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Lower HbA1c (lower + hba1c)
Selected AbstractsThe effect of biopsy-positive silent coeliac disease and treatment with a gluten-free diet on growth and glycaemic control in children with Type 1 diabetesDIABETIC MEDICINE, Issue 12 2009S. Sun Abstract Objective, To determine the effect of coeliac disease and treatment with a gluten-free diet on growth and glycaemic control in asymptomatic children with Type 1 diabetes. Methods, Data were compared in children with coeliac disease diagnosed by annual antibody screening and jejunal biopsy and treated with a gluten-free diet (n = 49) against individuals who were antibody negative (n = 49) matched for age, sex and duration of diabetes. Results, No differences in growth were observed. In the years prior to diagnosis of coeliac disease, mean glycated haemoglobin (HbA1c) was lower in cases compared with control subjects [8.3 ± 1.1% vs. 8.7 ± 0.9%, P = 0.02 (mean ± sd)]. In cases, HbA1c deteriorated 12 months from the start of a gluten-free diet to levels similar to control subjects (8.9 ± 1.5% vs. 8.8 ± 1.5%, P -value for analysis of variance = 0.9). In regression analysis, the diagnosis of coeliac disease and start of a gluten-free diet was associated with a rise in HbA1c in the first year of treatment [odds ratio 1.56 (95% confidence intervals 1.16,2.10), P = 0.003] after adjusting for insulin dose and regimen and other variables. Conclusions, In children with Type 1 diabetes, lower HbA1c prior to diagnosis of silent coeliac disease rises following treatment with a gluten-free diet to levels similar to those without coeliac disease. Although unproven, these observations may relate to abnormalities at the small bowel mucosa before the appearance of circulating coeliac antibodies. [source] Initiating insulin therapy in elderly patients with Type 2 diabetes: efficacy and safety of lispro mix 25 vs. basal insulin combined with oral glucose-lowering agentsDIABETIC MEDICINE, Issue 11 2009B. H. R. Wolffenbuttel Abstract Aims, To compare starter insulins in the elderly subgroup of the DURABLE trial 24-week initiation phase. Methods, In a post-hoc analysis of the , 65 years subgroup enrolled in the DURABLE trial, we compared the safety and efficacy of lispro mix 25 (LM25: lispro 25%/insulin lispro protamine suspension 75%), n = 258, vs. glargine, n = 222, added to oral glucose-lowering agents. Results, Baseline glycated hemoglobin (HbA1c) was similar (LM25 8.7 ± 1.2, glargine 8.8 ± 1.1%, P = 0.612). At 24-weeks, LM25 patients had lower HbA1c (7.0 ± 0.9 vs. 7.3 ± 0.9%, P < 0.001), greater HbA1c reduction (,1.7 ± 1.2 vs. ,1.5 ± 1.1%, P < 0.001), and more patients reaching HbA1c < 7.0% (55.6 vs. 41.0%, P = 0.005). LM25 patients were on more insulin (0.40 ± 0.19 vs. 0.33 ± 0.19 u/kg/day, P < 0.001) and experienced more weight gain (3.6 ± 3.6 vs. 1.8 ± 3.2 kg, P < 0.001). Additionally, LM25-treated patients reported a higher mean overall hypoglycaemia rate than glargine patients (40.8 ± 47.6 vs. 31.1 ± 48.5 episodes/patient/year, P = 0.037), while nocturnal hypoglycaemia rates were similar. Over 24 weeks, incidence of severe hypoglycaemia was higher for LM25 (4.3% vs. 0.9%, P = 0.018); however, by 24-week endpoint incidence was similar (0.8% vs. 0.0%P = 0.125). Conclusions, In this elderly subgroup post-hoc analysis, LM25 demonstrated a lower endpoint HbA1c and a higher % of patients reaching HbA1c target of < 7.0%, but with more weight gain and higher rates of hypoglycaemia compared to glargine. [source] Comprehensive studies of cognitive impairment of the elderly with type 2 diabetesGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2006Takashi Sakurai Type 2 diabetes mellitus is associated with cognitive dysfunction and increases the risk of dementia for the elderly. The aim of the study presented here was to provide a brief review of how disturbance of glucose and metabolic homeostasis may be implicated in the cognitive decline of patients with type 2 diabetes. Several risk factors such as nutrition, cerebrovascular disorders and the neurotoxic effects of hyperglycemia may combine for the formation of mechanisms of cognitive decline in the diabetic elderly. It should be noted that cognitive deficits of diabetes are accompanied by neuroradiological changes in the brain, so that cognitive dysfunction both with and without brain structural changes may overlap during cognitive decline of the diabetic elderly. Recently, we conducted two studies to explore, by means of brain imaging, hierarchical relationships among clinical profiles of diabetes, cognitive function, white matter hyperintensity and brain atrophy. The results suggested that subcortical brain atrophy and hyperintensity constitute predictors of the rate of progression of cognitive dysfunction in the diabetic elderly, while cortical atrophy is associated with high diastolic blood pressure and lower HbA1c. These hypotheses may explain in part the underlying mechanisms of cognitive impairment in the diabetic elderly. Prospective intervention studies are needed, however, to clarify the mechanism of cognitive dysfunction of the diabetic elderly and what the targets are for preventive measures. [source] Coping with type-2 diabetes: the role of sense of coherence compared with active managementJOURNAL OF ADVANCED NURSING, Issue 6 2000Birgitta Sandén-Eriksson PhD Coping with type-2 diabetes: the role of sense of coherence compared with active management Changes in lifestyle, particularly