Association of glycated haemoglobin and serum ferritin levels in type 2 diabetics of rural population

Serum ferritin, an acute phase reactant, is an indicator of the body's iron reserves. Increased body iron reserves and subclinical hemochromatosis have been linked to the development of hyperglycaemia, type 2 diabetes, metabolic syndrome, and potentially diabetic retinopathy, nephropathy, and vascular dysfunction, according to recent research. The objective of this study was to see if there was a link between Serum Ferritin and Type 2 diabetes and metabolic syndrome, as well as to see if there was a link between S. ferritin and HbA1c.The present study included 50 diagnosed cases of type 2 diabetes mellitus (males: 32, females: 18) and 50 healthy controls of same age (males: 28, females: 22). Serum ferritin levels, glycated hemoglobin were measured and compared. : When diabetic patients were compared to controls, serum ferritin was considerably greater, and serum ferritin had a positive correlation with the duration of diabetes and glycated hemoglobin. Positive correlation was found between serum ferritin levels and glycated hemoglobin and duration of disease.

Digitally enabled flash glucose monitoring for inpatients with COVID-19: Feasibility and pilot implementation in a teaching NHS Hospital in the UK

Background COVID-19 placed significant challenges on healthcare systems. People with diabetes are at high risk of severe COVID-19 with poor outcomes. We describe the first reported use of inpatient digital flash glucose monitoring devices in a UK NHS hospital to support management of people with diabetes hospitalized for COVID-19. Methods Inpatients at University Hospitals Coventry & Warwickshire (UHCW) NHS Trust with COVID-19 and diabetes were considered for digitally enabled flash glucose monitoring during their hospitalization. Glucose monitoring data were analysed, and potential associations were explored between relevant parameters, including time in hypoglycaemia, hyperglycaemia, and in range, glycated haemoglobin (HbA1c), average glucose, body mass index (BMI), and length of stay. Results During this pilot, digital flash glucose monitoring devices were offered to 25 inpatients, of whom 20 (type 2/type 1: 19/1; mean age: 70.6 years; mean HbA1c: 68.2 mmol/mol; mean BMI: 28.2 kg/m2) accepted and used these (80% uptake). In total, over 2788 h of flash glucose monitoring were recorded for these inpatients with COVID-19 and diabetes. Length of stay was not associated with any of the studied variables (all p-values >0.05). Percentage of time in hyperglycaemia exhibited significant associations with both percentage of time in hypoglycaemia and percentage of time in range, as well as with HbA1c (all p-values <0.05). The average glucose was significantly associated with percentage of time in hypoglycaemia, percentage of time in range, and HbA1c (all p-values <0.05). Discussion We report the first pilot inpatient use of digital flash glucose monitors in an NHS hospital to support care of inpatients with diabetes and COVID-19. Overall, there are strong arguments for the inpatient use of these devices in the COVID-19 setting, and the findings of this pilot demonstrate feasibility of this digitally enabled approach and support wider use for inpatients with diabetes and COVID-19.

Protein hydrolysates from boarfish (Capros aper) and Atlantic salmon (Salmo salar) skin gelatin improve metabolic control in genetically obese diabetic (ob/ob) mice

There is increasing interest in dietary protein for management of Type 2 diabetes mellitus (T2DM) and obesity. The effects of twice-daily oral administration of a salmon skin gelatin hydrolysate (SSGH, 50 mg/kg), boarfish protein hydrolysate (BPH, (50 mg/kg), metformin (200 mg/kg), or saline control, were investigated in ob/ob mice. Non-fasting blood glucose was significantly reduced with SSGH (p<0.01), BPH (p<0.001) and metformin (p<0.001), which were reflected in reductions in glycated haemoglobin (HbA1c) (p<0.001, p<0.01 and p<0.01, respectively). Responses to oral and intraperitoneal glucose tolerance were improved (p<0.05-0.01), as well as circulating plasma lipid profiles (p<0.05-0.001). Chronic BPH treatment increased circulating plasma insulin (p<0.01), whereas SSGH improved insulin sensitivity (p<0.05), versus respective controls. All treatments significantly reduced energy intake (p<0.05-<0.001) versus (ob/ob) controls, without affecting overall bodyweight. These findings suggest that fish hydrolysates mediate potent anti-diabetic actions similar to metformin and might be suitable for the management and prevention of T2DM.

