Indicators of glycemic control in patients with gestational diabetes mellitus and pregnant women with diabetes mellitus

Recently, it has become clear that mild abnormal glucose tolerance increases the incidence of perinatal maternalinfant complications, and so the definition and diagnostic criteria of gestational diabetes mellitus(GDM) have been changed. Therefore, in patients with GDM and pregnant women with diabetes mellitus, even stricter glycemic control than before is required to reduce the incidence of perinatal maternal-infant complications. Strict glycemic control cannot be attained without an indicator of glycemic control; this review proposes a reliable indicator. The gold standard indicator of glycemic control in patients with diabetes mellitus is hemoglobin A1c(Hb A1c); however, we have demonstrated that Hb A1 c does not reflect glycemic control accurately during pregnancy because of iron deficiency. It has also become clear that glycated albumin, another indicator of glycemic control, is not influenced by iron deficiency and therefore might be a better indicator of glycemic control in patients with GDM and pregnant women with diabetes mellitus. However, largepopulation epidemiological studies are necessary in order to confirm our proposal. Here, we outline the most recent findings about the indicators of glycemic control during pregnancy including fructosamine and 1,5-anhydroglucitol.

The Effect of Standardized Nutritional Care Combined with Exercise Intervention in Patients with Gestational Diabetes Mellitus and Its Effect on FPG,2hPG,and HbA1c Levels

Objective:To study the application effect of standardized nutritional care combined with exercise intervention in patients with gestational diabetes mellitus and the effect on fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),and glycated hemoglobin(HbA1c)levels.Methods:Ninety cases of gestational diabetes mellitus diagnosed between June 2022 and June 2023 were selected and randomly divided into two groups of 45 cases each.The control group received conventional intervention,while the observation group received combined standardized nutritional care and exercise intervention.Blood glucose levels,adverse pregnancy outcomes,and adverse neonatal outcomes were compared.Results:On the day before delivery,the FPG,2hPG,and HbA1c levels of patients in the observation group were lower than those of patients in the control group(P<0.05).The incidence of adverse pregnancy outcomes(4.44%)and adverse neonatal outcomes(2.22%)in the observation group was lower than in the control group(P<0.05).Conclusion:The blood glucose levels of gestational diabetes mellitus patients can be controlled through standardized nutritional care and exercise interventions,leading to improved pregnancy and neonatal outcomes.

Evaluation of teplizumab's efficacy and safety in treatment of type 1 diabetes mellitus:A systematic review and meta-analysis

BACKGROUND Islets of Langerhans beta cells diminish in autoimmune type 1 diabetes mellitus(T1DM).Teplizumab,a humanized anti-CD3 monoclonal antibody,may help T1DM.Its long-term implications on clinical T1DM development,safety,and efficacy are unknown.AIM To assess the effectiveness and safety of teplizumab as a therapeutic intervention for individuals with T1DM.METHODS A systematic search was conducted using four electronic databases(PubMed,Embase,Scopus,and Cochrane Library)to select publications published in peerreviewed journals written in English.The odds ratio(OR)and risk ratio(RR)were calculated,along with their 95%CI.We assessed heterogeneity using Cochrane Q and I2 statistics and the appropriate P value.RESULTS There were 8 randomized controlled trials(RCTs)in the current meta-analysis with a total of 1908 T1DM patients from diverse age cohorts,with 1361 patients receiving Teplizumab and 547 patients receiving a placebo.Teplizumab was found to have a substantial link with a decrease in insulin consumption,with an OR of 4.13(95%CI:1.72 to 9.90).Teplizumab is associated with an improved Cpeptide response(OR 2.49;95%CI:1.62 to 3.81)and a significant change in Glycated haemoglobin A1c(HbA1c)levels in people with type 1 diabetes[OR 1.75(95%CI:1.03 to 2.98)],and it has a RR of 0.71(95%CI:0.53 to 0.95).CONCLUSION In type 1 diabetics,teplizumab decreased insulin consumption,improved C-peptide response,and significantly changed HbA1c levels with negligible side effects.Teplizumab appears to improve glycaemic control and diabetes management with good safety and efficacy.

