Glucagon-like peptide-1 receptor agonists:Exploring the mechanisms from glycemic control to treatment of multisystemic diseases

This editorial takes a deeper look at the insights provided by Soresi and Giannitrapani,which examined the therapeutic potential of glucagon-like peptide-1 receptor agonists(GLP-1RAs)for metabolic dysfunction-associated fatty liver disease.We provide supplementary insights to their research,highlighting the broader systemic implications of GLP-1RAs,synthesizing the current understanding of their mechanisms and the trajectory of research in this field.GLP-1RAs are revolutionizing the treatment of type 2 diabetes mellitus and beyond.Beyond glycemic control,GLP-1RAs demonstrate cardiovascular and renal protective effects,offering potential in managing diabetic kidney disease alongside renin–angiotensin–aldosterone system inhibitors.Their role in bone metabolism hints at benefits for diabetic osteoporosis,while the neuroprotective properties of GLP-1RAs show promise in Alzheimer's disease treatment by modulating neuronal insulin signaling.Additionally,they improve hormonal and metabolic profiles in polycystic ovary syndrome.This editorial highlights the multifaceted mechanisms of GLP-1RAs,emphasizing the need for ongoing research to fully realize their therapeutic potential across a range of multisystemic diseases.

Utilising continuous glucose monitoring for glycemic control in diabetic kidney disease

In this editorial,we comment on the article by Zhang et al.Chronic kidney disease(CKD)presents a significant challenge in managing glycemic control,especially in diabetic patients with diabetic kidney disease undergoing dialysis or kidney transplantation.Conventional markers like glycated haemoglobin(HbA1c)may not accurately reflect glycemic fluctuations in these populations due to factors such as anaemia and kidney dysfunction.This comprehensive review discusses the limitations of HbA1c and explores alternative methods,such as continuous glucose monitoring(CGM)in CKD patients.CGM emerges as a promising technology offering real-time or retrospective glucose concentration measure-ments and overcoming the limitations of HbA1c.Key studies demonstrate the utility of CGM in different CKD settings,including hemodialysis and peritoneal dialysis patients,as well as kidney transplant recipients.Despite challenges like sensor accuracy fluctuation,CGM proves valuable in monitoring glycemic trends and mitigating the risk of hypo-and hyperglycemia,to which CKD patients are prone.The review also addresses the limitations of CGM in CKD patients,emphasizing the need for further research to optimize its utilization in clinical practice.Altogether,this review advocates for integrating CGM into managing glycemia in CKD patients,highlighting its superiority over traditional markers and urging clinicians to consider CGM a valuable tool in their armamentarium.

Blood Pressure Profile and Glycemic Control of Type 2 Diabetics and Hypertensives at the Yalgado Ouedraogo University Hospital: A Review of 116 Cases

Objective: The association hypertension and diabetes is important. The two pathologies may influence each other. The aim was to study the correlation between glycemic control and blood pressure control and to determine the factors associated with blood pressure control. Methodology: This was a descriptive cross-sectional study with an analytical focus over 7 months. Patients were recruited as outpatients and all underwent ambulatory blood pressure measure, glycated hemoglobin and creatinine measurements, and assessment of compliance with treatment. Results: During this period 116 patients were collected. The predominance was female 69%. The mean age of the patients was 62 ± 7 years with a peak between 60 and 70 years. The average age of hypertension was 12 years and that of diabetes 6 1/2 years. The most frequently associated cardiovascular risk factor was a sedentary lifestyle (71.5%) after age. 57.8% of patients were not controlled at the office, with a predominance of systolic hypertension (58.2%). 61.6% of patients were controlled by ambulatory blood pressure measure, a rate of 47.8% of white coat hypertension. Glycemic control was observed in 42.2% of cases and 87% of patients had good renal function (glomerular filter rate ≥ 60 ml/mn). Therapeutic compliance was good in 53.4% of cases and dual therapy was the most used therapeutic modality 44.8% (52 patients) followed by triple therapy. The factors associated with poor blood pressure control were glycemic imbalance, non-compliance and monotherapy. Dual therapy had a protective effect. Conclusion: The association of hypertension and type 2 diabetes is frequent. The risk of occurrence increases with age. Ambulatory blood pressure measure is the best method to assess blood pressure control. Optimization of blood pressure control should also include optimization of glycemic control.

