Can non-invasive features including limited joint mobility be used to predict glucose control?

2020 ◽  
Vol 7 (1) ◽  
pp. 26-32
Author(s):  
Sterling Ramroach ◽  
Andrew Dhanoo ◽  
Brian Cockburn ◽  
Ajay Joshi
Keyword(s):  
Glycaemic Control ◽  
Glucose Control ◽  
Glycated Haemoglobin ◽  
Diabetes Research ◽  
Joint Mobility ◽  
Limited Joint Mobility ◽  
Non Invasive ◽  
Full Dataset ◽  
Machine Learning Model

IntroductionLimited joint mobility (LJM) has been linked to deficient glycaemic control but is an understudied area of type 2 diabetes research. We set out to investigate the correlation between glycated haemoglobin (HbA1c) and the quantification of LJM of finger joints and non-invasive anthropometrics.MethodsBlood samples were taken from 170 participants at diabetes awareness drives in Trinidad. These participants were aged 59.61 ± 15.46, with a body mass index (BMI) of 29.73 ± 7.65 and HbA1c levels of 8.42 ± 2.22. There were 110 women and 60 men. Finger joint angles were recorded using a goniometer.ResultsThe K-Nearest Neighbour machine learning model was tested via 10-fold cross validation to differentiate good from poor glycaemic control (HbA1c ≤ 6.5%) using non-invasive features. There is some correlation between LJM and HbA1c. Our model scored a mean accuracy of 74.71% ± 1.81 (p=0.01) classifying the full dataset, 82.14% ± 2.20 (p=0.01) and 72.76% ± 1.41 (p=0.059) on the male/female subsets, respectively.DiscussionThe time since diagnosis, age and BMI were important features linked to glucose control. Our results support the notion that the first signs of LJM in the fingers occur in the first and fifth fingers as these particular angles were ranked highly in the list of most important features.ConclusionOur results show that LJM has some role to play in monitoring HbA1c, although not as important as more conventional anthropometrics. Our results support the idea that there should be a separate test for each sex.

scholarly journals Neutrophil-lymphocyte ratio correlates with limited joint mobility of hand in patients with type 2 diabetes

2018 ◽  
Vol 65 (10) ◽  
pp. 1011-1017
Author(s):  
Yusuke Mineoka ◽  
Michiyo Ishii ◽  
Yoshitaka Hashimoto ◽  
Naoto Nakamura ◽  
Yasukazu Katsumi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Joint Mobility ◽  
Limited Joint Mobility ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio

scholarly journals Impact of pharmacist-led care on glycaemic control of patients with uncontrolled type 2 diabetes: a randomised controlled trial in Nigeria

2021 ◽  
Vol 19 (3) ◽  
pp. 2402
Author(s):  
Emmanuel A. David ◽  
Rebecca O. Soremekun ◽  
Isaac O. Abah ◽  
Roseline I. Aderemi-Williams
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Usual Care ◽  
Usual Care Group ◽  
Intervention Group ◽  
Glycated Haemoglobin ◽  
Care Group ◽  
Laboratory Parameters ◽  
Randomised Controlled

Background: Diabetes mellitus is a chronic, degenerative disease, requiring a multi-dimensional, multi-professional care by healthcare providers and substantial self-care by the patients, to achieve treatment goals. Objective: To evaluate the impact of pharmacist-led care on glycaemic control in patients with uncontrolled Type 2 Diabetes Methods: In a parallel group, single-blind randomised controlled study; type 2 diabetic patients, with greater than 7% glycated haemoglobin (A1C) were randomised into intervention and usual care groups and followed for six months. Glycated haemoglobin analyzer, lipid analyzer and blood pressure monitor/apparatus were used to measure patients’ laboratory parameters at baseline and six months. Intervention group patients received pharmacist-structured care, made up of patient education and phone calls, in addition to usual care. In an intention to treat analysis, Mann-Whitney U test was used to compare median change at six months in the primary (A1C) and secondary outcome measures. Effect size was computed and proportion of patients that reached target laboratory parameters were compared in both arms. Results: All enrolled participants (108) completed the study, 54 in each arm. Mean age was 51 (SD 11.75) and majority were females (68.5%). Participants in the intervention group had significant reduction in A1C of -0.75%, compared with an increase of 0.15% in the usual care group (p<0.001; eta-square= 0.144). The proportion of those that achieved target A1C of <7% at 6 months in the intervention and usual care group was 42.6% vs 20.8% (p=0.02). Furthermore, intervention patients were about 3 times more likely to have better glucose control; A1C<7% (aOR 2.72, 95%CI: 1.14-6.46) compared to usual care group, adjusted for sex, age, and duration of diabetes. Conclusions: Pharmacist-led care significantly improved glycaemic control in patients with uncontrolled T2DM.

scholarly journals Lixisenatide – A New Glucagon-like Peptide 1 Receptor Agonist in the Treatment of Type 2 Diabetes

