scholarly journals Different Indexes of Glycemic Variability as Identifiers of Patients with Risk of Hypoglycemia in Type 2 Diabetes Mellitus

2018 ◽  
Vol 12 (5) ◽  
pp. 1007-1015 ◽  
Author(s):  
Ana M. Gómez ◽  
Oscar M. Muñoz ◽  
Alejandro Marin ◽  
Maria Camila Fonseca ◽  
Martin Rondon ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Clinical Practice ◽  
Blood Glucose ◽  
Area Under The Curve ◽  
Glycemic Variability ◽  
Optimal Cutoff ◽  
High Blood Glucose

Introduction: Recent publications frequently introduce new indexes to measure glycemic variability (GV), quality of glycemic control, or glycemic risk; however, there is a lack of evidence supporting the use of one particular parameter, especially in clinical practice. Methods: A cohort of type 2 diabetes mellitus (T2DM) patients in ambulatory care were followed using continuous glucose monitoring sensors (CGM). Mean glucose (MG), standard deviation, coefficient of variation (CV), interquartile range, CONGA1, 2, and 4, MAGE, M value, J index, high blood glucose index, and low blood glucose index (LBGI) were estimated. Hypoglycemia incidence (<54 mg/dl) was calculated. Area under the curve (AUC) was determined for different indexes as identifiers of patients with risk of hypoglycemia (IRH). Optimal cutoff thresholds were determined from analysis of the receiver operating characteristic curves. Results: CGM data for 657 days from 140 T2DM patients (4.69 average days per patient) were analyzed. Hypoglycemia was present in 50 patients with 144 hypoglycemic events in total (incidence rate of 0.22 events per patient/day). In the multivariate analysis, both CV (OR 1.20, 95% CI 1.12-1.28, P < .001) and LBGI (OR 4.83, 95% CI 2.41-9.71, P < .001) were shown to have a statistically significant association with hypoglycemia. The highest AUC were for CV (0.84; 95% CI 0.77-0.91) and LBGI (0.95; 95% CI 0.92-0.98). The optimal cutoff threshold for CV as IRH was 34%, and 3.4 for LBGI. Conclusion: This analysis shows that CV can be recommended as the preferred parameter of GV to be used in clinical practice for T2DM patients. LBGI is the preferred IRH between glycemic risk indexes.

scholarly journals Comparison of CGM-Derived Measures of Glycemic Variability Between Pancreatogenic Diabetes and Type 2 Diabetes Mellitus

2019 ◽  
Vol 15 (1) ◽  
pp. 134-140 ◽  
Author(s):  
Channabasappa Shivaprasad ◽  
Yalamanchi Aiswarya ◽  
Shah Kejal ◽  
Atluri Sridevi ◽  
Biswas Anupam ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Risk Assessment ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Glycemic Variability ◽  
High Blood Glucose ◽  
Therapeutic Implications ◽  
Duration Of Diabetes

Background: To compare glycemic variability (GV) indices between patients with fibrocalculous pancreatic diabetes (FCPD) and type 2 diabetes mellitus (T2D) using continuous glucose monitoring (CGM). Methods: We measured GV indices using CGM (iPro™2 Professional CGM, Medtronic, USA) data in 61 patients each with FCPD and T2D who were matched for glycated hemoglobin A1c (HbA1c) and duration of diabetes. GlyCulator2 software was used to estimate the CGM-derived measures of GV (SD, mean amplitude of glycemic excursion [MAGE], continuous overall net glycemic action [CONGA], absolute means of daily differences [MODD], M value, and coefficient of variance [%CV]), hypoglycemia (time spent below 70 mg/dL, AUC below 70 mg/dL, glycemic risk assessment diabetes equation hypoglycemia, Low Blood Glucose Index), and hyperglycemia (time spent above 180 mg/dL at night [TSA > 180], AUC above 180 mg/dL [AUC > 180], glycemic risk assessment diabetes equation hyperglycemia, High Blood Glucose Index [HBGI], and J index). The correlation of GV indices with HbA1c, duration of diabetes, and demographic and biochemical parameters were also assessed. Results: All the CGM-derived measures of GV (SD, MAGE, CONGA, MODD, and %CV), except M value, were significantly higher in the FCPD group than in the T2D group ( P < 0.05). Measures of hyperglycemia (TSA >180, AUC >180, HBGI, and J index) were significantly higher in the FCPD group than in the T2D group ( P < 0.05). The measures of hypoglycemia were not significantly different between the two groups. All the hyperglycemia indices showed a positive correlation with HbA1c in both groups. Conclusions: FCPD is associated with higher GV than is T2D. The findings of higher postprandial glycemic excursions in patients with FCPD could have potential therapeutic implications.

