A Position Statement of the Utilization and Support Status of Continuous Glucose Monitoring in Korea

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.

A Snapshot of Risk Stratification of Diabetic Patients Fasting during the Month of Ramadan

Objectives: To get a clinical snapshot of the diabetic patients who planned to fast during the month of Ramadan and to determine the ability of the RRR application to effectively risk-stratify patients. Study Design: Observational study. Place and Duration of Study: Department of Diabetes & Endocrinology, Armed Forces Hospital Al-Hada, Taif, Kingdom of Saudi Arabia from 1st April 2018 to 31st May 2018. Methodology: Ninety six patients over 15 years of age with diabetes mellitus were risk stratified using standardized risk criteria were enrolled. Detailed analysis of the information was performed to paint a clinical landscape of the patients who intended to fast. Results: Seventy four percent of the patients were type 2 diabetics, 11% GDM, 31% were between 60-70 years and 17 % had diabetes for more than 20 years. 17% of participants had serious complications during the last three months before Ramadan including hypoglycemia, Diabetic Ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). 59% had chronic diabetic complications. 28 % of patients were on both insulin and oral hypoglycemic agents (OHA) together and 16 % on high risk medications. 25% of patients had an HbA1C of more than 10%. Pertaining to the previous Ramadan experience 19% disclosed having serious complications in the past. 6 % were categorized as low risk individuals, 76% as moderate, 6% high and 12 % as very high risk. Conclusions: Astonishingly all the patients advised to refrain from fasting insisted on fasting. Considering the latest IDF numbers the above calculated percentages would translate into very huge numbers who are in serious jeopardy. In order to prevent serious consequences it is highly recommends that evidence based and validated risk stratification strategies are implemented in routine clinical practices. Keywords: Diabetes mellitus, Fast, Hypoglycemia, High risk patients

Evaluation of Risk Factors for Dementia Incidence Based on Previous Questionnaire Results of Specific Health Checkups in Japan

The prevalence of dementia is rapidly increasing worldwide, and its treatment and prevention are a health concern. The prevention of dementia requires the identification of risk factors through longitudinal studies of lifestyle. In this study, we aimed to identify the risk factors for the development of dementia in Japan and to clarify their primary care strategies. We analyzed the relationship between the cognitive ability level determined by the survey of long-term care certification and the past questionnaire results of a specific health examination in Japan 10 years ago. To analyze the risk factors for developing dementia, multivariate analysis was used, which showed that residents who gained more than 10 kg since reaching 20 years of age had a significantly lower risk of developing dementia. Regarding the “start of lifestyle modifications” question, those who answered “already started” had a significantly lower risk than those who answered “no plan to improve”. Conversely, residents receiving insulin injections or oral hypoglycemic agents were at a significantly higher risk of developing dementia based on the results of the questionnaire of the health checkups surveyed 10 years prior.

