Glycaemic Control is Correlated with Well-Being Index (WHO-5) in Subjects with Type 2 Diabetes

Individuals with type 2 diabetes (T2D) require a long-term dietary strategy for blood glucose management and may benefit from time-restricted eating (TRE, where the duration between the first and last energy intake is restricted to 8–10 h/day). We aimed to determine the feasibility of TRE for individuals with T2D. Participants with T2D (HbA1c >6.5 to <9%, eating window >12 h/day) were recruited to a pre-post, non-randomised intervention consisting of a 2-week Habitual period to establish baseline dietary intake, followed by a 4-weeks TRE intervention during which they were instructed to limit all eating occasions to between 10:00 and 19:00 h on as many days of each week as possible. Recruitment, retention, acceptability, and safety were recorded throughout the study as indicators of feasibility. Dietary intake, glycaemic control, psychological well-being, acceptability, cognitive outcomes, and physiological measures were explored as secondary outcomes. From 594 interested persons, and 27 eligible individuals, 24 participants enrolled and 19 participants (mean ± SD; age: 50 ± 9 years, BMI: 34 ± 5 kg/m2, HbA1c: 7.6 ± 1.1%) completed the 6-week study. Overall daily dietary intake did not change between Habitual (~8400 kJ/d; 35% carbohydrate, 20% protein, 41% fat, 1% alcohol) and TRE periods (~8500 kJ/d; 35% carbohydrate, 19% protein, 42% fat, 1% alcohol). Compliance to the 9 h TRE period was 72 ± 24% of 28 days (i.e., ~5 days/week), with varied adherence (range: 4–100%). Comparisons of adherent vs. non-adherent TRE days showed that adherence to the 9-h TRE window reduced daily energy intake through lower absolute carbohydrate and alcohol intakes. Overall, TRE did not significantly improve measures of glycaemic control (HbA1c −0.2 ± 0.4%; p = 0.053) or reduce body mass. TRE did not impair or improve psychological well-being, with variable effects on cognitive function. Participants described hunger, daily stressors, and emotions as the main barriers to adherence. We demonstrate that 4-weeks of TRE is feasible and achievable for these individuals with T2D to adhere to for at least 5 days/week. The degree of adherence to TRE strongly influenced daily energy intake. Future trials may benefit from supporting participants to incorporate TRE in regular daily life and to overcome barriers to adherence.

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Rationale and design of a cross-sectional study to investigate and describe the chronotype of patients with type 2 diabetes and the effect on glycaemic control: the CODEC study

BMJ Open ◽

10.1136/bmjopen-2018-027773 ◽

2019 ◽

Vol 9 (11) ◽

pp. e027773 ◽

Cited By ~ 3

Author(s):

Emer M Brady ◽

Andrew P Hall ◽

Emma Baldry ◽

Sudesna Chatterjee ◽

Lois J Daniels ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycaemic Control ◽

Dietary Habits ◽

Linear Regression Analysis ◽

Well Being ◽

Lifestyle Factors ◽

Cardiometabolic Health ◽

Cross Sectional ◽

Family History Of Diabetes

IntroductionA person’s chronotype is their entrained preference for sleep time within the 24 hours clock. It is described by the well-known concept of the ‘lark’ (early riser) and ‘owl’ (late sleeper). Evidence suggests that the ‘owl’ is metabolically disadvantaged due to the standard organisation of our society which favours the ‘lark’ and places physiological stresses on this chronotype. The aim of this study is to explore cardiometabolic health between the lark and owl in a population with an established metabolic condition - type 2 diabetes.MethodsThis cross-sectional, multisite study aims to recruit 2247 participants from both secondary and primary care settings. The primary objective is to compare glycaemic control between late and early chronotypes. Secondary objectives include determining if late-chronotype is associated with poorer cardiometabolic health and other lifestyle factors, including well-being, compared with early-chronotype; describing the prevalence of the five different chronotypes in this cohort and examining the trends in glycaemic control, cardiometabolic health, well-being and lifestyle factors across chronotype.AnalysisThe primary outcome (glycated haemoglobin (HbA1c)), linear regression analysis will compare HbA1c between early and late chronotypes, with and without adjustment for confounding variables. Chronotype will be modelled as a categorical variable with all five levels (from extreme-morning to extreme-late type), and as a continuous variable to calculate p for trend across the five categories. A number of models will be created; unadjusted through to adjusted with age, sex, ethnicity, body mass index, duration of diabetes, family history of diabetes, current medication and dietary habits. All secondary outcomes will be analysed using the same method.EthicsEthical approval from the West Midlands - Black Country Research Ethics Committee (16/WM/0457).DisseminationThe results will be disseminated through publication in peer-reviewed medical journal, relevant medical/health conferences and a summary report sent to patients.Trial registration numberNCT02973412 (Pre-Results).

