The Insulin-Only Bionic Pancreas Improves Glycemic Control in Non-Hispanic White and Minority Adults and Children With Type 1 Diabetes
Luz E. CastellanosSteven RussellEdward R. DamianoRoy W. BeckViral N. ShahRyan BaileyPeter CalhounKeisha BirdNelly MaurasR. Paul WadwaGregory P. ForlenzaRobert H. SloverLaurel H. MesserErin CobryViral N. ShahSarit PolskyEmily JostCari BergetLindsey TowersSamantha LangeEstella EscobarChristie BeatsonSonya WalkerAngela J. KaramiEmily BoranianBruce A. BuckinghamRayhan A. LalLaya EkhlaspourMichael S. HughesMarina BasinaLiana HsuBetül HatipoğluKeren ZhouLeann OlanskyAna SurcklaLaura LomeliDiana IsaacsShannon M. KnappAndrea DebsTracy TomaroJulia E. BlanchetteSteven RussellJordan S. SherwoodLuz E. CastellanosMallory HillardMarwa TuffahaMelissa S. PutmanMollie SandsCOURTNEY A. BALLIROEvelyn GreauxBarbara SteinerSarah GastonRachel A. BartholomewKim MartinMark DanielsAmrit BhangooNikta ForghaniHimala KashmiriFrancoise SuttonHeather SpeerMarissa EricksonSamantha ThompsonA McDanielPhilip RaskinSuzanne StrowigLin JordanPerrin C. WhiteAbha ChoudharyJimmy PennMichael S. HensonYasmin MolinaChantal NwosuVanda KumarAngie BurrisK. JerniganBrittany MannJane LynchRabab JafriMaria RayasElia EscanameCatherine E. KerrRuby Favela-PrezasSara OlivarriJeremy PettusSchafer BoederTodd A. MayAdrienne ArmstrongErin GiovanettiIrl B. HirschSubbulaxmi TrikudanathanNancy SanbornXenia AverkiouRobin GolandKristen M. WilliamsNatasha LeibelJamie HyattSarah PollakElizabeth RobinsonEmily CascianoAnalía ÁlvarezEleanor ZagorenJaclynn JohnsonSilpa SharmaJohn B. BuseM. Sue KirkmanK. BergamoKlara R. KleinJean M. DostouSriram MachineniLaura YoungJamie DinerAlex KassVirginia PurringtonRachel FraserJulie M. UehlingDavida F. KrugerArti BhanJ. Kimberly JonesTerra CushmanHeather HunterNatalie CorkerShereen MukhashenNelly MaurasMatthew BensonKeisha BirdKimberly EnglertJ. PermuyKimberly PonthieuxAlbina TarkoAndrew MuirJ. Nina HamKristina CossenEric I. FelnerAmber AntichWanda SanchezMone AnzaiKathryn Jean LucasCatherine SimpsonJanet B. McGillMaamoun SalamJulie SilversteinSamantha E. AdamsonAndrea CedenoMary Jane CliftonToni SchweigerTraci BellFran R. CogenS. Spence MeighanAndrew DauberMeryll CastroTara McCarthyKimberly BoucherHelen JenkinsJill Weissberg‐BenchellKatrina J. RuedyRoy W. BeckSarah BorgmanSydnee BradshawPaige MillerZoey LiPeter CalhounMartin MarekRosa PritchardE. N. DolzhenkoEdward R. DamianoFiras H. El-KhatibDeanna GabrielsonJulie IdzorekAnne Elstrom-ParkGuillermo Arreaza-RubínThomas L. EggermanNeal GreenSteven H. BelleJessica R. CastleJennifer GreenLaurent LegaultSteven M. WilliCarol Wysham
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OBJECTIVE We evaluated the performance of the iLet bionic pancreas (BP) in non-Hispanic White individuals (here referred to as “Whites”) and in Black, Hispanic, and other individuals (here collectively referred to as “Minorities”). RESEARCH DESIGN AND METHODS A multicenter, randomized controlled trial evaluated glycemic management with the BP versus standard of care (SC) in 161 adult and 165 pediatric participants with type 1 diabetes over 13 weeks. RESULTS In Whites (n = 240), the mean baseline-adjusted difference in 13-week HbA1c between the BP and SC groups was −0.45% (95% CI −0.61 to −0.29 [−4.9 mmol/mol; −6.6 to −3.1]; P < 0.001), while this difference among Minorities (n = 84) was −0.53% (−0.83 to −0.24 [−6.0 mmol/mol; −9.2 to −2.8]; P < 0.001). In Whites, the mean baseline-adjusted difference in time in range between the BP and SC groups was 10% (95% CI 7–12; P < 0.001) and in Minorities was 14% (10–18; P < 0.001). CONCLUSIONS The BP improves glycemic control in both Whites and Minorities and offers promise in decreasing health care disparities.Objective To evaluate the therapeutic effects of one visit root canal therapy(RCT) and several visit RCT for cracked teeth.Methods Cracked teeth with pulposis or apical disease were randomized to receive one visit RCTor several visit RCT,their responses were compared.Results The long-term therapeutic effects of one visit RCT were batter than those of several visit RCT,but the differences were not significant.The concomitant symptoms were significantly less and treatment time was significantly shorter in one visit RCT group as compared with several visit RCT group.Conclusion One visit RCT is recommended for the RCT of cracked teeth.
