scholarly journals Medical care standards for diabetes in the hospital: evolution of views from glycemic control to metabolic surgery

2020 ◽  
Vol 4 (6) ◽  
pp. 340-346
Author(s):  
A.B. Fursov ◽  
◽  
R.A. Fursov ◽  
O.B. Ospanov ◽  
◽  
...  

A large number of patients with type 2 diabetes (T2D) have a high incidence of complications and disease decompensation, which becomes the reason for therapy inefficacy. In recent years, endocrinologists and diabetologists are increasingly paying attention to surgical methods for treating T2D. The review attempts to study and systematize new trends in the treatment of T2D, as well as to determine the historical vector of changes in diabetologist views on the control, stabilization of the glycemic level in diabetic patients, and surgical methods.A retrospective study of scientific approaches to the treatment of diabetes confirmed the opinion of some researchers that the evolution of treatment methods commonly consisted of improving control and means of insulin delivery to the body. The analysis of scientific papers that confirm that detection of glycemic disorders among those admitted to the surgical hospital has a direct and immediate benefit both in a planned and urgent order. The growth of economic costs associated with insufficient glycemic control in diabetic patients was studied. Over the past decades, medical care standards for diabetes are analyzed in chronological order. Using the American Diabetes Association Guidelines, new trends in the treatment of T2D have been developed, and a stable vector in changing views on the efficacy of surgical bariatric and metabolic methods has been identified.KEYWORDS: medical care standards, type 2 diabetes, glycemia, evolution of diabetes mellitus treatment, economic costs, guidelines, metabolic surgery, endoscopic methods.FOR CITATION: Fursov A.B., Fursov R.A., Ospanov O.B. Medical care standards for diabetes in the hospital: evolution of views from glycemic control to metabolic surgery. Russian Medical Inquiry. 2020;4(6):340–346. DOI: 10.32364/2587-6821-2020-4-6-340-346.

2019 ◽  
Vol 30 (2) ◽  
pp. 63-70
Author(s):  
Md Shameem Haidar

Background: Diabetes is global health burden of disease that requires life-long pharmacological and non-pharmacological management to prevent complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathy. Treatment of type 2 diabetes is based on an interplay of patient characteristics, severity of hyperglycemia and available therapeutic options. Metformin, sulfonylureas (SU) and DPP IV inhibitor are the most studied of the oral medications used worldwide. They play a prominent initial role in the type 2 diabetes treatment algorithm recommended by the several guideline. The growing evidence on new technologies and therapeutic interventions is rapidly expanding our knowledge and ability to manage diabetes and its complications; at the same time, however, it is challenge for physicians to select appropriate medication in appropriate dose for optimal patients care. Objectives: To compare the safety and efficacy of the dipeptidylpeptidase-4 (DPP-4) inhibitors combination with other oral hypoglycaemic agent(s) in patients with type 2 diabetes and inadequate glycemic control. Materials & method: Study was conducted among 600 patients over a period of 24 months. All the patients were adult male and female type 2 diabetic patients who received regular oral anti-diabetic drug(s) and duration of T2DM for one year or more were enrolled for study. Total 150 cases were selected. Patients with Type 1 DM, pregnant women with DM and who was receiving injectable antidiabetic medications were excluded from this study. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigations were done. Main outcome variable was Glycemic status (HbA1C, FBG, 2HABF). Effectiveness of drugs was evaluated by glycaemic status of the patients. Result: Maximum number of patients (38.5%) was between 31-40 years age group with mean age 37.8±9.5 years. Present study shows that, for good glycemic control, all three results (FBS, 2H ABF and HbA1c) were within targeted level in majority patients of DPP4 Inhibitor combination group. Although FBS was best result in metformin group. About 51.9% of SUs group achieved the glycemic control targets level. In case of metformin group it was in 59.8% of patients, and in combined therapy 67.1% patients shows good glycemic target. So DPP4 Inhibitor combination is better medication than other to maintain good glycemic status in type 2 DM patient, due to maximum number of patients reached all three components of result within target range. Conclusion: Diabetes is chronic illness. Good glycemic control with choosing appropriate anti-diabetic medication is pivotal for DM management. In this study it is observed that DPP4 Inhibitor combination group of drug is better than other anti-diabetic medication to maintain good glycemic status in type 2 DM patients. Bangladesh J Medicine July 2019; 30(2) : 63-70


2021 ◽  
Vol 45 (2) ◽  
pp. 95-102
Author(s):  
Blaženka Miškić ◽  
Vesna Čosić ◽  
Marijana Knezević Praveček ◽  
Daniel Rahelić ◽  
Blaženka Kljaić Bukvić ◽  
...  

