incorporating Phase 2 into food and beverage products have found that it can be integrated into various products without losing activity or altering the appearance, texture or taste of the food. There have been no serious side effects reported following consumption of Phase 2. Gastro-intestinal side effects are rare and diminish upon extended use of the product. In summary, Phase 2 has the potential to induce weight loss and reduce spikes in blood sugar caused by carbohydrates through its alpha-amylase inhibiting activity. PMID:21414227

  15. A proprietary alpha-amylase inhibitor from white bean (Phaseolus vulgaris): A review of clinical studies on weight loss and glycemic control

    PubMed Central

    2011-01-01

    Obesity, and resultant health hazards which include diabetes, cardiovascular disease and metabolic syndrome, are worldwide medical problems. Control of diet and exercise are cornerstones of the management of excess weight. Foods with a low glycemic index may reduce the risk of diabetes and heart disease as well as their complications. As an alternative to a low glycemic index diet, there is a growing body of research into products that slow the absorption of carbohydrates through the inhibition of enzymes responsible for their digestion. These products include alpha-amylase and glucosidase inhibitors. The common white bean (Phaseolus vulgaris) produces an alpha-amylase inhibitor, which has been characterized and tested in numerous clinical studies. A specific and proprietary product named Phase 2® Carb Controller (Pharmachem Laboratories, Kearny, NJ) has demonstrated the ability to cause weight loss with doses of 500 to 3000 mg per day, in either a single dose or in divided doses. Clinical studies also show that Phase 2 has the ability to reduce the post-prandial spike in blood glucose levels. Experiments conducted incorporating Phase 2 into food and beverage products have found that it can be integrated into various products without losing activity or altering the appearance, texture or taste of the food. There have been no serious side effects reported following consumption of Phase 2. Gastro-intestinal side effects are rare and diminish upon extended use of the product. In summary, Phase 2 has the potential to induce weight loss and reduce spikes in blood sugar caused by carbohydrates through its alpha-amylase inhibiting activity. PMID:21414227

  16. Once Daily Self-Monitoring of Blood Glucose (SMBG) Improves Glycemic Control in Oral Hypoglycemic Agents (OHA)–Treated Diabetes

    PubMed Central

    Harashima, Shin-ichi; Nishimura, Akiko; Ikeda, Kaori; Wang, Yu; Liu, Yanyan; Inagaki, Nobuya

    2015-01-01

    Background: The aim of this study was to compare glycemic control between SMBG-continued and -discontinued subjects with type 2 diabetes in the SMBG-OHA study. Method: Of the 96 subjects from the SMBG-OHA study, 59 were recruited for the 24-week, comparison follow-up study. The study outcomes were the differences in change in HbA1c levels at 24 weeks between the 2 groups, and change in SMBG frequency in SMBG-continued subjects. Results: Although health insurance does not cover the cost of SMBG, 22.0% of subjects continued SMBG of their own will after the SMBG-OHA study was completed. HbA1c levels were maintained from 6.81 ± 0.55% to 6.64 ± 0.53% in SMBG-continued subjects. Conversely, HbA1c levels were increased from 7.18 ± 0.63% to 7.48 ± 0.84% in SMBG-discontinued subjects. HbA1c levels were significantly different by 0.83 ± 0.25% (95% CI: −1.33 to −0.36). The difference in change in HbA1c between the groups was −0.46% (95% CI: −0.78 to −0.15). SMBG frequency was decreased from 2.02 ± 1.06 to 1.53 ± 0.86 times a day. Conclusions: HbA1c levels were maintained in SMBG-continued subjects but increased in SMBG-discontinued subjects. The study implied that almost once daily SMBG is helpful to maintain glycemic control in non-insulin-treated type 2 diabetes. PMID:26428934

  17. Time-dependent changes in insulin requirement for maternal glycemic control during antenatal corticosteroid therapy in women with gestational diabetes: a retrospective study.

    PubMed

    Itoh, Arata; Saisho, Yoshifumi; Miyakoshi, Kei; Fukutake, Marie; Kasuga, Yoshifumi; Ochiai, Daigo; Matsumoto, Tadashi; Tanaka, Mamoru; Itoh, Hiroshi

    2016-01-31

    Though recommended for pregnant women at risk of preterm birth to improve perinatal outcomes, antenatal corticosteroid (ACS) treatment can cause maternal hyperglycemia, especially in cases of glucose intolerance. A standardized protocol for preventing hyperglycemia during ACS treatment remains to be established. We herein retrospectively investigated the time-dependent changes in insulin dose required for maternal glycemic control during ACS treatment in gestational diabetes (GDM). Twelve singleton pregnant women with GDM who received 12 mg of betamethasone intramuscularly twice 24 hours apart were included in this analysis. Of those, eight also received ritodrine hydrochloride for preterm labor. The blood glucose levels were maintained at 70-120 mg/dL with continuous intravenous infusion of insulin and nothing by mouth for 48 hours after the first betamethasone administration. After the first dose of betamethasone, the insulin dosage needed for glycemic control gradually increased and reached a maximum (6.6 ± 5.8 units/hr) at 10 hours, then, decreased to 4.1 ± 1.5 units/hr at 24 hours. Similar changes in the insulin requirement were found after the second betamethasone dose (the maximum insulin dosage: 5.5 ± 1.6 units/hr at 9 hours following the second administration). Women treated with ritodrine hydrochloride needed more insulin, than those without ritodrine hydrochloride treatment (130.8 ± 15.0 vs. 76.8 ± 15.2 units/day, respectively, p < 0.05). Our data indicated that the requirement for insulin is highest 9-10 hours after each dose of betamethasone. When GDM is treated with ACS, levels of blood glucose should be carefully monitored, especially in patients treated with ritodrine hydrochloride. PMID:26510662

  18. The Longitudinal Effects of Achievement Goals and Perceived Control on University Student Achievement

    ERIC Educational Resources Information Center

    Daniels, Lia M.; Perry, Raymond P.; Stupnisky, Robert H.; Stewart, Tara L.; Newall, Nancy E. G.; Clifton, Rodney A.

    2014-01-01

    In the area of achievement motivation, students' beliefs pertaining to achievement goals and perceived control have separately guided a large amount theoretical and empirical research. However, limited research has considered the simultaneous effects of goals and control on achievement. The purpose of this study was to examine primary and…

  19. Tight glycemic control in critical care--the leading role of insulin sensitivity and patient variability: a review and model-based analysis.

    PubMed

    Chase, J Geoffrey; Le Compte, Aaron J; Suhaimi, Fatanah; Shaw, Geoffrey M; Lynn, Adrienne; Lin, Jessica; Pretty, Christopher G; Razak, Normy; Parente, Jacquelyn D; Hann, Christopher E; Preiser, Jean-Charles; Desaive, Thomas

    2011-05-01

    Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts. This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols. A model-based analysis of insulin sensitivity using data from three different critical care units, comprising over 75,000h of clinical data, is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (S(I)). Variation in S(I) provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra- and inter-patient variability in insulin resistance (1/S(I)) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration. PMID:21145614

  20. Glycemic Variability Assessed by Continuous Glucose Monitoring and Short-Term Outcome in Diabetic Patients Undergoing Percutaneous Coronary Intervention: An Observational Pilot Study.

    PubMed

    Nusca, Annunziata; Lauria Pantano, Angelo; Melfi, Rosetta; Proscia, Claudio; Maddaloni, Ernesto; Contuzzi, Rocco; Mangiacapra, Fabio; Palermo, Andrea; Manfrini, Silvia; Pozzilli, Paolo; Di Sciascio, Germano

    2015-01-01

    Poor glycemic control is associated with unfavorable outcome in patients undergoing percutaneous coronary intervention (PCI), irrespective of diabetes mellitus. However a complete assessment of glycemic status may not be fully described by glycated hemoglobin or fasting blood glucose levels, whereas daily glycemic fluctuations may influence cardiovascular risk and have even more deleterious effects than sustained hyperglycemia. Thus, this paper investigated the effectiveness of a continuous glucose monitoring (CGM), registering the mean level of glycemic values but also the extent of glucose excursions during coronary revascularization, in detecting periprocedural outcome such as renal or myocardial damage, assessed by serum creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and troponin I levels. High glycemic variability (GV) has been associated with worse postprocedural creatinine and NGAL variations. Moreover, GV, and predominantly hypoglycemic variations, has been observed to increase in patients with periprocedural myocardial infarction. Thus, our study investigated the usefulness of CGM in the setting of PCI where an optimal glycemic control should be achieved in order to prevent complications and improve outcome. PMID:26273664

  1. Glycemic index, glycemic load and childhood obesity: A systematic review

    PubMed Central

    Rouhani, Mohammad Hossein; Kelishadi, Roya; Hashemipour, Mahin; Esmaillzadeh, Ahmad; Azadbakht, Leila

    2014-01-01

    Background: Several evidences have been reported so far in terms of the relationship between obesity and glycemic index and glycemic load in children. However, the number of review studies that have dealt with recent findings is quite low. The purpose of present study is to review the existing evidences in this regard. Materials and Methods: First of all, the phrases: “Glycaemic index”, “Glycaemic load”, “Glycemic index” OR “Glycemic load” accompanied by one of the words: “Adolescent”, “Young”, “Youth” “Children” OR “Child” were searched in texts of articles existing in ISI and PUBMED databases which were obtained out of 1001 articles. Among these, some articles, which reviewed the relationship of obesity with glycemic index and glycemic load, were selected. Finally, 20 articles were studied in current review study. Results: The majority of cross-sectional studies have found children's obesity directly linked with glycemic index and glycemic load; however, cohort studies found controversial results. Also, the intervention studies indicate the negative effect of glycemic index and glycemic load on obesity in children. Conclusion: Published evidences reported inconsistent results. It seems that existing studies are not sufficient and more studies are needed in this regard. PMID:24627855

  2. Effects of Liraglutide Combined with Short-Term Continuous Subcutaneous Insulin Infusion on Glycemic Control and Beta Cell Function in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A Pilot Study

    PubMed Central

    Ke, Weijian; Liu, Liehua; Liu, Juan; Chen, Ailing; Deng, Wanping; Zhang, Pengyuan; Cao, Xiaopei; Liao, Zhihong; Xiao, Haipeng; Liu, Jianbin; Li, Yanbing

    2016-01-01

    The objective of this paper is to investigate the effects of liraglutide in combination with short-term continuous subcutaneous insulin infusion (CSII) therapy on glycemic control and beta cell function in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Thirty-nine eligible newly diagnosed T2DM patients were recruited and randomized to receive either of two therapies: short-term CSII alone (CSII alone group) or CSII in combination with liraglutide (CSII + Lira group) for 12 weeks. Blood glucose control, homeostasis model assessment (HOMA) indices, and acute insulin response (AIR) were compared between the two groups. The patients in CSII + Lira group achieved euglycemia with equivalent insulin dosage in shorter time (1 (0) versus 2 (3) days, P = 0.039). HbA1c at the end of study was comparable between two groups (6.3 ± 0.7% versus 6.0 ± 0.5%, for CSII alone group and CSII + Lira group, resp., P = 0.325). The increment of AIR was higher in CSII + Lira group (177.58 (351.57) μU·min/mL versus 58.15 (51.30) μU·min/mL, P < 0.001). However, after stopping liraglutide, its effect on beta cell function disappeared completely. Liraglutide combined with short-term CSII was effective in further improving beta cell function, but the beneficial effects did not sustain after suspension of the therapy. PMID:26640805

  3. Effect of Tocotrienols enriched canola oil on glycemic control and oxidative status in patients with type 2 diabetes mellitus: A randomized double-blind placebo-controlled clinical trial

    PubMed Central

    Vafa, Mohammadreza; Haghighat, Neda; Moslehi, Nazanin; Eghtesadi, Shahriar; Heydari, Iraj

    2015-01-01

    Background: Tocotrienols have been shown to improve glycemic control and redox balance in an animal study, but their effects on patients with diabetes are unknown. The study aimed to investigate whether tocotrienols improves glycemic control, insulin sensitivity, and oxidative stress in individuals with type 2 diabetes mellitus (T2DM). Materials and Methods: This study was a double-blinded, placebo-controlled, randomized trial. A total of 50 patients, aged 35-60 years, with T2DM treated by noninsulin hypoglycemic drugs were randomly assigned to receive either 15 mL/day tocotrienols (200 mg) enriched canola oil (n = 25) or pure canola oil (n = 25) for 8 weeks. Fasting blood sugar (FBS), fasting insulin, total antioxidant capacity (TAC), malondialdehyde (MDA), and homeostatic model assessment for insulin resistance (HOMA-IR) were determined before and after the intervention. The data were compared between and within groups, before and after the intervention. Results: Baseline characteristics of participants including age, sex, physical activity, disease duration, and type of drug consumption were not significantly different between the two groups. In tocotrienol enriched canola oil, FBS (mean percent change: –15.4% vs. 3.9%; P = 0.006) and MDA (median percent change: –35.6% vs. 16.3%; P = 0.003) were significantly reduced while TAC was significantly increased (median percent change: 21.4% vs. 2.3%; P = 0.001) compared to pure canola oil. At the end of the study, patients who treated with tocotrienols had lower FBS (P = 0.023) and MDA (P = 0.044) compared to the pure canola oil group. However, tocotrienols had no effect on insulin concentrations and HOMA-IR. Conclusion: Tocotrienols can improve FBS concentrations and modifies redox balance in T2DM patients with poor glycemic control and can be considered in combination with hypoglycemic drugs to better control of T2DM. PMID:26600828

  4. The effectiveness of regular leisure-time physical activities on long-term glycemic control in people with type 2 diabetes: A systematic review and meta-analysis.

    PubMed

    Pai, Lee-Wen; Li, Tsai-Chung; Hwu, Yueh-Juen; Chang, Shu-Chuan; Chen, Li-Li; Chang, Pi-Ying

    2016-03-01

    The objective of this study was to systematically review the effectiveness of different types of regular leisure-time physical activities and pooled the effect sizes of those activities on long-term glycemic control in people with type 2 diabetes compared with routine care. This review included randomized controlled trials from 1960 to May 2014. A total of 10 Chinese and English databases were searched, following selection and critical appraisal, 18 randomized controlled trials with 915 participants were included. The standardized mean difference was reported as the summary statistic for the overall effect size in a random effects model. The results indicated yoga was the most effective in lowering glycated haemoglobin A1c (HbA1c) levels. Meta-analysis also revealed that the decrease in HbA1c levels of the subjects who took part in regular leisure-time physical activities was 0.60% more than that of control group participants. A higher frequency of regular leisure-time physical activities was found to be more effective in reducing HbA1c levels. The results of this review provide evidence of the benefits associated with regular leisure-time physical activities compared with routine care for lowering HbA1c levels in people with type 2 diabetes. PMID:26822261

  5. Effect of Linagliptin on Glycemic Control in Chinese Patients with Newly-Diagnosed, Drug-Naïve Type 2 Diabetes Mellitus: A Randomized Controlled Trial.

    PubMed

    Wu, Wenjun; Li, Ying; Chen, Xiong; Lin, Dini; Xiang, Songying; Shen, Feixia; Gu, Xuemei

    2015-01-01

    BACKGROUND This study aimed to evaluate the efficacy and safety of linagliptin (a novel dipeptidyl peptidase (DPP)-4 inhibitor) on glucose metabolism and β-cell function in Chinese patients with newly-diagnosed, drug-naïve type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS Newly-diagnosed and drug-naïve T2DM patients were enrolled. After 4-week lifestyle modulation and 2-week placebo run-in, 57 patients were randomized to double-blind treatment with linagliptin (n=34) or placebo (n=23). The primary endpoint was the change from baseline in glycosylated hemoglobin A1c (HbA1c) after 24 weeks. Fasting plasma glucose (FPG), 2-h postprandial plasma glucose (2h-PPG), fasting insulin, proinsulin-to-insulin ratio, homeostasis model assessment of insulin resistance (HOMA-IR), and homeostasis model assessment of β-cell function (HOMA-β) were also evaluated. RESULTS Baseline characteristics were similar between the 2 groups. Compared with placebo, linagliptin therapy resulted in a significant decrease in HbA1C (-1.2±0.7% vs. -0.4±0.4%, P<0.001), FBG (-0.98±1.17 vs. -0.32±0.51 mmol/L, P=0.011, and 2h-PPG (-2.02±0.94 vs. -0.97±0.63 mmol/L, P<0.001). Significant differences were observed for the proinsulin/insulin ratio (P<0.001) and HOMA-β index (P=0.001). Rates of adverse events were similar between the 2 groups (30.3% vs. 27.3%). All adverse events were mild. One patient discontinued participation due to pregnancy. CONCLUSIONS Linagliptin treatment resulted in a significant and clinically meaningful improvement of glycemic control in drug-naïve Chinese patients with T2DM, as well as improved parameters of b-cell function. Linagliptin had an excellent safety profile. PMID:26350766

  6. Estimates of Savings Achievable from Irrigation Controller

    SciTech Connect

    Williams, Alison; Fuchs, Heidi; Whitehead, Camilla Dunham

    2014-03-28

    This paper performs a literature review and meta-analysis of water savings from several types of advanced irrigation controllers: rain sensors (RS), weather-based irrigation controllers (WBIC), and soil moisture sensors (SMS).The purpose of this work is to derive average water savings per controller type, based to the extent possible on all available data. After a preliminary data scrubbing, we utilized a series of analytical filters to develop our best estimate of average savings. We applied filters to remove data that might bias the sample such as data self-reported by manufacturers, data resulting from studies focusing on high-water users, or data presented in a non-comparable format such as based on total household water use instead of outdoor water use. Because the resulting number of studies was too small to be statistically significant when broken down by controller type, this paper represents a survey and synthesis of available data rather than a definitive statement regarding whether the estimated water savings are representative.

  7. Effect of Vitamin D3 Supplementation on Inflammatory Markers and Glycemic Measures among Overweight or Obese Adults: A Systematic Review of Randomized Controlled Trials

    PubMed Central

    Zuk, Aleksandra; Fitzpatrick, Tiffany; Rosella, Laura C.

    2016-01-01

    Background Obesity induced low-grade chronic inflammation disrupts proper immune and metabolic function. Vitamin D deficiency increases inflammation, which is associated with cardiometabolic risk. This systematic review examines the association between oral vitamin D (VD) supplementation and circulating inflammatory biomarkers and glycemic outcomes from randomized controlled trials (RCTs) of overweight and/or obese adults. Methods MEDLINE OVID, EMBASE and the Cochrane Central Register of Controlled Trials were searched according to a predefined protocol. Eligible RCTs included adults randomized to receive either oral VD or placebo. Two reviewers independently assessed RCTs for inclusion. Bias was assessed using the Cochrane Collaboration risk of bias tool. Mean differences were calculated comparing end-of-study sample means between the independent VD and placebo groups. Results Eleven unique RCTs met inclusion criteria from a total of 3,383 identified citations, including 79 screened articles and 14 full text data extractions. Inflammatory and glycemic measures were reported in 7 and 10 RCTs, respectively. Most trial findings were non-significant with considerable heterogeneity in design, participants and outcomes. All but one trial was rated as either high or unclear risk of bias. Two RCTs reported significant changes in inflammatory biomarkers; however, the mean difference between groups was not statistically significant: C-reactive protein 0.19 mg/L (p = 0.88); Tumor Necrosis Factor -0.54 pg/ml (p = 0.20). Two other trials found significant mean differences in fasting plasma glucose -0.32 mmol/L (p = 0.03), Hemoglobin A1c -0.13% (p = 0.04), and Homeostatic Model Assessment -0.86 (p = 0.02) following VD supplementation. Conclusions Overall, there is no clear established benefit of VD supplementation on inflammatory biomarkers among overweight/obese adults. Baseline serum VD possibly influences the effect of VD repletion on inflammatory markers. Risk of bias was

  8. Effects of a low–glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial1234

    PubMed Central

    Rhodes, Erinn T; Pawlak, Dorota B; Takoudes, Tamara C; Ebbeling, Cara B; Feldman, Henry A; Lovesky, Margaret M; Cooke, Emily A; Leidig, Michael M

    2010-01-01

    Background: The optimal diet for pregnancy that is complicated by excessive weight is unknown. Objective: We aimed to examine the effects of a low–glycemic load (low-GL) diet in overweight and obese pregnant women. Design: We randomly assigned 46 overweight or obese pregnant women to receive a low-GL or a low-fat diet. Participants received carbohydrate-rich foods, fats, and snack foods through home delivery or study visits. The primary outcome was birth weight z score. Other endpoints included infant anthropometric measurements, gestational duration, maternal weight gain, and maternal metabolic parameters. Results: There were no significant differences in birth weight z score or other measures of infant adiposity between groups. However, in the low-GL compared with the low-fat group, gestational duration was longer (mean ± SD: 39.3 ± 1.1 compared with 37.9 ± 3.1 wk; P = 0.05) and fewer deliveries occurred at ≤38.0 wk (13% compared with 48%, P = 0.02; with exclusion of planned cesarean deliveries: 5% compared with 53%; P = 0.002). Adjusted head circumference was greater in the low-GL group (35.0 ± 0.8 compared with 34.2 ± 1.3 cm, P = 0.01). Women in the low-GL group had smaller increases in triglycerides [median (interquartile range): 49 (19, 70) compared with 93 (34, 129) mg/dL; P = 0.03] and total cholesterol [13 (0, 36) compared with 33 (22, 56) mg/dL, P = 0.04] and a greater decrease in C-reactive protein [−2.5 (−5.5, −0.7) compared with −0.4 (−1.4, 1.5) mg/dL, P = 0.007]. Conclusions: A low-GL diet resulted in longer pregnancy duration, greater infant head circumference, and improved maternal cardiovascular risk factors. Large-scale studies are warranted to evaluate whether dietary intervention during pregnancy aimed at lowering GL may be useful in the prevention of prematurity and other adverse maternal and infant outcomes. This trial is registered at clinicaltrials.gov as NCT00364403. PMID:20962162

  9. Self-Care Behaviors and Glycemic Control in Low-Income Adults in México With Type 2 Diabetes Mellitus May Have Implications for Patients of Mexican Heritage Living in the United States.

    PubMed

    Compeán Ortiz, Lidia G; Del Ángel Pérez, Beatriz; Reséndiz González, Eunice; Piñones Martínez, Socorro; González Quirarte, Nora H; Berry, Diane C

    2016-04-01

    This study examined self-care behaviors and their relationship to glycemic control in low-income Mexican adults with type 2 diabetes in Southeastern Tamaulipas, México. A total of 135 patients were enrolled from 17 community health centers. The most frequent self-care behavior was medication management (80%), and the least frequent self-care behavior was self blood glucose monitoring (7%). All the patients demonstrated poor glycemic control, with glycated hemoglobin > 7%. Self-care behaviors were associated with fasting blood glucose (rs = .223, p = .005). Medication management was influenced by cognitive performance, F(1, 130) = 4.49, p = .036, and depression, F(1, 130) = 8.22, p = .005. Dietary behaviors were influenced by previous diabetes education, F(1, 130) = 6.73, p = .011. These findings indicate that education and cognitive behavioral interventions in Spanish for Mexican adults with type 2 diabetes are urgently needed. PMID:26040723

  10. Alliance for a Healthy Border: factors related to weight reduction and glycemic success.

    PubMed

    Wang, Xiaohui; Ghaddar, Suad; Brown, Cynthia; Pagán, José A; Balboa, Marvelia

    2012-04-01

    We examined the factors related to success in achieving weight reduction and glycemic control in Alliance for a Healthy Border (AHB), a chronic disease prevention program implemented from 2006 to 2009 through 12 federally qualified community health centers serving primarily Hispanics in communities located along the US-Mexico border region. We analyzed data from Phase I of AHB using logistic regression to examine the determinants of success in achieving weight reduction and glycemic control among the participants in AHB programs. Factors affecting weight reduction success were sex, age, employment status, income, insurance, diabetes, baseline body mass index (BMI), smoking status, family history of diabetes, session type, program duration, and physical activity changes. Factors affecting achievement of glycemic success included sex, age, employment status, diabetes, baseline BMI, family history of diabetes, program duration, and physical activity changes. We found that the AHB interventions were more successful in reducing participants' HbA1c level than BMI. In addition to sociodemographic factors, participants with better baseline health conditions (ie, participants without diabetes or family history of diabetes, normal BMI, former smokers) were more likely to achieve success after the interventions. Of the 4 key features defining each of the 12 interventions, session type and program duration were associated with success. Within a relatively short time period, physical activity improvements had a stronger effect on weight reduction and glycemic success than improvements in dietary habits. The effectiveness of diabetes and cardiovascular disease prevention programs can be improved substantially by considering these factors during program design and structure. PMID:22506803

  11. Counting Carbs? Understanding Glycemic Index and Glycemic Load

    MedlinePlus

    ... glycemic index and load concern carbohydrates, or carbs—one of the main types of nutrients in our diets. Carbs with a ... NIH. That’s why researchers came up with the concept of glycemic load. It captures both the types of carbs in a food and the amount ...

  12. The importance of the pharmacist's expanding role on the diabetes team: reinforcing nutritional guidelines for improved glycemic control.

    PubMed

    Johnson, L C; Beach, E

    1997-10-01

    The role of the pharmacist on the diabetes care team is expanding due to the increasing number of patients diagnosed with diabetes, limited health care dollars, and the education related to and required for patients by managed care organizations and insurance companies. In the past, training of patients in diabetes self-management skills has been inadequate, and this continues to be the case. Clinical pharmacists, in cooperation with physicians, have increased opportunities to provide education about medications and may include instructions for patients regarding the interaction of food consumed with changes in blood glucose levels. Because of monthly refills on prescribed medications, a patient's interaction with the pharmacist in the setting of a commercial pharmacy is more frequent than with any other member of the diabetes team. This contact offers an ideal educational opportunity. The action and efficacy of medications that affect the pancreas, hepatic glucose production, the utilization of glucose by muscle cells, and the absorption of glucose from the intestines are influenced directly by the meal plan. Nutritional guidelines, meal planning for the Type I and Type II patient, use of the exchange system, carbohydrate counting, artificial sweeteners, alcoholic beverages, and suggestions for guiding patients to establish eating habits that lead to improved diabetes control are important issues for every member of the diabetes team to address. The reinforcement of dietary principles may occur in the educational setting of the hospital or the clinic or within the commercial pharmacy setting. When the team presents accurate and current information, continuity of care and improved patient understanding are achieved. PMID:10173309

  13. Long-term ketogenic diet contributes to glycemic control but promotes lipid accumulation and hepatic steatosis in type 2 diabetic mice.

    PubMed

    Zhang, Xiaoyu; Qin, Juliang; Zhao, Yihan; Shi, Jueping; Lan, Rong; Gan, Yunqiu; Ren, Hua; Zhu, Bing; Qian, Min; Du, Bing

    2016-04-01

    The ketogenic diet (KD) has been widely used in weight and glycemic control, although potential side effects of long-term KD treatment have caused persistent concern. In this study, we hypothesized that the KD would ameliorate the progression of diabetes but lead to disruptions in lipid metabolism and hepatic steatosis in a mouse model of diabetes. In type 2 diabetic mouse model, mice were fed a high-fat diet and administered streptozotocin treatment before given the test diets for 8 weeks. Subsequently, ameliorated glucose and insulin tolerance in KD-fed diabetic mice was found, although the body weight of high-fat diet- and KD-fed mice was similar. Interestingly, the weight of adipose tissue in KD mice was greater than in the other groups. The KD diet resulted in higher serum triacylglycerol and cholesterol levels in diabetic mice. Moreover, the KD-fed mice showed greater hepatic lipid accumulation. Mice fed the KD showed significant changes in several key genes such as sterol regulatory element-binding protein, fibroblast growth factor 21, and peroxisome proliferator-activated receptor α, which are all important in metabolism. In summary, KD ameliorates glucose and insulin tolerance in a mouse model of diabetes, but severe hepatic lipid accumulation and hepatic steatosis were observed, which should be considered carefully in the long-term application of KD. PMID:27001280

  14. Glycemic Control Outcomes by Gender in the Pay-for-Performance System: A Retrospective Database Analysis in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Yuan, Shao-Ping; Huang, Chien-Ning; Liao, Hung-Chang; Lin, Yu-Tzu; Wang, Ya-huei

    2014-01-01

    Background. The purpose of this study was to investigate how the degree of glycemic control in patients with type 2 diabetes associated with lifestyle interventions as well as sociodemographic factors and further examine the differences by gender. Methods. This was a retrospective study using data collected from a diabetes quality improvement plan that began in 2002 in a medical center in Taiwan. Statistic analysis was used to determine the associations of sociodemographic data, lifestyle intervention, and treatment regimens with changes in HbA1c levels (between the initial visit and the latest follow-up measured level), and the differences were then sorted by the sex of the patients. Results. Our results showed that HbA1c averaged 7.50% for males and 7.80% for females at the initial visit, compared to levels averaging 7.50% for males and 7.70% for females at the most recent follow-up visit. There was no significant change (P = 0.541) in HbA1c in males, but there was a 0.10% (P = 0.384) reduction in females. The duration of the diabetes and medication regimen was associated with the decrease seen in the females. Conclusions. The results of these analyses provide important insights for policy makers to formulate healthcare policies related to chronic diseases or illnesses. PMID:25202328

  15. DNA aptamer raised against advanced glycation end products (AGEs) improves glycemic control and decreases adipocyte size in fructose-fed rats by suppressing AGE-RAGE axis.

    PubMed

    Ojima, A; Matsui, T; Nakamura, N; Higashimoto, Y; Ueda, S; Fukami, K; Okuda, S; Yamagishi, S

    2015-04-01

    Advanced glycation end products (AGEs) decrease adiponectin expression and suppress insulin signaling in cultured adipocytes through the interaction with a receptor for AGEs (RAGE) via oxidative stress generation. We have recently found that high-affinity DNA aptamer directed against AGE (AGE-aptamer) prevents the progression of experimental diabetic nephropathy by blocking the harmful actions of AGEs in the kidney. This study examined the effects of AGE-aptamer on adipocyte remodeling, AGE-RAGE-oxidative stress axis, and adiponectin expression in fructose-fed rats. Although AGE-aptamer treatment by an osmotic mini pump for 8 weeks did not affect serum insulin levels, it significantly decreased average fasting blood glucose and had a tendency to inhibit body weight gain in fructose-fed rats. Furthermore, AGE-aptamer significantly suppressed the increase in adipocyte size and prevented the elevation in AGEs, RAGE, and an oxidative stress marker, 8-hydroxydeoxyguanosine (8-OHdG), levels in adipose tissues of fructose-fed rats at 14-week-old, while it restored the decrease in adiponectin mRNA levels. Our present study suggests that AGE-aptamer could improve glycemic control and prevent adipocyte remodeling in fructose-fed rats partly by suppressing the AGE-RAGE-mediated oxidative stress generation. AGE-aptamer might be a novel therapeutic strategy for fructose-induced metabolic derangements. PMID:25105541

  16. Three years of liraglutide treatment offers continuously optimal glycemic control in a pediatric patient with maturity-onset diabetes of the young type 3.

    PubMed

    Urakami, Tatsuhiko; Habu, Masako; Okuno, Misako; Suzuki, Junichi; Takahashi, Shori; Yorifuji, Tohru

    2015-03-01

    Sulfonylureas (SUs) are recommended as the first-line pharmacological treatment in patients with uncontrolled maturity-onset diabetes of the young type 3 (MODY3). In contrast, glucagon-like peptide-1 (GLP-1) receptor agonists have the advantages of a low risk of hypoglycemia and maintained β-cell function. We report a pediatric patient with MODY3 treated with a GLP-1 receptor agonist, liraglutide. A 12-year-old Japanese girl with MODY3 had been treated with insulin for 6 months since the time of diagnosis. After genetic analysis, we switched her treatment from insulin to liraglutide. After switching to liraglutide, the patient maintained optimal glycemic control with hemoglobin A₁c levels of 6.8%-7.5% and had postprandial C-peptide levels >3.0 ng/mL during a 3-year treatment period. No adverse events associated with liraglutide were observed. GLP-1 receptor agonists are the potential medications for patients with MODY3 who maintain residual insulin secretion. PMID:25332292

  17. All-trans retinoic acid ameliorates glycemic control in diabetic mice via modulating pancreatic islet production of vascular endothelial growth factor-A.

