Retrospective, observational study to see the effect of evogliptin on continuous glucose monitoring (CGM) in T2DM Indian patients: A real-world experience

This study aimed to assess effectiveness of Evogliptin 5 mg through continues glucose monitoring (CGM) in patients with T2DM in retrospective observational real world settings. Overall 6 patients who received Evogliptin as routine clinical practice in management of T2DM were analyzed retrospectively from single center. Data collected from past medical records. FreeStyle Librepro 1.0.6 was used for CGM. CGM was done 15 days prior to adding Evogliptin and repeated immediately after that for next 15 days. Mean BG level, Percentage time in target range (80-140mg/dl), Percentage time above target and Percentage time below target were assessed prior and after adding Evogliptin in existing treatment regimen. Significant reduction in Mean blood glucose level seen after adding Evogliptin in existing treatment regimen from 215 mg/dl to 138 mg/dl (-77 mg/dl P=0.006). Significant improvement seen in Percentage time in target range (80-140mg/dl) from 17% to 44% (27% P value 0.007) and in Percentage time above target from 81% to 43% (- 38%, P valve 0.003). 13.5 % of the patients seen below target. Evogliptin was found to be effective when added to the patients who were uncontrolled on other oral anti-diabetic medications. It effectively showed improvement in continues glucose monitoring (CGM) parameters like Mean blood glucose, more number of patients were in Time in Target range i.e (80-140mg/dl) after adding Evogliptin to existing anti-diabetic medications & well tolerated. Small sample size and retrospective study

Reasons for Metformin Non-Use in Type 2 Diabetes Mellitus in a Hospital: A Retrospective Observational Study

Objective: To investigate and analyze the reasons for metformin non-use in a hospital. Methods: Research-related non-probability physicians and patients filled questionnaire. Results: Physicians’ main influencing factors were severe liver and kidney dysfunction; gastrointestinal adverse reactions and 11 other causes. Secondary factors.included the appearance of hypoglycemia and other adverse reactions (e.g., skin rash) . Patients’ main reasons included: worry about drug’s influence on liver and kidney function, gastrointestinal adverse reactions, hypoglycemia, and further weight loss, etc. Statistical analysis showed metformin has certain effects on the mean blood glucose and the mean glycated hemoglobin levels.Conclusion: Based on the research results, we can design more targeted medication education programs.

Improved HbA1c and reduced glycaemic variability after 1-year intermittent use of flash glucose monitoring

Flash glucose monitoring (FGM) was introduced in China in 2016, and it might improve HbA1c measurements and reduce glycaemic variability during T1DM therapy. A total of 146 patients were recruited from October 2018 to September 2019 in Liaocheng. The patients were randomly divided into the FGM group or self-monitoring blood glucose (SMBG) group. Both groups wore the FGM device for multiple 2-week periods, beginning with the 1st, 24th, and 48th weeks for gathering data, while blood samples were also collected for HbA1c measurement. Dietary guidance and insulin dose adjustments were provided to the FGM group patients according to their Ambulatory Glucose Profile (AGP) and to the SMBG group patients according to their SMBG measurements taken 3–4 times daily. All of the participants underwent SMBG measurements on the days when not wearing the FGM device. At the final visit, HbA1c, time in range (TIR), duration of hypoglycaemia and the number of diabetic ketoacidosis (DKA) events were taken as the main endpoints. There were no significant difference in the baseline characteristics of the two groups. At 24 weeks, the HbA1c level of the FGM group was 8.16 ± 1.03%, which was much lower than that of the SMBG group (8.68 ± 1.01%) (p = 0.003). The interquartile range (IQR), mean blood glucose (MBG), and the duration of hypoglycaemia in the FGM group also showed significant declines, compared with the SMBG group (p < 0.05), while the TIR increased in the FGM group [(49.39 ± 17.54)% vs (42.44 ± 15.49)%] (p = 0.012). At 48 weeks, the differences were more pronounced (p < 0.01). There were no observed changes in the number of episodes of DKA by the end of the study [(0.25 ± 0.50) vs (0.28 ± 0.51), p = 0.75]. Intermittent use of FGM by T1DM patients can improve their HbA1c and glycaemic control without increasing the hypoglycaemic exposure in insulin-treated individuals with type 1 diabetes in an developing country.

