scholarly journals The influence of baseline diastolic blood pressure on the effects of intensive blood pressure lowering on cardiovascular outcomes and all-cause mortality in type 2 diabetes mellitus

2020 ◽  
Author(s):  
Olesya L. Ilkun ◽  
Tom Greene ◽  
Alfred K. Cheung ◽  
Paul K. Whelton ◽  
Guo Wei ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Diastolic Blood Pressure ◽  
Controlled Trial ◽  
Cardiovascular Outcomes ◽  
P Value

<b><i>Objective:</i></b> To examine whether low baseline diastolic blood pressure (DBP) modifies the effects of intensive systolic blood pressure (SBP) lowering on cardiovascular outcomes in type 2 diabetes mellitus (T2DM). <p><b><i>Research Design and Methods:</i></b> The Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP),a 2X2 factorial randomized controlled trial, examined effects of SBP (<120 vs. <140 mmHg) and glycemic (HbA1C < 6% vs. 7.0–7.9% (<42 vs 53-63 mmol/mol)) control on cardiovascular events in T2DM (N=4731). We examined whether effects of SBP control on cardiovascular composite was modified by baseline DBP and glycemic control. </p> <p><b><i>Results: </i></b>Intensive SBP lowering decreased the risk of the cardiovascular composite (HR 0.76, 95% CI 0.59 to 0.98) in the standard glycemic arm but not in the intensive glycemic arm (HR=1.06, 95% CI 0.81 to 1.40). Spline regression models relating the effects of the intervention on the cardiovascular composite across the range of baseline DBP did not show evidence of effect modification by low baseline DBP for the cardiovascular composite in the standard or intensive glycemic arms. The relation between the effect of the intensive SBP intervention and baseline DBP was similar between glycemic arms for the cardiovascular composite (3-way interaction p-value = 0.83).</p> <p><b><i>Conclusions: </i></b>in persons with T2DM, intensive SBP lowering decreased the risk of cardiovascular composite endpoint irrespective of baseline DBP in the setting of standard glycemic control. Hence, low baseline DBP should not be an impediment to intensive SBP lowering in T2DM patients treated with guidelines recommended standard glycemic control. </p>

scholarly journals The influence of baseline diastolic blood pressure on the effects of intensive blood pressure lowering on cardiovascular outcomes and all-cause mortality in type 2 diabetes mellitus

2020 ◽  
Author(s):  
Olesya L. Ilkun ◽  
Tom Greene ◽  
Alfred K. Cheung ◽  
Paul K. Whelton ◽  
Guo Wei ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Diastolic Blood Pressure ◽  
Controlled Trial ◽  
Cardiovascular Outcomes ◽  
P Value

<b><i>Objective:</i></b> To examine whether low baseline diastolic blood pressure (DBP) modifies the effects of intensive systolic blood pressure (SBP) lowering on cardiovascular outcomes in type 2 diabetes mellitus (T2DM). <p><b><i>Research Design and Methods:</i></b> The Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP),a 2X2 factorial randomized controlled trial, examined effects of SBP (<120 vs. <140 mmHg) and glycemic (HbA1C < 6% vs. 7.0–7.9% (<42 vs 53-63 mmol/mol)) control on cardiovascular events in T2DM (N=4731). We examined whether effects of SBP control on cardiovascular composite was modified by baseline DBP and glycemic control. </p> <p><b><i>Results: </i></b>Intensive SBP lowering decreased the risk of the cardiovascular composite (HR 0.76, 95% CI 0.59 to 0.98) in the standard glycemic arm but not in the intensive glycemic arm (HR=1.06, 95% CI 0.81 to 1.40). Spline regression models relating the effects of the intervention on the cardiovascular composite across the range of baseline DBP did not show evidence of effect modification by low baseline DBP for the cardiovascular composite in the standard or intensive glycemic arms. The relation between the effect of the intensive SBP intervention and baseline DBP was similar between glycemic arms for the cardiovascular composite (3-way interaction p-value = 0.83).</p> <p><b><i>Conclusions: </i></b>in persons with T2DM, intensive SBP lowering decreased the risk of cardiovascular composite endpoint irrespective of baseline DBP in the setting of standard glycemic control. Hence, low baseline DBP should not be an impediment to intensive SBP lowering in T2DM patients treated with guidelines recommended standard glycemic control. </p>

scholarly journals Predictors of Glycemic Control Among Patients With Type 2 Diabetes in North West Ethiopia: a Longitudinal Study