    PubMed

    Chien, Chiao-Yun; Yuan, Tze-An; Cho, Candy Hsin-Hua; Chang, Fang-Pei; Mao, Wan-Yu; Wu, Ruei-Ren; Lee, Hsuan-Shu; Shen, Chia-Ning

    2016-09-01

    Patients with type 1 diabetes mellitus are associated with impairment in vitamin A metabolism. This study evaluated whether treatment with retinoic acid, the biologically active metabolite of vitamin A, can ameliorate diabetes. All-trans retinoic acid (atRA) was used to treat streptozotocin (STZ)-induced diabetic mice which revealed atRA administration ameliorated blood glucose levels of diabetic mice. This hyperglycemic amelioration was accompanied by an increase in the amount of β cells co-expressed Pdx1 and insulin and by restoration of the vascular laminin expression. The atRA-induced production of vascular endothelial growth factor-A from the pancreatic islets was possibly the key factor that mediated the restoration of islet vascularity and recovery of β-cell mass. Furthermore, the combination of islet transplantation and atRA administration significantly rescued hyperglycemia in diabetic mice. These findings suggest that vitamin A derivatives can potentially be used as a supplementary treatment to improve diabetes management and glycemic control. PMID:27381866

  18. Accelerated Insulin Pharmacokinetics and Improved Postprandial Glycemic Control in Patients With Type 1 Diabetes After Coadministration of Prandial Insulins With Hyaluronidase

    PubMed Central

    Hompesch, Marcus; Muchmore, Douglas B.; Morrow, Linda; Vaughn, Daniel E.

    2011-01-01

    OBJECTIVE To compare the pharmacokinetics, pharmacodynamics, and safety of insulin lispro or regular human insulin (RHI) with or without recombinant human hyaluronidase (rHuPH20) administered before a standardized meal. RESEARCH DESIGN AND METHODS In this four-way, crossover study, 22 patients with type 1 diabetes received injections of individually optimized doses of lispro or RHI with and without rHuPH20 before a liquid meal. RESULTS With rHuPH20 coadministration, early insulin exposure (0–60 min) increased by 54% (P = 0.0011) for lispro and 206% (P < 0.0001) for RHI compared with the respective insulin alone. Peak blood glucose decreased 26 mg/dL for lispro (P = 0.002) and 24 mg/dL for RHI (P = 0.017), reducing hyperglycemic excursions (area under the curve for blood glucose >140 mg/dL) by 79% (P = 0.09) and 85% (P = 0.049), respectively. Rates of hypoglycemia were comparable for lispro with or without rHuPH20, whereas coadministration of RHI and rHuPH20 reduced hypoglycemia. CONCLUSIONS Lispro or RHI with rHuPH20 produced earlier and greater peak insulin concentrations and improved postprandial glycemic control. PMID:21273493

  19. Early Low-Fat Diet Enriched With Linolenic Acid Reduces Liver Endocannabinoid Tone and Improves Late Glycemic Control After a High-Fat Diet Challenge in Mice.

    PubMed

    Demizieux, Laurent; Piscitelli, Fabiana; Troy-Fioramonti, Stephanie; Iannotti, Fabio Arturo; Borrino, Simona; Gresti, Joseph; Muller, Tania; Bellenger, Jerome; Silvestri, Cristoforo; Di Marzo, Vincenzo; Degrace, Pascal

    2016-07-01

    Evidence suggests that alterations of glucose and lipid homeostasis induced by obesity are associated with the elevation of endocannabinoid tone. The biosynthesis of the two main endocannabinoids, N-arachidonoylethanolamine and 2-arachidonoyl-glycerol, which derive from arachidonic acid, is influenced by dietary fatty acids (FAs). We investigated whether exposure to n-3 FA at a young age may decrease tissue endocannabinoid levels and prevent metabolic disorders induced by a later high-fat diet (HFD) challenge. Three-week-old mice received a 5% lipid diet containing lard, lard plus safflower oil, or lard plus linseed oil for 10 weeks. Then, mice were challenged with a 30% lard diet for 10 additional weeks. A low n-6/n-3 FA ratio in the early diet induces a marked decrease in liver endocannabinoid levels. A similar reduction was observed in transgenic Fat-1 mice, which exhibit high tissue levels of n-3 FA compared with wild-type mice. Hepatic expression of key enzymes involved in carbohydrate and lipid metabolism was concomitantly changed. Interestingly, some gene modifications persisted after HFD challenge and were associated with improved glycemic control. These findings indicate that early dietary interventions based on n-3 FA may represent an alternative strategy to drugs for reducing endocannabinoid tone and improving metabolic parameters in the metabolic syndrome. PMID:27207550

  20. Residential Mobility, Inhibitory Control, and Academic Achievement in Preschool

    ERIC Educational Resources Information Center

    Schmitt, Sara A.; Finders, Jennifer K.; McClelland, Megan M.

    2015-01-01

    Research Findings: The present study investigated the direct effects of residential mobility on children's inhibitory control and academic achievement during the preschool year. It also explored fall inhibitory control and academic skills as mediators linking residential mobility and spring achievement. Participants included 359 preschool…

  1. Residential Mobility, Inhibitory Control, and Academic Achievement in Preschool

    ERIC Educational Resources Information Center

    Schmitt, Sara A.; Finders, Jennifer K.; McClelland, Megan M.

    2015-01-01

    The present study investigated the direct effects of residential mobility on children's inhibitory control and academic achievement during the preschool year. It also explored fall inhibitory control and academic skills as mediators linking residential mobility and spring achievement. Participants included 359 preschool children (49% female)…

  2. Longitudinal Effects of Perceived Control on Academic Achievement

    ERIC Educational Resources Information Center

    You, Sukkyung; Hong, Sehee; Ho, Hsiu-Zu

    2011-01-01

    It is well established that perceived control plays an important role in student academic achievement, but little is known about its longitudinal stability, ethnic variation, and developmental effects on subsequent achievement during adolescence. Findings from this study indicated (a) perceived control remains stable during adolescence for each of…

  3. Evaluation of the Effects of Cornus mas L. Fruit Extract on Glycemic Control and Insulin Level in Type 2 Diabetic Adult Patients: A Randomized Double-Blind Placebo-Controlled Clinical Trial

    PubMed Central

    Soltani, Rasool; Gorji, Abdollah; Asgary, Sedigheh; Sarrafzadegan, Nizal; Siavash, Mansour

    2015-01-01

    Background. The plant Cornus mas L. (cornelian cherry) is traditionally used as an antidiabetic supplement; however, there is no related clinical trial. In this study, we evaluated the effects of the fruit extract of this plant on biomarkers of glycemic control in adult patients with type 2 diabetes. Methods. Sixty patients with type 2 diabetes were randomly assigned to two groups to receive either the extract or placebo capsules (2 capsules twice daily) for 6 weeks. Each drug capsule contained 150 mg of anthocyanins. Fasting plasma levels of glucose, insulin, HgbA1C, and triglyceride as well as 2-hour postprandial glucose level (2Hpp) were measured before and after the intervention and finally the mean values were compared between groups. Results. After 6 weeks of intervention, significant increase in insulin level (1.13 ± 1.90 versus −0.643 ± 1.82, P < 0.05) as well as decrease in HgbA1C (−0.24 ± 0.429 versus 0.023 ± 0.225, P < 0.05) and TG (−23.66 ± 55.40 versus 2.83 ± 15.71, P < 0.05) levels was observed in drug group compared to placebo. Conclusion. Daily consumption of the fruit extract of Cornus mas L. improves glycemic control by increasing insulin level and reduces TG serum level in type 2 diabetic adult patients. PMID:26508984

  4. Effect of Switching from Sulphonylurea to Repaglinide Twice or Three Times Daily for 4 Months on Glycemic Control in Japanese Patients with Type 2 Diabetes.

    PubMed

    Kamiyama, Hiroshi; Aoki, Kazutaka; Nakajima, Shigeru; Shinoda, Kazuaki; Kamiko, Kazunari; Taguri, Masataka; Terauchi, Yasuo

    2016-01-01

    Objective Switching from sulfonylureas to repaglinide in patients with type 2 diabetes improves glycemic control; however, the optimal dosage has not been fully evaluated. We designed to show that repaglinide was equivalent to sulfonylurea in Japanese patients with type 2 diabetes. We herein evaluated whether we could switch from sulfonylureas to repaglinide twice or thrice daily in Japanese adult patients who had been treated with anti-diabetic drugs, including sulfonylureas, and whose conditions were moderately well-controlled. Methods A total of 78 patients taking less than half the Japanese maximum dose of sulfonylurea were randomized into three groups: 26 in group A (switching from sulfonylureas to taking 0.25 or 0.5 mg of repaglinide just before breakfast and dinner twice daily), 27 in group B (switching from sulfonylureas to taking 0.25 or 0.5 mg of repaglinide just before meals thrice daily), and 25 in group C (continuing to take sulfonylurea). Blood samples were collected at 0, 1, 2, 3, and 4 months following the initiation of the maintenance period. Results The HbA1c and glycoalbumin levels did not significantly differ among the three groups after 4 months of treatment. Conclusion With the assumption that 1 mg of glimepiride is equivalent to 1.25 mg of glibenclamide or 40 mg of gliclazide, the administration of repaglinide (0.44 mg/meal) twice and thrice daily is similar to the efficacy of sulfonylurea (glimepiride 1.63-1.98 mg/day) after four months of treatment in Japanese patients with moderately well-controlled type 2 diabetes (HbA1c, 7-7.5%). PMID:27374668

  5. Investigating Sources of Heterogeneity in Randomized Controlled Trials of the Effects of Pharmacist Interventions on Glycemic Control in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis

    PubMed Central

    Aguiar, Patricia Melo; Brito, Giselle de Carvalho; Lima, Tácio de Mendonça; Santos, Ana Patrícia Alves Lima; Lyra, Divaldo Pereira; Storpirtis, Sílvia

    2016-01-01

    Objective To assess the effect of pharmacist interventions on glycemic control in type 2 diabetic patients and to examine factors that could explain the variation across studies. Methods A comprehensive literature search was performed in PubMed, Scopus, and LILACS databases for randomized controlled trials (RCTs) published up to July 2015. The search strategy included the use of MeSH terms or text words related to pharmacist interventions, type 2 diabetes, and randomized controlled trials. RCTs published in English, Portuguese, or Spanish that evaluated the effect of pharmacist intervention on glycemic control in type 2 diabetic outpatients were included. Two independent authors executed study selection, data extraction, and risk of bias assessment. Mean differences in glycosylated hemoglobin (HbA1c) were estimated using random-effect models, and heterogeneity was evaluated by subgroup and meta-regression analyses. Results The literature search yielded 963 records of potential interest, of which 30 were included in the systematic review and 22 in the meta-analysis. Most of these RCTs were conducted in the United States in patients in outpatient clinics using face-to-face contact only. All RCTs performed patient education, and most executed the medication review. The appraised sample showed uncertain or high risk of bias in most of the items evaluated, resulting in low-quality studies. In comparison with usual care, pharmacist interventions were associated with significant reductions in HbA1c levels (-8.5% [95% CI: -1.06, -0.65]; P < 0.0001; I2 = 67.3%). Subgroup analysis indicated differences of heterogeneity by country, baseline HbA1c levels, setting, intervention frequency, and random allocation. Age and HbA1c levels partly explained the variability across studies by meta-regression. Conclusions Our findings confirmed that pharmacist interventions improve glycemic control in patients with type 2 diabetes compared with usual care and suggest that younger patients

  6. Differentiating Approaches to Diabetes Self-Management of Multi-Ethnic Rural Older Adults at the Extremes of Glycemic Control

    ERIC Educational Resources Information Center

    Brewer-Lowry, Aleshia Nichol; Arcury, Thomas A.; Bell, Ronny A.; Quandt, Sara A.

    2010-01-01

    Purpose of the Study: This study identified approaches to diabetes self-management that differentiate persons with well-controlled from poorly controlled diabetes. Previous research has focused largely on persons participating in self-management interventions. Design and Methods: In-depth qualitative interviews were conducted with 48 adults, drawn…

  7. Glycemic control and chronic dosing of rhesus monkeys with a fusion protein of iduronidase and a monoclonal antibody against the human insulin receptor.

    PubMed

    Boado, Ruben J; Hui, Eric Ka-Wai; Lu, Jeff Zhiqiang; Pardridge, William M

    2012-10-01

    Hurler's syndrome, or mucopolysaccharidosis type I, is a lysosomal storage disorder caused by mutations in the gene encoding the lysosomal enzyme iduronidase (IDUA). The disease affects both peripheral tissues and the central nervous system (CNS). Recombinant IDUA treatment does not affect the CNS, because IDUA does not cross the blood-brain barrier (BBB). To enable BBB penetration, human IDUA was re-engineered as an IgG-IDUA fusion protein, where the IgG domain is a genetically engineered monoclonal antibody (MAb) against the human insulin receptor (HIR). The HIRMAb penetrates the brain from the blood via transport on the endogenous BBB insulin receptor and acts as a molecular Trojan horse to deliver the fused IDUA to the brain. Before human testing, the HIRMAb-IDUA fusion protein was evaluated in a 6-month weekly dosing toxicology study at doses of 0, 3, 9, and 30 mg/kg/week of the fusion protein administered to 40 rhesus monkeys. The focus of the present study is the effect of chronic high dose administration of this fusion protein on plasma glucose and long-term glycemic control. The results show that the HIRMAb has weak insulin agonist activity and causes hypoglycemia at the high dose, 30 mg/kg, after intravenous infusion in normal saline. When dextrose is added to the saline infusion solution, no hypoglycemia is observed at any dose. An intravenous glucose tolerance test performed at the end of the 6 months of chronic treatment showed no change in glucose tolerance at any dose of the HIRMAb-IDUA fusion protein. PMID:22822036

  8. Glycemic Control and Chronic Dosing of Rhesus Monkeys with a Fusion Protein of Iduronidase and a Monoclonal Antibody Against the Human Insulin Receptor

    PubMed Central

    Boado, Ruben J.; Hui, Eric Ka-Wai; Lu, Jeff Zhiqiang

    2012-01-01

    Hurler's syndrome, or mucopolysaccharidosis type I, is a lysosomal storage disorder caused by mutations in the gene encoding the lysosomal enzyme iduronidase (IDUA). The disease affects both peripheral tissues and the central nervous system (CNS). Recombinant IDUA treatment does not affect the CNS, because IDUA does not cross the blood-brain barrier (BBB). To enable BBB penetration, human IDUA was re-engineered as an IgG-IDUA fusion protein, where the IgG domain is a genetically engineered monoclonal antibody (MAb) against the human insulin receptor (HIR). The HIRMAb penetrates the brain from the blood via transport on the endogenous BBB insulin receptor and acts as a molecular Trojan horse to deliver the fused IDUA to the brain. Before human testing, the HIRMAb-IDUA fusion protein was evaluated in a 6-month weekly dosing toxicology study at doses of 0, 3, 9, and 30 mg/kg/week of the fusion protein administered to 40 rhesus monkeys. The focus of the present study is the effect of chronic high dose administration of this fusion protein on plasma glucose and long-term glycemic control. The results show that the HIRMAb has weak insulin agonist activity and causes hypoglycemia at the high dose, 30 mg/kg, after intravenous infusion in normal saline. When dextrose is added to the saline infusion solution, no hypoglycemia is observed at any dose. An intravenous glucose tolerance test performed at the end of the 6 months of chronic treatment showed no change in glucose tolerance at any dose of the HIRMAb-IDUA fusion protein. PMID:22822036

  9. Interrelationships of Study Habits and Attitudes, Locus of Control, Motivation Achievement Tendencies and Academic Achievement.

    ERIC Educational Resources Information Center

    Gadzella, Bernadette M.; And Others

    The study investigated (a) relationships between measures on study habits and attitudes, locus of control, achieving tendency, and semester grade-point averages (SGPA), (b) differences between the sexes on the above mentioned variables, and (c) best predictor of SGPA. The subjects were 39 males and 81 females. There were a number of significant…

  10. Transition from passive to active targeting of oral insulin nanomedicines: enhancement in bioavailability and glycemic control in diabetes.

    PubMed

    Kaklotar, Dhansukh; Agrawal, Poornima; Abdulla, Allabakshi; Singh, Rahul P; Mehata, Abhishesh K; Singh, Sanjay; Mishra, Brahmeshwar; Pandey, Bajarangprasad L; Trigunayat, Anshuman; Muthu, Madaswamy S

    2016-06-01

    Oral insulin nanomedicines are effective tools for therapy and management of both Type I and Type II diabetes. This review summarizes the various nanocarriers developed so far in the literature for oral delivery of insulin. It includes lipid-based (i.e., solid lipid nanoparticles and liposomes) and polymeric-based insulin nanomedicines (i.e., chitosan nanoparticles, alginate nanoparticles, dextran nanoparticles and nanoparticles of synthetic polymers) for sustained, controlled and targeted oral delivery of insulin. Mainly, goblet cell-targeting, vitamin B12 receptor-targeting, folate receptor-targeting and transferrin receptor-targeting aspects were focused. Currently, passive and active targeting approaches of oral insulin nanomedicines have improved the oral absorption of insulin and its bioavailability (up to 14%) that produced effective glycaemic control in in vivo models. These results indicate a promising future of oral insulin nanomedicines for the treatment of diabetes. PMID:27171572

  11. Mobile Diabetes Intervention for Glycemic Control in 45- to 64-Year-Old Persons With Type 2 Diabetes.

    PubMed

    Quinn, Charlene C; Shardell, Michelle D; Terrin, Michael L; Barr, Erik A; Park, DoHwan; Shaikh, Faraz; Guralnik, Jack M; Gruber-Baldini, Ann L

    2016-02-01

    The purpose of this study was to assess effects of a mobile coaching system on glycated hemoglobin (HbA1c) levels in younger versus older patients over 1 year. Participants (n = 118) included adult patients with Type 2 diabetes cared for by community physicians. Intervention patients received mobile phone coaching and individualized web portal. Control patients received usual care. Patients were stratified into two age groups: younger (<55 years) and older (≥ 55 years). The intervention resulted in greater 12-month declines in HbA1c, compared with usual care, for patients in both age groups (p < .0001). Among older patients, HbA1c changed by -1.8% (95% confidence interval [CI] = [-2.4, -1.1]) in the intervention group and -0.3% (95% CI = [-0.9, +0.3]) in the control group. Among younger patients, HbA1c changed by -2.0% (95% CI = [-2.5, -1.5]) in the intervention group and -1.0% (95% CI = [-1.6, -0.4]) in the control group. The mobile health intervention was as effective at managing Type 2 diabetes in older adults as younger persons. PMID:25098253

  12. The Impact of Locus of Control on Language Achievement

    ERIC Educational Resources Information Center

    Nodoushan, Mohammad Ali Salmani

    2012-01-01

    This study hypothesized that students' loci of control affected their language achievement. 198 (N = 198) EFL students took the Rotter's (1966) locus of control test and were classified as locus-internal (ni = 78), and locus-external (ne = 120). They then took their ordinary courses and at the end of the semester, they were given their exams.…

  13. Effect of telenursing (telephone follow-up) on glycemic control and body mass index (BMI) of type 2 diabetes patients

    PubMed Central

    Borhani, Fariba; Lashkari, Tahereh; Sabzevari, Sakineh; Abbaszadeh, Abbas

    2013-01-01

    Background: Telenursing includes every nursing and care-giving services conducted remotely. In telenursing, telephone as a device, which is available for most of the people, is being used increasingly. In a telephone-based system, patients are being contacted by health care providers on regular bases and they would be provided with some information about their illness and their treatment method. This study was conducted to determine the effect of phone-based follow-ups on diabetes patients’ metabolic control in the city of Kerman in Iran. Materials and Methods: This is a quasi-experimental study conducted on 50 type II diabetes patients in Kerman during 2011. Data were collected using a demographic questionnaire and also by taking physiological measurement of fasting blood suger (FBS), Glycated Hemoglobin (HbA1c), and postprandial glucose (PPG). Participants’ body mass index (BMI) was calculated by measuring height and weight. Patients completed the questionnaire at the beginning of the study and 12 weeks later. The patients were randomly divided into two groups of experiment and control. Patients in the experimental group received phone calls by the researcher for 12 weeks, and the follow-ups included instructions on self-care and advices to follow their diets, exercise, and insulin titration. Data analysis was done using descriptive and inferential statistical methods (chi-square, analysis of variance [ANOVA], independent t-test, and paired t-test). Results: The decrease of HbA1c and PPG was significantly more in the intervention group compared with the controls (P < 0.001). However, there was no significant difference between the mean of FBS (P = 0.42), and BMI (P = 0.31) in both groups after the intervention. Conclusions: According to the results of this study, telenursing was able to improve the metabolic indices of the patients. Therefore, using this method is recommended for patients with type II diabetes. PMID:24554942

  14. [Improvement in glycemic control, cardiovascular risk factors and anthropometric data in type 2 diabetic patients after the switch from biphasic human insulin to biphasic premix analog insulin aspart].

    PubMed

    Gero, László; Gyimesi, András; Hidvégi, Tibor; Jánosi, István

    2009-08-30

    Long-term studies involving large number of type 2 diabetic patients supplied evidence that constant adequate metabolic control may prevent the late (micro- and macrovascular) diabetic complications. In the present non-interventional, retrospective study, authors performed an analysis of type 2 diabetic patients who had been previously treated with biphasic human insulin (BHI) and their therapy was changed to biphasic analog insulin aspart 30/70 (BIAsp = NovoMix 30). The switch of the insulin therapy was carried out in years 2007 and 2008 with the cooperation of 50 accredited diabetes centers. Data were obtained at the time of therapeutical change and six months later. The number of suitable patients was 2898 with an age of 66.20 +/- 10.10 year, and the duration of diabetes was >10 years in 43% of the patients. After the six-month therapy with NovoMix 30, the mean HbA 1c level decreased statistically significantly from the initial value of 9.10 +/- 1.44% to 7.62 +/- 1.00% ( p < 0.001). The lipid profile also improved although target values were not always attained. A reduction was also observed in both systolic and diastolic blood pressure. Mean body weight decreased from 84.2 +/- 14.9 kg to 82.6 +/- 13.9 kg ( p < 0.01). All these changes occurred in spite of a significantly reduced daily insulin dose (48.4 +/- 17.6 IU) as compared with the initial value (49.0 +/- 17.4 IU, p < 0.001). A marked decrement was also observed in the frequency of hypoglycemic reactions. These results confirm that treatment with NovoMix 30 insulin leads to a significant amelioration of glycemic control as reflected by the decreased level of HbA 1c and the higher proportion of patients attaining the target value, as well as the lower frequency of hypoglycemic episodes. The significant improvements in cardiovascular risk factors are also important, but the explanation is still missing and would require the accomplishment of prospective, controlled studies. PMID:19692308

  15. Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics

    PubMed Central

    Le Floch, Jean-Pierre

    2010-01-01

    Insulin detemir is an analog of human insulin designed to provide a long duration of basal insulin action. This is achieved by protracted absorption from the injection depot, which results in part from increased self-association of insulin detemir molecules and in part from reversible albumin binding. Subsequent albumin binding in the circulation is thought to buffer changes in the effects at target tissues that could otherwise arise from variability in absorption rate. In consequence, insulin detemir has shown a less variable pharmacodynamic profile than alternative basal insulins; this manifests as more consistent temporal glucose reduction profiles in repeat-clamp studies. In clinical trials, insulin detemir has been characterized by consistent risk reductions in hypoglycemia, as well as reduced weight gain in comparison with other basal insulins. Given some recent associations that have been made in prospective and epidemiologic studies between glucose variability and/or hypoglycemia and increased cardiovascular risk, and the long-known association between excess weight and cardiovascular risk, it is possible that the clinical profile of insulin detemir may carry prognostic value with regard to cardiovascular safety, although this is yet to be substantiated. There have also been some concerns raised recently over the use of insulin analogs and cancer risk, but available clinical data and the receptor interaction profile of insulin detemir suggest no excess in risk in comparison with human insulin therapy. Optimal approaches for the clinical use of insulin detemir have been emerging through an increasing clinical study base, and the analog is becoming established as a potentially valuable therapy option. PMID:21437089

  16. Implementation of the chronic care model in small medical practices improves cardiovascular risk but not glycemic control.

    PubMed

    Frei, Anja; Senn, Oliver; Chmiel, Corinne; Reissner, Josiane; Held, Ulrike; Rosemann, Thomas

    2014-04-01

    OBJECTIVE To test whether the implementation of elements of the Chronic Care Model (CCM) via a specially trained practice nurse leads to an improved cardiovascular risk profile among type 2 diabetes patients. RESEARCH DESIGN AND METHODS This cluster randomized controlled trial with primary care physicians as the unit of randomization was conducted in the German part of Switzerland. Three hundred twenty-six type 2 diabetes patients (age >18 years; at least one glycosylated hemoglobin [HbA1c] level of ≥7.0% [53 mmol/mol] in the preceding year) from 30 primary care practices participated. The intervention included implementation of CCM elements and involvement of practice nurses in the care of type 2 diabetes patients. Primary outcome was HbA1c levels. The secondary outcomes were blood pressure (BP), LDL cholesterol, accordance with CCM (assessed by Patient Assessment of Chronic Illness Care [PACIC] questionnaire), and quality of life (assessed by the 36-item short-form health survey [SF-36]). RESULTS After 1 year, HbA1c levels decreased significantly in both groups with no significant difference between groups (-0.05% [-0.60 mmol/mol]; P = 0.708). Among intervention group patients, systolic BP (-3.63; P = 0.050), diastolic BP (-4.01; P < 0.001), LDL cholesterol (-0.21; P = 0.033), and PACIC subscores (P < 0.001 to 0.048) significantly improved compared with control group patients. No differences between groups were shown in the SF-36 subscales. CONCLUSIONS A chronic care approach according to the CCM and involving practice nurses in diabetes care improved the cardiovascular risk profile and is experienced by patients as a better structured care. Our study showed that care according to the CCM can be implemented even in small primary care practices, which still represent the usual structure in most European health care systems. PMID:24513589

  17. Angiotensin I–Converting Enzyme Type 2 (ACE2) Gene Therapy Improves Glycemic Control in Diabetic Mice

    PubMed Central

    Bindom, Sharell M.; Hans, Chetan P.; Xia, Huijing; Boulares, A. Hamid; Lazartigues, Eric

    2010-01-01

    OBJECTIVE Several clinical studies have shown the benefits of renin-angiotensin system (RAS) blockade in the development of diabetes, and a local RAS has been identified in pancreatic islets. Angiotensin I–converting enzyme (ACE)2, a new component of the RAS, has been identified in the pancreas, but its role in β-cell function remains unknown. Using 8- and 16-week-old obese db/db mice, we examined the ability of ACE2 to alter pancreatic β-cell function and thereby modulate hyperglycemia. RESEARCH DESIGN AND METHODS Both db/db and nondiabetic lean control (db/m) mice were infected with an adenovirus expressing human ACE2 (Ad-hACE2-eGFP) or the control virus (Ad-eGFP) via injection into the pancreas. Glycemia and β-cell function were assessed 1 week later at the peak of viral expression. RESULTS In 8-week-old db/db mice, Ad-hACE2-eGFP significantly improved fasting glycemia, enhanced intraperitoneal glucose tolerance, increased islet insulin content and β-cell proliferation, and reduced β-cell apoptosis compared with Ad-eGFP. ACE2 overexpression had no effect on insulin sensitivity in comparison with Ad-eGFP treatment in diabetic mice. Angiotensin-(1–7) receptor blockade by d-Ala7–Ang-(1-7) prevented the ACE2-mediated improvements in intraperitoneal glucose tolerance, glycemia, and islet function and also impaired insulin sensitivity in both Ad-hACE2-eGFP– and Ad-eGFP–treated db/db mice. d-Ala7–Ang-(1-7) had no effect on db/m mice. In 16-week-old diabetic mice, Ad-hACE2-eGFP treatment improved fasting blood glucose but had no effect on any of the other parameters. CONCLUSIONS These findings identify ACE2 as a novel target for the prevention of β-cell dysfunction and apoptosis occurring in type 2 diabetes. PMID:20660625

  18. Manipulating the sequence of food ingestion improves glycemic control in type 2 diabetic patients under free-living conditions.

    PubMed

    Tricò, D; Filice, E; Trifirò, S; Natali, A

    2016-01-01

    Lipid and protein ingested before carbohydrate reduce postprandial hyperglycemia. We tested feasibility, safety and clinical efficacy of manipulating the sequence of nutrient ingestion in patients with type 2 diabetes (T2D). After a 4-week run-in, 17 T2D patients were randomized to either a control diet (CD) or to an experimental diet (ED) allowing the consumption of high-carbohydrate foods only after high-protein and high-fat foods at each main meal (lunch+dinner). Both diets were accurately followed and neutral on arterial blood pressure, plasma lipids and indices of hepatic and kidney function. After 8 weeks, in spite of a similar reduction of body weight (ED -1.9 95% confidence interval (-3.4/-0.4)kg, P<0.03; CD -2.0 (-3.6/-0.5)kg, P<0.02) and waist circumference (ED -2.9 (-4.3/-1.5)cm, P<0.002; CD -3.3 (-5.9/-0.7)cm, P<0.02), the ED only was associated with significant reductions of HbA1c (-0.3 (-0.50/-0.02)%, P<0.04), fasting plasma glucose (-1.0 (-1.8/-0.3)mmol l(-1), P<0.01), postprandial glucose excursions (lunch -1.8 (-3.2/-0.4)mmol l(-1), P<0.01; dinner: -1.0 (-1.9/-0.1)mmol l(-1), P<0.04) and other indices of glucose variability (s.d.: -0.5 (-0.7/-0.2)mmol l(-1), P<0.02; Coefficient of variation: -6.6 (-10.4/-2.7)%, P<0.02). When compared with the CD, the ED was associated with lower post-lunch glucose excursions (P<0.02) and lower glucose coefficients of variation (P<0.05). Manipulating the sequence of nutrient ingestion might reveal a rapid, feasible, economic and safe strategy for optimizing glucose control in T2D. PMID:27548711

  19. The effect of purslane seeds on glycemic status and lipid profiles of persons with type 2 diabetes: A randomized controlled cross-over clinical trial

    PubMed Central

    Esmaillzadeh, Ahmad; Zakizadeh, Elahe; Faghihimani, Elham; Gohari, Mahmoodreza; Jazayeri, Shima

    2015-01-01

    Background: We are aware of limited data about the effects of purslane on diabetes. Earlier studies have mostly indicated the beneficial effects in animal models. This study aimed to evaluate the effect of purslane seeds on glycemic status and lipid profiles of persons with type 2 diabetes. Materials and Methods: This cross-over randomized controlled clinical trial was conducted on 48 persons with type 2 diabetes. Participants were randomly assigned to receive either 10 g/day purslane seeds with 240 cc low-fat yogurt (intervention group) or only 240 cc low-fat yogurt (as a control group) for 5 weeks. After a 2-week washout period, subjects were moved to the alternate arm for an additional 5 weeks. At baseline and end of each phase of the study, fasting blood samples were collected to quantify plasma glucose levels, as well as serum insulin and lipid profiles. Within-group and between-group changes in anthropometric measures, as well as biochemical indicators, were compared using a paired-samples t-test. Results: Mean age of study participants was 51.4 ± 6.0 year. We found a significant reduction in weight (−0.57 vs. 0.09 kg, P = 0.003) and body mass index (−0.23 vs. 0.02 kg/m2, P = 0.004) following purslane seeds consumption. Despite a slight reduction in fasting plasma glucose levels (−2.10 vs. −2.77 mg/dL, P = 0.90), we failed to find any significant effect on serum insulin levels and homeostatic model of assessment of insulin resistance score. Furthermore, purslane consumption decreased serum triglyceride levels (−25.5 vs. −1.8 mg/dL, P = 0.04) but could not affect serum high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol levels. We observed a significant reduction in systolic blood pressure (−3.33 vs. 0.5 mmHg, P = 0.01) and a borderline significant decrease in diastolic blood pressure (−3.12 vs. −0.93 mmHg, P = 0.09) after purslane seeds intake. Conclusion: In summary, consumption of purslane

  20. Purpose plus: supporting youth purpose, control, and academic achievement.

    PubMed

    Pizzolato, Jane Elizabeth; Brown, Elizabeth Levine; Kanny, Mary Allison

    2011-01-01

    Research in the past decade suggests that a persistent achievement gap between students from low-income minority backgrounds and higher-income white backgrounds may be rooted in theories of student motivation and youth purpose. Yet limited research exists regarding the role of purpose on positive youth development as it pertains to academic achievement. Using a sample of 209 high school students, this study examines the effectiveness of an intervention designed to promote purpose development and internal control over academic success in high school students from a low-socioeconomic-status community. Findings reveal that a short-term intervention was effective in significantly increasing internal control over academic success and purpose in life for students participating in the intervention group. In addition, analysis of academic achievement for students who experienced positive gains in internal control and purpose demonstrates significant gains in academic achievement as measured by grade point average. Implications are made for further study of internal control and life purpose as a means of academic intervention in the effort to address the achievement gap. PMID:22275280

  1. Relationship between adherence to diet, glycemic control and cardiovascular risk factors in patients with type 1 diabetes: a nationwide survey in Brazil

    PubMed Central

    2014-01-01

    Background To determine the relationship between adherence to the diet reported by patients with type 1 diabetes under routine clinical care in Brazil, and demographic, socioeconomic status, glycemic control and cardiovascular risk factors. Methods This was a cross-sectional, multicenter study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. The data was obtained from 3,180 patients, aged 22 ± 11.8 years (56.3% females, 57.4% Caucasians and 43.6% non-Caucasians). The mean time since diabetes diagnosis was 11.7 ± 8.1 years. Results Overall, 1,722 (54.2%) of the patients reported to be adherent to the diet without difference in gender, duration of diabetes and socioeconomic status. Patients who reported adherence to the diet had lower BMI, HbA1c, triglycerides, LDL-cholesterol, non HDL-cholesterol and diastolic blood pressure and had more HbA1c at goal, performed more frequently self-monitoring of blood glucose (p < 0.001), and reported less difficulties to follow specific schedules of diet plans (p < 0.001). Less patients who reported to be adherent were obese or overweight (p = 0.005). The quantity of food and time schedule of the meals were the most frequent complaints. Logistic regression analysis showed that ethnicity, (Caucasians, (OR 1.26 [1.09-1.47]), number of medical clinical visits in the last year (OR 1.10 [1.06-1.15]), carbohydrate counting, (OR 2.22 [1.49-3.30]) and diets recommended by diabetes societies’, (OR 1.57 [1.02-2.41]) were related to greater patients’ adherence (p < 0.05) and age, [adolescents (OR 0.60 [0.50-0.72]), high BMI (OR 0.58 [0.94-0.98]) and smoking (OR 0.58 [0.41-0.84]) with poor patients’ adherence (p < 0.01). Conclusions Our results suggest that it is necessary to rethink medical nutrition therapy in order to help patients to overcome barriers that impair an optimized adherence to the diet. PMID:24607084

  2. Glycemic load effect on fasting and post-prandial serum glucose, insulin, IGF-1 and IGFBP-3 in a randomized, controlled feeding study

    PubMed Central

    Runchey, Shauna S.; Pollak, Michael N.; Valsta, Liisa M.; Coronado, Gloria D.; Schwarz, Yvonne; Breymeyer, Kara L.; Wang, Chiachi; Wang, Ching-Yun; Lampe, Johanna W.; Neuhouser, Marian L.