Sitagliptin: A DPP-4 Inhibitor for the Treatment of Type 2 Diabetes Mellitus

2011 ◽  
Vol 3 ◽  
pp. CMT.S6227 ◽  
Author(s):  
Kathryn MS Johnson ◽  
Kathleen Schurr
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Diabetes Therapy ◽  
High Blood Glucose ◽  
Adverse Side Effects ◽  
Glucose Levels ◽  
Blood Glucose Levels

Type 2 diabetes mellitus (T2DM) has become an epidemic, with worldwide projections indicating that more than 336 million people will be afflicted with the disease by 2030. T2DM is characterized by inappropriately high blood glucose levels due to a deficiency in insulin secretion, action, or both. Despite the horrific complications that occur with chronic elevations of blood glucose levels, less than half of those with T2DM do not maintain proper glycemic control. Sitagliptin (Januvia, Merck and Co., Whitehouse Station, New Jersey) is a novel diabetes therapy approved for use in the U.S. and Europe. This small molecule inhibits the activity of DPP-4, a peptidase that degrades the glucoregulatory hormone GLP-1. Sitagliptin increases glucoregulation in individuals with T2DM both as a monotherapy and in combination with other antihyperglycemic drugs, with a low risk of adverse side effects.

scholarly journals Penghambatan Enzim Alpha-Glukosidase oleh Daun Mimba (Azadirachta indica) dan Rimpang Temu Mangga (Curcuma mangga)

2021 ◽  
pp. 56-64
Author(s):  
Nursalinda Kusumawati ◽  
Haryoto Haryoto ◽  
Peni Indrayudha
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
High Blood Glucose ◽  
Mango Ginger ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Neem Leaves

Type 2 diabetes mellitus is a chronic disease of the digestive system characterized by high blood glucose levels. The main enzyme in carbohydrate metabolism is α-glucosidase. One of the therapeutic approaches to treat T2DM is to make glucose uptake into the blood delayed through inhibition of the α-glucosidase enzyme activity. Neem leaves and mango ginger are reported to reduce blood glucose levels. This study aims to determine the potential inhibitor of neem leaves extract and mango ginger extract and their respective fractions on α-glucosidase activity. Simplicia of neem leaves and mango ginger were macerated using 96% ethanol for 24 hours. The ethanol extract of neem leaves and mango rhizome were fractionated using silica gel 60 GF254 as adsorbent and a combination of ethyl acetate and n-hexane as eluent. The extracts of neem leaves and mango rhizome and fractions of both plants were tested for α-glucosidase inhibition with acarbose as a comparison. The results showed that both plants provided inhibitory activity on α-glucosidase with the lowest IC50 value from the semi-polar fraction of neem leaves about 24.16±4.58 μg/mL. Neem leaves and mango ginger have potential as α-glucosidase inhibitors to treat type 2 diabetes mellitus.

scholarly journals Correlates of type-2 diabetes mellitus in urban slums population Moradabad

