Continuous subcutaneous insulin infusion and MDI have similar effects on glycemic control and hypoglycemia, except CSII has a favorable effect on glycemic control in adults with type 1 diabetes mellitus. For glycemic control, rt-CGM is superior to SMBG and sensor-augmented insulin pumps are superior to MDI and SMBG without increasing the risk for hypoglycemia (Annals of Internal Medicine)
Diabetes News
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Insulin pump therapy in T2D after failure of multiple daily injections
We found that CSII in patients with DM2 who have failed MDI improves glucose control despite a decrease in overall insulin requirements. This includes patients with severe insulin resistance using U-500 insulin. Use of frequent bolus adjustment incorporating carbohydrate counting and current glucose level does not appear to be required for this benefit (Endocrine Practice)
Enterovirus-induced gene expression profile critical for islet destruction
The results suggest a distinct, virus-strain-specific, gene expression pattern leading to pancreatic islet destruction and pro-inflammatory effects after enterovirus infection. However, neither viral replication nor cytotoxic cytokine production alone are sufficient to induce necrotic cell death. More likely the combined effect of these and possibly cellular energy depletion lie behind the enterovirus-induced necrosis of islets (Diabetologia)
Effectiveness & safety of metformin in T2D & different levels of renal function
A cohort study from the Swedish National Diabetes Register (BMJ)
Increased glycohemoglobin A1c lead to overestimation arterial oxygen saturation
Elevated blood HbA1c levels lead to an overestimation of SaO2 by SpO2, suggesting that arterial blood gas analysis may be needed for type 2 diabetic patients with poor glycemic control during the treatment of hypoxemia (Cardiovascular Diabetology)
Targeting the incretin system
Novel advances in the treatment of diabetes (Formulary)
Antihypertensive drug use and the risk of dementia in patients with DM
Comorbid hypertension was associated with increased risk of dementia, whereas antihypertensive medications, especially angiotensin-converting enzyme inhibitors and ARBs, were associated with reduced risk, even among patients without hypertension. Consequently, these agents may have potential therapeutic roles in delaying the onset of dementia in patients with diabetes (Alzheimer’s & Dementia)
Urinary MCP-1 & RBP: Independent predictors of renal outcome in macroalbuminuria
Urinary RBP and MCP-1 are independently related to the risk of CKD progression in patients with macroalbuminuric DN. Whether these biomarkers have a role in the setting of normoalbuminuria and microalbuminuria in DN should be further investigated (Diabetes and Its Complications)
Rapid skin permeabilization by dual-frequency, high-intensity ultrasound
These results were corroborated with glucose (180 Da) and inulin (5000 Da) transdermal flux experiments, which showed greater permeant delivery both into and through the dual-frequency pre-treated skin (Journal of Controlled Release Via Science Direct)
Optimal T2D management: OPTIMISE benchmarking study: six European countries
OPTIMISE confirms that target achievement in the primary care setting is suboptimal for all three critical quality indicators. This represents an unmet but modifiable need to revisit the mechanisms and management of improving care in type 2 diabetes. OPTIMISE will help to assess whether benchmarking is a useful clinical tool for improving outcomes in type 2 diabetes (European Journal of Preventive Cardiology)
Invasive or Conservative Strategy in DM and Non ST-Segment Elevation
An early invasive strategy yielded similar RR reductions in overall cardiovascular events in diabetic and nondiabetic patients. However, an invasive strategy appeared to reduce recurrent nonfatal MI to a greater extent in diabetic patients. These data support the updated guidelines that recommend an invasive strategy for patients with diabetes mellitus and non–ST-segment elevation acute coronary syndromes (Journal of the American College of Cardiology)
Use & efficacy of continuous glucose monitoring in T1D with insulin pump therapy
Continuous glucose monitoring was associated with decreased HbA1c levels and time spent in hypoglycaemia in individuals with type 1 diabetes using CSII. More frequent self-adjustments of insulin therapy may have contributed to these effects (Diabetologia)
Benefits of Early Hypertension Control on Cardiovascular Outcomes
Failure to adequately control BP within 1 year of HT onset significantly increased the likelihood of major cardiovascular events within 3 years. Prompt control of new-onset HT in patients with diabetes may provide important short-term clinical benefits (Diabetes Care)
Novel & Reversible Mechanisms of Smoking-Induced Insulin Resistance
These data indicate nicotine induces insulin resistance in skeletal muscle by activating mTOR. Therapeutic agents designed to oppose skeletal muscle mTOR activation may prevent insulin resistance in humans who are unable to stop smoking or are chronically exposed to secondhand smoke (Diabetes)
HbA1c Categories & ß-Cell Function Relative to Insulin Sensitivity in Obesity
Overweight/obese adolescents with HbA1c in the at-risk/prediabetes category demonstrate impaired ß-cell function relative to insulin sensitivity, a metabolic marker for heightened risk of type 2 diabetes. Thus, HbA1c may be a suitable screening tool in large-scale epidemiological observational and/or interventional studies examining the progression or reversal of type 2 diabetes risk (Diabetes Care)
Dysglycemia not lipids is associated with abnormal urinary albumin excretion
In this cross-sectional study of 2141 KEEP participants with DM and CKD stages 3-5, overall glycemic control but not lipids were associated with abnormal urinary albumin excretion, a marker of increased risk for progressive disease (BMC Nephrology)
Differences HbA1c & oral glucose tolerance test for diagnosis glucose tolerance
HbA1c identifies a smaller proportion of prediabetic individuals and even a smaller proportion of T2DM individuals than OGTT, with no difference in IR, insulin secretion, and cardiovascular risk profile. Subjects fulfilling both diagnostic methods for prediabetes or T2DM are characterized by a worse metabolic profile (Diabetes Care)
Blood sugar control does not help infants & children with heart surgery
NIH-supported findings diverge from previous studies showing that blood sugar control benefits adults (National Heart, Lung, and Blood Institute)
Recommendations for age-appropriate education of children and adolescents in EU
This survey highlights a profound diversity of practices across centers in Europe, in terms of organization as well as the practices and the content of initial and continuing education (Pediatric Diabetes)
Patient-reported outcomes in trials of incretin-based therapies in T2D
It is plausible that superior patient-reported benefits found in clinical trials may translate into improved, clinically meaningful, long-term outcomes through increased treatment acceptability. Long-term, prospective data are needed to ascertain whether this is the case in practice (Diabetes, Obesity and Metabolism)
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