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Coping strategies in Type 1 and Type 2 diabetes patients using insulin: the relationship with emotional well-being and glycaemic control

Diabetes Mellitus ◽

10.14341/dm7550 ◽

2015 ◽

Vol 18 (4) ◽

pp. 41-47

Author(s):

Oleg G. Motovilin ◽

Shishkova Y. Andreevna ◽

Elena V. Surkova

Keyword(s):

Type 2 Diabetes ◽

Glycaemic Control ◽

Coping Strategies ◽

Depression Scale ◽

Well Being ◽

Glycated Haemoglobin ◽

Epidemiologic Studies ◽

Hba1c Levels

Background. Over the long disease course of diabetes mellitus (DM), with its demands in terms of everyday self-management of the disease, individual psychological characteristics may be associated with both emotional well-being (WB) and glycaemic control. The former includes various types of coping strategies (CSs) of the patients, which comprise the common ways for patients to overcome difficult situations.Aim. To study the relationships between CS and both glycaemic control and emotional WB in patients with Type 1 diabetes (T1D) and Type 2 diabetes (T2D) treated with insulin.Materials and methods. The study included 84 patients with T1D and 56 patients with insulin-treated T2D [age, 22.5 ± 3.3 and 61.0 ± 8.9 years; men/women, 29/55 and 11/45; duration of DM, 11.9 ± 5.36 and 11.6 ± 6.2 years and glycated haemoglobin (HbA1c), 9.1% ± 2.2% and 9.0% ± 1.4%, respectively]. The HbA1c levels were determined in all patients. The Strategic Approach to Coping Scale constructed by S. Hobfoll was used to study CS, and emotional WB was assessed based on the severity of anxiety and depression. Further, we used the State-Trait Anxiety Inventory developed by C.D. Spielberger and adapted by Y.L. Khanin and the Center for Epidemiologic Studies Depression Scale. Only Russian validated versions of the questionnaires were used in the study.Results. In both groups of patients, ‘Assertive (Persistent) Actions’ was positively associated with emotional WB. In patients with T2D, WB increases when using ‘Cautious Action’ and ‘Social Joining’. The deterioration of emotional WB was associated with ‘Aggressive Actions’ in both groups of patients. In patients with T1D, negative WB was also associated with ‘Avoidance’, while in patients with T2D, negative WB was associated with ‘Instinctive Actions’. In patients with T1D, ‘Instinctive Action’ was associated with higher HbA1c levels. In patients with T2D, ‘Cautious Action’, ‘Avoidance’ and ‘Antisocial Action’ were associated with lower HbA1c levels.Conclusion. In patients with T1D and T2D, CSs are associated with both emotional WB and glycaemic control. Emotional WB and lower HbA1c levels are associated with ‘Assertive Action’, ‘Cautious Action’, ‘Avoidance’ and ‘Asocial Action’. Negative WB and higher HbA1c levels are associated with ‘Aggressive Action’ and ‘Instinctive Action’.

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Cost Effectiveness of Insulin Glargine versus Neutral Protamin Hagedorn Insulin in the Treatment of Type 2 Diabetes Patients in Turkey

Journal of Health Economics and Outcomes Research ◽

10.36469/9858 ◽

2013 ◽

Vol 1 (2) ◽

pp. 108-122

Author(s):

Ilhan Satman ◽

Hayley Bennett ◽

Candeger Yilmaz ◽

Sazi Imamoglu ◽

Goksun Ayvaz ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cost Effectiveness ◽

Glycaemic Control ◽

Insulin Glargine ◽

Well Being ◽

World Health ◽

Health Improvement ◽

Nph Insulin ◽

The Cost

Background: Type 2 diabetes mellitus (T2DM) poses a significant burden on population well being and healthcare expenditure in Turkey, with disease prevalence continuing to increase. Insulin treatment is necessary for patients failing to achieve glycaemic control with lifestyle modification or oral antidiabetic drugs. While neutral protamin Hagedorn (NPH) insulin has been traditionally prescribed for insulin introduction, insulin glargine has been shown to reduce glycated hemoglobin (HbA1c) with a more favourable hypoglycaemic profile. Objective: To evaluate the cost-effectiveness of insulin glargine compared to NPH insulin in patients with T2DM in Turkey, from a Social Security Institution perspective. Methods: A previously published discrete event simulation model of T2DM progression was utilised to characterise the cost-effectiveness of insulin glargine in a Turkish population given the benefits observed in clinical practice. Improvements in glycaemic control have been incorporated using data from The Health Improvement Network (THIN) database in the United Kingdom, combined with meta-regression results describing the relationship between hypoglycaemia and glycaemic control. Outcomes were evaluated over a 40-year horizon, and costs and benefits discounted at an annual rate of 3.5%. Results are reported in Turksih lira (TL), 2012. Results: Over a lifetime, the Incremental Cost-effectiveness Ratio (ICER) of insulin glargine compared to NPH was 40,101 TL per Quality-adjusted Life Year (QALY). Almost 52 hypoglycaemic events per patient were avoided with the use of insulin glargine compared to NPH, at an incremental lifetime cost of 7,140 TL per patient. The cost-effectiveness of insulin glargine is reduced when modelling only those benefits considered in the trial setting, while the cost-effectiveness profile can be expected to further improve in patients with higher HbA1c levels at baseline. Conclusion: It is difficult to interpret the results of modelling as there is no official cost-effectiveness threshold in Turkey. However, the results may be evaluated using thresholds derived according to methodology proposed by the World Health Organisation (WHO). Insulin glargine is expected to be costeffective compared to NPH insulin, with an ICER below three times the estimated gross domestic product (GDP) per capita; 56,850 TL.