Association of vitamin D and magnesium with insulin sensitivity and their influence on glycemic control

Insulin resistance increases the risk of developing diabetes,and the degree of resistance influences the glycemic control of patients with diabetes.Numerous researchers have focused on improving insulin sensitivity in order to prevent diabetes-related complications and other chronic diseases.Several studies have also linked vitamin D levels to insulin secretion and resistance,given that both vitamin D and its receptor complex play important roles in regulating pancreaticβ-cells.It has been suggested that vitamin D supplementation improves vitamin D levels,but further research is needed to confirm this as neither insulin function nor glycemic control improves when vitamin D levels increase.Magnesium is a cofactor for many enzymes.Although the role of magnesium in the management of diabetes has long been evaluated,it has not yet been determined whether magnesium supplements improve insulin function.However,several researchers have found that patients with good glycemic control have high magnesium levels.Magnesium is closely related to vitamin D and is necessary for the transport and activation of vitamin D in humans.Combined supplementation with vitamin D and magnesium improves glycemic control in patients with diabetes.

Early neonatal complications in pregnant women with gestational diabetes mellitus and the effects of glycemic control on neonatal infection

BACKGROUND Gestational diabetes mellitus(GDM)has become increasingly prevalent globally.Glycemic control in pregnant women with GDM has a critical role in neonatal complications.AIM To analyze the early neonatal complications in GDM,and examine the effect of blood glucose control level on neonatal infection.METHODS The clinical data of 236 pregnant women with GDM and 240 healthy pregnant women and newborns during from March 2020 to December 2021 the same period were retrospectively analyzed,and the early complications in newborns in the two groups were compared.The patients were divided into the conforming glycemic control group(CGC group)and the non-conforming glycemic control group(NCGC group)based on whether glycemic control in the pregnant women with GDM conformed to standards.Baseline data,immune function,infectionrelated markers,and infection rates in neonates were compared between the two groups.RESULTS The incidence of neonatal complications in the 236 neonates in the GDM group was significantly higher than that in the control group(P<0.05).Pregnant women with GDM in the NCGC group(n=178)had significantly higher fasting plasma glucose,2 h postprandial blood glucose and glycated hemoglobin A1C levels than those in the CGC group(n=58)(P<0.05).There were no differences in baseline data between the two groups(P>0.05).Additionally,the NCGC group had significantly decreased peripheral blood CD3^(+),CD4^(+),CD8^(+)T cell ratios,CD4/CD8 ratios and immunoglobulin G in neonates compared with the CGC group(P<0.05),while white blood cells,serum procalcitonin and C-reactive protein levels increased significantly.The neonatal infection rate was also significantly increased in the NCGC group(P<0.05).CONCLUSION The risk of neonatal complications increased in pregnant women with GDM.Poor glycemic control decreased neonatal immune function,and increased the incidence of neonatal infections.

Relation between sleep quality and glycemic control among type 2 diabetic patients

Objective:To investigate the relation between sleep quality and glycemic control among type 2 diabetic patients.Methods:Across sectional descriptive design was used;the study sample including 125 diabetic patients was recruited at diabetic clinics in Zagazig University hospitals.The interview questionnaire sheet consists of 4 par ts:(1)demographic data,(2)medical history,(3)an Arabic version of the Pittsburgh sleep quality index(PSQI),and(4)glycated hemoglobin A1c(Hb A1c)analysis test.Results:The mean of sleep duration was the highest score of PSQI components,96.8%of diabetic patients had poor sleep quality,and 90.4%of diabetic patients had poor glycemic control.A highly statistically significant relationship was found between Hb A1c and sleep quality.Moreover,income,duration of disease and smoking were independent positive predictors of Hb A1c level,while the female gender was a statistically significant negative predictor.Additionally,female gender and income were statistically significant independent positive predictors of PSQI score.Conclusions:Poor sleep quality and poor glycemic control were very common among type 2 diabetic patients.There was a highly significant relation between sleep quality and glycemic control.