2018 ◽  
Vol 5 (6) ◽  
pp. 2425
Author(s):  
Shiv Prasad Bahal ◽  
Sumit Saxena ◽  
Anurag Srivastava
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Socioeconomic Status ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Urban Slums ◽  
Age Group ◽  
High Blood Glucose ◽  
Prevalence Of Diabetes Mellitus

Background: Epidemiological transitions in India in the 21st century have led to non-communicable diseases becoming a major public health problem of growing magnitude. One of the important diseases in this respect is diabetes, which is considered a “disease of urbanization”. Risk factors for type 2 diabetes mellitus are: age, gender, ethnicity, family history, obesity, inactivity, gestational diabetes, hypertension, cardiovascular diseases, high blood glucose on previous testing, impaired glucose tolerance and glycated hemoglobin ≥5.7%.Methods: A community based cross- sectional study was conducted in urban slums which are the field practice area of Community Medicine department under the head of Teerthanker Mahaveer Medical College and Research Center, Moradabad. The final analysis was conducted on 640 participants. Each interview began with a general discussion to build rapport with the participants. Repeat visit was made on the consecutive day early in the morning to measure fasting blood glucose level with the help of Glucometer.Results: The overall prevalence of diabetes mellitus in the present study was found to be 15.6%. Maximum prevalence of diabetes mellitus was found between the age group of 60-69 years i.e. 44 (28.0%) followed by 26 (19.6%) in 50-59 years and 22 (18.1%) in 40-49 age group. In socioeconomic status, the prevalence of diabetes mellitus was 18 (21.6%) and 26 (25.2%) in class I and class II respectively.Conclusions: Based on study findings it has been observed that there was statistically significant association between socio-demographic variables like age, sex, education, socioeconomic status and type 2 diabetes mellitus. 

scholarly journals Evaluating Glycemic Control During Basalin or Lantus Administration in Adults With Controlled Type 2 Diabetes Mellitus Using Continuous Glucose Monitoring

2021 ◽  
Vol 12 ◽  
Author(s):  
Huiying Wang ◽  
Yunting Zhou ◽  
Xiaofang Zhai ◽  
Bo Ding ◽  
Ting Jing ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Area Under The Curve ◽  
Mean Amplitude

AimThis study aims at evaluating glycemic control during Basalin or Lantus administration in adults with controlled type 2 diabetes mellitus using continuous glucose monitoring system (CGM).Methods47 patients with well-controlled T2DM using both Basalin and oral hypoglycemic drugs were recruited. CGM were applied from day 1 to day 3 with the unchanged dose of Basalin and then removed from day 4. A washout was performed with Lantus at the same dose as Basalin from day 4 to day 10. Then patients were continued to install the CGM under Lantus administration from day 11 to day 13. Variables of CGM, such as the area under the curve (AUC) for both hyperglycemia and hypoglycemia, 24h mean blood glucose (24h MBG), 24h standard deviation of blood glucose (24h SDBG), 24h mean amplitude of glycemic excursion (24h MAGE), PT (percentage of time), and time in range (TIR), were calculated and compared between Basalin group and Lantus group.ResultsThe group of Lantus showed lower 24h MBG (p&lt;0.01), 24h MAGE (p&lt;0.05), and lower 24h SDBG (p&lt;0.01) than the Basalin group. Lantus−treated patients had a lower PT and AUC when the cut-off point for blood glucose was 10 mmol/L (p&lt;0.05) and 13.9 mmol/L (p&lt;0.05), respectively. In this study, no patient developed symptomatic hypoglycemia, few hypoglycemia was observed and there was no difference of hypoglycemia between the two groups.ConclusionIn patients with well-controlled T2DM who were treated with insulin glargine, Lantus group showed lower MBG, GV, and lower PT (BG &gt; 10.0 mmol/L, BG &gt; 13.9 mmol/L) than Basalin group. In summary, for T2DM population with HbA1c ≤ 7%, Lantus may be a better choice compared with Basalin.

