Serum calcium and phosphorous balance in diabetic nephropathy and its correlation with glycated hemoglobin

Background: Timely control of hemoglobin A1c (HbA1c) level is very important in patients with diabetic kidney disease. Diabetic nephropathy brings changes in mineral metabolism. The changes in calcium and phosphorous level is a reason for increased morbidity or decreased quality of life in these patients. Conflicting reports are available on serum calcium level and decline in kidney function. This study is to analyse the changes in calcium and phosphorous level in different stages of diabetic nephropathy and its correlation with glycated haemoglobin.Methods: A cross sectional study with 60 diabetic nephropathy patients admitted in MES Medical College for a period of 1.5 years. Patients with cardiac, liver, thyroid dysfunction, under dialysis were excluded from the study. Fasting blood sugar, HbA1c, calcium, phosphorous, creatinine were assessed by VITROS 5600 integrated system. The study population is divided into groups by two different means, according to HbA1c and estimated glomerular filtration rate (eGFR) value. Statistical analysis was performed by statistical package for the social sciences (SPSS) software. Level of significance calculated at 95%.Results: eGFR value showed a highly significant correlation with age (p=0.016), creatinine (p≤0.00001), calcium (p≤0.00001), phosphorous (p≤0.00001) and HbA1c (p=0.00001). There was no significant difference in creatinine and eGFR between male and female subjects. Only eGFR (p=0.0396) showed a significant difference between poor and good glycaemic control groups.Conclusions: This study shows highly significant correlation between the decreased eGFR hypocalcaemia, hyperphosphatemia, increased serum creatinine level and HbA1c. Strict glycemic control is crucial in maintenance of mineral homeostasis and prevention of blood calcium, phosphorous abnormalities.

Glycaemic control in critical care: Can flash glucose monitoring help?

Good glycaemic control confers an outcome benefit in both diabetic and non-diabetic critically unwell patients. Critically unwell patients receiving intravenous insulin in the intensive care unit (ICU) require hourly glucose monitoring. This brief communication highlights the impact of the introduction of the FreeStyle Libre glucose monitor, a form of continuous glucose monitoring, on the frequency of glucose recordings in patients receiving intravenous insulin in the ICU at York Teaching Hospital NHS Foundation Trust.

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

FAMILY SUPPORT IN THE CARE OF PEOPLE WITH TYPE 2 DIABETES AND FACTORS ASSOCIATED WITH CONTROL OF BLOOD SUGAR

Family plays a key role in supporting the self-care management of people with Type 2 diabetes (T2DM). The perceptions of support of the people with T2DM and their carer and its associated factors have not yet been explored. This study aimed to examine the perceptions of the people with T2DM and their carers and factors associated with family support and glycaemic control. A cross-sectional analytical study was conducted with 608 people with T2DM and their carers. Two sets of self-administered questionnaires were used. The participants' medical records were reviewed. Family support was explored from both the people with T2DM and their carers and then compared on a case-by-case basis. The response rate of the T2DM participants was 79.6% (n = 242). In all, 160 (66.1%) participants had poor glycaemic control, and 85 (38.3%) participants had family support. Having family support was not associated with good glycaemic control but poor self-care behavior (p = 0.003). The response rate of the carers was 44.4%. There were differences in perceptions of aspects of family support between the participants and their carers on a case-by-case basis, including problem-solving (p = 0.008), roles (p < 0.001), and affective responses (p = 0.036). The novel results of this study are the differences in perceptions of family support between people with T2DM and their carers, which may explain the non-association between family support and good glycaemic control. This highlights the need to explore the extent of support people with T2DM need regarding their self-care management from their families.