Relationship between perioperative glycemic control and postoperative infections

Perioperative hyperglycemia in critically ill surgery patients increases the risk of postoperative infection (POI), which is a common, and often costly, surgical complication. Hyperglycemia is associated with abnormalities in leukocyte function, including granulocyte adherence, impaired phagocytosis, delayed chemotaxis, and depressed bactericidal capacity. These leukocyte deficiencies are the cause ofinfection and improve with tight glycemic control, which leads to fewer POIs in critically ill surgical patients. Tight glycemic control, such as intensive insulin therapy, has a risk of hypoglycemia. In addition, the optimal targeted blood glucose range to reduce POI remains unknown. Since 2006, we have investigated tight perioperative blood glucose control using a closed-loop artificial endocrine pancreas system, to reduce POI and to avoid hypoglycemia. In this Topic Highlight, we review the relationship between perioperative glycemic control and POI, including the use of the artificial pancreas.

Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy

AIM To evaluate the impact of glycemic control and nutritional status after total pancreatectomy(TP) on complications, tumor recurrence and overall survival.METHODS Retrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were identified.RESULTS High early postoperative fasting blood glucose(FBG) levels(OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels(OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative Hb A1 c levels over 7%(HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative Hb A1 c levels over 7% had much poorer overall survival than those with Hb A1 c levels less than 7%(9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus(HR = 15.019, 95%CI: 1.278-176.211, P= 0.031) and alcohol history(B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, respectively.CONCLUSION At least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on longterm outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.

Effect of glycemic control on markers of subclinical atherosclerosis in patients with type 2 diabetes mellitus:A review

Cardiovascular disease is the predominant cause of death in type 2 diabetes mellitus(T2DM).Evidence suggests a strong association between duration and degree of hyperglycemia and vascular disease.However,large trials failed to show cardiovascular benefit after intensive glycemic control,especially in patients with longer diabetes duration.Atherosclerosis is a chronic and progressive disease,with a long asymptomatic phase.Subclinical atherosclerosis,which is impaired in T2DM,includes impaired vasodilation,increased coronary artery calcification(CAC),carotid intima media thickness,arterial stiffness,and reduced arterial elasticity.Each of these alterations is represented by a marker of subclinical atherosclerosis,offering a cost-effective alternative compared to classic cardiac imaging.Their additional use on top of traditional risk assessment strengthens the predictive risk for developing coronary artery disease(CAD).We,herein,review the existing literature on the effect of glycemic control on each of these markers separately.Effective glycemic control,especially in earlier stages of the disease,attenuates progression of structural markers like intima-media thickness and CAC.Functional markers are improved after use of newer antidiabetic agents,such as incretin-based treatments or sodium-glucose cotransporter-2 inhibitors,especially in T2DM patients with shorter disease duration.Larger prospective trials are needed to enhance causal inferences of glycemic control on clinical endpoints of CAD.

Number of parous events affects the association between physical exercise and glycemic control among women with gestational diabetes mellitus:A prospective cohort study