COVID-19 pandemic has changed everyday life and medical supervision of chronically ill patients. Epidemiological measures, social distancing, and limited access to medical care impair glycemic control in patients with diabetes. Also, type 2 diabetes is a risk factor for more severe form of coronavirus disease. A large proportion of diabetic patients are placed in foster families who also adapt to the new situation. The purpose of this study was to examine the manner and frequency of glycemic control in patients with type 2 diabetes who are placed in foster families in the region of Brod- Posavina County. We established contact with patients suffering from type 2 diabetes situated in foster families and their caregivers. Measurement of glycemia was performed several times a day with regular notes and the data were supplemented by an insight into the medical documentation of patients in the hospital information system. The study included 33 patients with type 2 diabetes. The relationship between HbA1C with fasting and postprandial glycemia was linear. There were no statistically significant differences in HbA1C regulation by type of therapy. There was a significant difference in the number of complications according to the level of HbA1C (Hi square test = 25.982, p <.001). The number of complications generally increased as HbA1C regulation was poorer. During current COVID-19 pandemic, care for patients with type 2 diabetes is significantly limited. Improved medical care for patients can be achieved by establishing cooperation and daily communication between caregivers, family physicians and, if necessary, diabetologists, especially through the use of online platforms and telephone communication, all with the aim of early detection of diabetes complications and adequate treatment of patients in current conditions.


Author(s):  
Momina Abid ◽  
Farah Ahmed ◽  
Shehla Shaheen ◽  
Zahida Memon ◽  
M. Zaman Shaikh ◽  
...  

Aims: The aim of this study was to observe the effect of Apple Cider Vinegar (ACV) in combination with Metformin on the Body Mass Index (BMI) and glycemic control of newly diagnosed type 2 diabetic patients. Study Design: Single arm pre post quasi experimental clinical trial. Place and Duration of Study: Department of Medicine of a tertiary care hospital and a Diabetes and Endocrinology clinic, based in Karachi, Pakistan from April to July 2019. Methodology: A total of 30 newly diagnosed type 2 diabetic patients were enrolled in the study (Males: 17; females: 13; age range: 27-55 years) after obtaining written informed consent. The parameters of Body weight, BMI, Fasting Blood Sugar (FBS) and Hemoglobin A1c (HbA1c) of each patient were assessed before and after 12 weeks of treatment with Metformin 750 mg plus 2 tablespoons of ACV per day. The baseline and post treatment values of the aforementioned were compared with each other. Results: In all the 30 patients assessed after 12 weeks of treatment, the weight was significantly reduced from 85.66±18.30 kg. to 82.96±18.43 kg with a consequently significant change in the BMI from 29.38±5.08 kg/m2 to 28.43±5.16 kg/m2. Moreover, the glycemic control, assessed as FBS and HbA1c also showed significant reduction in the FBS (127.76±9.17 to 121.23±9.54) and HbA1c (7.14±0.29 to 6.92±0.29) after 12 weeks of treatment in all 30 patients (p<0.01). Conclusion: Apple Cider Vinegar seems to be effective therapy in combination with metformin for newly diagnosed type 2 diabetic patients in improving glycemic control as well as augmenting weight reduction.


2020 ◽  
Vol 8 (E) ◽  
pp. 133-137
Author(s):  
Rusdiana Rusdiana ◽  
Maya Savira ◽  
Sry Suryani Widjaja ◽  
Dedi Ardinata

