Evaluation of the selected parameters of the fetal diastolic functions in normally grown or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control

Objective: This study aimed to investigate whether the third trimester fetal cardiac diastolic function measured by selected conventional Doppler indices is affected in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers with poor glycaemic control. Methods: This cross-sectional study included 93 pregnant women divided into two groups. Group 1 included 45 appropriate-for-gestational-age or macrosomic fetuses from gestational diabetic mothers with poor glycaemic control (study group). Group 2 included 48 appropriate-for-gestational-age fetuses from gestational age-matched healthy mothers (control group). Functional fetal cardiac parameters and fetoplacental Doppler parameters were measured. Data were compared between the two groups. Results: Maternal characteristics did not differ significantly between the study and the control group. There were no significant differences in the early and late velocity, early/late velocity ratio of both mitral and tricuspid valves, the fetal pulmonary vein pulsatility index, and the ductus venosus pulsatility index between the study and the control group. Moreover, the rate of abnormal Doppler findings in pulmonary vein (pulmonary vein pulsatility index >95th centile), ductus venosus (ductus venosus pulsatility index >95th centile), and peripheral vessels (umbilical artery pulsatility index >95th centile, middle cerebral artery pulsatility index <5th centile, cerebra-placental index >95th centile) were comparable in both groups. Conclusions: The third trimester fetal diastolic functions measured by selected conventional Doppler techniques do not seem to be altered in appropriate-for-gestational-age or macrosomic fetuses of gestational diabetic mothers who have poor glycaemic control.

Determinants of blood glucose control among people with Type 2 diabetes in a regional hospital in Ghana

Aims To assess the determinants of glycaemic control among patients with Type 2 diabetes mellitus (T2DM) presenting at the Greater Accra Regional Hospital, Ghana. Methods The study employed semi-structured questionnaires and review of clinical records of patients 16 years and above with Type 2 Diabetes. Results The mean age of participants was 56.6 ± 13.8 years, with majority (71.6%) being females. A total of 161 (59.4%) of patients had poor glycaemic control (HbA1c ≥8.1%; 95% CI: 53.6 to 65.3%). Poor glycaemic control was significantly associated with high body mass index of the patient (AOR 13.22; 95% CI: 1.95 to 89.80), having only elementary education (AOR 5.22, 95% CI 2.12–12.86, p<0.0001) and being on insulin therapy (AOR 2.88; 95% CI: 1.05 to 7.88). On the other hand, seldom coffee intake (AOR: 0.27; 95% CI: 0.11 to 0.64), high physical activity (AOR 1.57, 95% CI 1.06–2.35, p = 0.025) and having a cardiovascular disease (AOR: 0.15; 95% CI: 0.05 to 0.46) appeared to positively influence glycaemic control. Self-monitoring of blood glucose and diet interventions did not appear to influence glycaemic control. Conclusions The study results showing that a high proportion of patients attending the Diabetes Clinic with uncontrolled diabetes has serious implications for the management of T2DM diabetes as it suggests that current hospital-based treatment measures are less effective. Comprehensive management of T2DM targeting all the key factors identified in this study and incorporating a multispectral collaborative effort based on holistic approach, combined with non-pharmacological components are strongly warranted.

A STUDY TO EVALUATE THE EFFECT OF ANAEMIA IN TYPE-2 DIABETIC PATIENTS

Introduction: As the tribulation of diabetes escalates, developing countries like India is expected to be the diabetic capital in the world in coming years. Diabetes Mellitus progressively results in various complications including both microvascular and macrovascular disorders. The nephropathy undermines the renal production of erythropoietin, positively contributing to an increased anaemic framework. However, anaemia in type 2 diabetic patients is often untended. Aims And Objectives: • To correlate the levels of haemoglobin with the degree of glycaemic control (HbA1c>6.5% vs HbA1c<6.5%) • To determine the morphology and severity of anaemia in type 2 diabetic patients. • To know prevalence of other comorbidities as a result of anaemia and diabetes. Materials And Methods: A prospective observational study was conducted in 100 type 2 diabetic patients visiting the Out Patient Department in Acs Medical College and Hospital, Chennai. Haemoglobin and red cell indices were estimated. Comorbidities like hypertension, chronic kidney disease, arthritis and retinopathy were recorded. Peripheral blood smear examination was done using leishman's stain. Ion exchange chromatography was used to measure the HbA1c levels. Results: In the poor glycaemic control group, a signicant decrease in the haemoglobin levels was noted especially in females and elderly population. Microcytic Hypochromic Anaemia was the most prevalent which was of mild to moderate severity. Predominantly reduced iron stores in Microcytic Hypochromic Anaemia were attributed to increased HbA1c levels. The poor control of diabetes when associated with anaemia, were also found to have comorbidities like hypertension, chronic kidney disease, arthritis and retinopathy. Conclusion: To conclude, though anaemia is signicantly prevalent in diabetic patients, it is often neglected. In accordance with the study, poor glycaemic control is the result of increased glycation of haemoglobin A1c (HbA1c) due to reduced iron stores. Hence in diabetic patients, it would be benecial to assess haemoglobin levels often, for better quality of life