Background:Multiparous women are at a higher risk of gestational diabetes mellitus(GDM) than primiparas.Physical activity during pregnancy has been shown to be beneficial for GDM,but there is little evidence on the association between physical activity and glycemic control among women with GDM,whether primiparas or multiparas.Thus,the objective of the present study was to examine the association between physical activity and glycemic control in women with GDM and to determine what,if any,effects result from number of parous events.Methods:A prospective cohort of 1162 women with GDM was recruited,with 604 multiparas(51.98%).The general linear model was used to calculate the risk difference and its 95% confidence interval(95%CI) to quantify the impact of parous events on glycemic control in pregnancy as well as the association between physical activity time and glycemic control.Results:Among 1162 women with GDM,the median daily activity time was 65 mm(interquartile range(IQR):45-90 min),and the abnormal plasma glucose(PG) percentage,calculated as number of abnormal PG tests divided by the total number of PG tests,was 40.00%(IQR:22.22%-66.67%).The percentage of abnormal PG was stabilized and statistically lower with daily physical activity time exceeding 60 min among primiparas(IQR:30.89%-44.43%) and exceeding 90 min among multiparas(ranged from 27.76% to 38.82%).After adjusting for potential confoumders,primiparas tended to have a lower percentage of abnormal PG than do multiparas(rate difference=-0.39,95%CI:-3.61 to2.84).The same amount of physical activity time was significantly less effective for multiparas than for primiparas(trend p-value <0.01).Conclusion:In women with GDM,being multiparous is associated with less effective glycemic control through physical activity,such that multiparas need more physical activity to achieve glycemic control at a similar level to primiparas.

Pterostilbene Ameliorates Glycemic Control,Dyslipidemia and Liver Injury in Type 2 Diabetes Rats

Type 2 diabetes mellitus(T2DM)is typified by the increment of chronic blood glucose levels that is caused by an absolute and/or a relative deficiency of insulin,accounts for 90%of diabetes and causes a range of complications[1].

Intraoperative glycemic control procedures and the use of an artificial pancreas

Strict intraoperative glycemic control can significantly decrease the incidence of postoperative infection; however, anesthesiologists must carefully control blood glucose levels as well as properly manage the respiratory and cardiovascular systems. However, standard blood glucose measurement systems and insulin dosing algorithms, which are necessary for achieving strict glycemic control, have not yet been developed. An artificial pancreas (STG-22TM; Nikkiso Co., Tokyo, Japan) is considered a highly accurate blood glucose monitoring system capable of closed-loop control of blood glucose. The device has, however, many problems to be addressed since it is a large and expensive system with little versatility, and it requires a large amount of blood to be collected. Therefore, the development of less invasive and inexpensive systems with future technological progress is greatly anticipated.

Tight glycemic control using an artificial endocrine pancreas may play an important role in preventing infection after pancreatic resection

It is well known that perioperative hyperglycemia is the main cause of infectious complications after surgery.To improve perioperative glycemic control,we wish to highlight and comment on an interesting paper published recently by the Annals of Surgery entitled:"Early postoperative hyperglycemia is associated with postoperative complications after pancreatoduodenectomy(PD)" by Eshuis et al.The authors concluded that early postoperative glucose levels more than 140 mg/dL was significantly associated with complications after PD.Since we recommend that perioperative tight glycemic control(TGC) is an effective method to prevent postoperative complications including surgical site infection after distal,proximal,and total pancreatic resection,we support strongly this conclusion drawn in this article.However,if early postoperative glucose control in patients undergoing PD was administrated by conventional method such as sliding scale approach as described in this article,it is difficult to maintain TGC.Therefore,we introduce a novel perioperative glycemic control using an artificial endocrine pancreas against pancreatogenic diabetes after pancreatic resection including PD.

The Benefits of SGLT2 Inhibitors in Cardiovascular Prevention, Glycemic Control and Weight Loss, in the Treatment of Diabetes

The sodium and glucose co-transporter inhibitors type 2 (SGLT2) comprises a new class of hypoglycemic drugs to control type 2 diabetes mellitus, in an attempt to add new non-existing benefits to the so far arising classes. Regarding this new class of drugs, represented by dapaglifozin, canaglifozin and empaglifozin, it is important to highlight the benefits brought by these medications to combat hyperglycemia with insulin-independent mechanisms that are beyond glucose reduction, such as cardiovascular events prevention, reduction in HbA1c, weight loss and blood pressure lowering. Recently, a relevant study (Empa-Reg) brought hope and set the spotlight on the prevention of cardiac events among diabetic patients, which is the main cause of mortality within this group. However, despite coming out as a good treatment option, SGLT2 inhibitors are under constant clinical research and, as a new drug, it should be carefully carried out regarding the long-term effects of glycosuria and other possible side effects, such as the observed increase in the incidence of bladder, breast cancer and bone fractures, which require further studies. Therefore, these compounds might represent a landmark approach for the treatment of diabetes.