    2012-01-01

    Background/Objectives The effect of a low glycemic load (GL) diet on insulin-like growth factor-1 (IGF-1) concentration is still unknown but may contribute to lower chronic disease risk. We aimed to assess the impact of GL on concentrations of IGF-1 and IGFBP-3. Subjects/Methods We conducted a randomized, controlled crossover feeding trial in 84 overweight-obese and normal weight healthy individuals using two 28-day weight-maintaining high- and low-GL diets. Measures were fasting and post-prandial concentrations of insulin, glucose, IGF-1 and IGFBP-3. 20 participants completed post-prandial testing by consuming a test breakfast at the end of each feeding period. We used paired t-tests for diet-component and linear mixed models for biomarker analyses. Results The 28-day low-GL diet led to 4% lower fasting concentrations of IGF-1 (10.6 ng/mL, p=0.04) and a 4% lower ratio of IGF-1/IGFBP-3 (0.24, p=0.01) compared to the high-GL diet. The low-GL test breakfast led to 43% and 27% lower mean post-prandial glucose and insulin responses, respectively; mean incremental areas under the curve for glucose and insulin, respectively, were 64.3±21.8 (mmol/L/240min) (p<0.01) and 2253±539 (μU/mL/240min) (p<0.01) lower following the low- compared to the high-GL test meal. There was no effect of GL on mean HOMA-IR or on mean integrated post-prandial concentrations of glucose-adjusted insulin, IGF-1 or IGFBP-3. We did not observe modification of the dietary effect by adiposity. Conclusions Low-GL diets resulted in 43% and 27% lower post-prandial responses of glucose and insulin, respectively, and modestly lower fasting IGF-1 concentrations. Further intervention studies are needed to weigh the impact of dietary GL on risk for chronic disease. PMID:22892437

  3. Evaluating Quality of Glycemic Control

    PubMed Central

    2014-01-01

    Background: There is need for readily understandable graphical displays of glucose data to facilitate interpretation by clinicians and researchers. Methods: (1) Display of the percentage of glucose values above a specified threshold for hyperglycemia (%High) versus percentage of glucose values below a specified threshold for hypoglycemia (%Low). If all glucose values fell within the target range, then all data points would fall at the origin. (2) After an intervention, one can plot the change in percentage of glucose values above a specified threshold for hyperglycemia versus the change in percentage of glucose values below a specified threshold defining hypoglycemia: The quadrants of this graph correspond to (a) increased risk of both hyper- and hypoglycemia, (b) decreased hyperglycemia but increased risk of hypoglycemia, (c) decreases in both hypo- and hyperglycemia, and (d) decreased hypoglycemia but increased hyperglycemia. (3) A 2-dimensional triangular graph can be used for simultaneous display of %High, %Low, and percentage in target range. (4) Display of risk of hyper- versus risk of hypoglycemia based on both frequency and severity of departures from the target range can be used. (5) Graphs (1) and (4) can also be presented using percentile scores relative to a reference population. (6) It is also useful to analyze %Hypoglycemia or risk of hypoglycemia versus mean glucose. Results: These methods are illustrated with examples from representative cases and shown to be feasible, practical, and informative. Conclusions: These new types of graphical displays can facilitate rapid analysis of risks of hypo- and hypoglycemia simultaneously and responses to therapeutic interventions for individuals or in clinical trials. PMID:25316714

  4. Children's Effortful Control and Academic Achievement: Mediation through Social Functioning

    ERIC Educational Resources Information Center

    Valiente, Carlos; Eisenberg, Nancy; Haugen, Rg; Spinrad, Tracy L.; Hofer, Claire; Liew, Jeffrey; Kupfer, Anne

    2011-01-01

    Research Findings: The purpose of this study was to test the premise that children's effortful control (EC) is prospectively related to their academic achievement and to specify mechanisms through which EC is related to academic success. We used data from 214 children (M age at Time 1 [T1] = 73 months) to test whether social functioning (e.g.,…

  5. Results of the Adequacy of glycemiC Control in pAtients with type 2 Diabetes mEllitus treated with Metformin monotherapY at the maximal-tolerated dose (ACCADEMY) study.

    PubMed

    Giorda, Carlo B; Cercone, Stefania; Nada, Elisa

    2016-06-01

    The treatment objective in diabetes is prevention of the onset or progression of complications. Intensive treatment reduces the risk of complications. The aim of the study was to evaluate glycemic control in patients with type 2 diabetes mellitus treated with metformin monotherapy at the maximal-tolerated dose. This retrospective, multicenter, observational study, enrolled patients ≥45-year old receiving metformin as monotherapy for at least 36 months. Data were collected on demographic and disease characteristics, clinical status, lifestyle, comorbidities, and diabetes complications at baseline, 9, 18, and 24 months. Primary study variables were percentage of patients achieving HbA1c <7 % and mean HbA1c reduction after 9 months. Eligible patients (n = 524, mean age 65.9 ± 7.9 years) had a mean age at diagnosis of 57.5 ± 7.9 years. A second antidiabetic drug was added in 24 % of patients (126/524); time to treatment escalation was 44.7 ± 25.1 months. Regarding primary study variables, 61.7 % of patients (322/522) achieved HbA1c of 7.0 % at 9 months, compared to 37.0 % of patients (194/524) at baseline; mean HbA1c was reduced from 7.30 ± 0.95 to 6.84 ± 0.86 % after 9 months. The estimated mean time of exposure above 7 % was 19 months, 15 months for patients ≥65-year old, and 21 months for younger patients. Regression analysis revealed that patients with longer disease duration, and patients <65-year old responded less well to metformin. A substantial number of patients continued to receive monotherapy instead of intensified therapy and were exposed to hyperglycemia. PMID:26275456

  6. The purposes, achievements, and priorities of arms control

    SciTech Connect

    Brown, P.S.

    1987-09-01

    Arms control purposes include strengthening the framework of deterrence and reducing the threat of the use of nuclear weapons, reducing the dangers of attack and accidental nuclear war, and allowing more resources for the civilian economy. The paper briefly describes achievements in arms control since World War II. These include the Limited Test Ban Treaty (LTBT), Nonproliferation Treaty (NPT), Anti-Ballistic Missile Treaty (ABMT)-SALT I, SALT II, Threshold Test Ban Treaty (TTBT), Peaceful Nuclear Explosions Treaty (PNET), and Nuclear-Free Zones treaties. The author also discusses his views on what the priorities of arms control activities should be. (ACR)

  7. GLYCEMIC INDEX, CHOLECYSTOKININ, SATIETY AND DISINHIBITION: IS THERE AN UNAPPRECIATED PARADOX FOR OVERWEIGHT WOMEN?

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The clinical utility of a low glycemic index (GI) diet for appetite and food intake control is controversial. Complicating the issue is psychological and behavioral influences related to eating. The aim of the present study was to investigate the satiety and glycemic response to high and low GI meal...

  8. Dulce Wireless Tijuana: A Randomized Control Trial Evaluating the Impact of Project Dulce and Short-Term Mobile Technology on Glycemic Control in a Family Medicine Clinic in Northern Mexico

    PubMed Central

    Contreras, Sonia; Vargas-Ojeda, Adriana; Menchaca-Díaz, Rufino; Fortmann, Addie; Philis-Tsimikas, Athena

    2016-01-01

    Abstract Background: The global epidemic of diabetes calls for innovative interventions. This study evaluated the effectiveness of the Project Dulce model, with and without wireless technology, on glycemic control and other clinical and self-reported outcomes in patients with poorly controlled type 2 diabetes in Mexico. Subjects and Methods: Adults with type 2 diabetes and a glycated hemoglobin A1c (HbA1c) level of ≥8% were recruited from Family Medical Unit #27 of the Instituto Mexicano del Seguro Social (IMSS) in Tijuana, México, and randomly assigned to one of three groups: Project Dulce–only (PD); Project Dulce technology-enhanced with mobile tools (PD-TE); or IMSS standard of care/control group (CG). Clinical and self-reported outcomes were assessed at baseline, Month 4, and Month 10. Time-by-group interactions and within-group changes were analyzed. Results: HbA1c reductions from baseline to Month 10 were significantly greater in PD-TE (−3.0% [−33 mmol/mol]) and PD (−2.6% [−28.7 mmol/mol]) compared with CG (−1.3% [−14.2 mmol/mol]) (P = 0.009 and 0.001, respectively). PD-TE and PD also exhibited significant improvement in diabetes knowledge when compared with CG (P < 0.05 for both). No statistically significant differences were detected between PD and PD-TE on these indicators (P = 0.54 and 0.86, respectively). Several within-group improvements were observed on other clinical and self-report indicators but did not vary significantly across groups. Conclusions: Project Dulce with and without wireless technology substantially improved glycemic control and diabetes knowledge in high-risk patients with type 2 diabetes in a Mexican family medical unit, suggesting that integrating peer-led education, nurse coordination, and 3G wireless technology is an effective approach for improving diabetes outcomes in high-risk populations. PMID:26914371

  9. Treatment With the Human Once-Weekly Glucagon-Like Peptide-1 Analog Taspoglutide in Combination With Metformin Improves Glycemic Control and Lowers Body Weight in Patients With Type 2 Diabetes Inadequately Controlled With Metformin Alone

    PubMed Central

    Nauck, Michael A.; Ratner, Robert E.; Kapitza, Christoph; Berria, Rachele; Boldrin, Mark; Balena, Raffaella

    2009-01-01

    OBJECTIVE To evaluate the efficacy and safety of taspoglutide (R1583/BIM51077), a human once-weekly glucagon-like peptide-1 analog, in patients with type 2 diabetes inadequately controlled with metformin. RESEARCH DESIGN AND METHODS Type 2 diabetic (n = 306) patients who failed to obtain glycemic control (A1C 7–9.5%) despite 1,500 mg metformin daily were randomly assigned to 8 weeks of double-blind subcutaneous treatment with placebo or taspoglutide, either 5, 10, or 20 mg once weekly or 10 or 20 mg once every 2 weeks, and followed for 4 additional weeks. All patients received their previously established dose of metformin throughout the study. Glycemic control was assessed by change in A1C (percent) from baseline. RESULTS Significantly greater (P < 0.0001) reductions in A1C from a mean ± SD baseline of 7.9 ± 0.7% were observed in all taspoglutide groups compared with placebo after 8 weeks of treatment: –1.0 ± 0.1% (5 mg once weekly), –1.2 ± 0.1% (10 mg once weekly), –1.2 ± 0.1% (20 mg once weekly), –0.9 ± 0.1% (10 mg Q2W), and –1.0 ± 0.1% (20 mg Q2W) vs. –0.2 ± 0.1% with placebo. After 8 weeks, body weight loss was significantly greater in the 10 mg (–2.1 ± 0.3 kg, P = 0.0035 vs. placebo) and 20 mg (–2.8 ± 0.3 kg, P < 0.0001) once-weekly groups and the 20 mg once every 2 weeks (–1.9 ± 0.3 kg, P = 0.0083) group than with placebo (–0.8 ± 0.3 kg). The most common adverse event was dose-dependent, transient, mild-to-moderate nausea; the incidence of hypoglycemia was very low. CONCLUSIONS Taspoglutide used in combination with metformin significantly improves fasting and postprandial glucose control and induces weight loss, with a favorable tolerability profile. PMID:19366970

  10. Glycemic and insulinemic responses to carbohydrate rich whole foods.

    PubMed

    Ray, Kasturi Sen; Singhania, Pooja Ratan

    2014-02-01

    Glycemic and insulinemic responses to food may depend on several intrinsic factors such as the type of sugar, molecular arrangement, size of starch granules, co-components in the whole food like moisture, fat, protein, fiber, as well as external factors like processing technique and total amount consumed. The postprandial glycemic response to equivalent quantities of test food and standard food is compared using Glycemic Index food (GI food). The incremental area under the curve for blood glucose and insulin at fasting, 30, 60, 90 and 120 min after consumption of different doses (50 and 100 g) of carbohydrate rich foods like rice and chapatti were compared with standard food, white bread. The GI food value for 50 g of chapatti and rice was 44 and 11 respectively. The Insulinemic Index food (II food) values, calculated similarly, for 50 g portion of chapatti and rice were 39 and 6 respectively. Glycemic and insulinemic response showed a dose dependent increase from 50 to 100 g. Both glycemic and insulinemic impact of chapatti were found to be significantly higher than that of rice (p < 0.05). The GI food and II food values will facilitate qualitative and quantitative judgment about the selection of specific foods for effective metabolic control. PMID:24493894

  11. Gender-specific Effects of Treatment with Lifestyle, Metformin or Sulfonylurea on Glycemic Control and Body Weight: A German Multicenter Analysis on 9 108 Patients.

    PubMed

    Schütt, M; Zimmermann, A; Hood, R; Hummel, M; Seufert, J; Siegel, E; Tytko, A; Holl, R W

    2015-11-01

    Effects of diabetes treatment are strongly connected to individual factors, but the relevant role of gender has not been addressed so far. This observational study evaluates whether monotherapy with lifestyle, metformin or sulfonylurea has gender-specific effects on glycemic control and/or body weight. Data of 9 108 patients with type 2 diabetes from 129 German diabetes centers were assessed by a standardized, prospective, computer-based diabetes care and outcome documentation system (DPV-Wiss-database; age 63.1±12.8 years, diabetes duration 5.7±7.4 years, HbA1c 55±17.7 mmol/mol [7.2±1.6%], BMI 30.6±6.1 kg/m(2), 49.3% female patients). Antidiabetic concepts included lifestyle intervention (n=5,787), metformin (n=2,180), sulfonylurea (n=943) or other antidiabetic drugs (n=198), respectively. HbA1c and body weight were compared before and after a stable monotherapeutical period of 0.8±0.4 years. Women had a significantly higher reduction of body weight after treatment with lifestyle (women-0.8±0.1 vs. men-0.2±0.1 kg; p<0.05), metformin (women-1.8±0.2 vs. men-1.2±0.2 kg; p<0.05) or sulfonylurea drugs (women-0.9±0.2 vs. men - 0.1±0.2 kg; p<0.05), whereas men displayed significantly higher HbA1c-reductions after treatment with lifestyle (women-6.9±0.2 mmol/mol [- 0.6±0.02%] vs. men-7.5±0.2 mmol/mol [0.7±0.02%]; p<0.05) and metformin only (women-6.3±0.3 mmol/mol [- 0.6±0.03%] vs. men - 7.4±0.3 mmol/mol [- 0.7±0.03%]; p<0.05). No differences were seen for sulfonylurea monotherapy concerning the HbA1c-reduction (women - 5.6±0.5 mmol/mol [- 0.5±0.05%] vs. men-6.4±0.4 mmol/mol [- 0.6±0.04%]; p=0.196). In summary, antidiabetic treatment concepts might result in gender-specific effects on body weight and HbA1c. Gender might therefore represent another important factor in the context of an individualized treatment management of type 2 diabetes. PMID:26285070

  12. The effects of the combination of egg and fiber on appetite, glycemic response and food intake in normal weight adults - a randomized, controlled, crossover trial.

    PubMed

    Bonnema, Angela L; Altschwager, Deena K; Thomas, William; Slavin, Joanne L

    2016-09-01

    This study evaluated appetite and glycemic effects of egg-based breakfasts, containing high and moderate protein (30 g protein and 20 g protein +7 g fiber, respectively) compared to a low-protein cereal breakfast (10 g protein) examined in healthy adults (N = 48; age 24 ± 1 yr; BMI 23 ± 1 kg/m(2); mean ± SE). Meals provided 390 kcal/serving and equal fat content. Food intake was measured at an ad libitum lunch meal and blood glucose response was measured. Visual analog scales (VAS) were used to assess hunger, satisfaction, fullness, and prospective food intake. The egg-based breakfast meal with high protein produced greater overall satiety (p < 0.0001), and both high protein and moderate protein with fiber egg-based breakfasts reduced postprandial glycemic response (p < 0.005) and food intake (p < 0.05) at subsequent meal (by 135 kcal and 69 kcal; effect sizes 0.44 and 0.23, respectively) compared to a cereal-based breakfast with low protein and fiber. PMID:27306734

  13. Effects of Korean White Ginseng (Panax Ginseng C.A. Meyer) on Vascular and Glycemic Health in Type 2 Diabetes: Results of a Randomized, Double Blind, Placebo-controlled, Multiple-crossover, Acute Dose Escalation Trial

    PubMed Central

    Shishtar, Esra'; Jovanovski, Elena; Jenkins, Alexandra

    2014-01-01

    Korean red ginseng (steam treated Panax ginseng C.A. Meyer), among most prized traditional herbal remedies, has been clinically shown to improve cardiovascular disease (CVD) risk factors. Whether this holds true for the dried non-steamed variety, known as Korean white ginseng (KWG) is unclear. This study therefore, investigated the efficacy and safety of escalating doses of KWG on vascular and glycemic parameters in type 2 diabetes (T2DM). Using an acute, randomized, placebo-controlled, double-blind, crossover design, 25 participants with well-controlled T2DM (12-males: 13-females, age: 63 ± 9 years, A1c: 6.9 ± 0.7%, BMI: 29.3 ± 4.3 kg/m2) underwent five visits during which they received 1 g, 3 g, or 6 g KWG or 3 g wheat-bran control (twice) together with 50 g-glucose load. For the duration of 240 minutes, augmentation index (AI), and central blood pressure were measured at baseline and at 60 min-intervals, and ambulatory blood pressure was assessed at baseline and at 10 min-intervals. Additionally, capillary blood was collected at time zero and at 15, 30, 45, 60, 90, 120, and 180 minutes post-treatment. A symptoms questionnaire was used to assess safety and adverse events. Two-way ANOVA demonstrated a significant time-treatment interaction effect on AI (p = 0.01) with one-way ANOVA showing significant reductions in AI with 3 g KWG relative to control (p = 0.04). Compared to control, acute administration of KWG appeared to be safe, but did not affect any other postprandial, vascular or glycemic parameters. KWG might have a beneficial effect on AI, a cumulative indicator of arterial health. However, these results are preliminary and highlight the need for long-term investigation with a focus on its accountable components. Clinical Trial Registration: NCT01699074 PMID:25136536

  14. Glycemic Variability and Diabetes Complications: Does It Matter? Simply Put, There Are Better Glycemic Markers!

    PubMed

    Bergenstal, Richard M

    2015-08-01

    There is no argument that improving mean levels of glycemic control as judged by assays for glycated hemoglobin (HbA(1c)) reduces the risks of microvascular complications and cardiovascular disease events in patients with type 1 and type 2 diabetes. However, observations in some trials have suggested that targeting HbA(1c) to suggested targets may not always result in improved outcomes for people with long-standing type 2 diabetes. The reasons why the glycemic control strategies that primarily use HbA(1c) in these studies did not have predicted outcomes are not clear. Thus, controversy remains as to whether there are glycemic metrics beyond HbA(1c) that can be defined as effective measures that can be used in addition to HbA(1c) to help in assessing the risk of an individual developing diabetes complications. In this regard, the concept of "glycemic variability" (GV) is one metric that has attracted a lot of attention. GV can be simply defined as the degree to which a patient's blood glucose level fluctuates between high (peaks) and low (nadir) levels. The best and most precise way to assess GV is also one that is still debated. Thus, while there is universal agreement that HbA(1c) is the current gold standard for the primary clinical target, there is no consensus as to whether other proposed glycemic metrics hold promise to provide additional clinical data or whether there should be additional targets beyond HbA(1c). Therefore, given the current controversy, we provide a Point-Counterpoint debate on this issue. In the preceding point narrative, Dr. Hirsch provides his argument that fluctuations in blood glucose as assessed by GV metrics are deleterious and control of GV should be a primary treatment target. In the counterpoint narrative below, Dr. Bergenstal argues that there are better markers to assess the risk of diabetes than GV and provides his consideration of other concepts. PMID:26207055

  15. [Glycemic targets and cardiovascular morbi-mortality].

    PubMed

    Bordier, Lyse; Bauduceau, Bernard

    2013-05-01

    The 2008-year was full of learning experience and suspense in diabetologia. The past studies, UKPDS in type 2 diabetic patients and DCCT in type 1 diabetic patients have shown that intensive treatment during a short period did reduce the incidence of microvascular events and in the long term, the incidence of macrovascular events linked to diabetes. The conclusions of recent studies quote, from ACCORD, an increased mortality in the type 2 diabetic patients using intensive therapy, from ADVANCE, a reduction of microvascular complications and from VADT, no effect. The analysis of studies published since 2008 brings lessons for the clinical practice: presence of glycemic memory, absence of tensional memory, usefulness of control of every cardiovascular risk factors, need of early treatment of diabetes. Moreover, to define HbA1c objective, age, duration of diabetes, presence of cardiovascular risk factors, former HbA1c level and potential undesirable effects, such hypoglycaemia, must be considered. The management of type 2 diabetic patients requires an early, not to quick intensive treatment, which avoids hypoglycaemia and is combined with a strict control of cardiovascular risk factors. So, the recent position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consideres needs and preferences of each patient and individualizes glycemic targets and treatments. PMID:23286961

  16. Glycemic targets in hospital and barriers to attaining them.

    PubMed

    Miller, David B

    2014-04-01

    The importance of glycemic control in hospitalized patients has been a relatively recent revelation. There is somewhat contradictory evidence concerning the optimal glycemic target in critically ill patients. There is only indirect evidence in non-critically ill patients. This article reviews the evidence for glycemic targets in hospitalized patients. It also investigates which hospital-based treatments can act as barriers to attaining optimal blood glucose levels in hospital and system barriers to attaining those optimal levels. The systematic approach to and evaluation of in-hospital diabetes management has a short history. The first large clinical trial, the DIGAMI trial of peri-myocardial infarction insulin therapy, was published in 1995 (1). The first guideline discussion of in-hospital diabetes management occurred briefly in 2003, more fully in 2008 and 2013 (2-4) by the Canadian Diabetes Association; in 2005 and annually since then by the American Diabetes Association (5,6). Recently, there have been many more publications on the topic. A recent PubMed search, limited to the last 5 years, "hospital" and "diabetes" as a Medical Subject Headings (MeSH) major topic, revealed more than 5000 English-language clinical trials (PubMed.gov; accessed 6 Oct 2013). Still, relatively little is certain about appropriate glycemic targets in hospital. This has left us, in 2014, with consensus recommendations only for glycemic targets in non-critically ill patients from both the Canadian Diabetes Association Clinical Practice Guidelines (4) and the American Diabetes Association Standards of Medical Care in Diabetes (6). This article reviews recommended glycemic targets in various in-hospital populations and the barriers to obtaining them. PMID:24690500

  17. A pilot study examining the effects of consuming a high-protein vs normal-protein breakfast on free-living glycemic control in overweight/obese 'breakfast skipping' adolescents.

    PubMed

    Bauer, L B; Reynolds, L J; Douglas, S M; Kearney, M L; Hoertel, H A; Shafer, R S; Thyfault, J P; Leidy, H J

    2015-09-01

    To examine whether the daily consumption of normal-protein (NP) vs higher-protein (HP) breakfasts improve free-living glycemic control in overweight/obese, 'breakfast skipping' adolescents. Twenty-eight healthy, but overweight, teens (age: 19±1 year; BMI: 29.9±0.8 kg m(-2)) completed a 12-week randomized parallel-arm study in which the adolescents consumed either a 350 kcal NP breakfast (13 g protein) or HP breakfast (35 g protein). Pre- and post-study 24-h blood glucose measures were assessed using continuous glucose monitoring. Although no main effects of time or group were detected, time by group interactions were observed. Post hoc pairwise comparisons assessing the post-pre changes revealed that the daily consumption of the HP breakfasts tended to reduce the 24-h glucose variability (s.d.) vs NP (-0.17±0.09 vs +0.09±0.10 s.d.; P=0.06) and tended to reduce the time spent above the high glucose limit (-292±118 vs -24±80 min; P=0.09). The consumption of the HP breakfasts also reduced the 24-h maximal (peak) glucose response (-0.94±0.36 vs +0.30±0.18 mmol l(-1); P<0.01) and reduced postprandial glucose fluctuations (-0.88±0.44 vs +0.49±0.34 mmol l(-1); P<0.03) vs NP. These data suggest that the daily addition of a HP breakfast, containing 35 g of high-quality protein, has better efficacy at improving free-living glycemic control compared with a NP breakfast in overweight/obese, but otherwise healthy, 'breakfast skipping' adolescents. PMID:26028058

  18. Parental Behavioural Control and Academic Achievement: Striking the Balance between Control and Involvement

    ERIC Educational Resources Information Center

    Kramer, Karen Z.

    2012-01-01

    Using a longitudinal US dataset (N = 6,134) we examine the relationship between parental behavioural control and academic achievement and explore the moderating role of parental involvement and parental warmth. Analyses using multiple hierarchical regression with clustering controls shows that parental behavioural control is negatively associated…

  19. Effect of Probiotic Fermented Milk (Kefir) on Glycemic Control and Lipid Profile In Type 2 Diabetic Patients: A Randomized Double-Blind Placebo-Controlled Clinical Trial

    PubMed Central

    OSTADRAHIMI, Alireza; TAGHIZADEH, Akbar; MOBASSERI, Majid; FARRIN, Nazila; PAYAHOO, Laleh; BEYRAMALIPOOR GHESHLAGHI, Zahra; VAHEDJABBARI, Morteza

    2015-01-01

    Background: Diabetes is a global health problem in the world. Probiotic food has anti-diabetic property. The aim of this trial was to determine the effect of probiotic fermented milk (kefir) on glucose and lipid profile control in patients with type 2 diabetes mellitus. Methods: This randomized double-blind placebo-controlled clinical trial was conducted on 60 diabetic patients aged 35 to 65 years.Patients were randomly and equally (n=30) assigned to consume either probiotic fermented milk (kefir) or conventional fermented milk (dough) for 8 weeks. Probiotic group consumed 600 ml/day probiotic fermented milk containing Lactobacillus casei, Lactobacillus acidophilus and Bifidobacteria and control group consumed 600 ml/day conventional fermented milk.Blood samples tested for fasting blood glucose, HbA1C, triglyceride (TG), total cholesterol, HDL-C and LDL-C at the baseline and end of the study. Results: The comparison of fasting blood glucose between two groups after intervention was statistically significant (P=0.01). After intervention, reduced HbA1C compared with the baseline value in probiotic fermented milk group was statistically significant (P=0.001), also the HbA1C level significantly decreased in probiotic group in comparison with control group (P=0.02) adjusting for serum levels of glucose, baseline values of HbA1c and energy intake according to ANCOVA model. Serum triglyceride, total cholesterol, LDL-cholesterol and HDL- cholesterol levels were not shown significant differences between and within the groups after intervention. Conclusion: Probiotic fermented milk can be useful as a complementary or adjuvant therapy in the treatment of diabetes. PMID:25905057

  20. Effects of a Multicomponent Life-Style Intervention on Weight, Glycemic Control, Depressive Symptoms, and Renal Function in Low-Income, Minority Patients With Type 2 Diabetes: Results of the Community Approach to Lifestyle Modification for Diabetes Randomized Controlled Trial

    PubMed Central

    Moncrieft, Ashley E.; Llabre, Maria M.; McCalla, Judith Rey; Gutt, Miriam; Mendez, Armando J.; Gellman, Marc D.; Goldberg, Ronald B.; Schneiderman, Neil

    2016-01-01

    ABSTRACT Objective Few interventions have combined life-style and psychosocial approaches in the context of Type 2 diabetes management. The purpose of this study was to determine the effect of a multicomponent behavioral intervention on weight, glycemic control, renal function, and depressive symptoms in a sample of overweight/obese adults with Type 2 diabetes and marked depressive symptoms. Methods A sample of 111 adults with Type 2 diabetes were randomly assigned to a 1-year intervention (n = 57) or usual care (n = 54) in a parallel groups design. Primary outcomes included weight, glycosylated hemoglobin, and Beck Depression Inventory II score. Estimated glomerular filtration rate served as a secondary outcome. All measures were assessed at baseline and 6 and 12 months after randomization by assessors blind to randomization. Latent growth modeling was used to examine intervention effects on each outcome. Results The intervention resulted in decreased weight (mean [M] = 0.322 kg, standard error [SE] = 0.124 kg, p = .010) and glycosylated hemoglobin (M = 0.066%, SE = 0.028%, p = .017), and Beck Depression Inventory II scores (M = 1.009, SE = 0.226, p < .001), and improved estimated glomerular filtration rate (M = 0.742 ml·min−1·1.73 m−2, SE = 0.318 ml·min−1·1.73 m−2, p = .020) each month during the first 6 months relative to usual care. Conclusions Multicomponent behavioral interventions targeting weight loss and depressive symptoms as well as diet and physical activity are efficacious in the management of Type 2 diabetes. Trial Registration: This study is registered at Clinicaltrials.gov ID: NCT01739205. PMID:27359176

  1. Does a patient-managed insulin intensification strategy with insulin glargine and insulin glulisine provide similar glycemic control as a physician-managed strategy? Results of the START (Self-Titration With Apidra to Reach Target) Study: a randomized noninferiority trial.

    PubMed

    Harris, Stewart B; Yale, Jean-François; Berard, Lori; Stewart, John; Abbaszadeh, Babak; Webster-Bogaert, Susan; Gerstein, Hertzel C

    2014-01-01

    OBJECTIVE Diabetes self-management is universally regarded as a foundation of diabetes care. We determined whether comparable glycemic control could be achieved by self-titration versus physician titration of a once-daily bolus insulin dose in patients with type 2 diabetes who are unable to achieve optimal glycemia control with a basal insulin. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes, an HbA1c level >7% (53 mmol/mol), and either nocturnal hypoglycemia episodes or an insufficient basal insulin glargine level (with or without oral agents) to achieve a fasting plasma glucose level ≤6 mmol/L (108 mg/dL) were studied. Participants all had bolus insulin glulisine added at breakfast and were allocated to either algorithm-guided patient self-titration or physician titration. The primary outcome was an HbA1c level ≤7% (53 mmol/mol) without severe hypoglycemia. RESULTS After a mean (SD) follow-up of 159.4 days (36.2 days), 28.4% of participants in the self-titration arm vs. 21.2% in the physician titration arm achieved an HbA1c level of ≤7% (53 mmol/mol) without severe hypoglycemia (between-group absolute difference 7.2%; 95% CI -3.2 to 17.7). The lower end of this 95% confidence interval was within the predetermined noninferiority boundary of -5% (P noninferiority = 0.011). CONCLUSIONS In stable patients with type 2 diabetes who are receiving doses of basal insulin glargine who require bolus insulin, a simple bolus insulin patient-managed titration algorithm is as effective as a physician-managed algorithm. PMID:24170757

  2. Method of achieving the controlled release of thermonuclear energy

    DOEpatents

    Brueckner, Keith A.