2010 ◽  
Vol 9 (2) ◽  
pp. 76 ◽  
Author(s):  
Josep Vidal ◽  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Basal Insulin ◽  
Glycated Haemoglobin ◽  
Insulin Analogues ◽  
Receptor Agonists ◽  
Glucagon Like Peptide ◽  
Glucagon Like Peptide 1 ◽  
Long Acting

Optimal glycaemic control is essential to managing risks in patients with type 2 diabetes. However, glycaemic control remains poor among type 2 diabetes patients, particularly the control of post-prandial glucose (PPG). Almost half of patients treated with basal insulin and oral anti-diabetic drugs (OADs) do not achieve their glycated haemoglobin (HbA1c) goals, despite achieving fasting plasma glucose (FPG) control. Glycaemic control targets have emphasised FPG targets, but PPG contributes significantly to overall glycaemic control in type 2 diabetes. Glucagon-like peptide 1 (GLP-1) receptor agonists have shown substantial efficacy in improving overall glycaemic control but have differing effects on PPG, which is a result of their different mechanisms of action. Lixisenatide is unique among existing GLP-1 receptor agonists in that it is short acting but given as a once daily dose, and exerts its main effects during the prandial period. It has demonstrated efficacy in an extensive clinical trial programme. In particular, it has shown a beneficial effect on PPG compared with existing GLP-1 receptor agonists, probably a result of its effect on slowing gastric emptying. This has provided a strong rationale for its use as add-on therapy to long-acting basal insulin analogues, in cases where the latter is not providing adequate glycaemic control. The additive effects on glycaemic control may lead to a new treatment approach to manage blood glucose and prevent long-term complications in patients with type 2 diabetes.

Limited joint mobility of the hand correlates incident hospitalisation with infection in patients with type 2 diabetes

2020 ◽  
Vol 161 ◽  
pp. 108049
Author(s):  
Yusuke Mineoka ◽  
Michiyo Ishii ◽  
Yoshitaka Hashimoto ◽  
Shinnosuke Hata ◽  
Hiroyuki Tominaga ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Joint Mobility ◽  
Limited Joint Mobility

scholarly journals Use of the Bayer DCA 2000+ for the measurement of glycated haemoglobin in a remote Australian Aboriginal community

2003 ◽  
Vol 40 (5) ◽  
pp. 566-568 ◽  
Author(s):  
T Shemesh ◽  
LS Piers ◽  
K O'Dea
Keyword(s):  
Glycaemic Control ◽  
High Performance ◽  
Glycated Haemoglobin ◽  
Remote Communities ◽  
Community Based ◽  
Aboriginal Community ◽  
Good Glycaemic Control ◽  
Australian Aboriginal Community ◽  
Sensitivity Specificity

Background: Good glycaemic control in type 2 diabetes can reduce both morbidity and mortality, and monitoring of glycated haemoglobin A1c (HbA1c) is currently recommended for this purpose. Methods: Haemoglobin A1c can be measured using the portable Bayer DCA 2000+. As part of a community-based screening project for chronic diseases, subjects with impaired fasting glucose concentrations or diabetes had their HbA1c concentration measured on the analyser. HbA1c measurements were also made in a laboratory using cation-exchange high-performance liquid chromatography. Results were then compared to those obtained in the field. HbA1c values were loge transformed to obtain a normal distribution. Results: Mean (95% confidence interval) HbA1c measured on the DCA 2000+ ( n = 39) was 6.3% (5.8, 6.9%), while that measured in the laboratory was 6.5% (6.0, 7.0%). The correlation coefficient ( r) between the measurements was 0.96 ( P < 0.01). Bland-Altman analysis revealed that the DCA 2000+ estimate of HbA1c could be used interchangeably with that from the laboratory (mean bias = 0.1%, limits of agreement - 1.1, 0.8%). The sensitivity, specificity and positive predictive value of the DCA 2000+ estimate of HbA1c using a cut-off value of <7% for adequate glycaemic control, were all 100%. Conclusions: The DCA 2000+ may be used to measure HbA1c in remote communities.

Abstract P031: Weight Changes and Their Predictors Among 11,140 Patients With Type 2 Diabetes in The Advance Trial

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Susan van Dieren ◽  
Andre Pascal Kengne ◽  
John Chalmers ◽  
Joline Beulens ◽  
Yvonne van der Schouw ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Gain ◽  
Weight Change ◽  
Glucose Control ◽  
Diabetes Research ◽  
Mixed Effect ◽  
Glucose Lowering ◽  
The Mean