in dietary and exercise habits, are necessary for the majority of patients with type-2 diabetes but are difficult to carry out. However, Antonovsky describes a salutogenic health perspective grounded in patients' developing what he terms ,a sense of coherence' (SOC). Can a strong SOC help diabetes patients to control the disease? The aim of this study was to analyse the relationship between SOC and treatment results measured as glucolysed haemoglobine (HbA1c) in patients with type-2 diabetes. The aim was further to test the relationship between treatment results and an index of patients' participation in active management and emotional state. Eighty-eight patients answered a questionnaire containing 13 statements about sense of coherence (SOC-13), questions about self-assessed health, diabetes activity such as self-management of diet, exercise and self-control of blood sugar and emotional acceptance. There was no direct relationship between SOC-13 and treatment results measured as HbA1c but there was a positive correlation between SOC-13, self-assessed health and HbA1c (P < 0·02). Self-assessed health was seen as a mediating factor. The better patients' estimation of their own health, the higher were SOC-13 scores and the lower HbA1c. There was also a strong positive correlation between low levels of HbA1c and high levels of an index of active management and emotional acceptance of diabetes (P < 0·001). [source] Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 79JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2003U Del Carro Peripheral neuropathy is one of the most common secondary complications of diabetes mellitus, causing severe and prolonged morbidity. However, clinical and experimental studies have reported that careful glucose control may prevent, stabilize, and/or reverse neuropathy and other chronic diabetic complications. Unfortunately, insulin therapy does not prevent the development or progression of chronic lesions in the vessels, kidneys, eyes, or nerves of the diabetic patient. There is great interest in investigating other forms of endocrine replacement therapy, such as transplantation of the pancreas or of the islets of Langerhans (IT). Diabetic polyneuropathy (DP) evolution is characterized by progressive demyelination and axonal loss and is manifested by signs and symptoms on physical examination and abnormalities in nerve conduction studies (NCS). NCS provide reliable, noninvasive, objective measures of peripheral nerve function and constitute the most important technique for the evaluation of the severity of DP in clinical trials. Several research groups have demonstrated that skin biopsy with measurement of intraepidermal nerve fiber density is another method minimally invasive and repeatable that provides direct pathologic evidence of axonal damage in diabetic neuropathy. Fifty-one consecutive IDDM patients with or without end stage renal disease were enrolled at the moment of islet (Is), kidney (KD), kidney-pancreas (KP) or kidney-islet (KI) transplantation. Patients underwent skin biopsy punch, neurologic examination and neurophysiological investigation. Particularly, 20 pts underwent KP tx, 16 KD tx, 10 islet tx and 5 KI. The patients were comparable for duration of diabetes, dialysis (when present), age, lipid profile. In half of the patients a follow-up of 2 years has been reached. After KP tx, and partially with KI, a complete normalization of glycometabolic control has been achieved, with statistically lower HbA1c in comparison with KD group (KP = 6.2; 0.1% vs. KD = 8.4; 0.5%; p < 0.01). In the KI/Is group, a long-term restoration of islet endocrine function has been achieved, with insulin independence. When this has been lost, a persistent secretion of C-peptide was shown for a long period of time. This was correlated with a global improvement quality of life and vascular structure. Preliminary results will be presented. [source] The use of basal insulin (NPH) compared with pre-mixed biphasic insulin in patients with type 2 diabetes mellitusPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 4 2007A single centre experience Abstract The aim of this retrospective study was to compare glycaemic control and weight gain in patients with type 2 diabetes (T2DM) commenced on basal insulin (BI) or mixed insulin (MI). Subjects had T2DM (mean duration seven years) poorly controlled while treated with oral hypoglycaemic agents. Two hundred patients (BI 131 [65%], MI 69 [35%], median age 60 years [range 30,97]) were investigated. Follow up was over a mean period of 3.8 years. Patients started on BI had a significantly lower HbA1c (mean 10.6% vs 11.1%, p = 0.007) and higher body mass index (31.8kg/m2vs 29.6, p = 0.005) compared to those on MI. At 3.5 years patients injecting BI were on a lower daily dose of insulin (BI 66.6units vs MI 99.1units, p = 0.02) and a higher proportion were taking metformin (88% vs 62%, p = 0.01). There was no significant difference in HbA1c (8.5% vs 8.4%, p = 0.36) at the end of follow up. At 2.5 years subjects injecting BI had less weight gain (BI mean 4.0kg vs MI mean 8.0kg, p = 0.02). At 3.5 years the difference in weight gain was not statistically significant (mean 5.0kg vs 7.8kg, p = 0.20). In our experience BI, used in combination with metformin, is an effective treatment option in patients with T2DM, maintains glycaemic control over long-term follow up and is associated with less weight gain than MI. Copyright © 2007 John Wiley & Sons. [source] | ||||||||||