    1986-01-01

    A method of achieving the controlled release of thermonuclear energy by illuminating a minute, solid density, hollow shell of a mixture of material such as deuterium and tritium with a high intensity, uniformly converging laser wave to effect an extremely rapid build-up of energy in inwardly traveling shock waves to implode the shell creating thermonuclear conditions causing a reaction of deuterons and tritons and a resultant high energy thermonuclear burn. Utilizing the resulting energy as a thermal source and to breed tritium or plutonium. The invention also contemplates a laser source wherein the flux level is increased with time to reduce the initial shock heating of fuel and provide maximum compression after implosion; and, in addition, computations and an equation are provided to enable the selection of a design having a high degree of stability and a dependable fusion performance by establishing a proper relationship between the laser energy input and the size and character of the selected material for the fusion capsule.

  3. Long–Term Effects of Energy-Restricted Diets Differing in Glycemic Load on Metabolic Adaptation and Body Composition

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A randomized controlled trial of high glycemic load (HG) and low glycemic load (LG) diets with food provided for 6 months and self-administered for 6 additional months at 30% caloric restriction (CR) was performed in 29 overweight adults (mean+/-SD, age 35+/-5y; BMI 27.5+/-1.5 kg/m2). Total energy e...

  4. Preserved Insulin Secretory Capacity and Weight Loss Are the Predominant Predictors of Glycemic Control in Patients With Type 2 Diabetes Randomized to Roux-en-Y Gastric Bypass.

    PubMed

    Nguyen, Kim T; Billington, Charles J; Vella, Adrian; Wang, Qi; Ahmed, Leaque; Bantle, John P; Bessler, Marc; Connett, John E; Inabnet, William B; Thomas, Avis; Ikramuddin, Sayeed; Korner, Judith

    2015-09-01

    Improvement in type 2 diabetes after Roux-en-Y gastric bypass (RYGB) has been attributed partly to weight loss, but mechanisms beyond weight loss remain unclear. We performed an ancillary study to the Diabetes Surgery Study to assess changes in incretins, insulin sensitivity, and secretion 1 year after randomization to lifestyle modification and intensive medical management (LS/IMM) alone (n = 34) or in conjunction with RYGB (n = 34). The RYGB group lost more weight and had greater improvement in HbA1c. Fasting glucose was lower after RYGB than after LS/IMM, although the glucose area under the curve decreased comparably for both groups. Insulin sensitivity increased in both groups. Insulin secretion was unchanged after LS/IMM but decreased after RYGB, except for a rapid increase during the first 30 min after meal ingestion. Glucagon-like peptide 1 (GLP-1) was substantially increased after RYGB, while gastric inhibitory polypeptide and glucagon decreased. Lower HbA1c was most strongly correlated with the percentage of weight loss for both groups. At baseline, a greater C-peptide index and 90-min postprandial C-peptide level were predictive of lower HbA1c at 1 year after RYGB. β-Cell glucose sensitivity, which improved only after RYGB, and improved disposition index were associated with lower HbA1c in both groups, independent of weight loss. Weight loss and preserved β-cell function both predominantly determine the greatest glycemic benefit after RYGB. PMID:25901097

  5. Malaria in Turkey: successful control and strategies for achieving elimination.

    PubMed

    Özbilgina, Ahmet; Topluoglu, Seher; Es, Saffet; Islek, Elif; Mollahaliloglu, Salih; Erkoc, Yasin

    2011-01-01

    Turkey is located in the middle of Asia, Africa and Europe, close to Caucasia, Balkans and Middle East in subtropical climate zone. Malaria has been known since the early ages of human history and it was one of the leading diseases in Anatolian history, as well. Today, chloroquine-sensitive Plasmodium vivax is the only agent of autochthonous malaria cases in Turkey. The other Plasmodium species identified are isolated from imported cases of malaria. The most common vector of malaria in Turkey is Anopheles sacharovi followed by An. superpictus, An. maculipennis and An. subalpinus. In 2009, pre-elimination stage of Malaria Program was started due to dramatic decline in the number of malaria cases in Turkey (Total, 84; 38 autochthonous cases only in 26 foci in south-eastern Anatolia, and 46 imported cases; incidence: 0.1/100,000). As there were no detected cases of new autochthonous malaria in the first 8 months of 2010, elimination stage was started. The role of the persistent policies and successful applications of the Ministry of Health, such as the strict control of the patients using anti-malarial drugs especially chloroquine, avoidance of resistant insecticides, facilitation of access to patients via Health Transformation Program (HTP), establishment of close contact with the patients' families, and improvement of reporting and surveillance system, was essential. In addition, improvement maintained in the motivations and professional rights of malaria workers, as well in the coordination of field studies and maintenance of a decline or termination in vector-to-person transmission were all achieved with the insistent policies of the Ministry of Health. Other factors that probably contributed to elimination studies include lessening of military operations in south-eastern Anatolia and the lowering of malaria cases in neighbouring countries in recent years. Free access to health services concerning malaria is still successfully conducted throughout the country

  6. Epigenetic Changes in Endothelial Progenitors as a Possible Cellular Basis for Glycemic Memory in Diabetic Vascular Complications

    PubMed Central

    Rajasekar, Poojitha; O'Neill, Christina L.; Eeles, Lydia; Stitt, Alan W.; Medina, Reinhold J.

    2015-01-01

    The vascular complications of diabetes significantly impact the quality of life and mortality in diabetic patients. Extensive evidence from various human clinical trials has clearly established that a period of poor glycemic control early in the disease process carries negative consequences, such as an increase in the development and progression of vascular complications that becomes evident many years later. Importantly, intensive glycemic control established later in the disease process cannot reverse or slow down the onset or progression of diabetic vasculopathy. This has been named the glycemic memory phenomenon. Scientists have successfully modelled glycemic memory using various in vitro and in vivo systems. This review emphasizes that oxidative stress and accumulation of advanced glycation end products are key factors driving glycemic memory in endothelial cells. Furthermore, various epigenetic marks have been proposed to closely associate with vascular glycemic memory. In addition, we comment on the importance of endothelial progenitors and their role as endogenous vasoreparative cells that are negatively impacted by the diabetic milieu and may constitute a “carrier” of glycemic memory. Considering the potential of endothelial progenitor-based cytotherapies, future studies on their glycemic memory are warranted to develop epigenetics-based therapeutics targeting diabetic vascular complications. PMID:26106624

  7. Glycemic Index, Glycemic Load, Carbohydrates, and Type 2 Diabetes

    PubMed Central

    Greenwood, Darren C.; Threapleton, Diane E.; Evans, Charlotte E.L.; Cleghorn, Christine L.; Nykjaer, Camilla; Woodhead, Charlotte; Burley, Victoria J.

    2013-01-01

    OBJECTIVE Diets with high glycemic index (GI), with high glycemic load (GL), or high in all carbohydrates may predispose to higher blood glucose and insulin concentrations, glucose intolerance, and risk of type 2 diabetes. We aimed to conduct a systematic literature review and dose–response meta-analysis of evidence from prospective cohorts. RESEARCH DESIGN AND METHODS We searched the Cochrane Library, MEDLINE, MEDLINE in-process, Embase, CAB Abstracts, ISI Web of Science, and BIOSIS for prospective studies of GI, GL, and total carbohydrates in relation to risk of type 2 diabetes up to 17 July 2012. Data were extracted from 24 publications on 21 cohort studies. Studies using different exposure categories were combined on the same scale using linear and nonlinear dose–response trends. Summary relative risks (RRs) were estimated using random-effects meta-analysis. RESULTS The summary RR was 1.08 per 5 GI units (95% CI 1.02–1.15; P = 0.01), 1.03 per 20 GL units (95% CI 1.00–1.05; P = 0.02), and 0.97 per 50 g/day of carbohydrate (95% CI 0.90–1.06; P = 0.5). Dose–response trends were linear for GI and GL but more complex for total carbohydrate intake. Heterogeneity was high for all exposures (I2 >50%), partly accounted for by different covariate adjustment and length of follow-up. CONCLUSIONS Included studies were observational and should be interpreted cautiously. However, our findings are consistent with protective effects of low dietary GI and GL, quantifying the range of intakes associated with lower risk. Future research could focus on the type of sugars and other carbohydrates associated with greatest risk. PMID:24265366

  8. Self-Esteem, Locus of Control, and Student Achievement.

    ERIC Educational Resources Information Center

    Sterbin, Allan; Rakow, Ernest

    The direct effects of locus of control and self-esteem on standardized test scores were studied. The relationships among the standardized test scores and measures of locus of control and self-esteem for 12,260 students from the National Education Longitudinal Study 1994 database were examined, using the same definition of locus of control and…

  9. Concurrently adjusting interrelated control parameters to achieve optimal engine performance

    DOEpatents

    Jiang, Li; Lee, Donghoon; Yilmaz, Hakan; Stefanopoulou, Anna

    2015-12-01

    Methods and systems for real-time engine control optimization are provided. A value of an engine performance variable is determined, a value of a first operating condition and a value of a second operating condition of a vehicle engine are detected, and initial values for a first engine control parameter and a second engine control parameter are determined based on the detected first operating condition and the detected second operating condition. The initial values for the first engine control parameter and the second engine control parameter are adjusted based on the determined value of the engine performance variable to cause the engine performance variable to approach a target engine performance variable. In order to cause the engine performance variable to approach the target engine performance variable, adjusting the initial value for the first engine control parameter necessitates a corresponding adjustment of the initial value for the second engine control parameter.

  10. Purpose Plus: Supporting Youth Purpose, Control, and Academic Achievement

    ERIC Educational Resources Information Center

    Pizzolato, Jane Elizabeth; Brown, Elizabeth Levine; Kanny, Mary Allison

    2011-01-01

    Research in the past decade suggests that a persistent achievement gap between students from low-income minority backgrounds and higher-income white backgrounds may be rooted in theories of student motivation and youth purpose. Yet limited research exists regarding the role of purpose on positive youth development as it pertains to academic…

  11. Controlling open quantum systems: tools, achievements, and limitations

    NASA Astrophysics Data System (ADS)

    Koch, Christiane P.

    2016-06-01

    The advent of quantum devices, which exploit the two essential elements of quantum physics, coherence and entanglement, has sparked renewed interest in the control of open quantum systems. Successful implementations face the challenge of preserving relevant nonclassical features at the level of device operation. A major obstacle is decoherence, which is caused by interaction with the environment. Optimal control theory is a tool that can be used to identify control strategies in the presence of decoherence. Here we review recent advances in optimal control methodology that allow typical tasks in device operation for open quantum systems to be tackled and discuss examples of relaxation-optimized dynamics. Optimal control theory is also a useful tool to exploit the environment for control. We discuss examples and point out possible future extensions.

  12. Controlling open quantum systems: tools, achievements, and limitations.

    PubMed

    Koch, Christiane P

    2016-06-01

    The advent of quantum devices, which exploit the two essential elements of quantum physics, coherence and entanglement, has sparked renewed interest in the control of open quantum systems. Successful implementations face the challenge of preserving relevant nonclassical features at the level of device operation. A major obstacle is decoherence, which is caused by interaction with the environment. Optimal control theory is a tool that can be used to identify control strategies in the presence of decoherence. Here we review recent advances in optimal control methodology that allow typical tasks in device operation for open quantum systems to be tackled and discuss examples of relaxation-optimized dynamics. Optimal control theory is also a useful tool to exploit the environment for control. We discuss examples and point out possible future extensions. PMID:27143501

  13. Postprandial Hyperglycemia and Glycemic Variability

    PubMed Central

    Standl, Eberhard; Schnell, Oliver; Ceriello, Antonio

    2011-01-01

    The aim of this article is to evaluate the pros and cons of a specific impact of postprandial hyperglycemia and glycemic variability on the—mainly cardiovascular (CV)—complications of diabetes, above and beyond the average blood glucose (BG) as measured by HbA1c or fasting plasma glucose (FPG). The strongest arguments in favor of this hypothesis come from impressive pathophysiological studies, also in the human situation. Measures of oxidative stress and endothelial dysfunction seem to be especially closely related to glucose peaks and even more so to fluctuating high and low glucose concentrations and can be restored to normal by preventing those glucose peaks or wide glucose excursions. The epidemiological evidence, which is more or less confined to postprandial hyperglycemia and postglucose load glycemia, is also rather compelling in favor of the hypothesis, although certainly not fully conclusive as there are also a number of conflicting results. The strongest cons are seen in the missing evidence as derived from randomized prospective intervention studies targeting postprandial hyperglycemia longer term, i.e., over several years, and seeking to reduce hard CV end points. In fact, several such intervention studies in men have recently failed to produce the intended beneficial outcome results. As this evidence by intervention is, however, key for the ultimate approval of a treatment concept in patients with diabetes, the current net balance of attained evidence is not in favor of the hypothesis here under debate, i.e., that we should care about postprandial hyperglycemia and glycemic variability. The absence of a uniformly accepted standard of how to estimate these parameters adds a further challenge to this whole debate. PMID:21525442

  14. Genetic Risk Score Modelling for Disease Progression in New-Onset Type 1 Diabetes Patients: Increased Genetic Load of Islet-Expressed and Cytokine-Regulated Candidate Genes Predicts Poorer Glycemic Control.

    PubMed

    Brorsson, Caroline A; Nielsen, Lotte B; Andersen, Marie Louise; Kaur, Simranjeet; Bergholdt, Regine; Hansen, Lars; Mortensen, Henrik B; Pociot, Flemming; Størling, Joachim

    2016-01-01

    Genome-wide association studies (GWAS) have identified over 40 type 1 diabetes risk loci. The clinical impact of these loci on β-cell function during disease progression is unknown. We aimed at testing whether a genetic risk score could predict glycemic control and residual β-cell function in type 1 diabetes (T1D). As gene expression may represent an intermediate phenotype between genetic variation and disease, we hypothesized that genes within T1D loci which are expressed in islets and transcriptionally regulated by proinflammatory cytokines would be the best predictors of disease progression. Two-thirds of 46 GWAS candidate genes examined were expressed in human islets, and 11 of these significantly changed expression levels following exposure to proinflammatory cytokines (IL-1β + IFNγ + TNFα) for 48 h. Using the GWAS single nucleotide polymorphisms (SNPs) from each locus, we constructed a genetic risk score based on the cumulative number of risk alleles carried in children with newly diagnosed T1D. With each additional risk allele carried, HbA1c levels increased significantly within first year after diagnosis. Network and gene ontology (GO) analyses revealed that several of the 11 candidate genes have overlapping biological functions and interact in a common network. Our results may help predict disease progression in newly diagnosed children with T1D which can be exploited for optimizing treatment. PMID:26904692

  15. Relation of Dietary Glycemic Index and Glycemic Load to Coronary Artery Calcium in Asymptomatic Korean Adults.

    PubMed

    Choi, Yuni; Chang, Yoosoo; Ryu, Seungho; Cho, Juhee; Kim, Mi Kyung; Ahn, Younjhin; Lee, Jung Eun; Sung, Eunju; Kim, Boyoung; Ahn, Jiin; Kim, Chan-Won; Rampal, Sanjay; Zhao, Di; Zhang, Yiyi; Pastor-Barriuso, Roberto; Lima, Joao A C; Chung, Eun Chul; Shin, Hocheol; Guallar, Eliseo

    2015-08-15

    The relation between glycemic index, glycemic load, and subclinical coronary atherosclerosis is unknown. The aim of the study was to evaluate the associations between energy-adjusted glycemic index, glycemic load, and coronary artery calcium (CAC). This study was cross-sectional analysis of 28,429 asymptomatic Korean men and women (mean age 41.4 years) without a history of diabetes or cardiovascular disease. All participants underwent a health screening examination between March 2011 and April 2013, and dietary intake over the preceding year was estimated using a validated food frequency questionnaire. Cardiac computed tomography was used for CAC scoring. The prevalence of detectable CAC (CAC score >0) was 12.4%. In multivariable-adjusted models, the CAC score ratios (95% confidence intervals) comparing the highest to the lowest quintile of glycemic index and glycemic load were 1.74 (1.08 to 2.81; p trend = 0.03) and 3.04 (1.43 to 6.46; p trend = 0.005), respectively. These associations did not differ by clinical subgroups, including the participants at low cardiovascular risk. In conclusion, these findings suggest that high dietary glycemic index and glycemic load were associated with a greater prevalence and degree of CAC, with glycemic load having a stronger association. PMID:26073677

  16. Achieving process control through improved grinding techniques for ferrite materials

    SciTech Connect

    Bruce, J.

    1995-09-01

    In manufacturing soft ferrite materials the particle size of the raw material has a significant impact on the reactivity of calcination. The control of particle size distribution and final formulation at wet milling after calcining impacts the reactivity during sintering and the magnetic properties of the final product. This paper will deal with steps taken to improve process control during the grinding operations of raw material and calcine in soft ferrite production. Equipment modifications as well as changes to the grinding and material handling techniques will be included. All examples of process control and improvements will be supported by data.

  17. Debris control design achievements of the booster separation motors

    NASA Technical Reports Server (NTRS)

    Smith, G. W.; Chase, C. A.

    1985-01-01

    The stringent debris control requirements imposed on the design of the Space Shuttle booster separation motor are described along with the verification program implemented to ensure compliance with debris control objectives. The principal areas emphasized in the design and development of the Booster Separation Motor (BSM) relative to debris control were the propellant formulation and nozzle closures which protect the motors from aerodynamic heating and moisture. A description of the motor design requirements, the propellant formulation and verification program, and the nozzle closures design and verification are presented.

  18. Blood Glucose, Diet-Based Glycemic Load and Cognitive Aging Among Dementia-Free Older Adults

    PubMed Central

    Andel, Ross; McEvoy, Cathy; Dahl Aslan, Anna K.; Finkel, Deborah; Pedersen, Nancy L.

    2015-01-01

    Background. Although evidence indicates that Type II Diabetes is related to abnormal brain aging, the influence of elevated blood glucose on long-term cognitive change is unclear. In addition, the relationship between diet-based glycemic load and cognitive aging has not been extensively studied. The focus of this study was to investigate the influence of diet-based glycemic load and blood glucose on cognitive aging in older adults followed for up to 16 years. Methods. Eight-hundred and thirty-eight cognitively healthy adults aged ≥50 years (M = 63.1, SD = 8.3) from the Swedish Adoption/Twin Study of Aging were studied. Mixed effects growth models were utilized to assess overall performance and change in general cognitive functioning, perceptual speed, memory, verbal ability, and spatial ability as a function of baseline blood glucose and diet-based glycemic load. Results. High blood glucose was related to poorer overall performance on perceptual speed as well as greater rates of decline in general cognitive ability, perceptual speed, verbal ability, and spatial ability. Diet-based glycemic load was related to poorer overall performance in perceptual speed and spatial ability. Conclusion. Diet-based glycemic load and, in particular, elevated blood glucose appear important for cognitive performance/cognitive aging. Blood glucose control (perhaps through low glycemic load diets) may be an important target in the detection and prevention of age-related cognitive decline. PMID:25149688

  19. An active control strategy for achieving weak radiator structures

    SciTech Connect

    Naghshineh, K. . Acoustics and Radar Technology Lab.); Koopmann, G.H. . Center for Acoustics and Vibration)

    1994-01-01

    A general control strategy is presented for active suppression of total radiated sound power from harmonically excited structures based on the measurement of their response. Using the measured response of the structure together with knowledge of its structural mobility, and equivalent primary excitation force is found at discrete points along the structure. Using this equivalent primary force and performing a quadratic optimization of the power radiated form the structure, a set of control forces is found at selected points on the structure that results in minimum radiated sound power. A numerical example of this strategy is presented for a simply supported beam in a rigid baffle excited by a harmonic plane wave incident at an oblique angle. A comparison of the response of the beam with and without control forces shows a large reduction in the controlled response displacement magnitude. In addition, as the result of the action of the control forces, the magnitude of the wave number spectrum of the beam's response in the supersonic region is decreased substantially. The effect of the number and location of the actuators on reductions in sound power level is also studied. The actuators located at the anti-nodes of structural modes within the supersonic region together with those located near boundaries are found to be the most effective in controlling the radiation of sound from a structure.

  20. Artificial Pancreas Using a Personalized Rule-Based Controller Achieves Overnight Normoglycemia in Patients with Type 1 Diabetes

    PubMed Central

    Rigla, Mercedes; García-Sáez, Gema; Rodríguez-Herrero, Agustín; Pons, Belén; Subías, David; García-García, Fernando; Gallach, Maria; Aguilar, Montserrat; Pérez-Gandía, Carmen; Gómez, Enrique J.; Caixàs, Assumpta; Hernando, M. Elena

    2014-01-01

    Abstract Objective: This study assessed the efficacy of a closed-loop (CL) system consisting of a predictive rule-based algorithm (pRBA) on achieving nocturnal and postprandial normoglycemia in patients with type 1 diabetes mellitus (T1DM). The algorithm is personalized for each patient's data using two different strategies to control nocturnal and postprandial periods. Research Design and Methods: We performed a randomized crossover clinical study in which 10 T1DM patients treated with continuous subcutaneous insulin infusion (CSII) spent two nonconsecutive nights in the research facility: one with their usual CSII pattern (open-loop [OL]) and one controlled by the pRBA (CL). The CL period lasted from 10 p.m. to 10 a.m., including overnight control, and control of breakfast. Venous samples for blood glucose (BG) measurement were collected every 20 min. Results: Time spent in normoglycemia (BG, 3.9–8.0 mmol/L) during the nocturnal period (12 a.m.–8 a.m.), expressed as median (interquartile range), increased from 66.6% (8.3–75%) with OL to 95.8% (73–100%) using the CL algorithm (P<0.05). Median time in hypoglycemia (BG, <3.9 mmol/L) was reduced from 4.2% (0–21%) in the OL night to 0.0% (0.0–0.0%) in the CL night (P<0.05). Nine hypoglycemic events (<3.9 mmol/L) were recorded with OL compared with one using CL. The postprandial glycemic excursion was not lower when the CL system was used in comparison with conventional preprandial bolus: time in target (3.9–10.0 mmol/L) 58.3% (29.1–87.5%) versus 50.0% (50–100%). Conclusions: A highly precise personalized pRBA obtains nocturnal normoglycemia, without significant hypoglycemia, in T1DM patients. There appears to be no clear benefit of CL over prandial bolus on the postprandial glycemia. PMID:24152323

  1. Achievement Goals and Emotions: The Mediational Roles of Perceived Progress, Control, and Value

    ERIC Educational Resources Information Center

    Hall, Nathan C.; Sampasivam, Lavanya; Muis, Krista R.; Ranellucci, John

    2016-01-01

    Background: The link between achievement goals and achievement emotions is well established; however, research exploring potential mediators of this relationship is lacking. The control-value theory of achievement emotions (Pekrun, 2006, "Educational Psychology Review," 18, 315) posits that perceptions of control and value mediate the…

  2. Achieving Acceptable Air Quality: Some Reflections on Controlling Vehicle Emissions

    NASA Astrophysics Data System (ADS)

    Calvert, J. G.; Heywood, J. B.; Sawyer, R. F.; Seinfeld, J. H.

    1993-07-01

    Motor vehicle emissions have been and are being controlled in an effort to abate urban air pollution. This article addresses the question: Will the vehicle exhaust emission control and fuel requirements in the 1990 Clean Air Act Amendments and the California Air Resources Board regulations on vehicles and fuels have a significant impact? The effective control of in-use vehicle emissions is the key to a solution to the motor vehicle part of the urban air pollution problem for the next decade or so. It is not necessary, except perhaps in Southern California, to implement extremely low new car emission standards before the end of the 20th century. Some of the proposed gasoline volatility and composition changes in reformulated gasoline will produce significant reductions in vehicle emissions (for example, reduced vapor pressure, sulfur, and light olefin and improved high end volatility), whereas others (such as substantial oxygenate addition and aromatics reduction) will not.

  3. Cognitive Control Predicts Academic Achievement in Kindergarten Children

    ERIC Educational Resources Information Center

    Coldren, Jeffrey T.

    2013-01-01

    Children's ability to shift behavior in response to changing environmental demands is critical for successful intellectual functioning. While the processes underlying the development of cognitive control have been thoroughly investigated, its functioning in an ecologically relevant setting such as school is less well understood. Given the alarming…

  4. ACHIEVING IRRIGATION RETURN FLOW QUALITY CONTROL THROUGH IMPROVED LEGAL SYSTEMS

    EPA Science Inventory

    The key to irrigated agricultural return flow quality control is proper utilization and management of the resource itself, and an accepted tool in out society is the law. This project is designed to develop legal alternatives that will facilitate the implementation of improved wa...

  5. Effects of Glycemic Regulation on Chronic Postischemia Pain

    PubMed Central

    Ross-Huot, Marie-Christine; Laferrière, André; Gi, Cho Min; Khorashadi, Mina; Schricker, Thomas; Coderre, Terence J.

    2015-01-01

    Background Ischemia-reperfusion (I/R) injuries consist of enhanced oxidative and inflammatory responses along with microvascular dysfunction following prolonged ischemia and reperfusion. Since I/R injuries induce chronic postischemia pain (CPIP) in laboratory animals, it is possible that surgical procedures utilizing prolonged ischemia may result in chronic postoperative pain. Glycemic modulation during ischemia and reperfusion could impact pain following I/R injury, as glucose triggers oxidative, inflammatory and thrombotic reactions, whereas insulin has anti-oxidative, anti-inflammatory and vasodilatory properties. Methods 110 rats underwent a 3-h period of ischemia followed by reperfusion to produce CPIP. CPIP rats had previously been divided into 6 groups with differing glycemic-modulation paradigms: 1) normal feeding; 2) fasting; 3) fasting with normal saline administration; 4) fasting with dextrose administration; 5) normal feeding with insulin administration; and 6) normal feeding with dextrose and insulin administration. Blood glucose levels were assessed during ischemia and reperfusion in these separate groups of rats, and they were tested for mechanical and cold allodynia over the following 21 days (on days 2, 5, 7, 9, 12 and 21 post-I/R injury). Results I/R injury in rats with normoglycemia or relative hyperglycemia (groups 1, 4) led to significant mechanical and cold allodynia; conversely, relative hypoglycemia associated with insulin treatment or fasting (groups 2, 3, and 5) reduced allodynia induced by I/R injury. Importantly, insulin treatment did not reduce allodynia when administered to fed rats given dextrose (group 6). Conclusion Our results suggest that glycemic levels at the time of I/R injury significantly modulate postinjury pain thresholds in CPIP rats. Strict glycemic control during I/R injury significantly reduces CPIP pain and, and conversely, hyperglycemia significantly enhances it, which could have potential clinical applications

  6. Achievements in and Challenges of Tuberculosis Control in South Korea.

    PubMed

    Kim, Ji Han; Yim, Jae-Joon

    2015-11-01

    After the Korean War (1950-1953), nearly 6.5% of South Korea's population had active tuberculosis (TB). In response, South Korea implemented the National Tuberculosis Program in 1962. From 1965 to 1995, the prevalence of bacteriologically confirmed pulmonary TB in South Korea decreased from 940 to 219 cases per 100,000 population. Astounding economic growth might have contributed to this result; however, TB incidence in South Korea remains the highest among high-income countries. The rate of decrease in TB incidence seems to have slowed over the past 15 years. A demographic shift toward an older population, many of whom have latent TB and various concurrent conditions, is challenging TB control efforts in South Korea. The increasing number of immigrants also plays a part in the prolonged battle against TB. A historical review of TB in South Korea provides an opportunity to understand national TB control efforts that are applicable to other parts of the world. PMID:26485188

  7. Personalized Nutrition by Prediction of Glycemic Responses.

    PubMed

    Zeevi, David; Korem, Tal; Zmora, Niv; Israeli, David; Rothschild, Daphna; Weinberger, Adina; Ben-Yacov, Orly; Lador, Dar; Avnit-Sagi, Tali; Lotan-Pompan, Maya; Suez, Jotham; Mahdi, Jemal Ali; Matot, Elad; Malka, Gal; Kosower, Noa; Rein, Michal; Zilberman-Schapira, Gili; Dohnalová, Lenka; Pevsner-Fischer, Meirav; Bikovsky, Rony; Halpern, Zamir; Elinav, Eran; Segal, Eran

    2015-11-19

    Elevated postprandial blood glucose levels constitute a global epidemic and a major risk factor for prediabetes and type II diabetes, but existing dietary methods for controlling them have limited efficacy. Here, we continuously monitored week-long glucose levels in an 800-person cohort, measured responses to 46,898 meals, and found high variability in the response to identical meals, suggesting that universal dietary recommendations may have limited utility. We devised a machine-learning algorithm that integrates blood parameters, dietary habits, anthropometrics, physical activity, and gut microbiota measured in this cohort and showed that it accurately predicts personalized postprandial glycemic response to real-life meals. We validated these predictions in an independent 100-person cohort. Finally, a blinded randomized controlled dietary intervention based on this algorithm resulted in significantly lower postprandial responses and consistent alterations to gut microbiota configuration. Together, our results suggest that personalized diets may successfully modify elevated postprandial blood glucose and its metabolic consequences. VIDEO ABSTRACT. PMID:26590418

  8. Understanding the Glycemic Index and Glycemic Load and Their Practical Applications

    ERIC Educational Resources Information Center

    Lazarim, Fernanda Lorenzi; Stancanelli, Mirtes; Brenzikofer, Rene; de Macedo, Denise Vaz

    2009-01-01

    We have introduced the study of synthesis pathways using two experiments: 1--the determination of the glycemic index (GI) of some foods and the effects of fiber and fat on the GI; 2--the determination of blood glucose levels after the ingestion of meals with high and low glycemic loads (GL). After a practice assembly, when the foods and meals that…

  9. Effect of Low- and High-Glycemic Load on Circulating Incretins in a Randomized Clinical Trial

    PubMed Central

    Runchey, Shauna S.; Valsta, Liisa M.; Schwarz, Yvonne; Wang, Chiachi; Song, Xiaoling; Lampe, Johanna W.; Neuhouser, Marian L.

    2012-01-01

    Objective Low-glycemic load diets lower post-prandial glucose and insulin responses; however, the effect of glycemic load on circulating incretin concentrations is unclear. We aimed assess effects of dietary glycemic load on fasting and post-prandial glucose, insulin and incretin (i.e., glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1)) concentrations and to examine for effect modification by adiposity. Materials and Methods We conducted a single-center, randomized controlled crossover feeding trial in which a subset of participants had post-prandial testing. Participants were recruited from the local Seattle area. We enrolled 89 overweight-obese (BMI 28.0–39.9 kg/m2) and lean (BMI 18.5–25.0 kg/m2) healthy adults. Participants consumed two 28-day, weight-maintaining high- and low-glycemic load controlled diets in random order. Primary outcome measures were post-prandial circulating concentrations of glucose, insulin, GIP and GLP-1, following a test breakfast. Results Of the 80 participants completing both diet interventions, 16 had incretin testing and comprise the group for analyses. Following each 28-day high- and low-glycemic load diet, mean fasting concentrations of insulin, glucose, GIP and GLP-1 were not significantly different. Mean integrated post-prandial concentrations of glucose, insulin and GIP were higher (1504±476 mg/dL/min, p<0.01; 2012±644 µU/mL/min, p<0.01 and 15517±4062 pg/ml/min, p<0.01, respectively) and GLP-1 was lower (−81.6±38.5 pmol/L/min, p<0.03) following the high-glycemic load breakfast as compared to the low-glycemic load breakfast. Body fat did not significantly modify the effect of glycemic load on metabolic outcomes. Conclusions High-glycemic load diets in weight-maintained healthy individuals leads to higher post-prandial GIP and lower post-prandial GLP-1 concentrations. Future studies evaluating dietary glycemic load manipulation of incretin effects would be helpful for establishing

  10. Can Chemical Mouthwash Agents Achieve Plaque/Gingivitis Control?

    PubMed

    Van der Weijden, Fridus A; Van der Sluijs, Eveline; Ciancio, Sebastian G; Slot, Dagmar E

    2015-10-01

    Also note that structured abstracts are not allowed per journal style: What is the effect of a mouthwash containing various active chemical ingredients on plaque control and managing gingivitis in adults based on evidence gathered from existing systematic reviews? The summarized evidence suggests that mouthwashes containing chlorhexidine(CHX) and essential oils (EO) had a large effect supported by a strong body of evidence. Also there was strong evidence for a moderate effect of cetylpyridinium chloride(CPC). Evidence suggests that a CHX mouthwash is the first choice, the most reliable alternative is EO. No difference between CHX and EO with respect to gingivitis was observed. PMID:26427569

  11. A review of glycemic efficacy of liraglutide once daily in achieving glycated hemoglobin targets compared with exenatide twice daily, or sitagliptin once daily in the treatment of type 2 diabetes.