Prevalence of pre-diabetes in adolescents aged 11-17 years with high risk factors

Background: Obesity is a rising global epidemic in children which leads to pre-diabetes and overt diabetes. Identification at early stage helps in early intervention. This study was undertaken to study the prevalence of pre-diabetes in urban school going adolescents aged 11-17 years with high risk factors.Methods: This was a prospective cross-sectional study conducted in Chennai, India between December 2011 and November 2012. Overweight or obese adolescents in the age group 11-17 years, either with family history of diabetes or acanthosis nigricans or both were included. After obtaining informed consent from parents, history was obtained in pre-tested questionnaire.Results: 148 adolescents were enrolled in the study (n=148), 71.62% were females, mean weight was 59.54±10.44 kg, mean height was 150.92±8.62 cm, mean BMI was 26.19±3.23 and mean blood glucose was 82.1 mg/dl. 60.81% of subjects were overweight and others obese. Girls had statistically significant higher mean weight and mean BMI than boys. 78.37% had acanthosis nigricans, 47.29% had family history of diabetes, 12.16% had pre-diabetes and the mean blood glucose in pre-diabetics was 104.9 mg/dl. Pre-diabetes was higher in adolescents with family history of diabetes (p=0.038).Conclusions: Recognition of risk of type 2 diabetes in the asymptomatic pre-diabetes phase needs to be emphasized and targeted screening of high risk children for pre-diabetes seems to be justified. The morbidity and mortality of youth onset type 2 diabetes can be reduced only by early detection and treatment.

Glycemic Variability Impacted by SGLT2 Inhibitors and GLP 1 Agonists in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis

To investigate the effect of sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) agonists on glycemic variability (GV), the mean amplitude of glucose excursion (MAGE), mean blood glucose (MBG) levels, and percentage of time maintaining euglycemia were evaluated. Randomized controlled trials evaluating the efficacy of SGLT-2 inhibitors and GLP-1 agonists for treating people with diabetes were selected through searches of PubMed, EMBASE, and other databases. Sixteen studies were finally analyzed. There were no differences in the reductions in MAGE after treatment with SGLT-2 inhibitors or GLP-1 agonists (standardized mean difference (SMD) = −0.59, 95% CI = −0.82 to −0.36 vs. SMD = −0.43, 95% CI = −0.51 to −0.35, respectively), and treatment with SGLT-2 inhibitors was associated with an increased reduction in MBG levels (SMD = −0.56, 95% CI = −0.65 to −0.48, p < 0.00001). Monotherapy and add-on therapy with medications were correlated with MAGE and MBG level reductions. In conclusion, SGLT-2 inhibitors and GLP-1 agonists were associated with a reduction in GV and could be alternatives for treating people with diabetes.

CGMS and Glycemic Variability, Relevance in Clinical Research to Evaluate Interventions in T2D, a Literature Review

Glycemic variability (GV) appears today as an integral component of glucose homeostasis for the management of type 2 diabetes (T2D). This review aims at investigating the use and relevance of GV parameters in interventional and observational studies for glucose control management in T2D. It will first focus on the relationships between GV parameters measured by continuous glucose monitoring system (CGMS) and glycemic control and T2D-associated complications markers. The second part will be dedicated to the analysis of GV parameters from CGMS as outcomes in interventional studies (pharmacological, nutritional, physical activity) aimed at improving glycemic control in patients with T2D. From 243 articles first identified, 63 articles were included (27 for the first part and 38 for the second part). For both analyses, the majority of the identified studies were pharmacological. Lifestyle studies (including nutritional and physical activity-based studies, N-AP) were poorly represented. Concerning the relationships of GV parameters with those for glycemic control and T2D related-complications, the standard deviation (SD), the coefficient of variation (CV), the mean blood glucose (MBG), and the mean amplitude of the glycemic excursions (MAGEs) were the most studied, showing strong relationships, in particular with HbA1c. Regarding the use and relevance of GV as an outcome in interventional studies, in pharmacological ones, SD, MAGE, MBG, and time in range (TIR) were the GV parameters used as main criteria in most studies, showing significant improvement after intervention, in parallel or not with glycemic control parameters’ (HbA1c, FBG, and PPBG) improvement. In N-AP studies, the same results were observed for SD, MAGE, and TIR. Despite the small number of N-AP studies addressing both GV and glycemic control parameters compared to pharmacological ones, N-AP studies have shown promising results on GV parameters and would require more in-depth work. Evaluating CGMS-GV parameters as outcomes in interventional studies may provide a more integrative dimension of glucose control than the standard postprandial follow-up. GV appears to be a key component of T2D dysglycemia, and some parameters such as MAGE, SD, or TIR could be used routinely in addition to classical markers of glycemic control such as HbA1c, fasting, or postprandial glycemia.