AIM: The aim of this study was to evaluate the effect of short-term education on glycemic control (glycated hemoglobin [HbA1c] and fasting blood sugar [FBS]) among type 2 diabetes mellitus patients attending to primary health care (PHC) in Medan Johor of North Sumatera, Indonesia. METHODS: The study was performed on type 2 diabetes mellitus patients in Johor PHC, Medan of North Sumatera, on 40 patients with type 2 diabetes mellitus. We took the samples of all the patients of type 2 diabetes mellitus who attend PHC in Medan Johor. The patients received for 3 months intervention by education. An educational course of diabetes together with exercise training and nutritional education was designed for the study population in order to increase the patients’ knowledge and attitude toward diabetes and to increase their participation in the self-monitoring of glycemic control. Samples of FBS and HbA1c were recorded for each patient at the time of the baseline survey, then health education was conducted to the diabetic patients of both sexes attending PHC. The patients received standard advice on diet management and variation about activity. We put HbA1c <6.5% as cut limit for the control of diabetes mellitus. RESULTS: All 40 type 2 diabetes patients completed the educational course. The mean of age of the samples is 62.53 years old, the mean of body mass index was 24.81 kg/m, and the mean of waist size was 92.15 cm. Before the education, the mean of FBS level was 238.83 mg/dl and the mean of Hba1c value is 8.90%. After education, the FBS was 216.88 mg/dl, the mean of HbA1c value was 8.74%. CONCLUSION: The effect of health education in Johor Public Health Care Medan city reduced glycemic control (FBS) in type 2 diabetes mellitus patients, North Sumatera, Indonesia.


Author(s):  
Gangaram Bhadarge ◽  
Pratibha Dawande ◽  
Nandkishor Bankar ◽  
Raunak Kotecha

Introduction: Zn supplementation improved glutathione peroxidase enzyme activity and decreased malondialdehyde and nitric oxide levels in diabetic rats, revealing Zn's defensive effect against oxidative stress in type 2 diabetes. The investigators have discovered that consuming Zn increased liver function and protected pancreatic tissue from damage caused by diabetes. Since Zn also prevents chronic hyperglycemia, it helps to minimize oxidative stress caused by type 2 diabetes. Diabetes mellitus (DM) is a global health problem that affects more than 3 million people worldwide (16% of population). Chronic hyperglycemia causes oxidative stress in diabetic patients by the development of free radicals (oxidants) and lowering the antioxidant protection mechanism. Aim: Glycaemic Regulation with Zinc Combination in Type 2 Diabetes Mellitus. Materials and Methods: Faculty of Medicine and Diabetic Opd, Datta Meghe Mediсаl Соllege and Shаlinitаi Meghe Hоsрitаl аnd Reseаrсh Сenter, Nаgрur in соllаbоrаtion with Dаttа Meghe Institute оf Mediсаl Sсienсes Deemed to be University, Sаwаngi, Wаrdhа, Mаhаrаshtrа. Results: The mean Zn level was 12.213±2.342in all participants and 9.121±1.782 in the control group, whereas it was significantly low (9.121±1.782) in the diabetic group, and there was statistically significant difference in Zn levels between the controls and the diabetic group (P < 0.001).FBS, HbA1C, serum Zinc mean effects between control and patients showed statistically significant differences in type 2 diabetes mellitus (P <0.0001). Conclusion: Our findings show that people with diabetes have lower levels of Zn than healthy people. The cause and effect of the association between very low levels of Zn and the progression of diabetes, or diabetes that causes Zn deficiency, is still unknown. Low levels of Zn are associated with poor glycemic control, and poor glycemic control is a good indication of Zn deficiency, as there was a negative association between serum Zn and FBS and HBA1C. If diabetic patients have low glycemic regulation, a long history of diabetes, obesity, or are over the age of 50, we look to assess their levels in Zn so that Zn alternative treatment can begin to release oxidative stress in this high-risk group.


2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Francis Agyemang-Yeboah ◽  
Benjamin Ackon Jnr. Eghan ◽  
Max Efui Annani-Akollor ◽  
Eliezer Togbe ◽  
Sampson Donkor ◽  
...  