    PubMed

    Alshali, Khalid Z; Karawagh, Abdullah M

    2016-08-01

    Incretin-based therapies such as glucagon-like peptide-1 (GLP-1) receptor agonists (RA) and dipeptidyl peptidase-4 (DPP-4) inhibitors have gained prominence in recent years for the treatment of type 2 diabetes (T2D). Such therapies offer the potential to stimulate endogenous insulin activity in proportion to circulating glucose levels; thereby, lowering the risk of hypoglycemic episodes. The synthetic GLP-1 RA exenatide, the human GLP-1 RA liraglutide, and the DPP-4 inhibitor sitagliptin are the first agents in their respective classes to be approved for the treatment of T2D and their efficacy and safety has been studied extensively in clinical trials. This article reviewed the efficacy of liraglutide once daily in achieving clinical guidelines-recommended glycated hemoglobin A1c levels in patients with T2D compared with exenatide twice daily, or sitagliptin once daily, based on published literature, with an aim to elucidate the preferred choice of incretin-related therapy in treating uncontrolled T2D. PMID:27464858

  12. Achievements in and Challenges of Tuberculosis Control in South Korea

    PubMed Central

    Kim, Ji Han

    2015-01-01

    After the Korean War (1950–1953), nearly 6.5% of South Korea’s population had active tuberculosis (TB). In response, South Korea implemented the National Tuberculosis Program in 1962. From 1965 to 1995, the prevalence of bacteriologically confirmed pulmonary TB in South Korea decreased from 940 to 219 cases per 100,000 population. Astounding economic growth might have contributed to this result; however, TB incidence in South Korea remains the highest among high-income countries. The rate of decrease in TB incidence seems to have slowed over the past 15 years. A demographic shift toward an older population, many of whom have latent TB and various concurrent conditions, is challenging TB control efforts in South Korea. The increasing number of immigrants also plays a part in the prolonged battle against TB. A historical review of TB in South Korea provides an opportunity to understand national TB control efforts that are applicable to other parts of the world. PMID:26485188

  13. Muscle function in avian flight: achieving power and control

    PubMed Central

    Biewener, Andrew A.

    2011-01-01

    Flapping flight places strenuous requirements on the physiological performance of an animal. Bird flight muscles, particularly at smaller body sizes, generally contract at high frequencies and do substantial work in order to produce the aerodynamic power needed to support the animal's weight in the air and to overcome drag. This is in contrast to terrestrial locomotion, which offers mechanisms for minimizing energy losses associated with body movement combined with elastic energy savings to reduce the skeletal muscles' work requirements. Muscles also produce substantial power during swimming, but this is mainly to overcome body drag rather than to support the animal's weight. Here, I review the function and architecture of key flight muscles related to how these muscles contribute to producing the power required for flapping flight, how the muscles are recruited to control wing motion and how they are used in manoeuvring. An emergent property of the primary flight muscles, consistent with their need to produce considerable work by moving the wings through large excursions during each wing stroke, is that the pectoralis and supracoracoideus muscles shorten over a large fraction of their resting fibre length (33–42%). Both muscles are activated while being lengthened or undergoing nearly isometric force development, enhancing the work they perform during subsequent shortening. Two smaller muscles, the triceps and biceps, operate over a smaller range of contractile strains (12–23%), reflecting their role in controlling wing shape through elbow flexion and extension. Remarkably, pigeons adjust their wing stroke plane mainly via changes in whole-body pitch during take-off and landing, relative to level flight, allowing their wing muscles to operate with little change in activation timing, strain magnitude and pattern. PMID:21502121

  14. Children's effortful control and academic achievement: do relational peer victimization and classroom participation operate as mediators?

    PubMed

    Valiente, Carlos; Swanson, Jodi; Lemery-Chalfant, Kathryn; Berger, Rebecca H

    2014-08-01

    Given that early academic achievement is related to numerous developmental outcomes, understanding processes that promote early success in school is important. This study was designed to clarify how students' (N=291; M age in fall of kindergarten=5.66 years, SD=0.39 year) effortful control, relational peer victimization, and classroom participation relate to achievement, as students progress from kindergarten to first grade. Effortful control and achievement were assessed in kindergarten, classroom participation and relational peer victimization were assessed in the fall of first grade, and achievement was reassessed in the spring of first grade. Classroom participation, but not relational peer victimization, mediated relations between effortful control and first grade standardized and teacher-rated achievement, controlling for kindergarten achievement. Findings suggest that aspects of classroom participation, such as the ability to work independently, may be useful targets of intervention for enhancing academic achievement in young children. PMID:25107413

  15. Effects of the antitumor drug OSI-906, a dual inhibitor of IGF-1 receptor and insulin receptor, on the glycemic control, β-cell functions, and β-cell proliferation in male mice.

    PubMed

    Shirakawa, Jun; Okuyama, Tomoko; Yoshida, Eiko; Shimizu, Mari; Horigome, Yuka; Tuno, Takayuki; Hayasaka, Moe; Abe, Shiori; Fuse, Masahiro; Togashi, Yu; Terauchi, Yasuo

    2014-06-01

    The IGF-1 receptor has become a therapeutic target for the treatment of cancer. The efficacy of OSI-906 (linstinib), a dual inhibitor of IGF-1 receptor and insulin receptor, for solid cancers has been examined in clinical trials. The effects of OSI-906, however, on the blood glucose levels and pancreatic β-cell functions have not yet been reported. We investigated the impact of OSI-906 on glycemic control, insulin secretion, β-cell mass, and β-cell proliferation in male mice. Oral administration of OSI-906 worsened glucose tolerance in a dose-dependent manner in the wild-type mice. OSI-906 at a dose equivalent to the clinical daily dose (7.5 mg/kg) transiently evoked glucose intolerance and hyperinsulinemia. Insulin receptor substrate (IRS)-2-deficient mice and mice with diet-induced obesity, both models of peripheral insulin resistance, exhibited more severe glucose intolerance after OSI-906 administration than glucokinase-haploinsufficient mice, a model of impaired insulin secretion. Phloridzin improved the hyperglycemia induced by OSI-906 in mice. In vitro, OSI-906 showed no effect on insulin secretion from isolated islets. After daily administration of OSI-906 for a week to mice, the β-cell mass and β-cell proliferation rate were significantly increased. The insulin signals in the β-cells were apparently unaffected in those mice. Taken together, the results suggest that OSI-906 could exacerbate diabetes, especially in patients with insulin resistance. On the other hand, the results suggest that the β-cell mass may expand in response to chemotherapy with this drug. PMID:24712877

  16. Why achievement motivation predicts success in business but failure in politics: the importance of personal control.

    PubMed

    Winter, David G

    2010-12-01

    Several decades of research have established that implicit achievement motivation (n Achievement) is associated with success in business, particularly in entrepreneurial or sales roles. However, several political psychology studies have shown that achievement motivation is not associated with success in politics; rather, implicit power motivation often predicts political success. Having versus lacking control may be a key difference between business and politics. Case studies suggest that achievement-motivated U.S. presidents and other world leaders often become frustrated and thereby fail because of lack of control, whereas power-motivated presidents develop ways to work with this inherent feature of politics. A reevaluation of previous research suggests that, in fact, relationships between achievement motivation and business success only occur when control is high. The theme of control is also prominent in the development of achievement motivation. Cross-national data are also consistent with this analysis: In democratic industrialized countries, national levels of achievement motivation are associated with strong executive control. In countries with low opportunity for education (thus fewer opportunities to develop a sense of personal control), achievement motivation is associated with internal violence. Many of these manifestations of frustrated achievement motivation in politics resemble authoritarianism. This conclusion is tested by data from a longitudinal study of 113 male college students, showing that high initial achievement motivation combined with frustrated desires for control is related to increases in authoritarianism (F-scale scores) during the college years. Implications for the psychology of leadership and practical politics are discussed. PMID:21039527

  17. Cheonggukjang, a soybean paste fermented with B. licheniformis-67 prevents weight gain and improves glycemic control in high fat diet induced obese mice

    PubMed Central

    Choi, Joo-Hee; Pichiah, P.B.Tirupathi; Kim, Min-Jung; Cha, Youn-Soo

    2016-01-01

    In this study, we investigated the anti-obesity effects of soybean paste—Cheonggukjang, fermented with poly gamma glutamic acid producing Bacillus licheniformis-67 in diet induced obese C57BL/6J mice. Forty male C57BL/6J mice aged 4 weeks were divided into four dietary groups; normal diet control, high fat diet control, high fat diet containing 30% of unfermented soybean and high fat diet containing 30% Cheonggukjang fermented with Bacillus licheniformis-67. After 13 weeks of dietary intervention the mice were sacrificed; serum and tissue samples were examined. Serum and hepatic lipid profile, blood glucose, insulin, leptin level were lower (<0.05) along with the body weight and epididymal fat pad weight in the 30% Cheonggukjang supplemented group compared with the high fat diet control group. The expression level of lipid anabolic gene was significantly decreased; whereas the expression level of lipid catabolic genes were significantly increased in the 30% Cheonggukjang supplemented group compared to the high fat diet control group. Collectively, these results suggested that intake of Cheonggukjang fermented with Bacillus licheniformis-67 significantly prevents obesity related parameters. PMID:27499576

  18. 'Glycemic Index' May Be Too Unreliable to Manage Diabetes

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_160837.html 'Glycemic Index' May Be Too Unreliable to Manage Diabetes: Study ... 2016 WEDNESDAY, Sept. 7, 2016 (HealthDay News) -- Glycemic index values of the same foods can vary widely ...

  19. Glycemic responses and sensory characteristics of whole yellow pea flour added to novel functional foods.

    PubMed

    Marinangeli, Christopher P F; Kassis, Amira N; Jones, Peter J H

    2009-01-01

    A fundamental understanding regarding postprandial glycemic responses to foods containing whole yellow-pea flour (WYPF) remains unknown. This, alongside concerns that WYPF possesses unfavorable sensory characteristics has limited the incorporation of WYPF into new functional food products as a healthy novel ingredient. The objective of this study was to evaluate how WYPF modulates postprandial glycemic responses as well as sensory characteristics in novel foods. In a single-blind crossover trial, the present study assessed postprandial glycemic responses of banana bread, biscotti, and spaghetti containing either WYPF or whole wheat flour (WWF). Boiled yellow peas (BYP) and white bread (WB) were used as positive and negative controls, respectively. On day 1, subjects evaluated appearance, taste, texture, smell as well as overall acceptance of each WYPF and WWF food on a 5-point hedonic scale. WYPF banana bread (97.9 +/- 17.8 mmol x min/L) and biscotti (83 +/- 13 mmol x min/L), as well as BYP (112.3 +/- 19.9 mmol x min/L), reduced (P < 0.05) glycemic responses compared to WB (218.1 +/- 29.5 mmol x min/L). The glycemic response of WYPF pasta (160.7 +/- 19.4 mmol x min/L) was comparable to WB. WYPF biscotti produced a lower (P = 0.019) postprandial glycemic response compared to WWF biscotti (117.2 +/- 13.1 mmol x min/L). Hedonic responses between corresponding foods were similar except for the WYPF pasta (2.9 +/- 0.9) which possessed a lower sensory score (P = 0.02) for smell compared to WWF pasta (3.6 +/- 1). WYPF can be used to produce low-glycemic functional foods possessing sensory attributes that are comparable to identical food products containing WWF. PMID:20492127

  20. Establishment of normal reference ranges for glycemic variability in Chinese subjects using continuous glucose monitoring

    PubMed Central

    Zhou, Jian; Li, Hong; Ran, Xingwu; Yang, Wenying; Li, Qiang; Peng, Yongde; Li, Yanbing; Gao, Xin; Luan, Xiaojun; Wang, Weiqing; Jia, Weiping

    2011-01-01

    Summary Background Glycemic variability is increasingly recognized as an important issue in diabetes management. However, the lack of normative values may limit its applicability in the clinical setting. The objective of this study was to establish preliminary normal reference ranges for glycemic variability by analyzing continuous glucose monitoring (CGM) data obtained from healthy Chinese adults. Material/Methods Three-day CGM data were obtained from 434 healthy adults at 10 academic hospitals throughout China. Glycemic variability was calculated as the 24-hour mean amplitude of glycemic excursions (MAGE) and standard deviations (SD) of blood glucose readings. Results 434 healthy subjects (male 213, female 221; age 43±14, 20–69 years old; BMI 21.8±1.7 kg/m2, 18.5–24.9 kg/m2) completed the study. MAGE and SD values for the 434 healthy subjects were 1.73 (1.08) mmol/L and 0.75 (0.42) mmol/L [median (interquartile range)], respectively. In both men and women, MAGE and SD tended to increase with age. Neither MAGE nor SD showed a significant difference between men and women. Values for both parameters were non-normally distributed within the population. The 95th percentiles of MAGE and SD were 3.86 and 1.40 mmol/L, respectively. These values were adopted as the upper limits of normal. Conclusions MAGE <3.9 mmol/L and SD <1.4 mmol/L are recommended as the normal reference ranges for glycemic variability in Chinese adults. The values established in this study may facilitate the adoption of glycemic variability as a metric of overall glycemic control in diabetes. PMID:21169911

  1. Effect of green tea catechins on the postprandial glycemic response to starches differing in amylose content.

    PubMed

    Liu, Jie; Wang, Mingzhu; Peng, Shanli; Zhang, Genyi

    2011-05-11

    The effect of tea polyphenols (TPLs), specifically tea catechins, on the postprandial glycemic response to cooked starches differing in amylose contents was investigated. The in vivo test using a mouse model showed a moderate reduction of the postprandial glycemic response to co-cooked normal (containing 27.8% amylose) or waxy corn starch with 10% TPLs (dry weight of starch), while an augmented glycemic response with a delayed blood glucose peak was observed when high amylose corn starch (HAC, containing 79.4% amylose) was used as the starch component. Enzyme kinetics results demonstrated that TPLs noncompetitively inhibit the digestion of waxy or normal corn starch, while the digestion rate of HAC starch was increased in the presence of TPLs, which supports the observed postprandial glycemic responses. Further studies using X-ray powder diffraction showed that the diffraction intensity (area under the diffraction curves) of normal and HAC starch was increased by 45% and 74%, respectively, whereas no change was observed for waxy corn starch. Consistently, dynamic laser light scattering studies using a solution of pure amylose showed an increased hydrodynamic radius of amylose molecules from ∼54 nm to ∼112 nm in the presence of TPLs. These experimental results indicate that there might exist an interaction between TPLs and amylose, which facilitates the association of amylose molecules to form a special nonordered structure that can produce a high and sustained postprandial glycemic response. Thus, a combination of tea polyphenols and specific starches could be used to manipulate postprandial glycemic response for glycemic control and optimal health. PMID:21401210

  2. Relations among Peer Acceptance, Inhibitory Control, and Math Achievement in Early Adolescence

    ERIC Educational Resources Information Center

    Oberle, Eva; Schonert-Reichl, Kimberly A.

    2013-01-01

    This study examined relations among peer acceptance, inhibitory control, and math achievement in ninety-nine 4th and 5th grade early adolescents. Teachers rated students on peer acceptance and students completed a computerized executive function task assessing inhibitory control. Math achievement was assessed via end of year math grades. Results…

  3. Criterion-Related Validity of the Nowicki-Strickland Locus of Control Scale with Academic Achievement.

    ERIC Educational Resources Information Center

    Nunn, Gary D.; And Others

    1986-01-01

    Investigated the relationships between student locus of control and academic achievement in grades five through eight. The Nowicki-Strickland Locus of Control Scale (NSLOCS) was used to measure motivation, and the Iowa Tests of Basic Skills (ITBS) to assess academic achievement. Results indicated moderate inverse relationships between level of…

  4. Soluble RAGE and the RAGE ligands HMGB1 and S100A12 in critical illness: impact of glycemic control with insulin and relation with clinical outcome.

    PubMed

    Ingels, Catherine; Derese, Inge; Wouters, Pieter J; Van den Berghe, Greet; Vanhorebeek, Ilse

    2015-02-01

    Systemic inflammation often leads to complications in critically ill patients. Activation of the receptor for advanced glycation end-products (RAGE) generates inflammatory cytokines, proteases, and oxidative stress and may link inflammation to subsequent organ damage. Furthermore, hyperglycemia-induced oxidative stress increases RAGE ligands and RAGE expression. We hypothesized that preventing hyperglycemia during critical illness reduces the risk of excessively enhanced RAGE signaling, which could relate to clinical outcomes and risk of death. In 405 long-stay surgical intensive care unit patients randomized to intensive or conventional insulin treatment, serum concentrations of soluble RAGE (decoy receptor) and the RAGE ligands high-mobility group box 1 (HMGB1) and S100A12 were measured on admission, day 7, and last day. These were compared with levels in 71 matched control subjects and with C-reactive protein (CRP) as a routinely monitored inflammation marker. On admission, soluble RAGE, HMGB1, S100A12, and CRP were higher in patients than in controls. The HMGB1, S100A12, and CRP remained elevated throughout intensive care unit stay, whereas soluble RAGE decreased to levels lower than in controls by day 7. Unexpectedly, insulin treatment did not affect the circulating levels of these markers. In univariable analysis, elevated levels of soluble RAGE on admission were associated with adverse outcome, including circulatory failure, kidney failure, liver dysfunction, and mortality. The associations with circulatory and kidney failure remained significant in multivariable logistic regression analysis corrected for baseline risk factors. Critical illness affects components of RAGE signaling, unaffected by insulin treatment. Elevated on-admission soluble RAGE was associated with adverse outcomes. PMID:25394242

  5. Moving the Achievement Goal Approach One Step Forward: Toward a Systematic Examination of the Autonomous and Controlled Reasons Underlying Achievement Goals

    ERIC Educational Resources Information Center

    Vansteenkiste, Maarten; Lens, Willy; Elliot, Andrew J.; Soenens, Bart; Mouratidis, Athanasios

    2014-01-01

    An important recent development in the achievement goal literature is to define achievement goals strictly as aims. In this overview, we argue that this restrictive definition of achievement goals paves the way for a systematic consideration of the autonomous and controlled reasons underlying individuals' achievement goals, a distinction…

  6. The impact of community health workers on behavioral outcomes and glycemic control of diabetes patients on the U.S.-Mexico border.

    PubMed

    Ryabov, Igor

    2010-01-01

    This study attempts to determine the impact of Community Health Workers (promotoras de salud) on the self-management practices of people with diabetes on the U.S.-Mexico Border. The region has higher incidence rates of type 2 diabetes than the nation as a whole due to its Mexican-American population, an ethnic group genetically vulnerable to the disease. Unlike prior research that investigated the overall effectiveness of the CHWs, this study monitored a wide range of biologic (HbA1c, BMI) and behavioral (diabetes knowledge, self-efficacy, self-management activities scores) outcomes among the diabetes patients. The experimental research design tested whether or not the monthly visits by CHWs to the diabetic patients helped them in controlling their disease. The sample (N = 30) was recruited from Mexican-American diabetes patients aged 30 or above. The intervention group received monthly visits from CHWs, while the control group did not. The intervention group showed a significant improvement after 2 years of intervention in all outcomes, except Body Mass Index (BMI). PMID:22192944

  7. Glycemic control, self-care behaviors, and psychosocial factors among insulin treated diabetics: a test of an extended health belief model.

    PubMed

    Aalto, A M; Uutela, A

    1997-01-01

    The relations of diet adherence (DA) and self-monitoring of blood glucose (SMBG) to metabolic control, as measured with glycosylated hemoglobin A(tc) (GHbA(tc), and correlates of self-care were examines among a type I diabetic sample (n = 423). The Health Belief Model (HBM), supplemented by other factors (locus of control, self-efficacy, health value, and social support), was used as a theoretical model. In multiple regression analyses both DA (p<.01) and SMBG (p<.001). SMBG showed strong associations with self-efficacy in SMBG (p,.001) and net benefits of SMBG (p<.001). The revised models explained 14% and 21% of the variation in DA and SMBG, respectively. The results suggest that although perceived net benefits are important determinants of both SMBG and DA, DA is also related to diabetes support, whereas SMBG is more strongly related to perceived self-efficacy. Thus self-care regimen should be planned individually for diabetic patients. PMID:16250728

  8. A randomized study of raisins versus alternative snacks on glycemic control and other cardiovascular risk factors in patients with type 2 diabetes mellitus.

    PubMed

    Bays, Harold; Weiter, Kathy; Anderson, James

    2015-02-01

    Just as the type and duration of physical activity can have variable effects on the glucose levels and other cardiometabolic parameters among patients with type 2 diabetes mellitus (T2DM), so can the types of foods have variable effects as well. This 12-week randomized study of 51 study participants evaluated the impact of routine consumption of dark raisins versus alternative processed snacks on glucose levels and other cardiovascular risk factors among patients with type T2DM. In this study, compared to alternative processed snacks, those who consumed raisins had a significant 23% reduction in postprandial glucose levels (P = 0.024). Also compared to snacks, those who consumed raisins had a 19% reduction in fasting glucose and 0.12% reduction in hemoglobin A1c, although these latter findings did not achieve statistical significance. Regarding blood pressure, compared to alternative processed snacks, those who consumed raisins had a significant 8.7 mmHg reduction in systolic blood pressure (P = 0.035) (7.5% [P = 0.031]) but did not experience a significant reduction in diastolic blood pressure. Compared to alternative processed snacks, those who consumed raisins did not have a significant improvement in body weight, body mass index, waist circumference, fasting insulin, homeostatic model assessment of insulin resistance, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL), triglyceride, or non-HDL cholesterol levels. Overall, these data support raisins as a healthy alternative compare to processed snacks in patients with T2DM. PMID:25609549

  9. Kidney function decline in metformin versus sulfonylurea initiators: assessment of time-dependent contribution of weight, blood pressure and glycemic control

    PubMed Central

    Hung, Adriana M.; Roumie, Christianne L.; Greevy, Robert A.; Liu, Xulei; Grijalva, Carlos G.; Murff, Harvey J.; Griffin, Marie R.

    2016-01-01

    Background and objective We recently reported that kidney function declined faster among initiators of sulfonylureas compared to metformin; however, sulfonylurea compared to metformin use was also associated with increases in body mass index (BMI) and systolic blood pressure (SBP). We sought to determine if differences between sulfonylureas and metformin on kidney function decline were mediated by differential effects on BMI, SBP, or glucose control. Methods We identified 13238 veterans who initiated sulfonylurea or metformin treatment (2000–2007) with a baseline estimated glomerular filtration rate (eGFR) >60 ml/min, and followed them until a study event occurred, non-persistence on treatment, loss of follow-up or end of the study. The composite outcome was a sustained decline from baseline eGFR of ≥25%, end stage renal disease, or death. We estimated the association of cumulative measurements of potential mediators including BMI, SBP and glycated hemoglobin on the study outcome. We determined if controlling for these time-varying covariates accounted for the differences in outcome between sulfonylurea and metformin initiators. Results Compared to sulfonylurea use, metformin use was associated with a lower risk for renal function decline or death [adjusted hazard ratio (aHR) 0.82, 95% confidence interval 0.70, 0.97]. This protective association remained significant [aHR 0.83 (0.70–0.98)] when accounting for the cumulative time varying measurements of the three mediators of interest. Conclusion Metformin initiation was associated with a lower risk of kidney function decline or death compared to sulfonylureas which appeared to be independent of changes in BMI, SBP and glycated hemoglobin over time. PMID:23592561

  10. Randomized Trial on the Influence of the Length of Two Insulin Pen Needles on Glycemic Control and Patient Preference in Obese Patients with Diabetes

    PubMed Central

    Kreugel, Gillian; Keers, Joost C.; Kerstens, Michiel N.

    2011-01-01

    Abstract Objective This study determined the influence of needle length for insulin administration on metabolic control and patient preference in obese patients with diabetes mellitus. Methods In this multicenter, open-label crossover study, insulin pen needles of two different lengths (5 mm and 8 mm) were compared. A total of 130 insulin-treated type 1 and type 2 diabetes patients with a body mass index ≥30 kg/m2 were randomized, and 126 patients completed the study. Patients started using the 5-mm needle for 3 months, after which they switched to injecting insulin with the 8-mm needle for another 3 months, or vice versa. Hemoglobin A1c (A1C), fructosamine, and 1,5-anhydroglucitol were measured, and self-reported side effects and patient preference were recorded. Results No within-group changes were observed with respect to A1C, serum fructosamine, 1,5-anhydroglucitol, hypoglycemic events, bruising, and pain. When data of all 126 subjects were pooled, there was a small, but significant, difference between needle lengths (5-mm, A1C 7.47 ± 0.9%; 8-mm, 7.59 ± 1.0%; P = 0.02). Patients reported less bleeding with the 5-mm needle (P = 0.04) and less insulin leakage from the skin with the 8-mm needle (P = 0.01). There were no significant differences in patient preference, with 46% of the patients preferring the 5-mm needle, 41% the 8-mm needle, and 13% not preferring a particular needle length. Conclusions A 5-mm needle is similar to an 8-mm needle in obese patients with diabetes with respect to metabolic control, injection-related complaints, or patient preference and can be used safely. PMID:21476936

  11. Effect of Habitual Khat Chewing on Glycemic Control, Body Mass Index, and Age at Diagnosis of Diabetes in Patients with Type 2 Diabetes Mellitus in Yemen

    PubMed Central

    Al-Sharafi, Butheinah A; Gunaid, Abdallah A

    2015-01-01

    Khat chewing is common in Yemen. We conducted this study to see if it affected diabetes control in patients with type 2 diabetes mellitus (DM). We studied 1540 patients with type 2 DM attending an endocrinology clinic in Sana’a, Yemen, of which 997 were khat chewers (KC) and 543 were non-khat chewers (NKC). The patients answered a questionnaire regarding khat chewing. Hemoglobin A1c (HbA1c) and body mass index (BMI) were measured. KC had a higher mean HbA1c of 9.8 (95% confidence interval (95% CI) 9.6–10) than the NKC, with a mean of 9.1 (95% CI 8.9–9.4) (adjusted odds ratios (AOR) 1.74, P < 0.001) after multivariate regression analysis. KC also had a lower mean BMI, 26.9 (95% CI 26.6–27.2), than the NKC, mean BMI 27.6 (95% CI 27.1–28) (P < 0.01). The mean age at diagnosis of DM among the KC group was 43.3 (10.1) and among the NKC group was 45.9 (11.8) (AOR 1.4 P < 0.008) after multivariate regression analysis. KC patients had a higher mean HbA1c, a lower BMI, and a younger age at diagnosis of type 2 DM when compared with NKC. PMID:26064075

  12. Low-Volume Insulin Degludec 200 Units/mL Once Daily Improves Glycemic Control Similarly to Insulin Glargine With a Low Risk of Hypoglycemia in Insulin-Naïve Patients With Type 2 Diabetes

    PubMed Central

    Gough, Stephen C.L.; Bhargava, Anuj; Jain, Rajeev; Mersebach, Henriette; Rasmussen, Søren; Bergenstal, Richard M.

    2013-01-01

    OBJECTIVE The 200 units/mL formulation of insulin degludec (IDeg 200 units/mL) contains equal units of insulin in half the volume compared with the 100 units/mL formulation. We compared the efficacy and safety of IDeg 200 units/mL once daily with 100 units/mL insulin glargine (IGlar) in insulin-naïve subjects with type 2 diabetes (T2DM) inadequately controlled with oral antidiabetic drugs. RESEARCH DESIGN AND METHODS In this 26-week, open-label, treat-to-target trial, subjects (n = 457; mean HbA1c 8.3% [67 mmol/mol], BMI 32.4 kg/m2, and fasting plasma glucose [FPG] 9.6 mmol/L [173.2 mg/dL]) were randomized to IDeg 200 units/mL or IGlar, both given once daily in combination with metformin with or without a dipeptidyl peptidase-4 inhibitor. Basal insulin was initiated at 10 units/day and titrated weekly to an FPG target of <5 mmol/L (<90 mg/dL) according to mean prebreakfast self-measured blood glucose values from the preceding 3 days. RESULTS By 26 weeks, IDeg reduced HbA1c by 1.30% and was not inferior to IGlar. Mean observed FPG reductions were significantly greater with IDeg than IGlar (−3.7 vs. −3.4 mmol/L [–67 vs. –61 mg/dL]; estimated treatment difference: −0.42 [95% CI −0.78 to −0.06], P = 0.02). Despite this difference, rates of overall confirmed hypoglycemia were not higher with IDeg than with IGlar (1.22 and 1.42 episodes/patient-year, respectively), as were rates of nocturnal confirmed hypoglycemia (0.18 and 0.28 episodes/patient-year, respectively). Mean daily basal insulin dose was significantly lower by 11% with IDeg 200 units/mL compared with IGlar. IDeg was well-tolerated, and the rate of treatment-emergent adverse events was similar across groups. CONCLUSIONS In this treat-to-target trial in insulin-naïve patients with T2DM, IDeg 200 units/mL improved glycemic control similarly to IGlar with a low risk of hypoglycemia. PMID:23715753

  13. Effects of Performing Morning Versus Afternoon Exercise on Glycemic Control and Hypoglycemia Frequency in Type 1 Diabetes Patients on Sensor-Augmented Insulin Pump Therapy

    PubMed Central

    Gomez, Ana Maria; Gomez, Claudia; Aschner, Pablo; Veloza, Angelica; Muñoz, Oscar; Rubio, Claudia; Vallejo, Santiago

    2015-01-01

    Background: Although physical exercise (PE) is recommended for individuals with type 1 diabetes (DM1), participation in exercise is challenging because it increases the risk of severe hypoglycemia and the available therapeutic options to prevent it frequently result in hyperglycemia. There is no clear recommendation about the best timing for exercise. The aim of this study was to compare the risk of hypoglycemia after morning or afternoon exercise sessions up to 36 hours postworkout. Methods: This randomized crossover study enrolled subjects with DM1, older than 18 years of age, on sensor-augmented insulin pump (SAP) therapy. Participants underwent 2 moderate-intensity exercise sessions; 1 in the morning and 1 in the afternoon, separated by a 7 to 14 day wash-out period. Continuous glucose monitoring (CGM) data were collected 24 hours before, during and 36 hours after each session. Results: Thirty-five subjects (mean age 30.31 ± 12.66 years) participated in the study. The rate of hypoglycemia was significantly lower following morning versus afternoon exercise sessions (5.6 vs 10.7 events per patient, incidence rate ratio, 0.52; 95% CI, 0.43-0.63; P < .0001). Most hypoglycemic events occurred 15-24 hours after the session. On days following morning exercise sessions, there were 20% more CGM readings in near-euglycemic range (70-200 mg/dL) than on days prior to morning exercise (P = .003). Conclusions: Morning exercise confers a lower risk of late-onset hypoglycemia than afternoon exercise and improves metabolic control on the subsequent day. PMID:25555390

  14. Acarbose improves glycemic control as add-on or monotherapy in Indian type-2 diabetes: Findings from the GlucoVIP multinational observational study

    PubMed Central

    Philip, Elizabeth; Sundaram, Meenakshi L.; Das, Rupam; Chauhan, Sushil Kumar; Deshpande, Sandeep; Ambhore, Sanjay; Rathod, Rahul; Manjrekar, Pravin

    2013-01-01

    Objective: To investigate the efficacy and tolerability of the anti-diabetic agent acarbose (Glucobay®) as add-on or monotherapy in a range of patients with type-2 diabetes mellitus (T2DM), including those with cardiovascular morbidities in India. Materials and Methods: This was a part of a prospective, non-interventional, non-controlled, multicentre, multinational, observational study. The study included patients of either gender if they were aged at least 18 years and had untreated or pre-treated type-2 diabetes mellitus (T2DM) or impaired glucose tolerance and no acarbose treatment within the 3 months before study inclusion. Results: In total, 1996 Indian patients were included in the effectiveness and 2010 in the safety analysis. Patients received acarbose (25-150 mg/day). The mean age of the patients was 50.1 years and the mean BMI was 27.2 kg/m2. Mean 2-h post-prandial plasma glucose (PPG) value and fasting blood glucose (FBG) decreased from 243.9 to 169.5 mg/dl and 158.3 to 120.4 mg/dl, respectively after the last follow-up of 12.4 weeks. The mean HbA1c value at initial visit was 8.4% and was 7.4% at the last follow-up visit. FBG, PPG and HbA1c deceased in 90.6%, 94.4% and 52.4% patients respectively, by the last follow-up visit. The mean decrease in weight and waist circumference was 1.4 kg and 1.6 cm, respectively by the last follow-up visit. Physicians assessed the efficacy of drug as positive response in “very good to good” in 91.08%, “sufficient” in 7.92% and “insufficient” in 0.90% of patients. Also, continuation of Acarbose was reported in 97.09% of patients. Adverse events were reported in 2.74% and drug-related adverse events were reported in 2.19% of patients. Majority of them were gastrointestinal adverse events but were not serious. Conclusion: Acarbose is effective and safe in Indian patients with T2DM. Further, it helps in weight reduction and has very good compliance in patients with T2DM. PMID:24910836

  15. Hyperglycemia, hypoglycemia and glycemic variability in the elderly: a fatal triad?

    PubMed

    Monami, Matteo; Aleffi, Sara

    2016-01-01

    Diabetes mellitus is one of the most important causes of cardiovascular morbidity and mortality; the incidence of chronic complications of diabetes appears to be closely related to the degree of hyperglycaemia. However, results of clinical trials showed that intensive treatment of hyperglycaemia prevents microvascular complications, but has little or no effect on the incidence of cardiovascular events. Different hypoglycaemic drugs show different effects on cardiovascular risk. However, those trials have shown a neutral effect on cardiovascular mortality. This paradoxical result could be explained with the frequent use, in the past, of glucose-lowering agents capable of increasing the risk of hypoglicemia, glycemic variability and weight gain. In conclusion, an adequate glycemic control, in particular in elderly patients, should be achieved, whenever possible, using agents not inducing hypogycemia, glucose fluctuations, and weight gain. In fact, hypoglycaemia and glucose variability should be considered as independent cardiovascular risk factors to a similar extent to hyperglycemia. In this article, the author will review literature supporting the hypothesis that hyperglycemia, hypoglycaemia and glycemic variability are a fatal triad capable of increasing morbidity and mortality in patients with diabetes mellitus. RiassuntoIl diabete mellito è una delle più importanti cause di morbilità e mortalità cardiovascolare, ed è stata dimostrata una stretta correlazione tra compenso glicometabolico ed incidenza di complicanze croniche del diabete mellito. Tuttavia, negli studi di intervento, il controllo accurato dell'iperglicemia sembra poter prevenire le complicanze microvascolari, ma ha effetti soltanto marginali sull'incidenza di eventi cardiovascolari secondari a malattia macrovascolare. Inoltre, i grandi trial di intervento hanno mostrato come la riduzione degli eventi cardiovascolari non si accompagni ad una riduzione della mortalità cardiovascolare. Tale

  16. Emerging trends in optical sensing of glycemic markers for diabetes monitoring

    PubMed Central

    Pandey, Rishikesh; Dingari, Narahara Chari; Spegazzini, Nicolas; Dasari, Ramachandra R.; Horowitz, Gary L.; Barman, Ishan

    2015-01-01

    In the past decade, considerable attention has been focused on the measurement of glycemic markers, such as glycated hemoglobin and glycated albumin, that provide retrospective indices of average glucose levels in the bloodstream. While these biomarkers have been regularly used to monitor long-term glucose control in established diabetics, they have also gained traction in diabetic screening. Detection of such glycemic markers is challenging, especially in a point-of-care setting, due to the stringent requirements for sensitivity and robustness. A number of non-separation based measurement strategies were recently proposed, including photonic tools that are well suited to reagent-free marker quantitation. Here, we critically review these methods while focusing on vibrational spectroscopic methods, which offer highly specific molecular fingerprinting capability. We examine the underlying principles and the utility of these approaches as reagentless assays capable of multiplexed detection of glycemic markers and also the challenges in their eventual use in the clinic. PMID:25598563

  17. Carbohydrate provision in the era of tight glucose control.

    PubMed

    Miller, Keith R; Lawson, Christy M; Smith, Vance L; Harbrecht, Brian G

    2011-08-01

    Glycemic control in the critically ill patient has remained a controversial issue over the last decade. Several large trials, with widely varying results, have generated significant interest in defining the optimal target for blood-glucose control necessary for improving care while minimizing morbidity. Nutritional support has evolved into an additional area of critical care where appropriate practices have been associated with improved patient outcomes. Carbohydrate provision can impact blood-glucose levels, and the relationship between nutrition and glucose levels has become more complex in the era of improved glycemic control. This review discusses the controversy surrounding intensive-insulin therapy in the intensive care unit and explores the relationship with nutritional support, both in the enteral and parenteral form. Achieving realistic goals in both carbohydrate provision and glycemic control may improve patient outcome, and are not mutually exclusive practices. PMID:21604041

  18. Carbohydrate Provision in the Era of Tight Glucose Control

    PubMed Central

    Miller, Keith R.; Lawson, Christy M.; Smith, Vance L.; Harbrecht, Brian G.