2021 ◽  
Author(s):  
Nigusie Gashaye Shita ◽  
Ashagrie Sharew Iyasu
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Systolic Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Good Glycemic Control ◽  
Diabetes Patients

Abstract Background: Type 2 diabetes mellitus patients with hyperglycemia for a long period are significant causes of mortality and morbidity worldwide. Studying the predictors of glycemic control helps to minimize deaths and the development of acute and chronic diabetes complication. Hence, this study aims to assess predictors of glycemic control among patients with Type 2 diabetes in Ethiopia.Methods: A retrospective cohort study was conducted among type 2 Diabetes mellitus (T2DM) patients enrolled between December 2011 and December 2012 at Debre Markos and Felege Hiwot Referral Hospital. A total of 191 T2DM patients were included in the study meets the eligibility criteria. A generalized linear mixed model was employed. Results: The prevalence of good glycemic control among type 2 diabetes patients was 58.4% whereas 23.25% of the variation was explained in the fitted model due to adding the random effects. The significance predictors of glycemic control among patients with Type 2 diabetes at 95% confidence level were reside in rural(0.454, 0.614)), patients age 38-50, 51-59 and 60-66 years(1.267,1.776), (1.057,1.476) and (1.004, 1.403), respectively, Proteinuria Positive (1.211, 1.546), diastolic blood pressure ≥90 (1.101, 1.522), systolic blood pressure ≥140 (1.352, 1.895), creatinine (0.415, 0.660), duration per visit (0.913, 0.987), duration since diagnosis (0.985, 0.998), weight 78-88(0.603, 0.881).Conclusion: The level of glycemic control among type 2 diabetes patients was poor. Type 2 diabetes mellitus patients having higher age of the patient, higher weight, reside in rural, longer duration of T2DM since diagnosis, longer duration of type 2DM per visit, increase creatinine, positive protein urea, diastolic blood pressure≥90, and systolic blood pressure≥140 were significant predictors of poor glycemic control among type 2 DM patients. During diabetic patients follow up, clinicians should give appropriate attention to these significant variables for good glycemic control since it is the main goal of diabetes management.

scholarly journals Effects of yoga in modifying blood pressure in patients of type 2 diabetes mellitus

2018 ◽  
Vol 6 (9) ◽  
pp. 3080
Author(s):  
Namita Shrivastava ◽  
Basant Kumar Maheswari ◽  
Debapriya Rath ◽  
Debashree Sarkar
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Waist Circumference ◽  
Diastolic Blood Pressure ◽  
Dietary Habits ◽  
P Value

Background: The incidence of diabetes mellitus is increasing with the increase in unhealthy dietary habits, physical inactivity and sedentary lifestyle. Hypertension complicated with diabetes further aggravates the problem. Yoga has been found to be helpful in delaying the progression and complications of the disease. The present study was undertaken with an aim to evaluate the effect of yoga in modifying blood pressure in patients of diabetes mellitus.Methods: Thirty patients of diabetes mellitus who were known case of hypertension were taken and their fasting and post-prandial blood glucose levels, systolic and diastolic blood pressure and waist circumference were analysed before and after ninety days of yoga in the department of physiology and biochemistry.Results: Systolic and diastolic blood pressure, waist circumference and fasting and post-prandial blood glucose level showed significant reduction (p value <0.05).Conclusions: This study emphasizes the importance of yoga in the control and management of type 2 diabetes mellitus and hypertension.

Effect the Pharmaceutical Care and Health Education on Knowledge and Disease Control for Type 2 Diabetes Mellitus Patients: A sample of Iraqi Patients

2020 ◽  
pp. 40-54
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Health Education ◽  
Pharmaceutical Care ◽  
P Value ◽  
Diabetes Knowledge

Objective: To study the effect of Pharmaceutical Care (PC) program and health education delivered by pharmacist on Type 2 Diabetes Mellitus (T2DM) patient’s knowledge about diabetes, glycemic control, blood pressure and Body Mass Index (BMI). Patients and methods: A prospective interventional study including T2DM patients with poor glycemic control, i.e. glycated hemoglobin (HbA1c) more than 7%. Patients receiving PC and education about T2DM and cardiovascular disease by the researcher pharmacist. Patients were followed for 26 weeks. The study parameters included HbA1c, Fasting Blood Sugar (FBS), Systolic Blood pressure (SBP), Diastolic Blood Pressure (DBP), BMI and Diabetes Knowledge Questionnaire (DKQ-24). Results: Thirty-eight T2DM patients were included in the study. Thirty-two completed the program. A significant decrease in the HbA1c and FBS at the end line measurements (from 9.1% to 7.4%, P-value = 0.001) and (from 187.4 to 135.3, P-value = 0.001) respectively. A significant decrease occurred in both SBP and DBP (from 129.8 to 125.2, P-value = 0.009) and (from 82.0 to 77.9, P-value =0.001) respectively. Diabetes knowledge score also showed a significant increase at the end of study (from 52.6 to 63.7, P-value =0.001) Conclusion: Pharmaceutical care and health education with continuous follow up delivered by the pharmacist even for a relatively short period of time in collaboration with specialist physician, resulted in improved T2DM Knowledge plus better glycemic and blood pressure control.