Effect of COVID-19 pandemic on glycaemic monitoring and other processes of care in Type 2 Diabetes: Protocol for a retrospective cohort study (Preprint)

BACKGROUND Social distancing and other non-pharmaceutical interventions to reduce spread of COVID-19 infection in the UK have led to substantial changes in delivering ongoing care for patients with chronic conditions, including type 2 diabetes mellitus (T2DM). Clinical guidelines for management and prevention of complications for people with T2DM delivered in primary care services advise ‘routine annual reviews’ and were developed when face-to-face consultations were the norm. The shift in consultations from face-to-face to remoted-consultations caused a reduction in direct clinical contact and may impact on the process of care for people with T2DM. OBJECTIVE The aim of this study is to explore the impact of the first year of COVID-19 pandemic on the monitoring of T2DM with ‘routine annual reviews’ from a national primary care perspective in England. METHODS A retrospective cohort study of adults with T2DM will be performed using routinely collected primary care data from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). We will describe the change in the rate of monitoring of glycated haemoglobin (HbA1c) between the first year of the COVID pandemic (2020) and the preceding year (2019). We will also report any change in the eight checks that compose the components of these reviews. The change in glycated haemoglobin (HbA1c) monitoring rates will be determined using a multi-level logistic regression model adjusting for patient and practice characteristics and similarly the change in a composite measure of the completeness of all eight checks will be modelled using ordinal regression. The models will be adjusted for the following patient level variables: age, gender, socio economic status, ethnicity, COVID-19 shielding status, duration of diabetes, comorbidities; then at practice-level: urban versus rural, practice size, Quality and Outcomes Framework (QOF) achievement, NHS Region and proportion of face-to-face consultations. Ethical approval was provided by the University of Oxford Medical Sciences Interdivisional Research Ethics Committee (2nd September 2021, Reference: R77306/RE001). RESULTS To create the retrospective diabetic cohort, we will use a representative sample of the adult Orchid-RCGP RSC population of approximately 6.5 million from 721 practices, 128 (17.8%) in the rural setting and 593 (82.2%) urban. The number of adults aged between 18 and 115 years, with a T2DM diagnosis was 393,987 (6.1%). CONCLUSIONS The COVID-19 pandemic has impacted on the delivery of care but little is known on the process of care of people with T2DM. This study will report the impact of the COVID-19 pandemic on these process of care.

An indirect treatment comparison of semaglutide 2.0 mg versus dulaglutide 3.0 mg and 4.5 mg using multilevel network meta-regression

Aims Currently no head-to-head data are available comparing semaglutide 2.0 mg with dulaglutide 3.0 mg or 4.5 mg. We conducted an indirect treatment comparison (ITC) of their effects on glycated haemoglobin (HbA1c) and body weight in patients with type 2 diabetes (T2D). Materials and methods Multilevel network meta-regression (MLNMR) was conducted, based on a connected evidence network of published results from the AWARD-11 trial and individual patient data (IPD) from the SUSTAIN FORTE and SUSTAIN 7 trials. Results Semaglutide 2.0 mg significantly reduced HbA1c versus dulaglutide 3.0 mg and 4.5 mg, with estimated treatment differences (ETD) of –0.44%-points (95% credible interval [CrI]: –0.68, –0.19) and –0.28%-points (95% CrI: –0.52, –0.03), respectively. Semaglutide 2.0 mg also significantly reduced body weight versus dulaglutide 3.0 mg and 4.5 mg with ETDs of –3.29 kg (95% CrI: –4.62, −1.96) and –2.57 kg (95% CrI: –3.90, –1.24), respectively. Odds of achieving HbA1c &lt;7.0% were significantly greater for semaglutide 2.0 versus dulaglutide 3.0 mg (odds ratio [OR]: 2.23 [95% CrI: 1.15, 3.90]), while this did not reach significance for semaglutide 2.0 mg versus dulaglutide 4.5 mg (OR: 1.58 [95% CrI: 0.82, 2.78]). Sensitivity analyses supported the main analysis findings. Conclusions This ITC demonstrated significantly greater reductions from baseline in HbA1c and body weight with semaglutide 2.0 mg vs dulaglutide 3.0 mg and 4.5 mg. The findings of this study provide important comparative effectiveness information until randomised head-to-head studies become available.

Comparative Evaluation of BGR-34 and Sitagliptin in Diabetic Subjects-Open Labelled Randomised Parallel Clinical Study

This article is mainly concerned with the simultaneous open model clinical study of the drug named sitagliptin, a potent hyperglycaemic drug against a novel entity of the natural origin BGR- 34 in diabetic subjects. This was a 3-month randomized, parallel, comparative study. One hundred subjects were planned to be included in the study. The patients were randomly divided into two groups and according to the appropriate sample size analysis, both groups consisted of 100 patients, following the inclusion and exclusion criteria. A total of 90 patients (both male and female) of the mean patient age 30-65 years with the type 2 diabetes were enrolled in the phase 4 of this study and then the data were analyzed on the basis of the different test which included HbA1c (glycated haemoglobin), RBS (random blood sugar), FBS (fasting blood sugar) and PPG (postprandial glucose) values. After completion of the data calibration, the results were analyzed and as a result 10-20% decreased values of HBA1C values accompanied with the RBS, FBS and PPG values were seen in the patients undergoing a 12-week course with BGR-34. Based on the results obtained in the present study, it can be concluded that BGR-34 is effective in reducing high blood sugar levels and this reflects that the BGR-34 therapy is more effective drug in the treatment of diabetes suggesting that it is better in efficacy, and reliability with little or no adverse effects.