scholarly journals Patterns of Glycemic Variability During a Diabetes Self-Management Educational Program

2019 ◽  
Vol 7 (3) ◽  
pp. 52 ◽  
Author(s):  
Ankur Joshi ◽  
Arun Mitra ◽  
Nikhat Anjum ◽  
Neelesh Shrivastava ◽  
Sagar Khadanga ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Optimal Control ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Glycemic Variability ◽  
Self Management ◽  
Control Group

Background: Variations in blood glucose levels over a given time interval is termed as glycemic variability (GV). Higher GV is associated with higher diabetes-related complications. The current study was done with the aim of detecting the sensitivity of various GV indices among individuals with type 2 diabetes mellitus of different glycemic control status. Methods: We performed a longitudinal study among individuals with type 2 diabetes mellitus (T2DM) who were participating in a two-week diabetes self-management education (DSME) program. Participants were categorized by their HbA1c as poor (≥8%), acceptable (7%–8%), and optimal control (<7%). Continuous glucose monitoring (CGM) sensors recorded interstitial glucose every 15 min from day 1. The evaluated GV measures include standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), continuous overlapping net glycemic action (CONGA), mean of daily difference for inter-day variation (MODD), high blood glucose index (HBGI), and low blood glucose index (LBGI). Results: A total of 41 study participants with 46347 CGM values were available for analysis. Of 41 participants, 20 (48.7%) were in the poor, 10 (24.3%) in the acceptable, and 11 (26.8%) in the optimal control group. The GV indices (SD; CV; MODD; MAGE; CONGA; HBGI) of poorly controlled (77.43; 38.02; 45.82; 216.63; 14.10; 16.62) were higher than acceptable (50.02; 39.32; 30.79; 138.01; 8.87; 5.56) and optimal (34.15; 29.46; 24.56; 126.15; 8.67; 3.13) control group. Glycemic variability was reduced in the poorly and acceptably controlled groups by the end of the 2-week period. There was a rise in LBGI in the optimally controlled group, indicating pitfalls of tight glycemic control. Conclusion: Indices of glycemic variability are useful complements, and changes in it can be demonstrated within short periods.

Epigenetic modulation of autophagy genes linked to diabetic nephropathy by administration of isorhamnetin in Type 2 diabetes mellitus rats

Epigenomics ◽  
2021 ◽  
Author(s):  
Marwa Matboli ◽  
Doaa Ibrahim ◽  
Amany H Hasanin ◽  
Mohamed Kamel Hassan ◽  
Eman K Habib ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Fasting Blood Glucose ◽  
Light And Electron Microscopy ◽  
Lipid Profiles ◽  
Mirna Regulation ◽  
Protein Levels

Aim: To assess isorhamnetin efficacy for diabetic kidney disease in a Type 2 diabetes mellitus rat model, through investigating its effect at the epigenetic, mRNA and protein levels. Materials & methods: Type 2 diabetes mellitus was induced in rats by streptozotocin and high-fat diet. Rats were treated with isorhamnetin (50 mg/kg/d) for 4 or 8 weeks. Fasting blood glucose, renal and lipid profiles were evaluated. Renal tissues were examined by light and electron microscopy. Autophagy genes ( FYCO1, ULK, TECPR1 and  WIPI2) and miR-15b, miR-34a and miR-633 were assessed by qRT-PCR, and LC3A/B by immunoblotting. Results: Isorhamnetin improved fasting blood glucose, renal and lipid profiles with increased autophagosomes in renal tissues. It suppressed miRNA regulation of autophagy genes Conclusion: We propose a molecular mechanism for the isorhamnetin renoprotective effect by modulation of autophagy epigenetic regulators.

scholarly journals Application value of combination therapy of periodontal curettage and root planing on moderate-to-severe chronic periodontitis in patients with type 2 diabetes