Background. Metabolic syndrome (MS) is a collection of cardiovascular risk factors comprising insulin resistance, dyslipidemia, obesity, and hypertension, which may cause further complications in diabetes. Although metabolic syndrome (MS) is increasing in incidence in diabetics and leading to significant cardiovascular diseases and mortality, there is dearth of data in Ghana. This study investigated metabolic syndrome, its prevalence, and its associated risk factors in type 2 diabetes at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Methods. The study involved 405 diabetic patients attending the Diabetic Clinic of the Komfo Anokye Teaching Hospital (KATH) Kumasi, in the Ashanti Region of Ghana. A well-structured questionnaire was used to obtain demographic background such as their age and gender. Anthropometric measurements were obtained using the Body Composition Monitor (Omron ® 500, Germany) which generated digital results on a screen and also by manual methods. Fasting venous blood was collected for the measurement of biochemical parameters comprising fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), high density lipoprotein cholesterol (HDL-c), and triglyceride (TG). Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Results. Out of the total of 405 participants, 81 were males and 324 were females, and the estimated mean age was 58.5 ± 9.9 years. The female patients exhibited higher mean waist circumference (WC) and mean hip circumference (HC) as well as an approximately higher body mass index than males (28.3 ± 5.1, 26.5 ± 4.2 for the female and male respectively). Overall, the prevalence of metabolic syndrome observed among the study population was 90.6%. Conclusions. The prevalence of metabolic syndrome observed among the study population was 90.6%, with a higher percentage in females than males. High triglyceride levels and high waist circumference were the main risk factors for MS in the diabetic population.


2016 ◽  
Vol 33 (S1) ◽  
pp. S404-S405
Author(s):  
H. abuhegazy ◽  
H. Elkeshishi ◽  
A. Kamel ◽  
A. Ismail ◽  
K. Sherra ◽  
...  

Objectiveto examine the longitudinal effect of depression on glycemic control in a sample of patients with type 2 diabetes.Methodsthe patients were recruited from diabetes clinic in Saudi airlines medical center, in Jeddah, the base line study community consisted from 172 patients with type 2 diabetes. They were assessed for depression using BDI II, and diagnostic interview, and for diabetic control using HbA1c. We created a person-period data set for each patient to cover 6 months intervals up to 3 years. We used generalized estimation equation (GEE) for analysis of longitudinal data. HbA1C was the response variable while depression and time were the main covariates. Variables were included in GEE models based on clinical importance and preliminary analysis. Other variables included as covariates were gender, education, duration of diabetes, co-morbidity and LDL. All statistical analysis used α = 0.05 level of significance and were performed using SPSS software version 21.ResultsUnadjusted HbA1c means were significantly higher in depressed vs. non-depressed subjects at all time points. The adjusted HbA1c means in final GEE model were significantly higher in depressed vs. non-depressed subjects. In all adjusted models depression was a predictor of glycemic control weather it was BDI score (estimate = .049, P = .002), diagnoses of MDD (estimate = 2.038, P = .000), or other depressive diagnosis (estimate = 1.245, P = .000).ConclusionThis study on clinical sample of type 2 diabetic patients demonstrates that there is a significant longitudinal relationship between depression and glycemic control and that depression is associated with persistently higher HbA1c over time.Disclosure of interestThe authors have not supplied their declaration of competing interest.


PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251506
Author(s):  
Shambel Nigussie ◽  
Nigussie Birhan ◽  
Firehiwot Amare ◽  
Getnet Mengistu ◽  
Fuad Adem ◽  
...  

Objective To assess the rate of glycemic control and associated factors among type 2 diabetes mellitus patients at Dilchora Referral Hospital, Dire Dawa, Eastern Ethiopia. Methods A cross-sectional study was conducted from 13 May to 16 August 2019. Type 2 diabetic patients on follow up at Dilchora Referral Hospital who fulfilled the inclusion criteria of the study were included. Systematic random sampling was used to select study participants. Data was collected by a face-to-face interview and review of medical records. The primary outcome was the level of blood glucose during three consecutive visits. Poor glycemic control was defined as a blood sugar level of more than 154 mg/dL based on the average of measurements from three consecutive visits. Multivariate logistic regression analysis was used to identify determinants of glycemic control. Result A total of 394 participants responded to the interview and were included in the final analysis. The overall prevalence of poor glycemic control was 45.2% (95%CI: 40.6%-50.0%). Patients who were on oral anti-diabetic drug plus insulin had more than two times greater chance of poor glycemic control than patients on oral anti-diabetic drug alone: 2.177(95%CI:1.10–4.29). The odds of poor glycemic control in patients who did not understand the pharmacist’s instructions was two times higher than patients with good understanding of instructions 1.86(95%CI: 1.10–3.13). Patients who had poor level of practice were found to have poor glycemic control: 1.69(95% CI: 1.13–2.55). Conclusion The overall prevalence of poor glycemic control was high among type 2 diabetes patients. Oral anti-diabetic drugs in combination with insulin, lack of understanding of pharmacist’s advice, and poor practice of diabetic patients were significant factors of poor glycemic control. Pharmacists should reassure the understanding of patients before discharge during counseling. Optimization of the dose of antidiabetic medications and combination of oral hypoglycemic agents should be considered.