Background/Aim: To determine the baseline characteristics and glucose lowering therapies associated with weight change among subjects with type 2 diabetes. Methods: 11,140 participants in the ADVANCE trial, were randomly assigned to an intensive (aiming for an HbA 1c ≤ 6.5%) or a standard blood glucose control strategy. Weight was measured at baseline and every 6 months over a median follow-up of 5 years. Multivariable linear regression and linear mixed effect models were used to examine predictors of weight change. Results: The mean difference in weight between the intensive and standard glucose control arm during follow-up was 0.75 kg (95% CI: 0.56 to 0.94), p-value<0.001. The mean weight decreased by 0.70 kg (95% CI: 0.53 to 0.87), p <0.001 by the end of follow-up in the standard arm but remained stable in the intensive arm, with a non-significant gain of 0.16 kg (95% CI: -0.02 to 0.34), p=0.075. Baseline factors associated with weight gain were younger age, higher HbA 1c , Caucasian ethnicity and number of glucose lowering medications. Treatment combinations including insulin [3.20 kg (95% CI: 2.90 to 3.50)] and thiazolidinediones [3.05 kg (95% CI: 2.68 to 3.42)] were associated with the greatest weight gain whilst treatment combinations including sulphonylureas were associated with less weight gain [0.71 kg (95%CI: 0.39 to 1.03)] (Figure 1). Conclusion: Intensive glucose control regimens are not necessarily associated with substantial weight gain. Patient characteristic associated with weight change were age, ethnicity, smoking and HbA1c. The main treatment strategies predicting weight gain were the use of insulin and thiazolidinediones. Acknowledgements: This research was supported by a program grant from the National Health and Medical Research Council of Australia, the Center for Translational Molecular Medicine (CTMM) and the Netherlands Heart Foundation, Dutch Diabetes Research Foundation and Dutch Kidney Foundation (PREDICCt).

Associations between glycaemic control and activation of the renin-angiotensin-aldosterone system in participants with type 2 diabetes mellitus and hypertension

2017 ◽  
Vol 55 (3) ◽  
pp. 373-384 ◽  
Author(s):  
TP Griffin ◽  
D Wall ◽  
GA Browne ◽  
MC Dennedy ◽  
PM O'Shea
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycaemic Control ◽  
Plasma Renin Activity ◽  
Linear Correlation ◽  
Plasma Renin ◽  
Glycated Haemoglobin ◽  
Renin Activity

Introduction Hyperglycaemia increases succinate concentrations and succinate receptor activation in the kidney resulting in renin release. The aim of our study was to determine if there is an association between glycaemic control as evidenced by glycated haemoglobin values and activation of the renin-angiotensin-aldosterone system in patients with type 2 diabetes mellitus and hypertension. Methods A cross-sectional study was conducted at Galway University Hospitals between December 2014 and March 2015. Participants ( n = 66) were identified following interrogation of the electronic database for patients with type 2 diabetes mellitus. Baseline clinical demographics, aldosterone, plasma renin activity, direct renin concentration, urea and electrolytes, glycated haemoglobin, cholesterol, urine sodium and albumin creatinine ratio were recorded. Results There was a significant positive linear correlation between glycated haemoglobin and renin (both plasma renin activity [ P = 0.002] and direct renin concentration [ P = 0.008]) and between serum creatinine and aldosterone measured using both radioimmunoassay ( P = 0.008) and immunochemiluminometric assay ( P = 0.008). A significant negative linear correlation was demonstrated between serum sodium and plasma renin activity ( P = 0.005) and direct renin concentration ( P = 0.015) and between estimated glomerular filtration rate and aldosterone measured using radioimmunoassay ( P = 0.02) and immunochemiluminometric assay ( P = 0.016). A significant negative linear correlation existed between urine sodium and plasma renin activity ( P = 0.04) and aldosterone measured using radioimmunoassay ( P = 0.045). Conclusions There is a direct positive association between glycaemic control and renin. We advocate for renin measurement to be part of the diabetologist's armamentarium to assess, guide and optimize therapeutic strategies in patients with diabetes.

scholarly journals The OPT2MISE Study – A Review of the Major Findings and Clinical Implications

2015 ◽  
Vol 11 (02) ◽  
pp. 105
Author(s):  
Yves Reznik ◽  
Michael Joubert ◽  
◽  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Therapy Group ◽  
Insulin Dose ◽  
Glycated Haemoglobin ◽  
Target Range ◽  
Insulin Regimen ◽  
Pump Therapy ◽  
Multiple Injections

Many patients with type 2 diabetes struggle to achieve adequate glucose control despite escalation of therapy including complex insulin regimens with multiple daily injections (MDIs). Previous randomised controlled trials failed to show a significant improvement in glycaemic control with pump therapy over multiple injections. The OPT2MISE study enrolled 495 adult patients with poorly controlled type 2 diabetes despite an intensified insulin regimen using rapid and slow-acting insulin analogues. After a 2-month run-in period, patients were randomised to switch to pump therapy or to maintain their MDI regimen. After 6 months, patients with pump therapy achieved a better glycaemic control than those who used multiple injections (glycated haemoglobin [HbA1c] difference of -0.7 %), and twice as many patients reached the target range of 8 % or less in the pump-therapy group compared with the injection group. Patients using pump therapy had a 20 % reduction of their total daily insulin dose. A moderate weight gain was observed with both treatments, and no severe hypoglycaemia nor ketoacidosis occurred in the pump therapy group. Pump therapy may now be considered as a valuable option in type 2 diabetes patients who fail to respond to an intensified insulin regimen.

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

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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