Prevalence and determinants of poor glycaemic control among adults with type 2 diabetes mellitus in a selected urban population of Mysuru district

Background: India is referred to as the “diabetic capital of the world” and is home to the second-largest number of adults with diabetes worldwide. Urbanization is a key reason for the Indian diabetes epidemic. Poor glycaemic control in type 2 diabetes patients is a serious public health issue and a key risk factor for both progression and complication of diabetes. This study, therefore, intends to assess glycaemic control status and factors influencing poor glycaemic control among T2DM patients.Methods: This was a community-based cross-sectional study done over a period of four months, among T2DM patients in urban Mysuru, using a pre-tested semi-structured questionnaire by interview method. A total of 372 T2DM patients who had the latest reports of fasting blood sugar value were included in the study. SPSS version 23 was used to analyse the collected data and to identify the determinants and risk factors leading to poor glycaemic control.Results: Among 372 study participants, 63.7% of patients had poor glycaemic control. The mean FBS value of the study population was 146.886±43.2700 and the mean age of the study participants was 55.50±12.238 years. Further, it was found that longer diseases durations, irregular check-ups, type of medication, non-adherence to both medication and diabetic diet were risk factors for poor glycaemic status.Conclusions: The prevalence of poor glycaemic control among diabetics in Mysuru was found to be high; therefore, proper health education, counselling of diabetics and organizing health awareness programmes are needed to control it and hence reduce the disease burden.

1452A Cohort Study of Comorbidities of Diabetes in Regional Australia

Background Epidemic of diabetes mellitus and its complications poses a major global threat and the burden of type 2 DM (T2DM) is also a worldwide phenomenon. However, data to rationalize continuous health promotion at local context such as regional New South Wales are lacking, and this underscores the need for continued epidemiological study. This study investigated if poorly controlled T2DM coexists with comorbidities more than those with good glycaemic control. Methods This was a cohort study at a private General Practice in Orange NSW, Australia. The study involved 137 de-identified adults living with T2DM. HbA1c and other biochemical and haematological records were reviewed. Other data included clinical notes including comorbidities, and complications. The cohort was separated into 2 groups: well-controlled versus poor glycaemic control. The resulting data were analysed for frequency, using the statistical software for Microsoft Excel. Results There were 37/137 of the T2DM cohort with baseline HbA1c of ≤ 6.5%, implying 73% poor glycaemic control in the region, at first time of testing. According to the clinical notes, the well-controlled group showed 29.7% comorbidities, including 2.7% queried infection. Among the 100 cases with abnormal HbA1c, comorbidities were observed in 22% including 4% who had infections. Conclusions Our observation implies no less comorbidities in well-controlled diabetes. However, the higher percentage of infection among the poorly controlled group is confirmation of need for continuous health promotion among people living with diabetes. Key messages This primary health statistic suggests the need to monitor for comorbidities equally, whether poor or well-controlled diabetes

Glycated Hemoglobin and short-term Prognosis in Patients with Acute Coronary Syndrome with Diabetes Mellitus: A Prospective Cohort Study

Background: Data on the association between glycemic control after percutaneous coronary intervention (PCI) and clinical outcomes are limited and controversial in diabetic patients. Objective:The aim of the study was to assess the impact of good glycaemic control on three months clinical outcomes in diabetic acute coronary syndrome (ACS) patients undergoing PCI, from a Bangladesh health service perspective. Materials and methods:This prospective cohort study which was conducted in UCC, BSMMU included 346 consecutive diabetic ACS patients who underwent PCI at department of cardiology, BSMMU. Diabetic patients were categorized into two groups based on their 3 months HbA1c levels: 169 (48.84%) diabetics with good glycaemic control (HbA1c < 7%) and 177 (51.16%) diabetics with poor glycaemic control (HbA1c ≥7%).The outcome was major adverse cardiovascular events (MACEs), defined as cardiac death, myocardial infarction (MI), definite stent thrombosis, target vessel revascularization and stroke. Results: At 3 months follow up, patients with poor glycaemic control had a significantly higher incidence of MI (6.2% vs 1.2%; p=0.021). No other adverse events were found significantly different between the groups at 3 months of PCI. Conclusion:Good glycaemic control to obtain HbA1c level <7% in diabetic ACS patients undergoing coronary artery stenting may be beneficial in reducing the risk of MACEs and improvement of clinical outcome after PCI during 3 months follow up. University Heart Journal Vol. 17, No. 2, Jul 2021; 108-113

Neurodevelopmental disorders, glycaemic control and diabetic complications in type 1 diabetes: a nationwide cohort study