Type 2 diabetes mellitus in children and adolescents in the world and in Ukraine

Introduction. Recently, many studies have been devoted to the study of type 2 diabetes mellitus (DM2) worldwide. In most countries of the world, the increase in the prevalence of DM2 among children and adolescents is accompanied by an increase in childhood obesity. The presence of obesity or overweight in children can complicate the diagnosis of various types of DM. Detection and treatment of DM2 is extremely important for the society due to the wide range of severe diabetes complications.The aim of this work was to analyze the frequency of DM2 according to the Register of patients with DM, and to determine the state of glycemic control in children with DM2. Materials and methods. An analysis of glycemic control in children with DM2 who received various treatment regimens: with diet and lifestyle modifications, or with additional oral hypoglycemic agents (metformin monotherapy, or combination with insulin therapy). The glycemic control was assessed by measurement of glycated hemoglobin (HbA1c) level. Results. According to the data Register in Ukraine, the prevalence of DM among children has a tendency to rise — from 8.6 per 10 thousand children in 2005, to 13.14 — in 2019 year. The prevalence of DM2 in 2019 was 0.47 % of all cases of DM, and its prevalence contained 0.062 per 10 thousand children under 19 years of age with significant differences in the frequency of its diagnosis in different regions of Ukraine. We analyzed the state of glycemic control in children with DM2 aged from 9 up to 19 years old (Me 16.2 [15.5; 18.0]), with a disease duration 0.5—12 years (Me 4.5 [1.0] ; 7.5]). The age of diagnosis of DM2 was 2-17 years old (Me 11.7 [8.5; 15.0]), and 91.3 % of patients had obesity. Diet and lifestyle modifications were used in 34.8 % of patients, metformin monotherapy in 52.2 %, and metformin and insulin combination therapy in 13 % of patients. HbA1c values ​​ranged from 5.0 to 11.4 % (Me 7.2 % [5,8; 8,0]). The proportion of children who had ideal or optimal glycemic control (HbA1c 7.0—7.5 %) was 52.2 %, suboptimal (HbA1c 7.6—9.0 %) — 39.1 %, high-risk glycemic control (HbA1c> 9.1 %) — 8.7 % of children. The most unsatisfactory HbA1c levels ​​were registered in children who received metformin in combination with insulin (Me 10.6 % [10,15; 11,4]). Chronic complications of DM2 have not been reported.Conclusions. We found a low prevalence of DM2 among the pediatric population in Ukraine, more likely due to the low quality of its detection among children diagnosed with DM, as well as among children among high risk groups. Most children with DM 2 were obese. The majority of patients with DM2 (52.2 %) received metformin monotherapy, more than a third did not receive oral hypoglycemic agents. In most children with DM2 (52,2 %), the state of glycemic control corresponded to the optimal (< 7.5 %), but higher levels of HbA1c were found children who received metformin in combination with insulin.

Herbal Drugs with Anti-Diabetic Potential

Diabetes mellitus (DM), also known as insulin-dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM), is a common and serious metabolic condition that affects people all over the world. Traditional herbal plants have been utilized to treat diabetes mellitus all throughout the world. Several herbs have been found to treat and control diabetes among numerous medicines and poly herbal plants; they also have no adverse effects. Diabetes mellitus is a horrible disease that affects people all over the world and is becoming a serious danger to humanity's health. Thus, herbal plants may be a possible source of anti-diabetic medicines, with ethno botanical data indicating that around 800 plants may have anti-diabetic potential. Although synthetic oral hypoglycemic agents/insulin are a popular diabetes therapy and are effective in controlling hyperglycemia, they have significant side effects and do not significantly modify the course of diabetic complications. This is the primary reason why an increasing number of individuals are looking for alternative medicines with fewer or no adverse effects. The botanical name, common name, component, and mechanism of action for anti-diabetic activity were provided in this review study, as well as plant-based commercial poly herbal formulations. Keywords: Diabetes mellitus, Medicinal plants, glucose, poly herbal plants

Incidence of Autonomic Neuropathy during Assessment in Diabetes Mellitus Patients in PAC

Background: Diabetes mellitus (DM) is a clinical syndrome characterized by hyperglycaemia due to absolute or relative insulin deficiency. Autonomic neuropathy invokes potentially life threatening outcomes especially in poorly controlled diabetic patients. Objectives: The objective of this study is to assess the incidence of autonomic neuropathy in patients with type 2 diabetes mellitus. Materials and Methods: The Study was conducted on 80 Type 2 Diabetes Mellitus patients in Pre Anesthetic Clinic of Department of Anesthesiology, Saveetha Medical College and Hospital during the period of March 2021 to August 2021. Informed consent was obtained from all those who met the inclusion criteria and their BP and Heart Rate variability to various manoeuvres were assessed. Results: According to our study 40% and 30% had borderline and definite autonomic neuropathy respectively. Conclusion: Autonomic neuropathy is common in patients with poorly controlled Diabetes Mellitus, especially those on oral hypoglycemic agents. As nowadays no therapy is able to effectively reverse this process, prevention with strict glycemic control, multifactorial intervention, and lifestyle modification remains essential.