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Yonghuan Bian ◽  
Changhao Liu ◽  
Zhaojiang Fu
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Chronic Periodontitis ◽  
Root Planing ◽  
Tnf Α ◽  
Significant Difference ◽  
Hs Crp

Abstract Background Our study attempted to observe the value of periodontal curettage combined with root planing on moderate-to-severe chronic periodontitis in patients with type 2 diabetes. Methods There involved 72 patients with type 2 diabetes mellitus complicated with moderate-to-severe chronic periodontitis who were diagnosed and treated in our hospital from January 2019 to December 2019. The patients enrolled were randomly divided into four groups using a computer-generated table: root planing and periodontal curettage combined group (n = 18), root planning group (n = 18), periodontal curettage group (n = 18) and cleansing group (n = 18). Blood glucose, plaque index (PI), gingival index (GI), probing depth (PD), attachment loss (AL), serum levels of inflammatory factors (Tumor Necrosis Factor Alpha [TNF- α] and hypersensitive C-reactive protein [hs-CRP]) were observed before and after treatment. The collecting dates were analyzed by the chi-square χ 2 test, repeated measurement analysis of variance, or t-test according to different data types and research objectives. Results Before treatment, there was no significant difference in PI, GI, PD and AL among the four groups (P> 0.05), while after 3-month treatment, the levels of PI, GI, PD and AL in the combined group were lower than those in the root planing group, periodontal curettage group and cleansing group, with both root planing group and periodontal curettage group significantly lower than cleansing group (P< 0.05). The fasting blood glucose, 2-h postprandial blood glucose and glycosylated hemoglobin in the combined group, root planing group, periodontal curettage group and cleansing group were significantly lower than those before treatment (P < 0.05). Before treatment, there was no significant difference in TNF- α and hs-CRP among the four groups (P> 0.05), but the levels of TNF- α and hs-CRP in the four groups decreased significantly after 3-month treatment (P< 0.05). The levels of TNF- α and hs-CRP in the combined group were lower than those in the root planing group, periodontal curettage group and cleansing group, and those in the root planing group and periodontal curettage group were significantly lower than those in the cleansing group (P< 0.05). Conclusion The combination therapy of periodontal curettage and root planing exerted beneficial effects on moderate-to-severe chronic periodontitis in patients with type 2 diabetes mellitus, which holds the potential to maintain the level of blood glucose and improve the quality of life of the patients.

scholarly journals Pharmaceutical hit of anti type 2 Diabetes mellitus on the phenolic extract of Malaka (Phyllanthus emblica L.) flesh

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Musri Musman ◽  
Mauli Zakia ◽  
Ratu Fazlia Inda Rahmayani ◽  
Erlidawati Erlidawati ◽  
Safrida Safrida
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Body Weight ◽  
Blood Glucose ◽  
Phyllanthus Emblica ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Phenolic Extract

Abstract Background Ethnobotany knowledge in a community has shaped local wisdom in utilizing plants to treat diseases, such as the use of Malaka (Phyllanthus emblica) flesh to treat type 2 diabetes. This study presented evidence that the phenolic extract of the Malaka flesh could reduce blood sugar levels in the diabetic induced rats. Methods The phenolic extract of the P. emblica was administrated to the glucose-induced rats of the Wistar strain Rattus norvegicus for 14 days of treatment where the Metformin was used as a positive control. The data generated were analyzed by the two-way ANOVA Software related to the blood glucose level and by SAS Software related to the histopathological studies at a significant 95% confidence. Results The phenolic extract with concentrations of 100 and 200 mg/kg body weight could reduce blood glucose levels in diabetic rats. The post hoc Dunnet test showed that the administration of the extract to the rats with a concentration of 100 mg/kg body weight demonstrated a very significant decrease in blood glucose levels and repaired damaged cells better than administering the extract at a concentration of 200 mg/kg weight body. Conclusion The evidence indicated that the phenolic extract of the Malaka flesh can be utilized as anti type 2 Diabetes mellitus without damaging other organs.

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