2021 ◽  
Vol 17 (4) ◽  
pp. 322-328
Author(s):  
A.V. Кovalchuk ◽  
О.В. Zinych ◽  
V.V. Korpachev ◽  
N.M. Кushnareva ◽  
О.В. Prybyla ◽  
...  

Recent studies have demonstrated the importance of bone as an endocrine organ that produces biologically active substances, which regulate both local bone metabolism and metabolic functions throughout the body. In the process of bone remodeling (formation/destruction), the active cells secrete specific biomarkers that help detect osteometabolic dysfunction. Among bone hormones, osteocalcin plays an important role as a coordinator of bone modeling processes, energy homeostasis, metabolism of glucose, lipids and minerals. Osteocalcin is a structural protein of the bone matrix, which is synthesized by osteoblasts and enters the bloodstream in the process of bone resorption. The level of osteocalcin in the serum is used as a specific marker of bone formation. Osteocalcin promotes pancreatic β-cell proliferation and insulin secretion, and also affects the insulin sensitivity of peripheral tissues. The inverse association of glycemia with the level of osteocalcin was revealed. Patients with type 2 diabetes mellitus usually have normal or even slightly elevated bone mineral density compared to age-appropriate controls. Decreased bone quality and increased risk of fractures are associated with changes in bone microarchitecture and local humoral environment. An imbalance in osteoblast/osteoclast activity may be due to oxidative stress and the accumulation of glycosylation end products, which contributes to chronic inflammation and bone resorbtion in patients with diabetes. It is shown that the level of osteocalcin in the blood serum is significantly reduced compared to healthy controls, both in patients with type 1 diabetes mellitus and, especially, in type 2 diabetes mellitus. Given the importance of developing new approaches to the diagnosis and correction of metabolic disorders in diabetic patients, the study of the influence of bone hormones on hormonal and metabolic parameters and bone status, including the risk of fractures, remains relevant in modern diabetology.


2021 ◽  
Author(s):  
Benjamin Panzer ◽  
Patricia P Wadowski ◽  
Kurt Huber ◽  
Simon Panzer ◽  
Thomas Gremmel

Abstract Background: Dual antiplatelet therapy is a cornerstone in the secondary prevention of ischemic events following percutaneous coronary intervention (PCI) with stent implantation. The new, more potent adenosine diphosphate (ADP) P2Y12 receptor inhibitors prasugrel and ticagrelor have been shown to improve patients’ outcomes. Whether or not these drugs have equal efficacy in diabetic as in non-diabetic individuals is disputed. Furthermore, platelets can be activated by thrombin, which is, at least in part, independent of ADP-inducible activation. Protease-activated receptor (PAR)-1 and -4 are thrombin receptors on human platelets activated by the agonists SFLLRN and AYPGKF, respectively. In the current study, we sought to compare the in vitro efficacy of prasugrel (n=121) and ticagrelor (n=99) to inhibit PAR-mediated platelet activation in patients with type 2 diabetes (n=55).Materials and Methods: We compared P2Y12-, PAR-1- and PAR-4-mediated platelet aggregation as assessed by multiple electrode platelet aggregometry between prasugrel- and ticagrelor-treated patients without and with type 2 diabetes who underwent acute PCI. Results: There were no significant differences of on-treatment platelet aggregation in response to ADP, SFLLRN and AYPGKF between patients on prasugrel or on ticagrelor. Diabetic and non-diabetic patients responded equally. There was no significant correlation between either; ADP-, SFLLRN-, or AYPGKF-inducible platelet aggregation and levels of HbA1c or the body mass index. However, we observed patients with high residual platelet reactivity to SFLLRN and AYPGKF in all cohorts.Conclusion: Prasugrel and ticagrelor inhibit platelet aggregation in diabetic and non-diabetic patients to a similar extent.


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