scholarly journals Efektivitas Mobile Health Intervention Terhadap Manajemen Diri Dan Kontrol Glikemik Pada Pasien Dengan Diabtes Melitus Tipe 2: A Systematic Review

2020 ◽  
Vol 11 (4) ◽  
pp. 342
Author(s):  
Wahyu Sukma Samudera ◽  
Novita Fajriyah ◽  
Ida Trisnawati
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Mobile Health ◽  
Controlled Trial ◽  
Health Intervention ◽  
Self Management ◽  
Diabetes Melitus

Background: Type 2 diabetes mellitus was one of non-communicable diseases that increased of prevalence in word wide, included in Indonesia. Utilization of technology as an effort of increase of diabetes treatment is important for achieving of optimum glycemic control and to prevent of complication of diabetes mellitus. However, intervention for self management in patients with diabetes mellitus at this time still not using technology based mobile health intervention. Purpose: This study aims to verify of effectiveness of mobile health intervention on self management and glycemic control in patient with type 2 diabetes mellitus. Method: Design of this studies was used systematic review of randomized controlled trial with PRISMA approach. Article search was carried out through databases: Scopus, Science Direct, and ProQuest with randomized controlled trial design within last 10 years. Results: The finding showed 407 articles have been obtained. Articles selection process were through few steps: topic selection, full text selection, design of studies and obtained 10 articles have been as appropriate of inclusion criteria. Based on results of finding of 10 articles were showed that mobile health intervention was effective in improving of glycemic control by decreasing hbA1c, fasting blood glucose, 2 hours post pandrial. Furthermore, mobile health intervention was effective in increasing of self management in patient with type 2 diabetes mellitus and increased adherence of diabetes medication. Moreover, mobile health intervention can also improve of insulin level and lipid profile in patient with type 2 diabetes mellitus. Conclusion: Mobile health intervention was effective in improving of glycemic control and self management, and giving of facilitate communication between patient and health providers Keywords: mobile health application; self management; glycemic control; diabetes mellitus ABSTRAK Latar belakang: diabetes melitus (DM) tipe 2 merupakan salah satu penyakit tidak menular yang mengalami peningkatan angka kejadian di dunia, termasuk di Indonesia. Penggunaan teknologi sebagai upaya meningkatkan manajemen diabetes melitus sangatlah penting untuk dilakukan guna mencapai kontrol glikemik optimal dan mencegah komplikasi dari Diabetes Melitus. Namun, manajemen diri pada sebagian besar pasien Diabetes Melitus saat ini masih belum menggunakan bantuan teknologi berbasis mobile health. Tujuan: Penelitian ini bertujuan untuk memverifikasi efektivitas dari penggunaan mobile health intervention terhadap manajemen diri dan kontrol glikemik pasien dengan diabetes melitus tipe 2. Metode: desain dalam penelitian ini adalah systematic review dengan menggunakan pendekatan PRISMA. Pencarian artikel dilakukan pada beberapa database yang meliputi: Scopus, Science Direct dan ProQuest dengan desain Randomized controlled trial dalam 10 tahun terakhir. Hasil: hasil temuan didapatkan sejumlah 407 artikel penelitian. Proses seleksi artikel dilakukan beberapa tahap meliputi: seleksi topik, fullteks, desain artikel penelitian dan didapatkan 10 artikel penelitian yang sesuai dengan kriteria inklusi. Berdasarkan hasil temuan dari 10 artikel penelitian yang digunakan, menunjukkan bahwa mobile health intervention efektif dalam memperbaiki kontrol glikemik pasien diabetes melalui penurunan kadar hbA1c, gula darah puasa, 2 jam post pandrial. Selanjutnya, mobile health intervention efektif dalam meningkatkan manajemen diri pasien diabetes dan meningkatkan kepatuhan pengobatan. Selain itu, mobile health intervention juga dapat memperbaiki level insulin dan profil lipid pasien diabetes melitus tipe 2. Kesimpulan: Mobile health intervention efektif dalam memperbaiki kontrol glikemik dan meningkatkan manajemen diri pasien diabetes melitus serta memudahkan komunikasi antara pasien dengan tenaga kesehatan Kata kunci: mobile health application; manajemen diri; kontrol glikemik; diabetes melitus

scholarly journals Efficacy and Safety of Ertugliflozin in Patients With Type 2 Diabetes Mellitus and Established Cardiovascular Disease Treated With Metformin and Sulfonylurea