Prevalenceof gestational diabetes and pregnancy outcome in Pakistan

Prevalence of gestational diabetes mellitus and the pregnancy outcome of women registered at the Aga Khan Maternity Home, Karachi was studied. Initial screening was by a glucose challenge test with 50 g glucose. If the 1-hour blood glucose level exceeded 130 mg%, then a 3-hour oral glucose tolerance test with 100 g glucose was performed. Diagnosis was based on O’Sullivan’s criteria. Insulin was prescribed if the fasting blood glucose was more than 95 mg%, and the 2-hour post-prandial over 125 mg%, after a week of diet therapy. The prevalence of gestational diabetes was 3.45% with an aggregate birth weight of 3.24 kg, and perinatal loss of 2.08%. The mean blood glucose values were 93.46 mg% fasting and 117.03 mg%, 2 hours post-prandial

A Clinical Trial on the Glycemic Index of Nutritional Product for Diabetes Mellitus

In the world as well as in Vietnam, diabetes have shown bad effects and there is increasing number of deaths over years because of diabetes as one of three leading causes of deaths. Penalver et al (2016) stated to achieve good metabolic control in diabetes and keep long term, a combination of changes in lifestyle and pharmacological treatment is necessary. The type of food tested was Nutritional product (Vietnam). Nutritional product solution with 83.3g diluted in 390 ml water. The food-to-water ratio followed the processing instruction from the manufacturer. In this study we discover a low GI of nutritional product, as of (48.2 ± 5.3). And also, we found out there is decrease (slow) of responses of mean blood glucose (Nutritional product) after 90 minutes (4.7 mmol/L) till 120 minutes (4.3 mmol/L). As we conduct this paper with younger subjects, comparing to older people, they can regulate blood sugar better. Finally, we also compare to other previous studies for literature review.

MO633GLYCAEMIC MARKERS IN PATIENTS WITH TYPE 2 DIABETES UNDERGOING HAEMODIALYSIS EVALUATED BY LONG-TERM CONTINUOUS GLUCOSE MONITORING*

Background and Aims The reliability of haemoglobin A1c (HbA1c) as a glycaemic marker in patients receiving haemodialysis (HD) remains unknown. To assess accuracy, we compared HbA1c and fructosamine levels with interstitial glucose levels measured by continuous glucose monitoring (CGM) in patients with type 2 diabetes receiving HD. Method The HD group (maintenance HD and type 2 diabetes) comprised 30 patients who completed the study period of 17 weeks; the control group (type 2 diabetes and an estimated glomerular filtration rate &gt;60 mL/min/1.73 m2) comprised 36 individuals. CGM (Ipro2®, Medtronic) for periods up to seven days was performed five times (with four weeks intervals) during a 16-week period. HbA1c and fructosamine were measured at week 17. The mean sensor glucose from CGM was compared with the measured HbA1c, its estimated mean blood glucose (eMBGA1c) and fructosamine levels. Results In the HD group, the mean sensor glucose from CGM was 1.4 (95% confidence interval [CI]: 1.0–1.8) mmol/L higher than the eMBGA1c, whereas the difference was 0.1 mmol/L (95% CI: -0.1–[0.4]; P&lt;0.001) in the control group. Adjusted for the mean sensor glucose, HbA1c was -7.3 (95% CI: -10.0–[-4.7]) mmol/mol lower in the HD group than in controls (P&lt;0.001), whereas no difference was detected for fructosamine (P=0.64). Conclusion HbA1c evaluated by CGM underestimates mean blood glucose levels in patients receiving maintenance HD; fructosamine appears to be more accurate. CGM-assessed blood glucose could complement or replace HbA1c in patients where HbA1c underestimates blood glucose levels.

COMPARISON OF BLOOD GLUCOSE LEVELS OF PATIENTS WITH DIABETES MELLITUS ON UNPRESSED FINGERS AND GETTED TO THE TELAGA BIRU MEDICAL CENTER GORONTALO DISTRICT

Examination of blood glucose levels using the POCT method using capillary blood helps diabetes mellitus patients monitor glucose levels. But often the insufficient stabbing causes the blood to come out a little so that the staff performs massage which can affect blood glucose levels. This study aims to determine the differences in the results of examination of blood glucose levels of patients with diabetes mellitus on fingers that are not massaged and massaged at Telaga Biru Public Health Center, Gorontalo District. This research is an experimental study with a Pre Experiment Design type One group Prettest-Postest Design with a total of 21 samples taken capillary blood to check blood glucose levels on the fingers that are not massaged and massaged. The results obtained were analyzed using the Faired Sample t-Test. The results showed that the mean blood glucose level on the fingers that was not massaged was 321 mg/dL, while the mean blood glucose level on the fingers that was massaged was 299 mg/dL. The results of the Faired Sample t-Test showed a significant value of 0.000 <0.05. There was a significant difference in the results of examining blood glucose levels on fingers that were not massaged and massaged by diabetes mellitus patients at Telaga Biru Health Center, Gorontalo District. Laboratory personnel are expected to perform deep punctures on the fingers so that the blood that comes out is enough for the POCT method of blood glucose testing.