    2012-01-01

    Glycemic control in the critically ill patient has remained a controversial issue over the last decade. Several large trials, with widely varying results, have generated significant interest in defining the optimal target for blood-glucose control necessary for improving care while minimizing morbidity. Nutritional support has evolved into an additional area of critical care where appropriate practices have been associated with improved patient outcomes. Carbohydrate provision can impact blood-glucose levels, and the relationship between nutrition and glucose levels has become more complex in the era of improved glycemic control. This review discusses the controversy surrounding intensive-insulin therapy in the intensive care unit and explores the relationship with nutritional support, both in the enteral and parenteral form. Achieving realistic goals in both carbohydrate provision and glycemic control may improve patient outcome, and are not mutually exclusive practices. PMID:21604041

  19. Analysis of achievable disturbance attenuation in a precision magnetically-suspended motion control system

    NASA Technical Reports Server (NTRS)

    Kuzin, Alexander V.; Holmes, Michael L.; Behrouzjou, Roxana; Trumper, David L.

    1994-01-01

    The results of the analysis of the achievable disturbance attenuation to get an Angstrom motion control resolution and macroscopic travel in a precision magnetically-suspended motion control system are presented in this paper. Noise sources in the transducers, electronics, and mechanical vibrations are used to develop the control design.

  20. Social Axioms and Achievement across Cultures: The Influence of Reward for Application and Fate Control

    ERIC Educational Resources Information Center

    Zhou, Fan; Leung, Kwok; Bond, Michael Harris

    2009-01-01

    The present research examined the relationships between two social axiom dimensions, reward for application and fate control, with various achievement-related indexes across a wide range of cultures. Results showed that there was no relationship between reward for application and academic achievement or economic competitiveness, but reward for…

  1. A Model of Parental Achievement-Oriented Psychological Control in Academically Gifted Students

    ERIC Educational Resources Information Center

    Garn, Alex C.; Jolly, Jennifer L.

    2015-01-01

    This study investigated achievement-oriented parent socialization as it pertains to school avoidance in a sample of gifted students. A serial mediation model examining relationships among parental achievement-oriented psychological control (APC), fear of academic failure, academic amotivation, and school avoidance was tested. The sample included…

  2. Parental Warmth, Control, and Involvement in Schooling: Predicting Academic Achievement among Korean American Adolescents.

    ERIC Educational Resources Information Center

    Kim, Kyoungho; Rohner, Ronald P.

    2002-01-01

    Explored the relationship between parenting style and academic achievement of Korean American adolescents, investigating the influence of perceived parental warmth and control and improvement in schooling. Survey data indicated that authoritative paternal parenting related to optimal academic achievement. Differences in maternal parenting styles…

  3. Interactions between Student Achievement, Locus of Control, and Two Methods of College Instruction.

    ERIC Educational Resources Information Center

    Root, Jon R.; Gall, Meredith Damien

    1981-01-01

    Fifty-nine undergraduate students, divided into two groups to compare the instructional motivational effects of auto-tutorial and conventional instruction, were tested for achievement via performance (Ac), achievement via independence (Ai), and internal-external locus of control. Significant interaction was found between Ac and the two methods of…

  4. Children's Self-Regulation and School Achievement in Cultural Contexts: The Role of Maternal Restrictive Control.

    PubMed

    Weis, Mirjam; Trommsdorff, Gisela; Muñoz, Lorena

    2016-01-01

    Self-regulation can be developed through parent-child interactions and has been related to developmental outcomes, e.g., such as educational achievement. This study examined cross-cultural differences and similarities in maternal restrictive control, self-regulation (i.e., behavior and emotion regulation) and school achievement and relations among these variables in Germany and Chile. Seventy-six German and 167 Chilean fourth graders, their mothers, and their teachers participated. Mothers and teachers rated children's behavior regulation with a subscale of the Strengths and Difficulties Questionnaire. Children reported their use of emotion regulation strategies on the Questionnaire for the Measurement of Stress and Coping. Mothers rated maternal restrictive control by answering the Parenting Practice Questionnaire. School achievement was assessed by grades for language and mathematics. Results showed higher behavior regulation of German children in comparison to Chilean children and a higher preference of restrictive parental control in Chilean mothers than in German mothers. Regression analyses revealed positive relations between children's behavior regulation and school achievement in Germany and in Chile. Further, in both cultural contexts, maternal restrictive control was related negatively to behavior regulation and positively to anger-oriented emotion regulation. In sum, the study showed the central function of behavior regulation for school achievement underlining negative relations of maternal restrictive control with children's self-regulation and school achievement in diverse cultural contexts. Culturally adapted interventions related to parenting practices to promote children's behavior regulation may assist in also promoting children's school achievement. PMID:27303318

  5. Children's Self-Regulation and School Achievement in Cultural Contexts: The Role of Maternal Restrictive Control

    PubMed Central

    Weis, Mirjam; Trommsdorff, Gisela; Muñoz, Lorena

    2016-01-01

    Self-regulation can be developed through parent-child interactions and has been related to developmental outcomes, e.g., such as educational achievement. This study examined cross-cultural differences and similarities in maternal restrictive control, self-regulation (i.e., behavior and emotion regulation) and school achievement and relations among these variables in Germany and Chile. Seventy-six German and 167 Chilean fourth graders, their mothers, and their teachers participated. Mothers and teachers rated children's behavior regulation with a subscale of the Strengths and Difficulties Questionnaire. Children reported their use of emotion regulation strategies on the Questionnaire for the Measurement of Stress and Coping. Mothers rated maternal restrictive control by answering the Parenting Practice Questionnaire. School achievement was assessed by grades for language and mathematics. Results showed higher behavior regulation of German children in comparison to Chilean children and a higher preference of restrictive parental control in Chilean mothers than in German mothers. Regression analyses revealed positive relations between children's behavior regulation and school achievement in Germany and in Chile. Further, in both cultural contexts, maternal restrictive control was related negatively to behavior regulation and positively to anger-oriented emotion regulation. In sum, the study showed the central function of behavior regulation for school achievement underlining negative relations of maternal restrictive control with children's self-regulation and school achievement in diverse cultural contexts. Culturally adapted interventions related to parenting practices to promote children's behavior regulation may assist in also promoting children's school achievement. PMID:27303318

  6. Dietary glycemic load and gastric cancer risk in Italy

    PubMed Central

    Bertuccio, P; Praud, D; Chatenoud, L; Lucenteforte, E; Bosetti, C; Pelucchi, C; Rossi, M; Negri, E; La Vecchia, C

    2009-01-01

    We investigated gastric cancer risk in relation to dietary glycemic index (GI) and glycemic load (GL), which represent indirect measures of carbohydrate absorption and consequently of dietary insulin demand, in a case-control study conducted in northern Italy between 1997 and 2007, including 230 patients with the incident, histologically confirmed gastric cancer and 547 frequency matched controls, admitted to the same hospitals as cases with acute non-neoplastic conditions. We used conditional logistic regression models, including terms for major recognised gastric cancer risk factors and non-carbohydrate energy intake. The odds ratios (ORs) in the highest vs lowest quintile were 1.9 (95% CI: 1.0–3.3) for GI and 2.5 (95% CI: 1.3–4.9) for GL. Compared with participants reporting low GL and high fruits/vegetables intake, the OR rose across strata of high GL and low fruits/vegetables, to reach 5.0 (95% CI: 2.2–11.5) for those reporting low fruits/vegetables intake and high GL. Our study may help to explain the direct relation observed in several studies between starchy foods and gastric cancer risk. PMID:19190635

  7. Glycemic targets in pregnancies affected by diabetes: historical perspective and future directions.

    PubMed

    Hernandez, Teri L

    2015-01-01

    The definition of optimal glycemic control in pregnancies affected by diabetes remains enigmatic. Diabetes phenotypes are heterogeneous. Moreover, fetal macrosomia insidiously occurs even with excellent glycemic control. Current blood glucose (BG) targets (FBG ≤95, 1-h post-prandial <140, 2 h <120 mg/dL) have improved perinatal outcomes, but arguably they have not normalized. The conventional management approach has been to replicate a pattern of glycemia in normal pregnancy. Although these patterns are lower than previously appreciated, a randomized controlled trial (RCT) has never compared current vs. lower glucose targets powered on maternal/fetal outcomes. This paper provides historical context to the current targets by reviewing evidence supporting their evolution. Using lower targets (FBG <90, 1 h <122, 2 h <110, mean BG ≤95 mg/dL) may help normalize outcomes, but phenotypic differences (type 1 vs. type 2 vs. gestational diabetes) might require different glycemic goals. There remains a critical need for well-designed RCTs to confirm optimal glycemic control that minimizes both small for and large for gestational age across pregnancies affected by diabetes. PMID:25398204

  8. The effects of the dietary glycemic load on type 2 diabetes risk factors during weight loss

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Objective. To compare the effects of two calorie-restricted diets that differ in glycemic load (GL) on glucose-insulin dynamics and systemic inflammation. Design. Randomized controlled feeding trial. Setting and Participants. Thirty-four healthy overweight adults aged 24-42 years with normal fasti...

  9. Goal Orientations, Locus of Control and Academic Achievement in Prospective Teachers: An Individual Differences Perspective

    ERIC Educational Resources Information Center

    Bulus, Mustafa

    2011-01-01

    The aim of this study is to investigate the role of the prospective teachers' locus of control in goal orientations and of both orientations in academic achievement. The participants were 270 undergraduate students studying in different majors at the Faculty of Education in Pamukkale University. Goal Orientations and Locus of Control Scales were…

  10. On the Relation of Locus of Control and L2 Reading and Writing Achievement

    ERIC Educational Resources Information Center

    Ghonsooly, Behzad; Shirvan, Majid Elahi

    2011-01-01

    Locus of control, a psychological construct, has been the focus of attention in recent decades. Psychologists have discussed the effect of locus of control on achieving life goals in social/psychological interactions. While learning a foreign language involves both social interactions and psychological processes, the role and relation of locus of…

  11. Alternate method for achieving temperature control in the -160 to +90 Celcius range

    NASA Technical Reports Server (NTRS)

    Johnson, Kenneth R. (Inventor)

    1995-01-01

    A single-pass method for accurate and precise temperature control in the -160 to +90 C range is discussed. The method exhibited minimal set-point overshoot during temperature transitions. Control to +/-2 C with transitions between set-points of 7 C per minute were achieved. The method uses commercially available temperature controllers and a gaseous nitrogen/liquid nitrogen mixer to dampen the amplitude of cold temperature spikes caused by liquid nitrogen pulsing.

  12. How do different components of Effortful Control contribute to children's mathematics achievement?

    PubMed

    Sánchez-Pérez, Noelia; Fuentes, Luis J; Pina, Violeta; López-López, Jose A; González-Salinas, Carmen

    2015-01-01

    This work sought to investigate the specific contribution of two different components of Effortful Control (EC) -attentional focusing (AF) and inhibitory control- to children's mathematics achievement. The sample was composed of 142 children aged 9-12 year-old. EC components were measured through the Temperament in Middle Childhood Questionnaire (TMCQ; parent's report); math achievement was measured via teacher's report and through the standard Woodcock-Johnson test. Additionally, the contribution of other cognitive and socio-emotional processes was taken into account. Our results showed that only AF significantly contributed to the variance of children's mathematics achievement; interestingly, mediational models showed that the relationship between effortful attentional self-regulation and mathematics achievement was mediated by academic peer popularity, as well as by intelligence and study skills. Results are discussed in the light of the current theories on the role of children's self-regulation abilities in the context of school. PMID:26441758

  13. Diets with High or Low Protein Content and Glycemic Index for Weight-Loss Maintenance

    PubMed Central

    Larsen, Thomas Meinert; Dalskov, Stine-Mathilde; van Baak, Marleen; Jebb, Susan A.; Papadaki, Angeliki; Pfeiffer, Andreas F.H.; Martinez, J. Alfredo; Handjieva-Darlenska, Teodora; Kunešová, Marie; Pihlsgård, Mats; Stender, Steen; Holst, Claus; Saris, Wim H.M.; Astrup, Arne

    2012-01-01

    Background Studies of weight-control diets that are high in protein or low in glycemic index have reached varied conclusions, probably owing to the fact that the studies had insufficient power. Methods We enrolled overweight adults from eight European countries who had lost at least 8% of their initial body weight with a 3.3-MJ (800-kcal) low-calorie diet. Participants were randomly assigned, in a two-by-two factorial design, to one of five ad libitum diets to prevent weight regain over a 26-week period: a low-protein and low-glycemic-index diet, a low-protein and high-glycemic-index diet, a high-protein and low-glycemic-index diet, a high-protein and high-glycemic-index diet, or a control diet. Results A total of 1209 adults were screened (mean age, 41 years; body-mass index [the weight in kilograms divided by the square of the height in meters], 34), of whom 938 entered the low-calorie-diet phase of the study. A total of 773 participants who completed that phase were randomly assigned to one of the five maintenance diets; 548 completed the intervention (71%). Fewer participants in the high-protein and the low-glycemic-index groups than in the low-protein–high-glycemic-index group dropped out of the study (26.4% and 25.6%, respectively, vs. 37.4%; P = 0.02 and P = 0.01 for the respective comparisons). The mean initial weight loss with the low-calorie diet was 11.0 kg. In the analysis of participants who completed the study, only the low-protein–high-glycemic-index diet was associated with subsequent significant weight regain (1.67 kg; 95% confidence interval [CI], 0.48 to 2.87). In an intention-to-treat analysis, the weight regain was 0.93 kg less (95% CI, 0.31 to 1.55) in the groups assigned to a high-protein diet than in those assigned to a low-protein diet (P = 0.003) and 0.95 kg less (95% CI, 0.33 to 1.57) in the groups assigned to a low-glycemic-index diet than in those assigned to a high-glycemic-index diet (P = 0.003). The analysis involving

  14. Locus of control, test anxiety, academic procrastination, and achievement among college students.

    PubMed

    Carden, Randy; Bryant, Courtney; Moss, Rebekah

    2004-10-01

    114 undergraduates completed the Internal-External Locus of Control scale, the Procrastination Scale, and the Achievement Anxiety Test. They also provided a self-report of their cumulative GPA. Students were divided into two groups by a median-split of 10.5, yielding an internally oriented group of 57 and an externally oriented group of 57. The former students showed significantly lower academic procrastination, debilitating test anxiety, and reported higher academic achievement than the latter. PMID:15587223

  15. Effect of the Glycemic Index of Carbohydrates on Acne vulgaris

    PubMed Central

    Reynolds, Rebecca C.; Lee, Stephen; Choi, James Y. J.; Atkinson, Fiona S.; Stockmann, Karola S.; Petocz, Peter; Brand-Miller, Jennie C.

    2010-01-01

    Acne vulgaris may be improved by dietary factors that increase insulin sensitivity. We hypothesized that a low-glycemic index diet would improve facial acne severity and insulin sensitivity. Fifty-eight adolescent males (mean age ± standard deviation 16.5 ± 1.0 y and body mass index 23.1 ± 3.5 kg/m2) were alternately allocated to high or low glycemic index diets. Severity of inflammatory lesions on the face, insulin sensitivity (homeostasis modeling assessment of insulin resistance), androgens and insulin-like growth factor-1 and its binding proteins were assessed at baseline and at eight weeks, a period corresponding to the school term. Forty-three subjects (n = 23 low glycemic index and n = 20 high glycemic index) completed the study. Diets differed significantly in glycemic index (mean ± standard error of the mean, low glycemic index 51 ± 1 vs. high glycemic index 61 ± 2, p = 0.0002), but not in macronutrient distribution or fiber content. Facial acne improved on both diets (low glycemic index −26 ± 6%, p = 0.0004 and high glycemic index −16 ± 7%, p = 0.01), but differences between diets did not reach significance. Change in insulin sensitivity was not different between diets (low glycemic index 0.2 ± 0.1 and high glycemic index 0.1 ± 0.1, p = 0.60) and did not correlate with change in acne severity (Pearson correlation r = −0.196, p = 0.244). Longer time frames, greater reductions in glycemic load or/and weight loss may be necessary to detect improvements in acne among adolescent boys. PMID:22253996

  16. Serum but not salivary cortisol levels are influenced by daily glycemic oscillations in type 2 diabetes.

    PubMed

    Bellastella, Giuseppe; Maiorino, Maria Ida; De Bellis, Annamaria; Vietri, Maria Teresa; Mosca, Carmela; Scappaticcio, Lorenzo; Pasquali, Daniela; Esposito, Katherine; Giugliano, Dario

    2016-07-01

    Diurnal salivary and plasma cortisol variations are considered valid expression of circadian cortisol rhythmicity. The aim of this study was to assess the reliability of salivary and plasma cortisol and if glycemia and glycemic oscillations may interfere with their concentration. Forty-seven type 2 diabetic patients and 31 controls were studied for glycemic profile and diurnal salivary and plasma cortisol variations on two contemporary samples taken at 08:00 a.m.-11:00 p.m (Late Night, LN). Glucose variability was evaluated in diabetic patients by considering the standard deviation of blood glucose (BGSD) readings, by calculating the mean amplitude of glycemic excursions (MAGEs) and continuous overlapping net glycemic action (CONGA). A significant correlation between LN serum cortisol and morning fasting glycemia (r = 0.78; p = 0.004) was observed in T2DM group but not in the control group (r = 0.09; p = 0.74). While LN serum cortisol significantly correlated with CONGA in diabetic patients (r = 0.50; p < 0.001), LN salivary cortisol did not correlate with any indices of glucose variability. Moreover, a highly significant correlation between LN salivary and LN serum cortisol concentrations was found in control group (r = 0.80; p < 0.001) but not in diabetic patients (r = 0.07; p = 0.62). This study shows for the first time that LN salivary rather than plasma cortisol may give information on the dynamics of adrenal function of type 2 diabetic patients, as it is not significantly influenced by glycemic variations. However, our preliminary results need to be confirmed by further studies with more complete evaluations including many more patients. PMID:26511948

  17. Control of large space structures: Status report on achievements and current problems

    NASA Technical Reports Server (NTRS)

    Lyons, M. G.; Aubrun, J. N.

    1983-01-01

    The objectives, state-of-the-art, and problems of large space structures control are outlined. The general objectives range from basic deployment and maneuvering, where some vibration modes may be suppressed, to disturbance rejection for very high performance imaging applications. The controls selected generally must produce some combination of eigenvalue/eigenvector and loads modification in order to achieve the mission objectives. An experiment illustrating the dynamic control of a suspended circular plate is described. Analysis methods used in system modelling, signal processing, and process control and monitoring are discussed. Sensor and actuator performance are assessed.

  18. Plasma adiponectin concentrations are associated with dietary glycemic index in Malaysian patients with type 2 diabetes.

    PubMed

    Loh, Beng-In; Sathyasuryan, Daniel Robert; Mohamed, Hamid Jan Jan

    2013-01-01

    Adiponectin, an adipocyte-derived hormone has been implicated in the control of blood glucose and chronic inflammation in type 2 diabetes. However, limited studies have evaluated dietary factors on plasma adiponectin levels, especially among type 2 diabetic patients in Malaysia. The aim of this study was to investigate the influence of dietary glycemic index on plasma adiponectin concentrations in patients with type 2 diabetes. A cross-sectional study was conducted in 305 type 2 diabetic patients aged 19-75 years from the Penang General Hospital, Malaysia. Socio-demographic information was collected using a standard questionnaire while dietary details were determined by using a pre-validated semi-quantitative food frequency questionnaire. Anthropometry measurement included weight, height, BMI and waist circumference. Plasma adiponectin concentrations were measured using a commercial ELISA kit. Data were analyzed using multiple linear regression. After multivariate adjustment, dietary glycemic index was inversely associated with plasma adiponectin concentrations (β =-0.272, 95% CI -0.262, - 0.094; p<0.001). It was found that in individuals who consumed 1 unit of foods containing high dietary glycemic index that plasma adiponectin level reduced by 0.3 μg/mL. Thirty two percent (31.9%) of the variation in adiponectin concentrations was explained by age, sex, race, smoking status, BMI, waist circumference, HDL-C, triglycerides, magnesium, fiber and dietary glycemic index according to the multiple linear regression model (R2=0.319). These results support the hypothesis that dietary glycemic index influences plasma adiponectin concentrations in patients with type 2 diabetes. Controlled clinical trials are required to confirm our findings and to elucidate the underlying mechanism. PMID:23635368

  19. Effortful Control and Impulsivity as Concurrent and Longitudinal Predictors of Academic Achievement

    ERIC Educational Resources Information Center

    Valiente, Carlos; Eisenberg, Nancy; Spinrad, Tracy L.; Haugen, Rg; Thompson, Marilyn S.; Kupfer, Anne

    2013-01-01

    The goal of this study was to test if both effortful control (EC) and impulsivity, a reactive index of temperament, uniquely predict adolescents' academic achievement, concurrently and longitudinally (Time 1: "N" = 168, X-bar[subscript age] = 12 years). At Time 1, parents and teachers reported on students' EC and impulsivity.…

  20. Examining Perceived Control Level and Instability as Predictors of First-Year College Students' Academic Achievement

    ERIC Educational Resources Information Center

    Stupnisky, Robert H.; Perry, Raymond P.; Hall, Nathan C.; Guay, Frederic

    2012-01-01

    The aim of the present study was to examine the intraindividual level and instability of perceived academic control (PC) among first-year college students, and their predictive effects on academic achievement. Two studies were conducted measuring situational (state) PC on different schedules: Study 1 (N = 242) five times over a 6-month period and…

  1. Locus of Control in Achievement and Affiliation (MMCS) as Related to Pathologies.

    ERIC Educational Resources Information Center

    Childers, John; Lao, Rosina C.

    The Multidimensional-Multiattributional Causality Scale (MMCS) is a goal-specific scale developed to assess locus of control in the areas of achievement and affiliation. The relationship between the MMCS and feelings of depression, hopelessness, and perceived stress was examined to validate the MMCS and determine if specific expectancies take…

  2. On-Line Tutoring for Math Achievement Testing: A Controlled Evaluation

    ERIC Educational Resources Information Center

    Beal, Carole R.; Walles, Rena; Arroyo, Ivon; Woolf, Beverly P.

    2007-01-01

    We report the results of a controlled evaluation of an interactive on-line tutoring system for high school math achievement test problem solving. High school students (N = 202) completed a math pre-test and were then assigned by teachers to receive interactive on-line multimedia tutoring or their regular classroom instruction. The on-line tutored…

  3. Autonomy Support versus Psychological Control, Perfectionism, and Taiwanese Adolescents' Achievement Goals

    ERIC Educational Resources Information Center

    Shih, Shu-Shen

    2013-01-01

    The author attempted to explore potential antecedents of achievement goals and relations of teacher and parental autonomy support versus psychological control to Taiwanese adolescents' perfectionistic tendencies. A total of 512 eighth-grade students completed self-reported questionnaires assessing variables of interest. Results indicated that…

  4. Training Theory of Mind and Executive Control: A Tool for Improving School Achievement?

    ERIC Educational Resources Information Center

    Kloo, Daniela; Perner, Josef

    2008-01-01

    In the preschool years, there are marked improvements in theory of mind (ToM) and executive functions. And, children's competence in these two core cognitive domains is associated with their academic achievement. Therefore, training ToM and executive control could be a valuable tool for improving children's success in school. This article reviews…

  5. The Effect of Inhibitory Control on General Mathematics Achievement and Fraction Comparison in Middle School Children

    ERIC Educational Resources Information Center

    Gómez, David Maximiliano; Jiménez, Abelino; Bobadilla, Roberto; Reyes, Cristián; Dartnell, Pablo

    2015-01-01

    Individual differences in inhibitory control have been shown to relate to general mathematics achievement, but whether this relation varies for specific areas within mathematics is a question that remains open. Here, we evaluate if inhibitory processes play a specific role in the particular case of fraction comparison, where learners must ignore…

  6. Diagnosis, Remediation, and Locus of Control: Effects on Immediate and Retained Achievement and Attitudes.

    ERIC Educational Resources Information Center

    Saunders-Harris, Ramona; Yeany, Russell H.

    1981-01-01

    Subjects were assessed for locus of control and experienced either: no diagnosis; diagnosis; or, diagnosis and remediation. Immediate achievement was measured twice during the experiment; retention was measured 30 days later. Findings suggest that diagnostic or diagnostic/remedial instruction is effective in increasing middle school science…

  7. Dot Display Affects Approximate Number System Acuity and Relationships with Mathematical Achievement and Inhibitory Control

    PubMed Central

    Norris, Jade Eloise; Castronovo, Julie

    2016-01-01

    Much research has investigated the relationship between the Approximate Number System (ANS) and mathematical achievement, with continued debate surrounding the existence of such a link. The use of different stimulus displays may account for discrepancies in the findings. Indeed, closer scrutiny of the literature suggests that studies supporting a link between ANS acuity and mathematical achievement in adults have mostly measured the ANS using spatially intermixed displays (e.g. of blue and yellow dots), whereas those failing to replicate a link have primarily used spatially separated dot displays. The current study directly compared ANS acuity when using intermixed or separate dots, investigating how such methodological variation mediated the relationship between ANS acuity and mathematical achievement. ANS acuity was poorer and less reliable when measured with intermixed displays, with performance during both conditions related to inhibitory control. Crucially, mathematical achievement was significantly related to ANS accuracy difference (accuracy on congruent trials minus accuracy on incongruent trials) when measured with intermixed displays, but not with separate displays. The findings indicate that methodological variation affects ANS acuity outcomes, as well as the apparent relationship between the ANS and mathematical achievement. Moreover, the current study highlights the problem of low reliabilities of ANS measures. Further research is required to construct ANS measures with improved reliability, and to understand which processes may be responsible for the increased likelihood of finding a correlation between the ANS and mathematical achievement when using intermixed displays. PMID:27195749

  8. High-Achieving High School Students and Not so High-Achieving College Students: A Look at Lack of Self-Control, Academic Ability, and Performance in College

    ERIC Educational Resources Information Center

    Honken, Nora B.; Ralston, Patricia A. S.