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A331-A331
Author(s):  
Matthew J Budoff ◽  
Timothy M E Davis ◽  
Alexandra G Palmer ◽  
Robert Frederich ◽  
David E Lawrence ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Body Weight ◽  
Glycemic Control ◽  
Sglt2 Inhibitor ◽  
Efficacy And Safety

Abstract Introduction: Ertugliflozin (ERTU), a sodium-glucose cotransporter 2 (SGLT2) inhibitor, is approved as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus (T2DM). Aim: As a pre-specified sub-study of the Phase 3 VERTIS CV trial (NCT01986881), the efficacy and safety of ERTU were assessed in patients with T2DM and established atherosclerotic cardiovascular disease (ASCVD) inadequately controlled with metformin and sulfonylurea (SU). Methods: Patients with T2DM, established ASCVD, and HbA1c 7.0–10.5% on stable metformin (≥1500 mg/day) and SU doses as defined per protocol were randomized to once-daily ERTU (5 mg or 15 mg) or placebo. The primary sub-study objectives were to assess the effect of ERTU on HbA1c compared with placebo and to evaluate safety and tolerability during 18-week follow-up. Key secondary endpoints included proportion of patients achieving HbA1c &lt;7%, fasting plasma glucose (FPG), body weight, and systolic blood pressure. Changes from baseline at Week 18 for continuous efficacy endpoints were assessed using a constrained longitudinal data analysis model. Results: Of the 8246 patients enrolled in the VERTIS CV trial, 330 patients were eligible for this sub-study (ERTU 5 mg, n=100; ERTU 15 mg, n=113; placebo, n=117). Patients had a mean (SD) age of 63.2 (8.4) years, T2DM duration 11.4 (7.4) years, estimated glomerular filtration rate 83.5 (17.8) mL/min/1.73 m2, and HbA1c 8.3% (1.0) (67.4 [10.6] mmol/mol). At Week 18, ERTU 5 mg and 15 mg were each associated with a significantly greater least squares mean (95% CI) HbA1c reduction from baseline versus placebo; the placebo-adjusted differences for ERTU 5 mg and 15 mg were –0.7% (–0.9, –0.4) and –0.8% (–1.0, –0.5), respectively (P&lt;0.001). A higher proportion of patients in each ERTU group achieved HbA1c &lt;7% relative to placebo (P&lt;0.001). ERTU significantly reduced FPG and body weight (P&lt;0.001, for each dose versus placebo), but not systolic blood pressure. Adverse events were reported in 48.0%, 54.9%, and 47.0% of patients in the ERTU 5 mg, 15 mg, and placebo groups, respectively. Genital mycotic infections were experienced by significantly higher proportions of male patients who received ERTU 5 mg and 15 mg (4.2% and 4.8%, respectively) versus placebo (0.0%; P≤0.05) and by a numerically, but not significantly, higher proportion of female patients who received ERTU 15 mg (10.3%) compared with placebo (3.8%) (P=0.36). The incidences of symptomatic hypoglycemia were 11.0% (5 mg), 12.4% (15 mg), and 7.7% (placebo), and of severe hypoglycemia 2.0% (5 mg), 1.8% (15 mg), and 0.9% (placebo). Conclusion: Among patients with T2DM and ASCVD, ERTU (5 mg and 15 mg) added to metformin and SU for 18 weeks improved glycemic control (HbA1c and FPG) and reduced body weight, and was generally well tolerated with a safety profile consistent with the SGLT2 inhibitor class.

scholarly journals The effect of OMEGA-3 polyunsaturated fatty acids on ambulatory blood pressure monitoring parameters in patients with type 2 diabetes mellitus and cardiovascular autonomic neuropathy

2019 ◽  
Vol 22 (1) ◽  
pp. 62-69
Author(s):  
Victoria A. Serhiyenko ◽  
Boris N. Mankovsky ◽  
Ludmila М. Serhiyenko ◽  
Aleksandr A. Serhiyenko
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Fatty Acids ◽  
Type 2 Diabetes Mellitus ◽  
Diastolic Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Pressure Monitoring ◽  
Time Index