Diabetic patients with COVID-19 need more attention and better glycemic control

BACKGROUND Coronavirus disease 2019 (COVID-19) is a pandemic disease spreading all overthe world and has aroused global concerns. The increasing mortality has revealedits severity. It is important to distinguish severe patients and provide appropriatetreatment and care to prevent damages. Diabetes is reported to be a commoncomorbidity in COVID-19 patients and associated with higher mortality. Weattempted to clarify the relationship between diabetes and COVID-19 patients’severity.AIMTo determine the role of type 2 diabetes in COVID-19 patients.METHODSTo study the relationship between diabetes and COVID-19, we retrospectivelycollected 61 patients’ data from a tertiary medical center in Wuhan. All thepatients were diagnosed with laboratory-confirmed COVID-19 and admitted tothe center from February 13 to March 1, 2020. Patients’ age, sex, laboratory tests,chest computed tomography findings, capillary blood glucose (BG), andtreatments were collected and analyzed. Fisher exact test was used for categoricaldata. Univariate and multivariate logistic regressions were used to explore therelationship between clinical characteristics and patients’ severity.RESULTSIn the 61 patients, the comorbidity of type 2 diabetes, hypertension, and heartdiseases were 24.6% (15 out of 61), 37.7% (23 out of 61), and 11.5% (7 out of 61),respectively. The diabetic group was related to more invasive treatments (P =0.02) and severe status (P = 0.003). In univariate logistic regression, histories ofdiabetes (OR = 7.13, P = 0.003), hypertension (OR = 3.41, P = 0.039), and hepaticdysfunction (OR = 7.69, P = 0.002) were predictors of patients’ severity while heart disease (OR = 4.21, P = 0.083) and large lung involvement (OR = 2.70, P = 0.093)also slightly exacerbated patients’ conditions. In the multivariate analysis,diabetes (OR = 6.29, P = 0.016) and hepatic dysfunction (OR = 5.88, P = 0.018)were risk factors for severe patients. Diabetic patients showed elevated BG in61.7% of preprandial tests and 33.3% of postprandial tests, revealing the limitedcontrol of glycemia in COVID-19 patients.CONCLUSIONA history of type 2 diabetes is correlated with invasive treatments and severestatus. Suboptimal glycemic control and hepatic dysfunction have negative effectson severity status and may lead to the exacerbation of COVID-19 patients.

Significance of intensive glycemic control on early diabetic nephropathy patients with microalbuminuria

Objective To investigate the therapeutic effect of intensive glycemic control on patients with early diabetic nephropathy. Methods A total of 41 type 2 diabetes patients who developed microalbuminuria were divided into two groups randomly. Patients in Group A received intensive glycemic control and the blood glucose in Group B was regularly controlled. Glycemic monitoring and control were followed for 12 weeks to observe the changes of microalbuminuria in both groups; meanwhile the levels of serum lipids and coagulation indices were also recorded. Results The urine albumin excretion rate (UAER) in Group A decreased significantly from (47.91±13.86)mg/24h to (35.31±14.56)mg/24h after 12 weeks (P<0.05),and this decrease was significantly greater than that in Group B. However,Group B had no significant difference in UAER decrease [(48.93±13.32)mg/24h to (40.48±19.62)mg/24h,P>0.05]. The decrease of triglyceride (TG) and low-density lipoprotein cholesterol (LDL cholesterol),and the increase of high-density lipoprotein cholesterol (HDL cholesterol) showed no significant differences (P>0.05). And the level of plasma fibrinogen (FIB) showed no significant decrease after 12 weeks,either (P>0.05). Conclusion Intensive glycemic control reduces the level of microalbuminuria and may ameliorate the progression of early diabetic nephropathy.