    2013-01-01

    This study investigated the relationship among lack of self-control, academic ability, and academic performance for a cohort of freshman engineering students who were, with a few exceptions, extremely high achievers in high school. Structural equation modeling analysis led to the conclusion that lack of self-control in high school, as measured by…

  9. Glycemic Variation in Tumor Patients with Total Parenteral Nutrition

    PubMed Central

    Yang, Jin-Cheng; Dai, Yuan-Yuan; Wang, Li-Ming; Xie, Yi-Bin; Zhou, Hai-Yan; Li, Guo-Hui

    2015-01-01

    Background: Hyperglycemia is associated with poor clinical outcomes and mortality in several patients. However, studies evaluating hyperglycemia variation in tumor patients receiving total parenteral nutrition (TPN) are scarce. The aim of this study was to assess the relationship between glycemia and tumor kinds with TPN by monitoring glycemic variation in tumor patients. Methods: This retrospective clinical trial selected 312 patients with various cancer types, whose unique nutrition treatment was TPN during the monitoring period. All patients had blood glucose (BG) values assessed at least six times daily during the TPN infusion. The glycemic variation before and after TPN was set as the indicator to evaluate the factors influencing BG. Results: The clinical trial lasted 7.5 ± 3.0 days adjusted for age, gender, family cancer history and blood types. There were six cancer types: Hepatic carcinoma (HC, 21.8%), rectal carcinoma (17.3%), colon carcinoma (CC, 14.7%), gastric carcinoma (29.8%), pancreatic carcinoma (11.5%), and duodenal carcinoma (DC, 4.8%). The patients were divided into diabetes and nondiabetes groups. No statistical differences in TPN glucose content between diabetes and nondiabetes groups were found; however, the tumor types affected by BG values were obvious. With increasing BG values, DC, HC and CC were more represented than other tumor types in this sequence in diabetic individuals, as well as in the nondiabetic group. BG was inclined to be more easily influenced in the nondiabetes group. Other factors did not impact BG values, including gender, body mass index, and TPN infusion duration time. Conclusions: When tumor patients are treated with TPN, BG levels should be monitored according to different types of tumors, besides differentiating diabetes or nondiabetes patients. Special BG control is needed for DC, HC and CC in both diabetic and nondiabetic patients. If BG overtly increases, positive measurements are needed to control BG values. The

  10. High school students' perceptions of EFL teacher control orientations and their English academic achievement.

    PubMed

    Kiany, Gholam Reza; Shayestefar, Parvaneh

    2011-09-01

    BACKGROUND. Theories distinguish between student-initiated and teacher-initiated regulation of students' learning activities, or between strong, shared, or loose teacher control during the completion of learning tasks. Empirical validations for such distinctions are scarce, however. AIM. The present study aimed at (a) investigating students' perceptions of control behaviours exhibited by their English teachers; and (b) exploring the contribution of different types of teacher control behaviours to students' cognitive outcomes (English Achievement). SAMPLE. The sample comprised 732 English as a Foreign Language (EFL) students studying in three major fields of high school (Mathematics, Natural Science, and Humanities). The participants (16-17 years of age) were selected from third-grade classes of 27 EFL teachers working in 25 high schools of 6 main different geographical regions in the Isfahan province, Iran. METHOD. To obtain a comprehensive picture of different control types exhibited by Iranian EFL teachers, the control subscales of the two existing questionnaires, i.e., the Questionnaire on Instructional Behaviours (QIB), adapted by Den Brok et al. (2004) and the Questionnaire on Lesson Activities (QLA) used by Den Brok (2001) were merged to form the Questionnaire of Teacher Control (QTC). The development of this Persian instrument involved several steps: translation and back translation by the researchers, one expert translator, and two EFL teachers; piloting; and a final administration of the questionnaire to the student sample. With respect to the second aim of the study, data regarding students' performances on the Standardized National English Achievement Tests were gathered from local educational offices and schools. RESULTS AND CONCLUSION. Statistical analyses supported acceptable reliability and validity of the instrument. A main factor structure with three types of teacher control (strong/high, shared/mid, and loose/low) was found to underlie students

  11. A Randomized Trial about Glycemic Index and Glycemic Load Improves Outcomes among Adults with Type 2 Diabetes

    ERIC Educational Resources Information Center

    Miller, Carla K.; Gutschall, Melissa

    2009-01-01

    Glycemic index (GI) represents the postprandial glucose response of carbohydrate foods, and glycemic load (GL) represents the quantity and quality of carbohydrate consumed. A diet lower in GI and GL may improve diabetes management. A 9-week intervention regarding GI and GL was evaluated among adults in the age range of 40-70 years who had had type…

  12. Effects of High vs Low Glycemic Index of Dietary Carbohydrate on Cardiovascular Disease Risk Factors and Insulin Sensitivity

    PubMed Central

    Sacks, Frank M.; Carey, Vincent J.; Anderson, Cheryl A. M.; Miller, Edgar R.; Copeland, Trisha; Charleston, Jeanne; Harshfield, Benjamin J.; Laranjo, Nancy; McCarron, Phyllis; Swain, Janis; White, Karen; Yee, Karen; Appel, Lawrence J.

    2015-01-01

    IMPORTANCE Foods that have similar carbohydrate content can differ in the amount they raise blood glucose. The effects of this property, called the glycemic index, on risk factors for cardiovascular disease and diabetes are not well understood. OBJECTIVE To determine the effect of glycemic index and amount of total dietary carbohydrate on risk factors for cardiovascular disease and diabetes. DESIGN, SETTING, AND PARTICIPANTS Randomized crossover-controlled feeding trial conducted in research units in academic medical centers, in which 163 overweight adults (systolic blood pressure, 120–159 mm Hg) were given 4 complete diets that contained all of their meals, snacks, and calorie-containing beverages, each for 5 weeks, and completed at least 2 study diets. The first participant was enrolled April 1, 2008; the last participant finished December 22, 2010. For any pair of the 4 diets, there were 135 to 150 participants contributing at least 1 primary outcome measure. INTERVENTIONS (1) A high–glycemic index (65% on the glucose scale), high-carbohydrate diet (58% energy); (2) a low–glycemic index (40%), high-carbohydrate diet; (3) a high–glycemic index, low-carbohydrate diet (40% energy); and (4) a low–glycemic index, low-carbohydrate diet. Each diet was based on a healthful DASH-type diet. MAIN OUTCOMES AND MEASURES The 5 primary outcomes were insulin sensitivity, determined from the areas under the curves of glucose and insulin levels during an oral glucose tolerance test; levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides; and systolic blood pressure. RESULTS At high dietary carbohydrate content, the low– compared with high–glycemic index level decreased insulin sensitivity from 8.9 to 7.1 units (−20%, P = .002); increased LDL cholesterol from 139 to 147 mg/dL (6%, P ≤ .001); and did not affect levels of HDL cholesterol, triglycerides, or blood pressure. At low carbohydrate content, the

  13. How do different components of Effortful Control contribute to children’s mathematics achievement?

    PubMed Central

    Sánchez-Pérez, Noelia; Fuentes, Luis J.; Pina, Violeta; López-López, Jose A.; González-Salinas, Carmen

    2015-01-01

    This work sought to investigate the specific contribution of two different components of Effortful Control (EC) -attentional focusing (AF) and inhibitory control- to children’s mathematics achievement. The sample was composed of 142 children aged 9–12 year-old. EC components were measured through the Temperament in Middle Childhood Questionnaire (TMCQ; parent’s report); math achievement was measured via teacher’s report and through the standard Woodcock–Johnson test. Additionally, the contribution of other cognitive and socio-emotional processes was taken into account. Our results showed that only AF significantly contributed to the variance of children’s mathematics achievement; interestingly, mediational models showed that the relationship between effortful attentional self-regulation and mathematics achievement was mediated by academic peer popularity, as well as by intelligence and study skills. Results are discussed in the light of the current theories on the role of children’s self-regulation abilities in the context of school. PMID:26441758

  14. Professional training in the workplace: the role of achievement motivation and locus of control.

    PubMed

    Suárez-Álvarez, Javier; Campillo-Álvarez, Angela; Fonseca-Pedrero, Eduardo; García-Cueto, Eduardo; Muñiz, José

    2013-01-01

    The core objective of the present work is to explore the reasons why workers from different employment sectors join training courses to improve their job. To this end we assessed achievement motivation, locus of control and professional qualifications according to the participants' employment sector. The final sample consisted of 1460 active Spanish workers from four different employment sectors: services, catering, metal construction, and others. Of the sample, 40.1% were male and 59.9% female, with a mean age of 33.3 years (SD = 9.7). The results show that the new scale developed to assess achievement motivation, locus of control and workers' qualifications presents adequate psychometric characteristics. Statistically significant differences were found in relation to employment sector. The areas studied showed satisfactory levels of workers' effort and achievement motivation to perform their jobs, though their attitudes toward the training courses as a basis for improving their employability are varied. Workers in the catering sector had higher levels of external attribution and the lowest interest in training. Those in the service sector had higher levels of achievement motivation and effort at work. Future research should develop a joint program covering the public and private sectors for the modification of these beliefs, attitudes and attributions. PMID:23866230

  15. Perceived Control Mediates the Relations between Depressive Symptoms and Academic Achievement in Adolescence.

    PubMed

    Moè, Angelica

    2015-01-01

    The present research examined the protective role played by perceived control in the relation between depressive symptoms and academic achievement in adolescence. A sample of 218 adolescents aged 11 to 16 filled in questionnaires to assess self-reported depressive symptoms and three factors tied with Perceived Control (PC): self-regulated learning strategies use, effort attribution, and perceived competence. Grade Point Average (GPA) was considered as a measure of academic achievement. A path model showed that the relation between GPA and depressive symptoms is mediated by PC (p<.05), and became non-significant when PC is considered. The discussion stresses the need to take into account the strategic and motivational factors favouring learning in planning programmes to prevent and treat depressive symptoms in adolescence. PMID:26377348

  16. An Active Suspension Controller Achieving the Best Ride Comfort at Any Specified Location on A Vehicle

    NASA Astrophysics Data System (ADS)

    Oya, Masahiro; Harada, Hiroshi; Araki, Yoshiaki

    In this paper, a new active suspension control scheme is developed so that ride comfort becomes best at any specified location on vehicle body. To achieve this end, two ideal vehicles are designed in which ride comfort becomes best at each different location. Then, linearly combining the two ideal vehicles, a combined ideal vehicle is constructed. It should be noted that we can easily force ride comfort at a specified location become best in the proposed combined ideal vehicle by setting only one design parameter. To achieve the good property stated above in actual vehicles, a robust tracking controller is proposed. It is shown by carrying out numerical simulations that ride comfort at a specified location can be easily improved in the closed loop system using the proposed combined ideal vehicle.

  17. Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

    PubMed Central

    Christofides, Elena A

    2016-01-01

    In acromegaly, achieving biochemical control (growth hormone [GH] level <1.0 ng/mL and age- and sex-normalized levels of insulin-like growth factor 1 [IGF-1]) through timely diagnosis and appropriate treatment provides an opportunity to improve patient outcomes. Diagnosis of acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. PMID:27471378

  18. Use a linear model to achieve stable composition control in a naphtha splitter

    SciTech Connect

    Karpe, P.

    1997-01-01

    The following two points using dual composition control in a naphtha splitter are emphasized: while literature provides general guidelines for design of control systems for distillation columns, each column is unique in terms of dynamic and steady state behavior. Multivariable control analytical tools, such as RGA and SVD, coupled with rigorous steady state simulations, can be effectively employed to achieve stable control in columns beset with severe loop interactions, and often in the absence of on-line analyzers, linear models representing the first order approximations of distillation columns can yield significant benefits. Such models are simple to understand, readily acceptable to operators, do not require special expertise to maintain, and therefore, offer high degree of reliability.

  19. Interaction between amylose and tea polyphenols modulates the postprandial glycemic response to high-amylose maize starch.

    PubMed

    Chai, Yanwei; Wang, Mingzhu; Zhang, Genyi

    2013-09-11

    High-amylose maize starch (HAM) is a common source material to make resistant starch with its high content of amylose (>70%). In the current investigation, the self-assembly of amylose in the presence of bioactive tea polyphenols (TPLs) and resulting slow digestion property of starch were explored. The experimental results using a mouse model showed a slow digestion property can be achieved with an extended and moderate glycemic response to HAM starch cocooked with TPLs. Further studies using a dilute aqueous amylose solution (0.1%, w/v) revealed an increased hydrodynamic radius of amylose molecules, indicating that TPLs could bridge them together, leading to increased molecular sizes. On the other hand, the bound TPLs interrupted the normal process of amylose recrystallizaiton evidenced by a decreased viscosity and storage modulus (G') of HAM (5%) gel, a rough surface of the cross-section of HAM film, and decreased short-range orders examined by Fourier transform infrared spectral analysis. Single-step degradation curves in the thermal gravimetric profile demonstrated the existence of a self-assembled amylose-TPL complex, which is mainly formed through hydrogen bonding interaction according to the results of iodine binding and X-ray powder diffraction analysis. Collectively, the amylose-TPL complexation influences the normal self-assembling process of amylose, leading to a low-ordered crystalline structure, which is the basis for TPLs' function in modulating the digestion property of HAM starch to produce a slowly digestible starch material that is beneficial to postprandial glycemic control and related health effects. PMID:23964645

  20. Glycemic index, glycemic load, wellness and beauty: the state of the art.

    PubMed

    Berra, Bruno; Rizzo, Angela Maria

    2009-01-01

    The glycemic index (GI) is a ranking system for carbohydrates' effect on blood glucose levels. It compares available carbohydrates gram for gram in individual foods, providing a numerical, evidence-based index of postprandial glycemia. The glycemic load (GL) is a ranking system for carbohydrate content in food portions based on their GI and the portion size. These two markers increasingly are being used to prevent typical diseases of the Western world, including type 2 diabetes mellitus, cardiovascular disease, obesity, metabolic syndrome, and acne. Data on the efficacy of GI and GL in the treatment of Western population diseases are discussed and critically evaluated, with a particular focus on acne and other skin disorders. PMID:19168005

  1. Glycemic index, glycemic load and mammographic breast density: the EPIC Florence longitudinal study.

    PubMed

    Masala, Giovanna; Assedi, Melania; Bendinelli, Benedetta; Ermini, Ilaria; Occhini, Daniela; Sieri, Sabina; Brighenti, Furio; Del Turco, Marco Rosselli; Ambrogetti, Daniela; Palli, Domenico

    2013-01-01

    A few studies have evaluated the association between diet and mammographic breast density (MBD) and results are inconsistent. MBD, a well-recognized risk factor for breast cancer, has been proposed as a marker of cumulative exposure to hormones and growth factors. Diets with a high glycemic index (GI) or glycemic load (GL) may increase breast cancer risk, via an effect on the insulin-like growth factor axis. We have investigated the association between carbohydrate intake, GI, GL and MBD in a prospective study. We identified a large series of women, in the frame of the EPIC-Florence cohort, with a mammogram taken five years after enrolment, when detailed information on dietary and lifestyle habits and anthropometric measurements had been collected. Mammograms have been retrieved (1,668, 83%) and MBD assessed according to Wolfe's classification. We compared women with high MBD (P2+DY Wolfe's categories) with those with low MBD (N1+P1) through logistic models adjusted for age, education, body mass index, menopause, number of children, breast feeding, physical activity, non-alcohol energy, fibers, saturated fat and alcohol. A direct association between GL and high MBD emerged in the highest quintile of intake in comparison with the lowest quintile (OR = 1.73, 95%CI 1.13-2.67, p for trend = 0.048) while no association with glycemic index was evident. These results were confirmed after exclusion of women reporting to be on a diet or affected with diabetes, and when Hormone Replacement Therapy at the date of mammographic examination used to assess MBD was considered. The effect was particularly evident among leaner women, although no interaction was found. A positive association was suggested for increasing simple sugar and total carbohydrates intakes limited to the highest quintiles. In this Italian population we observed an association between glycemic load, total and rapidly absorbed carbohydrates and high MBD. These novel results warrant further investigations. PMID

  2. Concepts for Life Cycle Cost Control Required to Achieve Space Transportation Affordability and Sustainability

    NASA Technical Reports Server (NTRS)

    Rhodes, Russel E.; Zapata, Edgar; Levack, Daniel J. H.; Robinson, John W.; Donahue, Benjamin B.

    2009-01-01

    Cost control must be implemented through the establishment of requirements and controlled continually by managing to these requirements. Cost control of the non-recurring side of life cycle cost has traditionally been implemented in both commercial and government programs. The government uses the budget process to implement this control. The commercial approach is to use a similar process of allocating the non-recurring cost to major elements of the program. This type of control generally manages through a work breakdown structure (WBS) by defining the major elements of the program. If the cost control is to be applied across the entire program life cycle cost (LCC), the approach must be addressed very differently. A functional breakdown structure (FBS) is defined and recommended. Use of a FBS provides the visibifity to allow the choice of an integrated solution reducing the cost of providing many different elements of like function. The different functional solutions that drive the hardware logistics, quantity of documentation, operational labor, reliability and maintainability balance, and total integration of the entire system from DDT&E through the life of the program must be fully defined, compared, and final decisions made among these competing solutions. The major drivers of recurring cost have been identified and are presented and discussed. The LCC requirements must be established and flowed down to provide control of LCC. This LCC control will require a structured rigid process similar to the one traditionally used to control weight/performance for space transportation systems throughout the entire program. It has been demonstrated over the last 30 years that without a firm requirement and methodically structured cost control, it is unlikely that affordable and sustainable space transportation system LCC will be achieved.

  3. Study of a Simulation Tool to Determine Achievable Control Dynamics and Control Power Requirements with Perfect Tracking

    NASA Technical Reports Server (NTRS)

    Ostroff, Aaron J.

    1998-01-01

    This paper contains a study of two methods for use in a generic nonlinear simulation tool that could be used to determine achievable control dynamics and control power requirements while performing perfect tracking maneuvers over the entire flight envelope. The two methods are NDI (nonlinear dynamic inversion) and the SOFFT(Stochastic Optimal Feedforward and Feedback Technology) feedforward control structure. Equivalent discrete and continuous SOFFT feedforward controllers have been developed. These equivalent forms clearly show that the closed-loop plant model loop is a plant inversion and is the same as the NDI formulation. The main difference is that the NDI formulation has a closed-loop controller structure whereas SOFFT uses an open-loop command model. Continuous, discrete, and hybrid controller structures have been developed and integrated into the formulation. Linear simulation results show that seven different configurations all give essentially the same response, with the NDI hybrid being slightly different. The SOFFT controller gave better tracking performance compared to the NDI controller when a nonlinear saturation element was added. Future plans include evaluation using a nonlinear simulation.

  4. The effects of hormonal contraceptives on glycemic regulation

    PubMed Central

    Cortés, Manuel E.; Alfaro, Andrea A.

    2014-01-01

    A number of side effects have been linked to the use of hormonal contraceptives, among others, alterations in glucose levels. Hence, the objective of this mini-review is to show the main effects of hormonal contraceptive intake on glycemic regulation. First, the most relevant studies on this topic are described, then the mechanisms that might be accountable for this glycemic regulation impairment as exerted by hormonal contraceptives are discussed. Finally, we briefly discuss the ethical responsibility of health professionals to inform about the potential risks on glycemic homeostasis regarding hormonal contraceptive intake. PMID:25249703

  5. Glycated Albumin versus Glycated Hemoglobin as a Glycemic Indicator in Diabetic Patients on Peritoneal Dialysis.

    PubMed

    Kobayashi, Hiroki; Abe, Masanori; Yoshida, Yoshinori; Suzuki, Hiroko; Maruyama, Noriaki; Okada, Kazuyoshi

    2016-01-01

    Compared with glycated hemoglobin (HbA1c), glycated albumin (GA) is superior in estimating glycemic control in diabetic patients on hemodialysis (HD). However, the better index for assessment of glycemic control in diabetic patients on peritoneal dialysis (PD) and the impact of protein loss on GA are unknown. Twenty diabetic patients on HD were matched by age, sex, and baseline postprandial plasma glucose (PG) levels to 20 PD patients. PG, HbA1c, GA, and serum albumin levels were measured for six months. Protein loss in PD patients was estimated by measuring the protein concentration in the peritoneal dialysate and by 24 h urine collection. Although PG and HbA1c did not differ significantly between the groups, the PD group had significantly lower GA (17.8% versus 20.8%, p < 0.001) and GA/HbA1c ratio (2.95% versus 3.45%, p < 0.0001) than the HD group. Although the PG level correlated significantly with the GA levels in both groups, it was not correlated with the HbA1c levels in both groups. HbA1c level was negatively associated with erythropoiesis-stimulating agent (ESA) dose in both groups, whereas GA was not significantly associated with serum albumin, hemoglobin concentration, ESA dose, and protein loss. Multiple regression analysis identified GA as the only independent factor associated with PG in PD patients. Our results suggested that GA was not significantly associated with protein loss, hemoglobin, serum albumin, and ESA dose. Although GA might underestimate glycemic status, it provided a significantly better measure for estimating glycemic control than HbA1c, even in PD patients. PMID:27120597

  6. Glycated Albumin versus Glycated Hemoglobin as a Glycemic Indicator in Diabetic Patients on Peritoneal Dialysis

    PubMed Central

    Kobayashi, Hiroki; Abe, Masanori; Yoshida, Yoshinori; Suzuki, Hiroko; Maruyama, Noriaki; Okada, Kazuyoshi

    2016-01-01

    Compared with glycated hemoglobin (HbA1c), glycated albumin (GA) is superior in estimating glycemic control in diabetic patients on hemodialysis (HD). However, the better index for assessment of glycemic control in diabetic patients on peritoneal dialysis (PD) and the impact of protein loss on GA are unknown. Twenty diabetic patients on HD were matched by age, sex, and baseline postprandial plasma glucose (PG) levels to 20 PD patients. PG, HbA1c, GA, and serum albumin levels were measured for six months. Protein loss in PD patients was estimated by measuring the protein concentration in the peritoneal dialysate and by 24 h urine collection. Although PG and HbA1c did not differ significantly between the groups, the PD group had significantly lower GA (17.8% versus 20.8%, p < 0.001) and GA/HbA1c ratio (2.95% versus 3.45%, p < 0.0001) than the HD group. Although the PG level correlated significantly with the GA levels in both groups, it was not correlated with the HbA1c levels in both groups. HbA1c level was negatively associated with erythropoiesis-stimulating agent (ESA) dose in both groups, whereas GA was not significantly associated with serum albumin, hemoglobin concentration, ESA dose, and protein loss. Multiple regression analysis identified GA as the only independent factor associated with PG in PD patients. Our results suggested that GA was not significantly associated with protein loss, hemoglobin, serum albumin, and ESA dose. Although GA might underestimate glycemic status, it provided a significantly better measure for estimating glycemic control than HbA1c, even in PD patients. PMID:27120597

  7. Inter- and Intra-Individual Variability in Glycemic Index Values for White Bread Determined Using Standardized Procedures

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This study was conducted to evaluate the inter- and intra-individual variability of the GI value when determined under strictly controlled conditions. Twenty-three healthy adults (20-70 y) completed up to three sets of two visits per set. Each pair of visits assessed the glycemic response to 50 g a...

  8. Metabolic and Glycemic Sequelae of Sleep Disturbances in Children and Adults

    PubMed Central

    Koren, Dorit; O'Sullivan, Katie L.; Mokhlesi, Babak

    2015-01-01

    The prevalence of obesity in adults and children has increased greatly in the past three decades, as have metabolic sequelae, such as insulin resistance and type 2 diabetes mellitus (T2DM). Sleep disturbances are increasingly recognized as contributors to this widespread epidemic in adults, and data are emerging in children as well. The categories of sleep disturbances that contribute to obesity and its glycemic co-morbidities include the following: (1) alterations of sleep duration, chronic sleep restriction and excessive sleep; (2) alterations in sleep architecture; (3) sleep fragmentation; (4) circadian rhythm disorders and disruption (i.e., shift work); and (5) obstructive sleep apnea. This article reviews current evidence supporting the contributions that these sleep disorders play in the development of obesity, insulin resistance, and T2DM as well as possibly influences on glycemic control in type 1 diabetes, with a special focus on data in pediatric populations. PMID:25398202

  9. Esmolol in a case of severe tetanus. Adequate haemodynamic control achieved despite markedly elevated catecholamine levels.

    PubMed

    Beards, S C; Lipman, J; Bothma, P A; Joynt, G M

    1994-03-01

    A patient with severe tetanus, who had a sympathetic crisis while sedated with 30 mg/h diazepam and 30 mg/h morphine, is described. Satisfactory control of the haemodynamic crisis was achieved with bolus doses of esmolol to a total of 180 mg. A disturbing finding was that although there was adequate control of the tachycardia and hypertension, arterial catecholamine levels remained markedly elevated. Adrenaline levels of 531 pg/ml (normal 10-110 pg/ml) and noradrenaline levels of 1,036 pg/ml (normal 100-500 pg/ml) were recorded when the patient had a systolic arterial pressure of 110 mmHg and a heart rate of 97/min. The implications of this finding are discussed. PMID:11218441

  10. Promotive effect of comprehensive management on achieving blood glucose control in senile type 2 diabetics.

    PubMed

    Yan, S-T; Li, C-X; Li, C-L; Li, J; Shao, Y-H; Liu, Y; Zhong, W-W; Fang, F-S; Sun, B-R; Tian, H

    2015-01-01

    The aim of this study was to evaluate the control of blood glucose and glycosylated hemoglobin A1c (HbA1c) and its influencing factors, in elderly type 2 diabetic mellitus (T2DM) patients undergoing comprehensive management. After years of comprehensive prevention of and control measures for diabetes, elderly T2DM patients who were receiving long-term health care were comprehensively evaluated through an annual physical examination. In addition to routine health examination, the patients were required to undergo HbA1c measurement. Among 688 patients, 652 were men and 36 were women, with a mean age of 78.2 ± 9.1 years. The average HbA1c was 6.6 ± 0.9%. A total of 50.6% of the patients had HbA1c <6.5%, whereas 76.3% had HbA1c <7.0%. Among all patients, 77.1, 46.4, 66.1, 67.8, 36.3, and 57.4% achieved the target total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), blood pressure, and body mass index (BMI) levels, respectively. The duration of disease and type of treatment, as well as the LDL, HDL, TG, BMI, and blood pressure levels, were significantly associated with HbA1c control. No patient was admitted because of ketoacidosis or hyperosmolar nonketotic diabetic coma in 10 years. Approximately half of the T2DM patients achieved the target HbA1c level. The more effective blood glucose control observed in our study compared with previous studies can be attributed to the effective monitoring of medical conditions and comprehensive management of patients. PMID:25966070

  11. The Control-Value Theory of Achievement Emotions: Assumptions, Corollaries, and Implications for Educational Research and Practice

    ERIC Educational Resources Information Center

    Pekrun, Reinhard

    2006-01-01

    This article describes the control-value theory of achievement emotions and its implications for educational research and practice. The theory provides an integrative framework for analyzing the antecedents and effects of emotions experienced in achievement and academic settings. It is based on the premise that appraisals of control and values are…

  12. The effect of acute treadmill walking on cognitive control and academic achievement in preadolescent children.

    PubMed

    Hillman, C H; Pontifex, M B; Raine, L B; Castelli, D M; Hall, E E; Kramer, A F

    2009-03-31

    The effect of an acute bout of moderate treadmill walking on behavioral and neuroelectric indexes of the cognitive control of attention and applied aspects of cognition involved in school-based academic performance were assessed. A within-subjects design included 20 preadolescent participants (age=9.5+/-0.5 years; eight female) to assess exercise-induced changes in performance during a modified flanker task and the Wide Range Achievement Test 3. The resting session consisted of cognitive testing followed by a cardiorespiratory fitness assessment to determine aerobic fitness. The exercise session consisted of 20 min of walking on a motor-driven treadmill at 60% of estimated maximum heart rate followed by cognitive testing once heart rate returned to within 10% of pre-exercise levels. Results indicated an improvement in response accuracy, larger P3 amplitude, and better performance on the academic achievement test following aerobic exercise relative to the resting session. Collectively, these findings indicate that single, acute bouts of moderately-intense aerobic exercise (i.e. walking) may improve the cognitive control of attention in preadolescent children, and further support the use of moderate acute exercise as a contributing factor for increasing attention and academic performance. These data suggest that single bouts of exercise affect specific underlying processes that support cognitive health and may be necessary for effective functioning across the lifespan. PMID:19356688

  13. THE EFFECT OF ACUTE TREADMILL WALKING ON COGNITIVE CONTROL AND ACADEMIC ACHIEVEMENT IN PREADOLESCENT CHILDREN

    PubMed Central

    Hillman, Charles H.; Pontifex, Matthew B.; Raine, Lauren B.; Castelli, Darla M.; Hall, Eric E.; Kramer, Arthur F.

    2009-01-01

    The effect of an acute bout of moderate treadmill walking on behavioral and neuroelectric indices of the cognitive control of attention and applied aspects of cognition involved in school-based academic performance were assessed. A within-subjects design included twenty preadolescent participants (Age = 9.5 ± 0.5 years; 8 female) to assess exercise-induced changes in performance during a modified flanker task and the Wide Range Achievement Test 3. The resting session consisted of cognitive testing followed by a cardiorespiratory fitness assessment to determine aerobic fitness. The exercise session consisted of 20 minutes of walking on a motor-driven treadmill at 60% of estimated maximum heart rate followed by cognitive testing once heart rate returned to within 10% of pre-exercise levels. Results indicated an improvement in response accuracy, larger P3 amplitude, and better performance on the academic achievement test following aerobic exercise relative to the resting session. Collectively, these findings indicate that single, acute bouts of moderately-intense aerobic exercise (i.e., walking) may improve the cognitive control of attention in preadolescent children, and further supports the use of moderate acute exercise as a contributing factor for increasing attention and academic performance. These data suggest that single bouts of exercise affect specific underlying processes that support cognitive health and may be necessary for effective functioning across the lifespan. PMID:19356688

  14. Establishing Causality Using Longitudinal Hierarchical Linear Modeling: An Illustration Predicting Achievement From Self-Control

    PubMed Central

    Duckworth, Angela Lee; Tsukayama, Eli; May, Henry

    2010-01-01

    The predictive validity of personality for important life outcomes is well established, but conventional longitudinal analyses cannot rule out the possibility that unmeasured third-variable confounds fully account for the observed relationships. Longitudinal hierarchical linear models (HLM) with time-varying covariates allow each subject to serve as his or her own control, thus eliminating between-individual confounds. HLM also allows the directionality of the causal relationship to be tested by reversing time-lagged predictor and outcome variables. We illustrate these techniques through a series of models that demonstrate that within-individual changes in self-control over time predict subsequent changes in GPA but not vice-versa. The evidence supporting a causal role for self-control was not moderated by IQ, gender, ethnicity, or income. Further analyses rule out one time-varying confound: self-esteem. The analytic approach taken in this study provides the strongest evidence to date for the causal role of self-control in determining achievement. PMID:20976121

  15. Consumption of a high glycemic load but not a high glycemic index diet is marginally associated with oxidative stress in young women.

    PubMed

    Arikawa, Andrea Y; Jakits, Holly E; Flood, Andrew; Thomas, William; Gross, Myron; Schmitz, Kathryn H; Kurzer, Mindy S

    2015-01-01

    Research studies have suggested that chronic consumption of high glycemic index foods may lead to chronically high oxidative stress. This is important because oxidative stress is suspected to be an early event in the etiology of many disease processes. We hypothesized that dietary glycemic index and glycemic load were positively associated with oxidative stress assessed by plasma F2-isoprostanes in healthy, premenopausal women (body mass index [BMI] = 24.7 ± 4.8 kg/m(2) and age 25.3 ± 3.5 years, mean ± SD). We measured plasma F2-isoprostanes in 306 healthy premenopausal women at the baseline visit for the Women In Steady Exercise Research study, using gas chromatography-mass spectrometry. Dietary glycemic index and load were calculated from the National Cancer Institute Diet History Questionnaire, and participants were divided into quartiles of dietary glycemic index and of glycemic load. Plasma F2-isoprostanes were compared across quartile groups of dietary glycemic index and glycemic load using linear regression models. Plasma F2-isoprostanes (pg/mL) increased with quartile of glycemic load (test for linear trend, P = .033), and also increased with quartile of glycemic index in participants with BMI ≥ 25 (P = .035) but not in those with BMI <25 (P = .924). After adjustment for BMI, alcohol consumption and total energy intake, both these positive trends remained marginally significant (P = .123 for quartiles of glycemic index and P = .065 for quartiles of glycemic load). PMID:25453541

  16. Glycemic Allostasis during Mental Activities on Fasting in Non-alcohol Users and Alcohol Users with Different Durations of Abstinence.

    PubMed

    Welcome, Mo; Pereverzev, Va

    2014-09-01

    Glycemic allostasis is the process by which blood glucose stabilization is achieved through the balancing of glucose consumption rate and release into the blood stream under a variety of stressors. This paper reviews findings on the dynamics of glycemic levels during mental activities on fasting in non-alcohol users and alcohol users with different periods of abstinence. Referred articles for this review were searched in the databases of PubMed, Scopus, DOAJ and AJOL. The search was conducted in 2013 between January 20 and July 31. The following keywords were used in the search: alcohol action on glycemia OR brain glucose OR cognitive functions; dynamics of glycemia, dynamics of glycemia during mental activities; dynamics of glycemia on fasting; dynamics of glycemia in non-alcohol users OR alcohol users; glycemic regulation during sobriety. Analysis of the selected articles showed that glycemic allostasis during mental activities on fasting is poorly regulated in alcohol users even after a long duration of sobriety (1-4 weeks after alcohol consumption), compared to non-alcohol users. The major contributor to the maintenance of euglycemia during mental activities after the night's rest (during continuing fast) is gluconeogenesis. PMID:25364589

  17. Glycemic Allostasis during Mental Activities on Fasting in Non-alcohol Users and Alcohol Users with Different Durations of Abstinence

    PubMed Central

    Welcome, MO; Pereverzev, VA

    2014-01-01

    Glycemic allostasis is the process by which blood glucose stabilization is achieved through the balancing of glucose consumption rate and release into the blood stream under a variety of stressors. This paper reviews findings on the dynamics of glycemic levels during mental activities on fasting in non-alcohol users and alcohol users with different periods of abstinence. Referred articles for this review were searched in the databases of PubMed, Scopus, DOAJ and AJOL. The search was conducted in 2013 between January 20 and July 31. The following keywords were used in the search: alcohol action on glycemia OR brain glucose OR cognitive functions; dynamics of glycemia, dynamics of glycemia during mental activities; dynamics of glycemia on fasting; dynamics of glycemia in non-alcohol users OR alcohol users; glycemic regulation during sobriety. Analysis of the selected articles showed that glycemic allostasis during mental activities on fasting is poorly regulated in alcohol users even after a long duration of sobriety (1-4 weeks after alcohol consumption), compared to non-alcohol users. The major contributor to the maintenance of euglycemia during mental activities after the night's rest (during continuing fast) is gluconeogenesis. PMID:25364589

  18. The Contributions of Onchocerciasis Control and Elimination Programs toward the Achievement of the Millennium Development Goals

    PubMed Central

    Dunn, Caitlin; Callahan, Kelly; Katabarwa, Moses; Richards, Frank; Hopkins, Donald; Withers, P. Craig; Buyon, Lucas E.; McFarland, Deborah

    2015-01-01

    In 2000, 189 member states of the United Nations (UN) developed a plan for peace and development, which resulted in eight actionable goals known as the Millennium Development Goals (MDGs). Since their inception, the MDGs have been considered the international standard for measuring development progress and have provided a blueprint for global health policy and programming. However, emphasis upon the achievement of priority benchmarks around the “big three” diseases—namely HIV, tuberculosis (TB), and malaria—has influenced global health entities to disproportionately allocate resources. Meanwhile, several tropical diseases that almost exclusively impact the poorest of the poor continue to be neglected, despite the existence of cost-effective and feasible methods of control or elimination. One such Neglected Tropical Disease (NTD), onchocerciasis, more commonly known as river blindness, is a debilitating and stigmatizing disease primarily affecting individuals living in remote and impoverished areas. Onchocerciasis control is considered to be one of the most successful and cost-effective public health campaigns ever launched. In addition to improving the health and well-being of millions of individuals, these programs also lead to improvements in education, agricultural production, and economic development in affected communities. Perhaps most pertinent to the global health community, though, is the demonstrated effectiveness of facilitating community engagement by allowing communities considerable ownership with regard to drug delivery. This paper reviews the contributions that such concentrated efforts to control and eliminate onchocerciasis make to achieving select MDGs. The authors hope to draw the attention of public policymakers and global health funders to the importance of the struggle against onchocerciasis as a model for community-directed interventions to advance health and development, and to advocate for NTDs inclusion in the post 2015 agenda

  19. The Contributions of Onchocerciasis Control and Elimination Programs toward the Achievement of the Millennium Development Goals.