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Background We investigated whether patients' perceived glycemic control and self-reported diabetes self-care correlated with their actual glycemic control. Methods A survey was administered among patients with diabetes mellitus at an outpatient clinic with structured self-report questionnaires regarding perceived glycemic control and diabetes self-management. Actual glycemic control was defined as a change in glycated hemoglobin (A1C) or fasting plasma glucose (FPG) since the last clinic visit. Results Patients who perceived their glycemic control as "improved" actually showed a mild but significant decrease in the mean A1C (-0.1%, P=0.02), and those who perceived glycemic control as "aggravated" had a significant increase in the mean FPG (10.5 mg/dL or 0.59 mmol/L, P=0.04) compared to the "stationary" group. However, one-half of patients falsely predicted their actual glycemic control status. Subjective assessment of diabetes self-care efforts, such as adherence to a diet regimen or physical activity, correlated positively with perceived glycemic control but showed no association with actual glycemic control. Conclusion Patients should be encouraged to assess and monitor diabetes self-care more objectively to motivate behavioral modifications and improve their actual glycemic control. Keywords: Perceived glycemic control; Actual glycemic control; Diabetes self-care
Glycated hemoglobin
Outpatient clinic
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Although glycemic control is known to reduce complications associated with diabetes, it is an elusive goal for many patients with diabetes. The objective of this study was to identify factors associated with sustained poor glycemic control, some glycemic variability, and wide glycemic variability among diabetes patients over 3 years.This retrospective study was conducted among 2,970 diabetes patients with poor glycemic control (hemoglobin A1c [HbA1c] >9%) who were enrolled in a health plan in Hawaii in 2006. We conducted multivariable logistic regressions to examine factors related to sustained poor control, some glycemic variability, and wide glycemic variability during the next 3 years. Independent variables evaluated as possible predictors were age, sex, type of insurance coverage, morbidity, diabetes duration, history of cardiovascular disease, and number of medications.Longer duration of diabetes, being under age 35, and taking 15 or more medications were significantly associated with sustained poor glycemic control. Preferred provider organization and Medicare (vs health maintenance organization) enrollees and patients with high morbidity were less likely to have sustained poor glycemic control. Wide glycemic variability was significantly related to being younger than age 50, longer duration of diabetes, having coronary artery disease, and taking 5 to 9 medications per year.Results indicate that duration of diabetes, age, number of medications, morbidity, and type of insurance coverage are risk factors for sustained poor glycemic control. Patients with these characteristics may need additional therapies and targeted interventions to improve glycemic control. Patients younger than age 50 and those with a history of coronary heart disease should be warned of the health risks of wide glycemic variability.