Factors influencing the effectiveness of using flash glucose monitoring on glycemic control for type 1 diabetes in Saudi Arabia

BACKGROUND In 2017,35000 Saudi children and adolescents were living with a type 1 diabetes(T1D)diagnosis.Diabetic complications are minimized upon strengthened glycemic regulation.The annual cost of treating diabetic patients with complications was four-fold higher than for patients without complications.The use of flash glucose monitoring(FGM)enables better diabetes treatment and thereby improves glycemic control.Understanding the factors that affect effectiveness of FGM will help enhance the device’s use and management of hospital resources,resulting in improved outcomes.AIM To investigate factors that affect effectiveness of the FGM system for glycated hemoglobin(HbA1c)levels/glycemic control among T1D patients.METHODS A retrospective empirical analysis of T1D patient records from King Abdul-Aziz University Hospital and Prince Sultan Military Medical City was performed.T1D patients who began FGM between 2017 and 2019 were included.RESULTS The data included 195 T1D patients(70 males and 125 females)with a mean age of 23.6±8.1 years.Among them,152 patients used multiple daily injection and 43 used an insulin pump.The difference in HbA1c level from baseline and after using FGM was-0.60±2.10,with a maximum of 4.70 and a minimum of-6.30.There was a statistically significant negative correlation between the independent variables(age,duration of diabetes,level of engagement)and HbA1c.The group with the highest HbA1c mean(9.85)was 18-years-old,while the group with the lowest HbA1c mean(7.87)was 45-years-old.Patients with a low level of engagement(less than six scans per day)had the highest HbA1c mean(9.84),whereas those with a high level of engagement(more than eight scans per day)had the lowest HbA1c mean(8.33).CONCLUSION With proper education,FGM can help people with uncontrolled T1D over the age of 18 years to control their glucose level.

Evaluation of Serum Iron, Zinc and Their Relationships with Glycemic Control Status in Iranian Elderly Women with Type 1 Diabetes Mellitus

It seems that defects on micro-minerals levels have an etiologic role involved in type 1 diabetes mellitus pathogenicity. The aim of our study were to evaluate the serum levels of zinc and iron and investigate their possible relationship between these biochemical parameters with demographic conditions and glycemic control in patients with type 1 diabetes mellitus disorder. In this case-control based study, 68 female with type 1 diabetes mellitus with a mean age of 52.2 ±2 as case group and 122 healthy women as a control group with a mean age of 49/4 ±3/2 were investigated .for biochemical analysis ,10 mL fasting venous blood sample were obtained from each subjects. FBS （fasting blood glucose）, fructosamine （glycemic control parameter） were determined （spectrophotometry method, （pars azmoon, Iran）, nitroblue tetrazoline method respectively）.serum zinc level with colorimetric method （Biorex-UK） and serum iron with photometric method （pars azmoon, Iran） were determined. Statistical analysis using SPSS software performed. Significant levels considered as P 〈 0.05. According to this study there is statistically significant difference between serum levels of iron and zinc in patients with type 1 diabetes compared to controls .indeed serum level of iron and zinc had lower level in patient group toward controls. In patients group, there are a positive correlation between age and decreased level of serum zinc （P 〈 0.05）. Also there was a significant negative correlation between the glycemic control status and serum zinc. Other studied parameters concluded BMI （body mass index）, Weight and height have not significant difference between groups. The decrease in serum iron and zinc level in women with type 1 diabetes may be related to low dietary intake or increased excretion of micro minerals or the presence of confounding factors that require more extensive intervention studies to confirm it.