Background: Cardiovascular autonomic neuropathy (CAN) in type 2 diabetes mellitus (T2DM), which is characterized by lesion of nerve fibers in parasympathetic and sympathetic nervous system is one of the leading causes of heart arrhythmias and an independent risk factor for cardiovascular mortality in patients with T2DM. Therefore, the problem of effective treatment of CAN is particularly relevant. Aims: To analyze the effect of long-chain polyunsaturated fatty acids (-3 PUFAs) on ambulatory blood pressure monitoring parameters in patients with T2DM and CAN. Materials and methods: 36 patients with T2DM and confirmed CAN were divided into two groups. First group received hypoglycemic therapy (n=15, control) for three months; patients in group 2 (n=21) in addition were administered 1 capsule/q.d. of -3 PUFAs for three month. Results: Treatment with -3 PUFAs led to significant decrease of the diastolic blood pressure (DBP) (p0,01), diastolic blood pressure load (p0,05), time index of DBP (p0,05) during the day; DBP (p0,05), diastolic blood pressure load (p0,05), time index of DBP (p0,05), SD DBP (p0,01) during the night (compared to the control group). Conclusions: The study showed that prescription of -3 PUFAs for three month was effective in decreasing diastolic blood pressure and its parameters among patients with T2DM and CAN.

scholarly journals Management of patients with type 2 diabetes mellitus in the Grand-Aides Program

2019 ◽  
Vol 10 (3) ◽  
pp. 1
Author(s):  
Rebekah M. Compton ◽  
Kimberly S. Bednar ◽  
Peggie E. Donowitz ◽  
M. Norman Oliver
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Emergency Department ◽  
Type 2 Diabetes Mellitus ◽  
Medication Adherence ◽  
Diastolic Blood Pressure ◽  
Home Visit ◽  
Ed Visits

Objective: To evaluate the Grand-Aides Program for patients with type 2 diabetes mellitus (T2DM) according to the variables of body weight, blood pressure, medication adherence, and hospital consultation and readmissions.Methods: Patients ages 18 years or older with a past medical history of T2DM, hypertension (HTN), and/or obesity and who were recently seen in the emergency department (ED) or recently admitted to the hospital were eligible to enroll in the Grand-Aides Program. Eligible patients were identified after hospital or ED discharge and were asked to enroll in the in-home based program from March 2016 through June 2018. In-home visit protocol was defined prior to patient enrollment with intense in-home visits during the first weeks of enrollment followed by monthly visits for the duration of enrollment in the program. In-home visit frequency was adjusted on as needed basis so that patients at higher risk for ED visits or hospitalization were seen more frequently. In-home visits were performed by trained Grand-Aide who for the purpose of this study was a certified nursing assistant (CNA). The Grand-Aide underwent eighty hours of didactic training which included visit protocols, visit schedules, and data collection. The one-on-one in-home patient with every visit were supervised by a registered nurse (RN) or nurse practitioner (NP) via video or telephone contact near the conclusion of the visit. Active patients at the University of Virginia Family Medicine clinic were eligible for enrollment. Fifty-seven patients with T2DM worked with Grand-Aides for three months and an additional forty-eight T2DM patients worked with Grand-Aides for twelve months. Emergency department visits, all 30-day hospital readmissions, as well as blood pressure readings, medication adherence, weights, and glycated hemoglobin (HbA1c) were compared with the prior twelve months.Results: Systolic (p < .001) and diastolic (p < .01) blood pressures decreased (p < .01) at 1 year. At baseline 56 percent of the patients had a systolic blood pressure of >130 mmHg despite treatment; after 12 months, 48 percent of these were < 130. In those whose baseline diastolic blood pressure was > 90 mmHg, 100 percent had diastolic blood pressure < 90 mmHg at 1 year. Medication adherence by ARMS test at 1 year was 94 percent. Despite trending downward, weight and HbA1c did not change significantly. In the preceding, 58 percent had at least one ED visit, which was reduced by 50 percent (p < .01) with Grand-Aides; 30-day all-cause readmissions reduced by 50 percent to 6.3 percent. Conclusions: The Grand-Aides program was associated with a significant change in blood pressure control, high medication adherence and reductions in ED visits and readmissions that compare favorably with published comparative data. For systems “at risk” for preventable increased health care expense burden, the Grand-Aides program can result in significant savings.

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