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Can viscous fiber lower glycemic markers in type 2 diabetes?The first meta-analysis to focus on viscous dietary fiber in T2D suggests a potential role for this supplement in improving glycemic control. PRACTICE CHANGERUnless contraindicated, recommend viscous fiber supplementation to your patients with type 2 diabetes (T2D), in addition to the usual evidence-based standards of care, to improve markers of glycemic control. STRENGTH OF RECOMMENDATIONC: Based on a meta-analysis and systematic review of 28 randomized controlled trials, without discussion of patient-oriented outcomes. 1
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Introduction:Remogliflozin etabonate is the latest addition to the Sodium glucose co-transporter-2 (SGLT2) inhibitor class of drugs which is a potent and selective inhibitor of SGLT2.A real world non-randomized, single centre, retrospective study was done to assess changes in glycemic and extra glycemic parameters of type 2 diabetes mellitus (T2DM) patients who were well controlled (HbA1c ≤ 7%) with other SGLT2 inhibitors (Dapagliflozin and Empagliflozin), but had difficulty to afford the high cost of therapy from out of pocket expenditure and voluntarily requested for a switchover for economic reasons. Materials and methods:Retrospective observation of the variations in glycemic and extra glycemic parameters including blood pressure, body weight, lipid profile and eGFR of 32 patients was recorded, when they were initiated on Remogliflozin etabonate, replacing other SGLT2 inhibitors (19 were on Empagliflozin and 13 were on Dapagliflozin).The data was tabulated for a total of three visits (First -initial, Second -at three months from initial and Third-at six months from initial), after which analysis was done.Results: There were no significant changes in HbA1c value from baseline after initiation of remogliflozin etabonate from dapagliflozin and empagliflozin.There was also no significant reduction of blood pressure, body weight and eGFR from baseline for patients switched from Dapagliflozin.However, the change in blood pressure and body weight was statistically significant for patients switched from Empagliflozin (p<0.01). Conclusion:Remogliflozin etabonate given as 100 mg twice daily is non-inferior to Empagliflozin 10 mg / Dapagliflozin 10 mg given as once daily to patients of T2DM as far as their glycemic goals are concerned with favourable extra glycemic benefit and cost burden reduction of more than 50%.
Variation (astronomy)
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Continuous glucose monitoring (CGM) provides comprehensive assessment of daily glucose measurements for patients with diabetes and can reveal high and low blood glucose values that may occur even when a patient’s A1C is adequately controlled. Among the measures captured by CGM, the percentage of time in the target glycemic range, or “time in range” (typically 70–180 mg/dL), has emerged as one of the strongest indicators of good glycemic control. This review examines the shift to using CGM to assess glycemic control and guide diabetes treatment decisions, with a focus on time in range as the key metric of glycemic control.
Target range
Blood Glucose Self-Monitoring
Blood glucose monitoring
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Continuous glucose monitoring (CGM) provides comprehensive assessment of daily glucose measurements for patients with diabetes and can reveal high and low blood glucose values that may occur even when a patient’s A1C is adequately controlled. Among the measures captured by CGM, the percentage of time in the target glycemic range, or “time in range,” (typically 70–180 mg/dL) has emerged as one of the strongest indicators of good glycemic control. This review examines the shift to using CGM to assess glycemic control and guide diabetes treatment decisions, with a focus on time in range as the key metric of glycemic control.
Target range
Blood Glucose Self-Monitoring
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Optimal glycemic control without the presence of diabetes-related complications is the primary goal for adequate diabetes management. Recent studies have shown that hemoglobin A1c level cannot fully evaluate diabetes management as glycemic fluctuations are demonstrated to have a major impact on the occurrence of diabetes-related micro- and macroangiopathic comorbidities. The use of continuous glycemic monitoring systems allowed the quantification of glycemic fluctuations, providing valuable information about the patients’ glycemic control through various indicators that evaluate the magnitude of glycemic fluctuations in different time intervals. This review highlights the significance of glycemic variability by describing and providing a better understanding of common and alternative indicators available for use in clinical practice.
Diabetes management
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