Sleep Disturbance among Type II Diabetic Patients and Influence of Glycemic Control

Background: Experimental and observational studies have indicated that poor sleep quantity and quality are associated with an increased risk of chronic diseases including insulin resistance. Additionally, sleep disorders have been reported to aggravate diabetes due to decreased glucose metabolism and elevated cortisol levels as well as it can increase the risk for the development of diabetes. Objectives: To assess the sleep quality and its determinants and impact on glycemic control of type II diabetic patients. Methods: A cross sectional study was adopted among a representative sample of patients diagnosed with type II Diabetes seen in Prince Mansour Military Hospital Diabetic Center in Taif throughout the study period (March-July 2021). A self-administered questionnaire was utilized in the present study including 5 main parts: demographic data of the patients, medical and social history, the Pittsburgh Sleep Quality Index (PSQI) to assess the subjective sleep quality, weight and height measurements and the most recent glycated hemoglobin (HbA1c) level. Results: The study included 270 type II diabetic patients out of a targeted 282 with a response rate of 95.7%. Most of them aged either between 51 and 60 years (34.8%) or over 60 years (42%). Females represent 63% of them. Majority of patients (87.8%) had HbA1c ≥ 7%, indicating uncontrolled blood glucose levels. Overall, poor sleep quality, based on PSQI was observed among 41.1% of type II diabetic patients. Results of multivariate logistic regression analysis revealed that compared to patients whose income was lower than 5000 SR/month, those with income of 50,001 - 1000 and >15,000 SR/month were at lower significant risk for having poor sleep (Adjusted odds ratio “AOR” = 0.44, 95% confidence interval “CI” = 0.22 - 0.86, p = 0.016 and AOR = 0.21, 95% CI = 0.06 - 0.77, p = 0.019;respectively). Opposed to diabetic patients with a duration of less than one year of DM, those with a duration exceeding 10 years were at almost 6-folds higher risk for poor sleep quality (AOR = 6.39, 95% CI = 1.12 - 36.43, p = 0.037). Patients with a history of social stressors were at a higher significant risk for poor sleep quality compared to those without such a history (AOR = 4.99, 95% CI = 1.71 - 14.67, p = 0.003). Conclusion: A considerable proportion of type II diabetic patients attending the diabetic center, Prince Manasour Military hospital in Taif, Kingdom of Saudi Arabia expressed poor sleep quality. However, there was no association between glycemic control level and poor sleep quality.

Analysis of the Relationship between Oral Diseases and Glycemic Control of Diabetes in the West African Context: Survey at the Centre Anti-Diabetique d’Abidjan (CADA),cote d’Ivoire

The relationship between diabetes and periodontitis is established and described as a bidirectional influence, whereas that with dental caries is still controversial. The objective of this study was to analyze the relationship between blood glucose control and oral diseases in a population of diabetics followed at the “Centre Anti Diabétique d’Abidjan” (CADA). The dental condition of the diabetics included in this cross-sectional study was assessed by the DMF index, periodontal condition by the CPITN and oral hygiene by the OHIS index. Diabetes data were extracted from CADA patient medical records. Blood glucose control has been defined by an average of the blood glucose values of the last 3 months less than or equal to 1.26 g/l. Regression models were constructed to estimate the risk of diabetes imbalance adjusted for all characteristics collected. The sample of 356 diabetics consisted of 53.7% women with an average age of 55.6 years (range: 12 - 85 years). The average DMF index was 7.9 (Std: 6.6) with an estimated prevalence of caries of 77.0%, that of periodontitis of 53.1%. The proportion of subjects with good glycemic control was estimated at 41.3%. The characteristics associated with glycemic control were: dry mouth (p = 0.005), type of diabetes treatment (p < 0.00014) and duration of diabetes (p = 0.039) and periodontal status assessed with the CPITN (p = 0.014). The results of this study confirmed the link between periodontitis and glycemic control of diabetes described in the literature but didn’t find significant association between dental caries and diabetes.