Combined effect of Levothyroxine, Antihyperlipidemic and oral hypoglycemic agents on lipid profile and cognition level in hypothyroidism patients

Aim: To evaluate the effect of combination therapy on lipid profile and cognition level in hypothyroidism patients. Methods: A prospective observational study was conducted in a private hospital at Tiruchengode. Patients who were under the management of thyroid disorder and hyperlipidemia more than 10 years was screened and selected for the study. There were 155 patients were included in the study and the patients who were on Levothyroxine 50mcg as control (Group 1), Group 2 Patients prescribed with levothyroxine 50mcg and Atorvastatin 20mg were checked with lipid profile parameter like Total cholesterol (TC), Triglycerides (TG), High density Lipoprotein (HDL-C), Low density Lipoprotein (LDL-C) and compared with control group values. Group 3 patients prescribed with levothyroxine 50mcg and Atorvastatin 20mg, Glimepride 2mg, Metformin 500mg were checked with lipid profile, compared with control group. The patients were interviewed using a Mini mental state examination questionnaire and their cognitive skills were assessed and compared with control group. Independent samples T test was used to compare the complication of the management. Conclusion: Hyperlipidemia management with levothyroxine 50mcg and Atorvastatin 20mg, Glimepride 2mg, Metformin 500mg (Group 3) has an association on the managing lipid profile efficiently than the control (Group 1) Significant (p<0.01). Cognition impairment was high in the combination therapy. (p <0.01)

Retrospective, observational study on usage of evogliptin in T2DM patients: A real-World experience in Indian patients

This study aimed to assess effectiveness and safety of Evogliptin 5 mg in patients with T2DM who were prescribed Evogliptin alone or with other oral hypoglycemic agents in real world scenario. Overall 20 patients who received Evogliptin as routine clinical practice in management of T2DM were analyzed retrospectively from single center. Data collected from past medical records. Primary endpoint was mean changes in HbA1c from baseline to weeks 24 and secondary endpoints were Change in HbA1c from baseline to weeks 12 Change from baseline in FPG & PPG at weeks 12 & 24.Significant reduction in HbA1c at the end of 12 and 24 weeks of Evogliptin therapy was - 0.9% and -1.45% respectively from the baseline of HbA1c 8.6% (p value &#60;0.001). At the end of 12 and 24 weeks of addition of Evogliptin, significant reduction in FBG were seen i.e -49.5 mg/dl and -90.7mg/dl respectively from base line of 182 mg/dl and reduction in PPG was -79.4mg/dl and -116.6mg/dl respectively from base line 277 mg/dl (p value &#60;0.001). Evogliptin was found to be effective when added to the patients who were uncontrolled on dual / triple oral anti-diabetic medications and even in treatment naïve patient. It effectively showed reduction in HbA1c, FBG and PPG and the end of 12 and 24 weeks when added to existing anti-diabetic medications & well tolerated in type 2 diabetes Indian patients.Small sample size and retrospective study

Switch to SGLT2 Inhibitors and Improved Endothelial Function in Diabetic Patients with Chronic Heart Failure

Purpose The use of sodium-glucose-cotransporter-type-2 inhibitors (SGLT2i) was associated in previous studies with an improved vascular function in non-human experimental models. We therefore sought to evaluate possible changes in endothelial function assessed by flow-mediated dilation (FMD) in patients with chronic heart failure (CHF) and type-2 diabetes mellitus (T2DM), switching from other oral hypoglycemic agents to SGLT2i in an observational study. Methods Twenty-two consecutive outpatients with CHF and T2DM were enrolled after switching to SGLT2i therapy, and compared with 23 consecutive controls from the same registry comparable for principal clinical characteristics. In all patients, endothelial function was assessed by FMD at baseline and after 3 months of follow-up. Results Three months of therapy with SGLT2i were associated with a statistically significant improvement in endothelial function (19.0 ± 5.7% vs 8.5 ± 4.1%, p < 0.0001); baseline levels of FMD were comparable between groups (p n.s.). Therapy with SGLT2i was significantly associated to improved FMD levels even at multivariable stepwise regression analysis (p < 0.001). Conclusions Switch to SGLT2i in patients with CHF and T2DM was associated in an observational non-randomized study with an improved endothelial function.