Context Neurodevelopmental disorders are more prevalent in childhood-onset type 1 diabetes than in the general population, and the symptoms may limit the individual’s ability of diabetes management. It remains unknown whether comorbid neurodevelopmental disorders are associated with long-term glycaemic control and risk of diabetic complications. Methods This population-based cohort study used longitudinally collected data from Swedish registers. We identified 11,326 individuals born 1973-2013, diagnosed with type 1 diabetes 1990-2013 (median onset age: 9.6 years). Out of them, 764 had a comorbid neurodevelopmental disorder, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and intellectual disability. We used multinomial logistic regression to calculate odds ratios (ORs) of having poor glycaemic control (assessed by mean of glycated haemoglobin [HbA1c]) and Cox regression to estimate hazard ratios (HRs) of nephropathy and retinopathy. Results The median of follow-up was 7.5 (IQR 3.9, 11.2) years. Having any neurodevelopmental disorder (ORadjusted 1.51 [95%CI 1.13, 2.03]), or ADHD (ORadjusted 2.31 [95%CI 1.54, 3.45]) was associated with poor glycaemic control (mean HbA1c &gt;8.5%). Increased risk of diabetic complications was observed in patients with comorbid neurodevelopmental disorders (HRadjusted 1.72 [95%CI 1.21, 2.44] for nephropathy, HRadjusted 1.18 [95%CI 1.00, 1.40] for retinopathy) and patients with ADHD (HRadjusted 1.90 [95%CI 1.20, 3.00] for nephropathy, HRadjusted 1.33 [95%CI 1.07, 1.66] for retinopathy). Patients with intellectual disability have a particularly higher risk of nephropathy (HRadjusted 2.64 [95%CI 1.30, 5.37]). Conclusions Comorbid neurodevelopmental disorders, primarily ADHD and intellectual disability, were associated with poor glycaemic control and a higher risk of diabetic complications in childhood-onset type 1 diabetes.

The Current Situation Regarding Long-Acting Insulin Analogues Including Biosimilars Among African, Asian, European, and South American Countries; Findings and Implications for the Future

Background: Diabetes mellitus rates continue to rise, which coupled with increasing costs of associated complications has appreciably increased global expenditure in recent years. The risk of complications are enhanced by poor glycaemic control including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia and improve adherence. Their considerably higher costs though have impacted their funding and use. Biosimilars can help reduce medicine costs. However, their introduction has been affected by a number of factors. These include the originator company dropping its price as well as promoting patented higher strength 300 IU/ml insulin glargine. There can also be concerns with different devices between the manufacturers.Objective: To assess current utilisation rates for insulins, especially long-acting insulin analogues, and the rationale for patterns seen, across multiple countries to inform strategies to enhance future utilisation of long-acting insulin analogue biosimilars to benefit all key stakeholders.Our approach: Multiple approaches including assessing the utilisation, expenditure and prices of insulins, including biosimilar insulin glargine, across multiple continents and countries.Results: There was considerable variation in the use of long-acting insulin analogues as a percentage of all insulins prescribed and dispensed across countries and continents. This ranged from limited use of long-acting insulin analogues among African countries compared to routine funding and use across Europe in view of their perceived benefits. Increasing use was also seen among Asian countries including Bangladesh and India for similar reasons. However, concerns with costs and value limited their use across Africa, Brazil and Pakistan. There was though limited use of biosimilar insulin glargine 100 IU/ml compared with other recent biosimilars especially among European countries and Korea. This was principally driven by small price differences in reality between the originator and biosimilars coupled with increasing use of the patented 300 IU/ml formulation. A number of activities were identified to enhance future biosimilar use. These included only reimbursing biosimilar long-acting insulin analogues, introducing prescribing targets and increasing competition among manufacturers including stimulating local production.Conclusions: There are concerns with the availability and use of insulin glargine biosimilars despite lower costs. This can be addressed by multiple activities.

Barriers to Diabetes Self-Management in a Subset of New Zealand Adults with Type 2 Diabetes and Poor Glycaemic Control

Background. Despite the fact that there is an increasingly effective armoury of medications to treat diabetes, many people continue to have substantially elevated blood glucose levels. The purpose of this study was to explore what the barriers to diabetes management are in a cohort of people with diabetes and poor glycaemic control. Methods. Qualitative semistructured interviews were carried out with 10 people with diabetes who had known diabetes and a recent HbA1c of >11.3% (100 mmol/mol) to explore their experiences of barriers to diabetes self-management and glycaemic control. Results. Barriers to diabetes management were based around two key themes: biopsychosocial factors and knowledge about diabetes. Specifically, financial concerns, social stigma, medication side effects, and cognitive impairment due to hyperglycaemia were commonly reported as barriers to medication use. Other barriers included a lack of knowledge about their own condition, poor relationships with healthcare professionals, and a lack of relevant resources to support diet and weight loss. Conclusion. People with diabetes with poor glycaemic control experience many of the same barriers as those reported elsewhere, but also experience issues specifically related to their severe hyperglycaemia. Management of diabetes could be improved via the increased use of patient education and availability of locally relevant resources.