    PubMed

    Dunn, Caitlin; Callahan, Kelly; Katabarwa, Moses; Richards, Frank; Hopkins, Donald; Withers, P Craig; Buyon, Lucas E; McFarland, Deborah

    2015-05-01

    In 2000, 189 member states of the United Nations (UN) developed a plan for peace and development, which resulted in eight actionable goals known as the Millennium Development Goals (MDGs). Since their inception, the MDGs have been considered the international standard for measuring development progress and have provided a blueprint for global health policy and programming. However, emphasis upon the achievement of priority benchmarks around the "big three" diseases--namely HIV, tuberculosis (TB), and malaria--has influenced global health entities to disproportionately allocate resources. Meanwhile, several tropical diseases that almost exclusively impact the poorest of the poor continue to be neglected, despite the existence of cost-effective and feasible methods of control or elimination. One such Neglected Tropical Disease (NTD), onchocerciasis, more commonly known as river blindness, is a debilitating and stigmatizing disease primarily affecting individuals living in remote and impoverished areas. Onchocerciasis control is considered to be one of the most successful and cost-effective public health campaigns ever launched. In addition to improving the health and well-being of millions of individuals, these programs also lead to improvements in education, agricultural production, and economic development in affected communities. Perhaps most pertinent to the global health community, though, is the demonstrated effectiveness of facilitating community engagement by allowing communities considerable ownership with regard to drug delivery. This paper reviews the contributions that such concentrated efforts to control and eliminate onchocerciasis make to achieving select MDGs. The authors hope to draw the attention of public policymakers and global health funders to the importance of the struggle against onchocerciasis as a model for community-directed interventions to advance health and development, and to advocate for NTDs inclusion in the post 2015 agenda. PMID

  20. Longitudinal relations among parents' reactions to children's negative emotions, effortful control, and math achievement in early elementary school.

    PubMed

    Swanson, Jodi; Valiente, Carlos; Lemery-Chalfant, Kathryn; Bradley, Robert H; Eggum-Wilkens, Natalie D

    2014-01-01

    Panel mediation models and fixed-effects models were used to explore longitudinal relations among parents' reactions to children's displays of negative emotions, children's effortful control (EC), and children's math achievement (N = 291; M age in fall of kindergarten = 5.66 years, SD = .39 year) across kindergarten through second grade. Parents reported their reactions and children's EC. Math achievement was assessed with a standardized achievement test. First-grade EC mediated the relation between parents' reactions at kindergarten and second-grade math achievement, beyond stability in constructs across study years. Panel mediation model results suggested that socialization of EC may be one method of promoting math achievement in early school; however, when all omitted time-invariant covariates of EC and math achievement were controlled, first-grade EC no longer predicted second-grade math achievement. PMID:24916765

  1. Effect of Low Glycemic Index Diet Versus Metformin on Metabolic Syndrome

    PubMed Central

    Rajabi, Shirin; Mazloom, Zohreh; Zamani, Ali; Tabatabaee, Hamid Reza

    2015-01-01

    Background: Metabolic syndrome (MetS) continues to be highly prevalent and contributes to a rapidly growing problem worldwide. The most important therapeutic intervention for metabolic syndrome is diet modification, an intervention whose efficacy has been proven for metabolic syndrome. Objectives: The aim of the present study was to compare the effects of low glycemic index diet versus metformin on MetS components in adults with MetS. Patients and Methods: Fifty-one adults with MetS participated in this randomized controlled clinical trial. Patients were randomly allocated to two groups of metformin and low glycemic index diet. The intervention period was eight weeks. The studied participants were compared at baseline and the end of the trial, regarding the following factors: weight, blood pressure, waist circumference, fasting blood sugar, hemoglobin A1c and lipid profiles (Triglyceride (TG), Total Cholesterol (TC), Low-Density Lipoprotein (LDL) cholesterol, and High-Density Lipoprotein (HDL) cholesterol). Results: The anthropometric measurements, Fasting Blood Sugar (FBS), Hemoglobin A1c, serum lipid profiles (TG, TC, LDL-C, HDL-C) and lipoprotein ratio (LDL/HDL) showed a significant decrease after the intervention in both groups (P < 0.05). Comparison of the difference between the two groups was not significant, except for the mean reduction in FBS, which was more in the metformin group although this was not clinically significant. Conclusions: This study supports the assumption that low glycemic index diet as well as metformin can positively affect metabolic syndrome components. PMID:26587028

  2. Hemorheological and Glycemic Parameters and HDL Cholesterol for the Prediction of Cardiovascular Events

    PubMed Central

    Cho, Sung Woo; Kim, Byung Gyu; Kim, Byung Ok; Byun, Young Sup; Goh, Choong Won; Rhee, Kun Joo; Kwon, Hyuck Moon; Lee, Byoung Kwon

    2016-01-01

    Background Hemorheological and glycemic parameters and high density lipoprotein (HDL) cholesterol are used as biomarkers of atherosclerosis and thrombosis. Objective To investigate the association and clinical relevance of erythrocyte sedimentation rate (ESR), fibrinogen, fasting glucose, glycated hemoglobin (HbA1c), and HDL cholesterol in the prediction of major adverse cardiovascular events (MACE) and coronary heart disease (CHD) in an outpatient population. Methods 708 stable patients who visited the outpatient department were enrolled and followed for a mean period of 28.5 months. Patients were divided into two groups, patients without MACE and patients with MACE, which included cardiac death, acute myocardial infarction, newly diagnosed CHD, and cerebral vascular accident. We compared hemorheological and glycemic parameters and lipid profiles between the groups. Results Patients with MACE had significantly higher ESR, fibrinogen, fasting glucose, and HbA1c, while lower HDL cholesterol compared with patients without MACE. High ESR and fibrinogen and low HDL cholesterol significantly increased the risk of MACE in multivariate regression analysis. In patients with MACE, high fibrinogen and HbA1c levels increased the risk of multivessel CHD. Furthermore, ESR and fibrinogen were significantly positively correlated with HbA1c and negatively correlated with HDL cholesterol, however not correlated with fasting glucose. Conclusion Hemorheological abnormalities, poor glycemic control, and low HDL cholesterol are correlated with each other and could serve as simple and useful surrogate markers and predictors for MACE and CHD in outpatients. PMID:26690693

  3. Dietary glycemic load, glycemic index, and associated factors in a multiethnic cohort of midlife women

    PubMed Central

    Hu, Youqing; Block, Gladys; Sternfeld, Barbara; Sowers, MaryFran

    2011-01-01

    Background Dietary glycemic load (GL) and glycemic index (GI), indicators of the postprandial glucose and insulin response to carbohydrate composition of diet, have been suggested as independent risk factors for cardiovascular disease and diabetes. However, current knowledge about the distribution, correlates, and major contributors of these two measures in human populations is limited. Objective To describe the intakes and correlates of GL and GI in African-American, Caucasian, Chinese and Japanese women in the Study of Women’s Health Across the Nation (SWAN). Design Data are from 2,025 women participating in SWAN, a multi-ethnic, community-based cohort study of women transitioning the menopause. GL and GI were estimated from dietary information obtained at study follow-up visit 05 using a modified Block food frequency questionnaire. The relationship of GL and GI to dietary factors and selected demographic measures, including race/ethnicity, and lifestyle factors was examined using bivariate and multivariate analyses. Results GI and GL were consistently lower in Caucasian women than African American, Japanese or Chinese women. Education was inversely associated with GL and alcohol consumption was inversely associated with GI among all the ethnic groups. The association between family income and glycemic measures varied across the ethnic groups. GI was positively associated with consumption of grains and potatoes and inversely associated with consumption of fruits, juices, dairy foods, protein sources and sweets among all the ethnic groups. Conclusions It is important for researchers to consider factors such as ethnicity, family income, and alcohol intake as potential confounders when investigating the associations of GL and GI with disease. PMID:20516263

  4. Achieving Energy Savings with Highly-Controlled Lighting in an Open-Plan Office

    SciTech Connect

    Rubinstein, Francis; Enscoe, Abby

    2010-04-19

    An installation in a Federal building tested the effectiveness of a highly-controlled, workstation-specific lighting retrofit. The study took place in an open-office area with 86 cubicles and low levels of daylight. Each cubicle was illuminated by a direct/indirectpendant luminaire with three 32 watt lamps, two dimmable DALI ballasts, and an occupancy sensor. A centralized control system programmed all three lamps to turn on and off according to occupancy on a workstation-by-workstation basis. Field measurements taken over the course of several monthsdemonstrated 40% lighting energy savings compared to a baseline without advanced controls that conforms to GSA's current retrofit standard. A photometric analysis found that the installation provided higher desktop light levels than the baseline, while an occupant survey found that occupants in general preferred the lighting system to thebaseline.Simple payback is fairly high; projects that can achieve lower installation costs and/or higher energy savings and those in which greenhouse gas reduction and occupant satisfaction are significant priorities provide the ideal setting for workstation-specific lighting retrofits.

  5. Glycemic Variability and Diabetes Complications: Does It Matter? Of Course It Does!

    PubMed

    Hirsch, Irl B

    2015-08-01

    There is no argument that improving mean levels of glycemic control as judged by assays for glycated hemoglobin (HbA(1c)) reduces the risks of microvascular complications and cardiovascular disease events in patients with type 1 and type 2 diabetes. However, observations in some trials have suggested that targeting HbA(1c) to suggested targets may not always result in improved outcomes for people with long-standing type 2 diabetes. The reasons why the glycemic control strategies that primarily use HbA(1c) in these studies did not have predicted outcomes are not clear. Thus, controversy remains as to whether there are glycemic metrics beyond HbA(1c) that can be defined as effective measures that can be used in addition to HbA(1c) to help in assessing the risk of an individual developing diabetes complications. In this regard, the concept of "glycemic variability" (GV) is one metric that has attracted a lot of attention. GV can be simply defined as the degree to which a patient's blood glucose level fluctuates between high (peaks) and low (nadir) levels. The best and most precise way to assess GV is also one that is still debated. Thus, while there is universal agreement that HbA(1c) is the current gold standard for the primary clinical target, there is no consensus as to whether other proposed glycemic metrics hold promise to provide additional clinical data or whether there should be additional targets beyond HbA(1c). Therefore, given the current controversy, we provide a Point-Counterpoint debate on this issue. In the point narrative below, Dr. Hirsch provides his argument that fluctuations in blood glucose as assessed by GV metrics are deleterious and control of GV should be a primary treatment target. In the following counterpoint narrative, Dr. Bergenstal argues that there are better markers to assess the risk of diabetes than GV and provides his consideration of other concepts. PMID:26207054

  6. Pollution control system design for achieving stringent emissions standards on waste incineration facilities -- a case study

    SciTech Connect

    Weaver, E.H.; Bourgoin, S.

    1998-12-31

    In Germany, environmental standards for non-municipal waste incineration are set to not only achieve very low emissions to the atmosphere, but to also ensure that the solid residues generated are of acceptable quality for final disposal and that no liquid effluent is discharged from the system. In order to control pollution from these facilities, an integrated system is required to address the air, liquid and solid regulatory issues. This paper examines one recent facility installed in Germany which incorporates all of the design features required to comply with those standards. The facility examined is an industrial waste incineration facility located at an oil refinery in northeastern Germany. Equipped with a spray dryer absorber, fabric filter, and wet scrubber, the system is designed to achieve HCl emissions of less than 10 mg/Nm{sup 3} and SO{sub 2} emissions of less than 50 mg/Nm{sup 3}. Particulate emissions must be below 10 mg/Nm{sup 3}. The limit for mercury emissions is 50 ug/Nm{sup 3}, while dioxin emissions must be below 0.10 ng/Nm{sup 3}. Purge water from the wet scrubbing system containing salts is dried in the spray dryer absorber and collected as a dry waste in the fabric filter following the spray dryer absorber. The detailed design of the pollution control system is discussed, along with considerations to ensure continuous compliance with allowable emission levels. Operation of the facility is discussed, along with special operating issues that have been encountered since startup. Finally, performance tests and emissions data are presented to illustrate the actual performance level of the facility.

  7. Adherence to Glycemic Monitoring in Diabetes

    PubMed Central

    Patton, Susana R.

    2015-01-01

    Glucose monitoring either by self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM) plays an important role in diabetes management and in reducing risk for diabetes-related complications. However, despite evidence supporting the role of glucose monitoring in better patient health outcomes, studies also reveal relatively poor adherence rates to SMBG and CGM use and numerous patient-reported barriers. Fortunately, some promising intervention strategies have been identified that promote at least short-term improvements in patients’ adherence to SMBG. These include education, problem solving, contingency management, goal setting, cognitive behavioral therapy, and motivational interviewing. Specific to CGM, interventions to promote greater use among patients are currently under way, yet one pilot study provides data suggesting better maintenance of CGM use in patients showing greater readiness for behavior change. The purpose of this review is to summarize the literature specific to glucose monitoring in patients with diabetes focusing specifically on current adherence rates, barriers to monitoring, and promising intervention strategies that may be ready to deploy now in the clinic setting to promote greater patient adherence to glucose monitoring. Yet, to continue to help patients with diabetes adhere to glucose monitoring, future research is needed to identify the treatment strategies and the intervention schedules that most likely lead to long-term maintenance of optimal glycemic monitoring levels. PMID:25591853

  8. The Target Achievement Control Test: Evaluating real-time myoelectric pattern recognition control of a multifunctional upper-limb prosthesis

    PubMed Central

    Simon, Ann M.; Hargrove, Levi J.; Lock, Blair A.; Kuiken, Todd A.

    2014-01-01

    Despite high classification accuracies (~95%) of myoelectric control systems based on pattern recognition, it is unclear how well offline measures translate to real-time closed-loop control. Recently, a real-time virtual test analyzed how well subjects completed motions using a multiple–degree of freedom (DOF) classifier. Although this test provided real-time performance metrics, the required task was oversimplified: motion speeds were normalized and unintended movements were ignored. We included these considerations in a new, more challenging virtual test, the Target Achievement Control (TAC) Test. Users attempted to move a virtual arm into a target posture using myoelectric pattern recognition. Five transradial amputees performed the test with various classifier (one vs. three DOF) and task complexities (one vs. three required motions per posture). No significant difference was found in classification accuracy between the one- and three- DOF classifiers (97.2%±2.0% and 94.1%±3.1%, respectively) (p=0.14). Subjects completed 31% fewer trials in significantly more time using the three-DOF classifier. Subjects took 3.6±0.8 times longer to reach a three-motion posture compared to a one-motion posture. The results highlight the need for closed-loop performance measures and demonstrate that the TAC Test provides a useful and more challenging tool to test real-time pattern recognition performance. PMID:21938650

  9. Should glycemic index and glycemic load be considered in dietary recommendations?

    PubMed

    Hare-Bruun, Helle; Nielsen, Birgit M; Grau, Katrine; Oxlund, Anne L; Heitmann, Berit L

    2008-10-01

    High glycemic index (GI) and glycemic load (GL) have been proposed to be associated with increased risk of lifestyle diseases. Since protein intake varies little in humans, adherence to the common recommendation to reduce fat intake probably leads to increases in carbohydrate intake, which emphasizes the need to investigate the effects of carbohydrate on diet-related conditions and diseases. This review examines the epidemiological literature linking GI and GL to heart disease, insulin sensitivity, type 2 diabetes, dyslipidemia, and obesity among initially healthy people. The evidence for associations between GI and particularly GL and health among free-living populations is mixed. Only the positive association between GI and development of type 2 diabetes was consistent across cross-sectional and longitudinal studies for both sexes. Low GI/GL may protect against heart disease in women, and cross-sectional studies indicate low GI/GL may reduce high-density-lipoprotein cholesterol and triacylglycerol levels in both sexes. Based on the evidence found in this review, it seems premature to include GI/GL in dietary recommendations. PMID:18826453

  10. Dietary glycemic index and glycemic load and their relationship to cardiovascular risk factors in Chinese children.

    PubMed

    Zhang, Xinyu; Zhu, Yanna; Cai, Li; Ma, Lu; Jing, Jin; Guo, Li; Jin, Yu; Ma, Yinghua; Chen, Yajun

    2016-04-01

    The purpose of this study was to examine the cross-sectional associations between dietary glycemic index (GI) and glycemic load (GL) and cardiovascular disease (CVD) risk factors in Chinese children. A total of 234 Chinese schoolchildren aged 8-11 years in Guangdong participated in the study. Dietary intake was assessed via a 3-day dietary record. Seven established cardiovascular indicators were analyzed in this study: fasting plasma glucose (FPG), fasting triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure, and diastolic blood pressure. Higher dietary GI was significantly associated with higher TG levels (P = 0.037) and lower HDL-C levels (P = 0.005) after adjusting for age, sex, nutritional intake, physical activity, and body mass index z score. LDL-C was found to differ across tertiles of dietary GL. The middle tertile tended to show the highest level of LDL-C. TC, FPG, and blood pressure were independent of both dietary GI and GL. Our findings suggest that higher dietary GI is differentially associated with some CVD risk factors, including lower HDL-C and higher TG, in school-aged children from south China. PMID:26944225

  11. Dietary Glycemic Index, Dietary Glycemic Load, Blood Lipids, and Coronary Heart Disease

    PubMed Central

    Denova-Gutiérrez, Edgar; Huitrón-Bravo, Gerardo; Talavera, Juan O.; Castañón, Susana; Gallegos-Carrillo, Katia; Flores, Yvonne; Salmerón, Jorge

    2010-01-01

    Objective. To examine the associations of dietary glycemic index (GI) and dietary glycemic load (GL) with blood lipid concentrations and coronary heart disease (CHD) in nondiabetic participants in the Health Worker Cohort Study (HWCS). Materials and Methods. A cross-sectional analysis was performed, using data from adults who participated in the HWCS baseline assessment. We collected information on participants' socio-demographic conditions, dietary patterns and physical activity via self-administered questionnaires. Dietary GI and dietary GL were measured using a validated food frequency questionnaire. Anthropometric and clinical measurements were assessed with standardized procedures. CHD risk was estimated according to the sex-specific Framingham prediction algorithms. Results. IIn the 5,830 individuals aged 20 to 70 who were evaluated, dietary GI and GL were significantly associated with HDL-C, LDL-C, LDL-C/HDL-C ratio, and triglycerides serum levels. Subjects with high dietary GI have a relative risk of 1.56 (CI 95%; 1.13–2.14), and those with high dietary GL have a relative risk of 2.64 (CI 95%; 1.15–6.58) of having an elevated CHD risk than those who had low dietary GI and GL. Conclusions. Our results suggest that high dietary GI and dietary GL could have an unfavorable effect on serum lipid levels, which are in turn associated with a higher CHD risk. PMID:20700407

  12. Effective glycemic management in hospitalized patients: a multidisciplinary approach.

    PubMed

    Bolton, Margaret; Richard, Anita; Blonde, Lawrence; Burshell, Alan

    2007-01-01

    The dual purpose of this process paper is to describe the implementation of an intensive insulin infusion program against multiple barriers, despite the increasing evidence in the literature supporting glycemic control, and to report the glucose outcomes. Traditional hyperglycemic management has been done either by subcutaneous sliding scale or intravenous insulin infusions based on absolute glucose numbers. A review of the literature, with particular evidence within the cardiothoracic surgical (CTS) population, has shown significant deleterious effects of even mild hyperglycemia.Increasing evidence supporting prevention of hyperglycemia, along with an unsatisfactory review of current methods used in-house, prompted the initiation of a pilot program to improve current methods utilizing insulin therapy. A multidisciplinary committee was formed consisting of the director of the intensive care unit, a dietician, a nursing unit director, a charge nurse, an endocrinologist, and two endocrinology nurse practitioners with extensive experience in intensive insulin therapy, including continuous subcutaneous insulin infusion. A review of literature was performed to evaluate available data and intravenous insulin infusion algorithms used by published authors. The CTS population was chosen as well as the intensive care unit. Nursing barriers in particular were extensive, and the use of a velocity driven insulin protocol required didactic instruction as well as individual reinforcement. All education, algorithm development, and oversight of patients were primarily performed by the nurse practitioners with immediate endocrinologist availability if needed. A review of glucose results indicated a significant reduction in hyperglycemia with a decrease in hypoglycemia and facilitated transition to subcutaneous therapy when necessary. PMID:21603515

  13. The Relationship of Locus of Control and Self-Efficacy to Academic Achievement of First-Year Students

    ERIC Educational Resources Information Center

    Hoover, Kathleen Geiger

    2003-01-01

    This correlation study assessed whether the psychological variables of college students' locus of control, self-efficacy, and achievement expectations strengthen the prediction of academic achievement beyond that of traditional cognitive measures of high school grade point average and scores on the ACT or SAT examination. The study used earned…

  14. The glycemic index (GI) and glycemic load (GL) of five commonly consumed foods of the South Pacific.

    PubMed

    Lako, Jimaima; Sotheeswaran, Subramania; Aalbersberg, William; Sreekumar, K P

    2004-03-01

    Glycemic index (GI) has been widely used in the management of blood sugar levels among diabetes however; in the South Pacific very little information regarding the GI of local foods is made available. The objectives of this research were to determine the glycemic index and the glycemic load of 5 South Pacific foods, which have not been studied. The foods tested were plantain (Musa AAB), tannia (Xanthosoma sagittifolium), roti or chappati, homemade pancake and Lees cabin crackers. Glucose powder mixed in 200 mL of water was used as reference food. Eight apparently healthy indigenous Fijian males from the Fiji Military Forces aged 25-36 years old were recruited for this study. Participants were given a 50 g carbohydrate portion of the test foods to ingest after a 10-12 hour fast the night before the test and the standard reference food were administered to participants on different days for comparison. In the morning, capillary blood samples were drawn from the fingers at 0 min, 15, 30, 45, 60, 90 and 120 minutes postprandially and the blood glucose level was determined. The equation of Wolever using computer software was used to calculate the glycemic index and the glycemic load was calculated using the formular provided in the Harvard Health Online. The results showed that individuals respond to foods differently thus affecting the GI average values. The glycemic index has been categorized by Miller as low GI is pounds 55, moderate GI is between 56-69 and high GI is > or = 70. All the five carbohydrate foods understudy have moderate GI values ranging from 59 to 68. The Glycemic Load (GL) for cabin biscuit was the highest. PMID:18181442

  15. [The glycemic index of some foods common in Mexico].

    PubMed

    Frati-Munari, A C; Roca-Vides, R A; López-Pérez, R J; de Vivero, I; Ruiz-Velazco, M

    1991-01-01

    To investigate the increase of glycemia due to the ingestion of usual food in Mexico, portions with 50 g of carbohydrate form white corn tortilla, yellow corn tortilla, spaghetti, rice, potatoes, beans brown and black, nopal (prickle pear cactus) and peanuts, compared with white bread, were given to 21 healthy and 27 non-insulin-dependent diabetic subjects. Serum glucose and insulin were measured every 30 min for 180 min long. Glycemic index was obtained as: (area under curve of glucose with test food/area under curve of glucose with white bread) X 100. A corrected index was calculated subtracting the area corresponding to initial values. Insulin index was obtained similarly. Each sample was studied 14-18 times. Glycemic and insulin indexes of white and yellow corn tortilla, spaghetti, rice and potatoes were not different from bread (P greater than 0.05). Corrected glycemic indexes of brown beans (54 +/- 15, +/- SE) and black beans (43 +/- 17) were low (p less than 0.05), as well as corrected insulin indexes (69 +/- 11 and 64 +/- 10 respectively, (P less than 0.02). Peanuts had low glycemic (33 +/- 17, P less than 0.01), but normal insulin index. Nopal had very low glycemic and insulin indexes (10 +/- 17 and 10 +/- 16, P less than 0.0001). These data might be useful in prescribing diets for diabetic subjects. PMID:1959761

  16. Boredom in Achievement Settings: Exploring Control-Value Antecedents and Performance Outcomes of a Neglected Emotion

    ERIC Educational Resources Information Center

    Pekrun, Reinhard; Goetz, Thomas; Daniels, Lia M.; Stupnisky, Robert H.; Perry, Raymond P.

    2010-01-01

    The linkages of achievement-related boredom with students' appraisals and performance outcomes were examined in a series of 5 exploratory, cross-sectional, and predictive investigations. Studies 1 and 2 assessed students' boredom in a single achievement episode (i.e., state achievement boredom); Studies 3, 4, and 5 focused on their habitual…

  17. Achieving a new controllable male contraception by the photothermal effect of gold nanorods.

    PubMed

    Li, Wen-qing; Sun, Chun-yang; Wang, Feng; Wang, Yu-cai; Zhai, Yi-wen; Liang, Meng; Liu, Wen-jing; Liu, Zhi-min; Wang, Jun; Sun, Fei

    2013-06-12

    During the process of human civilization, owning household pets has become increasingly popular. However, dogs and cats may be reservoirs or vectors of transmissible diseases to humans. Confronted with the overpopulation of pets, traditional contraception methods, surgical methods of sterilization, for animals are used, namely, ovariohysterectomy and orchidectomy. Therefore, a simple, nonsurgical, controllable, more effective and less expensive contraception method is highly desirable. In this study, we show that in situ testicular injection of methoxy poly(ethylene glycol)-modified gold nanorods with near-infrared irradiation in male mice can achieve short-lived or permanent male infertility. In a lower hyperthermia treatment, the morphology of testes and seminiferous tubules is only partly injured, and fertility indices are decreased to 10% at day 7, then recovered to 50% at day 60. In a higher hyperthermia treatment, the morphology of testes and seminiferous tubules are totally destroyed, and fertility indices are decreased to 0 at day 7. Overall, our results indicate a potential application of plasmonic nanomaterials for male contraception. PMID:23688274

  18. The glycemic effects of sympathomimetics in stressed mice.

    PubMed

    Fletcher, H P; Wannarka, G L; Sandage, B W

    1982-03-01

    Sympathomimetics are extensively used clinically as decongestants and bronchodilators in cough, cold, and sinus remedies. However, few studies have addressed the glycemic potentials of these drugs. In this study, the glycemic potentials of pseudoephedrine (PSD), ephedrine (EPD), and phenyl-propanolamine (PPA), the three most commonly used sympathomimetics, were evaluated. PSD caused a dose-dependent delayed hyperglycemia. This was attenuated when procedural stress was reduced. EPD and PPA did not increase the hyperglycemia due to procedural stress. EPD and PPA blunted the hyperglycemia in fed mice after a 2 g/kg oral glucose challenge; PSD had no effect. The effects of PPA and EPD on post-challenge glucose levels may be partially explained by increased insulin/glucose ratios at 15 minutes post-challenge. These studies indicate that there are differences in the glycemic effects among the sympathomimetics in stressed mice. PMID:7043680

  19. [The glycemic effect of glutinous rice dumplings in non-insulin-dependent diabetes mellitus].

    PubMed

    Hung, C T; Wang, F F

    1993-06-01

    Postprandial hyperglycemia is a known physiological effect in diabetics. The glycemic index classifies starchy carbohydrate foods into predictable postprandial glycemic responses and was thought to be a useful tool for the planning of diabetic diets. Recently, There has been some debates over the applicability of the glycemic index to mixed meals. The purpose of this study was to study the glycemic effect of glutinous rice dumplings, a mixed food, on non-insulin-dependent diabetics and discuss the applicability of rice dumplings in diet planning. A total of 31 patients with non-insulin-dependent diabetes mellitus participated in this study. The ingredients of the glutinous rice dumplings included 60 grams glutinous rice, 30 grams lean meat, 1/3 of a salted egg yolk, and 1/3 of a mushroom. After a preprandial blood sample, each subject ate one rice dumplings. Postprandial blood samples were taken at 30, 60, 90 and 120 minutes respectively. The glucose hexokinase method was used to determine the plasma glucose value. Subjects were divided into two groups (poor control group and fair control group) by preprandial blood glucose, the cutoff point was 140 mg/dL. For the poor control group, the preprandial value was 226.0 +/- 62.2 mg/dL compared to 102.8 +/- 19.0 mg/dL in the fair control group. The values for the poor and fair control groups postprandially were: 30 minutes, 212.7 +/- 47.6 mg/dL vs 138.3 +/- 30.3 mg/dL; 60 minutes, 259.5 +/- 51.8 mg/dL vs 189.9 +/- 34.6 mg/dL; 90 minutes, 291.5 +/- 69.5 mg/dL vs 210.6 +/- 46.4 mg/dL; and 120 minutes, 297.1 +/- 80.0 mg/dL vs 196.6 +/- 54.0 mg/dL.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7904202

  20. Prediction of Kindergartners' Academic Achievement from Their Effortful Control and Emotionality: Evidence for Direct and Moderated Relations

    ERIC Educational Resources Information Center

    Valiente, Carlos; Lemery-Chalfant, Kathryn; Swanson, Jodi

    2010-01-01

    The relations between effortful control, emotionality (anger, sadness, and shyness), and academic achievement were examined in a short-term longitudinal study of 291 kindergartners. Teachers and parents reported on students' effortful control and emotionality. Students completed the Continuous Performance Task and the Letter-Word, Passage…

  1. Effects of an Emotion Control Treatment on Academic Emotions, Motivation and Achievement in an Online Mathematics Course

    ERIC Educational Resources Information Center

    Kim, ChanMin; Hodges, Charles B.

    2012-01-01

    We designed and developed an emotion control treatment and investigated its effects on college students' academic emotions, motivation, and achievement in an online remedial mathematics course. The treatment group showed more positive emotions of enjoyment and pride than the control group. The treatment group also showed a higher level of…

  2. Child Effortful Control, Teacher-Student Relationships, and Achievement in Academically At-Risk Children: Additive and Interactive Effects

    ERIC Educational Resources Information Center

    Liew, Jeffrey; Chen, Qi; Hughes, Jan N.

    2010-01-01

    The joint contributions of child effortful control (using inhibitory control and task accuracy as behavioral indices) and positive teacher-student relationships at first grade on reading and mathematics achievement at second grade were examined in 761 children who were predominantly from low-income and ethnic minority backgrounds and assessed to…

  3. Glycemic index, glycemic load and insulinemic index of Chinese starchy foods

    PubMed Central

    Lin, Meng-Hsueh Amanda; Wu, Ming-Chang; Lu, Shin; Lin, Jenshinn

    2010-01-01

    AIM: To determine the glycemic index (GI), glycemic load (GL) and insulinemic index (II) of five starchy foods that are commonly used in Chinese diets. METHODS: Ten healthy subjects aged between 20-30 years were recruited. Each subject was asked to consume 50 g of available carbohydrate portions of test foods and reference food. Finger capillary blood samples were collected at the start of eating and 15, 30, 45, 60, 90 and 120 min after consumption. The GI and II of foods were calculated from the ratio of incremental area under the glucose/insulin response curves of test and reference foods. The GL f