A descriptive study of knowledge and attitude of diabetes mellitus and its management in rural population

: Diabetes Mellitus (DM) is a chronic disease, requiring long term medications and frequent monitoring of blood sugars. Education is one of the key components in ensuring better treatment and control of diabetes. Good glycaemic control with frequent monitoring of blood glucose, healthy diet, and adequate physical activity can go a long way in prolonging longevity of patients with DM and also in preventing morbidity. This study was taken up to assess the knowledge and attitude of people in Rural India towards DM. This being a hospital based descriptive cross sectional study, 550 Diabetics were evaluated by detailed questionnaire.: The mean age observed was 49.6±8.6 years, 73% of patients were illiterates. Majority of patients were farmers who indulged in heavy work (55%). (11%) was aware about diabetic diet while only 5%actually followed it. Majority (86.2%) were adherent to medications, while only 15.3% were actually aware regarding consequences and complications of missing medications dosage. None of patients were having facilities for home monitoring of glucose and only 9% got their sugars checked regularly. Only, 62.5% of patients used footwear regularly. Only 21.6% patients were aware regarding importance of foot examination, while only 7.4% performed it regularly.75% did not come to hospital for regular glycemic monitoring as there was no one to accompany them. Spreading knowledge regarding diabetes and its management in the form strict adherence to prescribed medications, diabetic diet, and regular physical activity will motivate individuals with diabetes to visit hospitals regularly. This is an important step in preventing diabetes-related complications. Awareness methodology specific for rural populations needs to be adopted

Insulin choice in feline diabetes mellitus

PICO question In cats with diabetes mellitus, do protamine zinc insulin (PZI) and glargine show a similar effect in reducing clinical signs and hypoglycaemia episodes? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed The number and type of study designs that were critically appraised was one. This study was a non-randomised retrospective trial. A systematic review was also found, which analyses the influence of insulin in diabetic remission Strength of evidence Weak Outcomes reported Compared to PZI, using glargine in recently diagnosed diabetic cats fed exclusively an ultra-low carbohydrate-high protein canned diet, may result in lower fructosamine and mean 12 hour blood glucose concentrations as well as less episodes of hypoglycaemia Conclusion In view of the strength of evidence and the outcomes from the study the following conclusion is made: in cats with diabetes mellitus where currently licensed insulin fails to result in a good glycaemic control, glargine may be considered How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

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

Insulin Withdrawal in Diabetic Kidney Disease: What Are We Waiting for?

The prevalence of type 2 diabetes mellitus worldwide stands at nearly 9.3% and it is estimated that 20–40% of these patients will develop diabetic kidney disease (DKD). DKD is the leading cause of chronic kidney disease (CKD), and these patients often present high morbidity and mortality rates, particularly in those patients with poorly controlled risk factors. Furthermore, many are overweight or obese, due primarily to insulin compensation resulting from insulin resistance. In the last decade, treatment with sodium–glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA) have been shown to be beneficial in renal and cardiovascular targets; however, in patients with CKD, the previous guidelines recommended the use of drugs such as repaglinide or dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors), plus insulin therapy. However, new guidelines have paved the way for new treatments, such as SGLT2i or GLP1-RA in patients with CKD. Currently, the new evidence supports the use of GLP1-RA in patients with an estimated glomerular filtration rate (eGFR) of up to 15 mL/min/1.73 m2 and an SGLT2i should be started with an eGFR > 60 mL/min/1.73 m2. Regarding those patients in advanced stages of CKD, the usual approach is to switch to insulin. Thus, the add-on of GLP1-RA and/or SGLT2i to insulin therapy can reduce the dose of insulin, or even allow for its withdrawal, as well as achieve a good glycaemic control with no weight gain and reduced risk of hypoglycaemia, with the added advantage of cardiorenal benefits.

Sodium-glucose co-transporter 2 inhibitors: game changers when handled with care?

Recent years have seen a paradigm shift in the management of patients with diabetes mellitus. Rather than good glycaemic control being the sole primary aim, the therapeutic focus has broadened to consider potential additional cardiovascular and renal benefits. Sodium-glucose co-transporter 2 inhibitors, such as empagliflozin, canagliflozin and dapagliflozin, have gained increasing prominence, with evidence suggesting significant improvement in outcomes in patients with established cardiovascular and renal disease. Here, we discuss the benefits and relative risks of these novel agents and highlight important clinical issues of relevance to general physicians.