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New insulin glargine 300 U/mL: glycaemic control and hypoclycaemia in insulin-naïve people with type 2 diabetes mellitus (EDITION 3)

Diabetologie und Stoffwechsel ◽

10.1055/s-0035-1549678 ◽

2015 ◽

Vol 10 (S 01) ◽

Author(s):

M Ziemen ◽

MC Riddle ◽

RM Bergenstal ◽

K Sestakauskas ◽

H Goyeau ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Glycaemic Control ◽

Insulin Glargine

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Clinical Experience with Insulin Detemir: Results from the Bangladesh Cohort of Global A1chieve Study

BIRDEM Medical Journal ◽

10.3329/birdem.v3i1.17121 ◽

2013 ◽

Vol 3 (1) ◽

pp. 11-18 ◽

Cited By ~ 1

Author(s):

Zafar Ahmed Latif ◽

Md. Faruque Pathan ◽

Md. Nazrul Islam Siddiqui ◽

MA Mannan ◽

SM Ashrafuzzaman ◽

...

Keyword(s):

Type 2 Diabetes ◽

Body Weight ◽

Glycaemic Control ◽

Insulin Therapy ◽

Hba1c Level ◽

Insulin Detemir ◽

Entire Cohort ◽

Baseline Visit ◽

Effective Option

Objective: To present results from the Bangladesh cohort of the A1chieve study receiving insulin detemir (Levemir) ± oral anti diabetic drugs. Methods: Out of 1093 patients recruited from 49 sites in Bangladesh, 370 were initiated on insulin detemir (Levemir).Study visits were defined as baseline, interim (around 12 weeks from baseline) and final (around 24 weeks from baseline) visit. Results: Glycaemic control was poor in all the groups at baseline. In the entire cohort at 24 weeks, significant reductions from baseline were observed in mean HbA1c (from 10.0 % to 7.2%, p<0.001), FPG (from 10.5 to 6.7 mmol/L, p<0.001) and PPPG (from 15.3 to 8.9 mmol/L, p<0.001) levels. Overall 45.5% of the participants achieved target HbA1c level of < 7% after 24 weeks. The rate of all hypoglycaemic events in the entire cohort reduced from 1.34 (baseline) to 0.12 events/person year after 24 weeks of insulin detemir therapy (p<0.0001). There was no clinically relevant change in body weight in insulin naïve or prior insulin users groups after 24 weeks of insulin detemir therapy. Conclusions: The current study suggests that insulin detemir may be considered as a safe and effective option for initiating insulin therapy for type 2 diabetes in Bangladesh. Birdem Med J 2013; 3(1): 11-18 DOI: http://dx.doi.org/10.3329/birdem.v3i1.17121

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797-P: Impact of Carbohydrate Counting on Glycaemic Control in People with Type 1 and Type 2 Diabetes on Intensified Insulin Therapy

Diabetes ◽

10.2337/db20-797-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 797-P

Author(s):

NORBERT HERMANNS ◽

DOMINIC EHRMANN ◽

BERNHARD KULZER

Keyword(s):

Type 2 Diabetes ◽

Glycaemic Control ◽

Insulin Therapy ◽

Carbohydrate Counting ◽

Intensified Insulin Therapy

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INCRETIN AND DIABETES

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.3.1 ◽

2011 ◽

pp. 5-10

Author(s):

Huu Dang Tran

Keyword(s):

Type 2 Diabetes ◽

Cell Proliferation ◽

Glycaemic Control ◽

Animal Studies ◽

Dipeptidyl Peptidase ◽

Pancreatic Β Cell ◽

Β Cell ◽

Glucose Sensitivity ◽

Cell Glucose

The incretins are peptide hormones secreted from the gut in response to food. They increase the secretion of insulin. The incretin response is reduced in patients with type 2 diabetes so drugs acting on incretins may improve glycaemic control. Incretins are metabolised by dipeptidyl peptidase, so selectively inhibiting this enzyme increases the concentration of circulating incretins. A similar effect results from giving an incretin analogue that cannot be cleaved by dipeptidyl peptidase. Studies have identified other actions including improvement in pancreatic β cell glucose sensitivity and, in animal studies, promotion of pancreatic β cell proliferation and reduction in β cell apoptosis.

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