Relationship between amino acid ratios and decline in estimated glomerular filtration rate in diabetic and non-diabetic patients in South Africa

Background: Diabetic kidney disease is a major complication resulting from type 1 and type 2 diabetes. Currently, the microalbuminuria test is used to monitor renal function; however, it does not detect albumin until progressive loss of renal function has occurred.Objective: This study analysed the relationship between changes in amino acid ratios and estimated glomerular filtration rate (eGFR) decline in diabetic and non-diabetic patients.Methods: Urine samples were collected from participants between February 2019 to April 2019 and analysed from November 2020 to January 2021. Diabetic (glycated haemoglobin 6.4%) and non-diabetic patients (glycated haemoglobin ≤ 6.4%) from Chris Hani Baragwanath Hospital, South Africa, were further categorised based on the degree of renal function predicted by the eGFRs. Amino acids were quantified using tandem mass spectrometry to determine the concentrations and ratios of tyrosine/phenylalanine, ornithine/arginine, arginine/citrulline and citrulline/ornithine at different stages of the chronic kidney disease.Results: Among diabetic patients, the tyrosine/phenylalanine ratio showed a statistically significant increase (p = 0.04) as the eGFR declined from stage 1 to stage 4; the ornithine/arginine ratio showed a strong negative correlation with eGFR. The citrulline/ornithine ratio differed between the diabetic and non-diabetic patients in stage 1 of chronic kidney disease.Conclusion: Amino acid ratios (ornithine/arginine and tyrosine/phenylalanine) are affected by the progression of diabetes and can be correlated to renal function. The citrulline/ornithine ratios differ between the studied groups in stage 1 of the disease and may be utilised to predict the onset of chronic kidney disease.

Bariatric Surgery Leads to a Reduction in Antibodies to Apolipoprotein A-1: a Prospective Cohort Study

Purpose Autoantibodies against apolipoprotein A-1 have been associated with cardiovascular disease, poorer CV outcomes and all-cause mortality in obese individuals. The impact of bariatric surgery (BS) on the presence of circulating anti-apoA-1 IgG antibodies is unknown. This study aimed to determine the effect of bariatric surgery on auto-antibodies titres against Apolipoprotein A-1 (anti-apoA-1 IgG), looking for changes associated with lipid parameters, insulin resistance, inflammatory profile and percentage of excess body mass index loss (%EBMIL). Materials and Methods We assessed 55 patients (40 women) before, 6 and 12 months post-operatively. Baseline and post-operative clinical history and measurements of body mass index (BMI), serum cholesterol, triglycerides, high- and low-density lipoprotein cholesterol (HDL-C and LDL-C), apoA-1, highly sensitive C-reactive protein (hsCRP), fasting glucose (FG), glycated haemoglobin (HbA1c) and HOMA-IR were taken at each point. Human anti-apoA-1 IgG were measured by ELISA. Results The mean age of participants was 50 years. BS significantly improved BMI, %EBMIL triglycerides, HDL-C, apoA-1, hsCRP, HBA1c, FG and HOMA-IR. Baseline anti-apoA-1 IgG seropositivity was 25% and was associated with lower apoA-1 and higher hsCRP levels. One year after BS, anti-apoA-1 IgG seropositivity decreased to 15% (p = 0.007) and median anti-apoA-1 IgG values decreased from 0.70 (0.56–0.84) to 0.47 (0.37–0.61) AU (p < 0.001). Post-operative anti-apoA-1 IgG levels were significantly associated with a decreased post-surgical %EBMIL at 1 year. Conclusion Bariatric surgery results in significant reduction in anti-apoA-1 IgG levels, which may adversely influence weight loss. The exact mechanisms underpinning these results are elusive and require further study before defining any clinical recommendations. Graphical abstract

Type 2 diabetes self-management: spirituality, coping and responsibility

Background In England, although The National Institute of Health and Care Excellence recommends that patients’ religious beliefs should be incorporated into individual healthcare plans, these components are often neglected in diabetes management care plans. A literature review identified a paucity of research regarding how the spirituality of British people may influence their approach to their self-management of type 2 diabetes (T2D). Aims To explore how the spirituality of a small group of adults with T2D, living in England, influenced their coping strategies and self-management of diet and exercise. Methods Biographic Narrative Interpretive Method of two interviews per participant and thematic analysis for data interrogation ( n = 8). Data as glycated haemoglobin, living situation, age, length of time since T2D diagnosis, body mass index and diabetic medicines contextualised the interview data. Results Participants’ spirituality, health beliefs, coping and sense of responsibility for T2D self-management overlapped in complex layers. Three themes were generated: (a) spirituality influences expectations in life; (b) beliefs influence coping styles of diabetes self-management; and (c) responsibility influences diabetes self-management. A model was created to assist nurses in addressing these components. Conclusion Nurses should consider how patients’ self-management of T2D may be influenced by their spirituality, health beliefs, coping and sense of responsibility.