Glycemic control indicators in patients with neonatal diabetes mellitus

Neonatal diabetes mellitus(NDM) is a type of diabetes mellitus caused by genetic abnormality which devel ops in insulin dependent state within 6 mo after birth HbA1c is widely used in clinical practice for diabetes mellitus as the gold standard glycemic control indica tor; however, fetal hemoglobin(HbF) is the main he moglobin in neonates and so HbA1c cannot be used as a glycemic control indicator in NDM. Glycated albumin(GA), another glycemic control indicator, is not affected by HbF. We reported that GA can be used as a glycemic control indicator in NDM. However, it was later found that because of increased metabolism of albumin, GA shows an apparently lower level in relation to plasma glucose in NDM; measures to solve this problem were needed. In this review, we outlined the most recen findings concerning glycemic control indicators in neo nates or NDM.

Complementary and Alternative Medicine: A Review on the Effects of Ginger, Cinnamon and Camellia Sinensis Leaf Tea in Diabetes

Diabetes mellitus is a chronic disease with a multitude of effects on different organ-systems. Its chronic nature makes it a challenging disease for patients to manage. Today, patients have access to many different types of conventional therapies for diabetes, each with a different mode of action and side effects. Despite the wide range of therapeutic agents available today, patients seek help from complementary and alternative medicine. The decision to use complementary and alternative medicine by patients stems from some of the harmful side effects of current conventional therapies, as well as their desire to find measures that will help them to manage their disease. Complementary and alternative medicine includes several modalities ranging from dietary components such as vitamins and herbal supplements to mind-body interventions such as yoga, meditation, and massage therapy. Here we review the use of complementary and alternative medicine including Ginger, Cinnamon, and Camellia sinensis leaf tea, and their effects on glycemic indices in diabetes.

Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic pancreatitis.The centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved outcomes.In this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic services.Type 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and outcome.Adequate preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative period.The incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe pancreatitis.Early involvement of a specialist diabetes team is essential to ensure a holistic management.In the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve outcomes.While various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required improvement.The need for perioperative support of diabetic patients by specialist diabetes teams is uniformly underlined,a fact that becomes clearly more prominent at all different stages in the setting of pancreatic surgery and the management of complex pancreatitis.Therefore,pancreatic surgery and tertiary pancreatitis services must be designed with a provision for support from specialist diabetes teams.With the ongoing accumulation of evidence,it would be reasonable to consider the design of specific guidelines for the glycaemic management of these patients.

Diagnosis and treatment of diabetes mellitus in chronic pancreatitis

Diabetes secondary to pancreatic diseases is commonly referred to as pancreatogenic diabetes or type 3c diabetes mellitus.It is a clinically relevant condition with a prevalence of 5%-10%among all diabetic subjects in Western populations.In nearly 80%of all type 3c diabetes mellitus cases,chronic pancreatitis seems to be the underlying disease.The prevalence and clinical importance of diabetes secondary to chronic pancreatitis has certainly been underestimated and underappreciated so far.In contrast to the management of type 1 or type2 diabetes mellitus,the endocrinopathy in type 3c is very complex.The course of the disease is complicated by additional present comorbidities such as maldigestion and concomitant qualitative malnutrition.General awareness that patients with known and/or clinically overt chronic pancreatitis will develop type 3c diabetes mellitus(up to 90%of all cases)is rather good.However,in a patient first presenting with diabetes mellitus,chronic pancreatitis as a potential causative condition is seldom considered.Thus many patients are misdiagnosed.The failure to correctly diagnose type 3 diabetes mellitus leads to a failure to implement an appropriate medical therapy.In patients with type 3c diabetes mellitus treating exocrine pancreatic insufficiency,preventing or treating a lack of fat-soluble vitamins(especially vitamin D)and restoring impaired fat hydrolysis and incretin secretion are key-features of medical therapy.

Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI,28kg/m^2:a multi-institutional study

Roux-en-Y gastric bypass surgery（RYGB） has been demonstrated to be successful for treating type-II diabetes2mellitus（T2DM） patients with a body mass index（BMI）,30 kg/m,but reports of RYGB for T2 DM patients with22 a BMI,28 kg/mare lacking.T2 DM patients with a BMI,28 kg/mwere prospectively recruited to participate in this study in four hospitals.The endpoint was T2 DM remission（defined by fasting blood glucose（FBG） level,110 mg/d L and hemoglobin（Hb）A1c level,6.0% at 12 months postoperatively）.Predictors of remission were investigated by univariate and multivariate analyses.Eighty-six patients were assessed.Eighty-five patients underwent RYGB,with one conversion to open surgery.We compared the values of various variables before and after2 surgery.The mean BMI decreased from 24.68±2.12 to 21.72±2.43 kg/m（P,0.001）.Fifty-eight（67.4%） patients were not treated by drugs or insulin after surgery,and 20 patients（23.3%） had complete remission of T2 DM at12 months after surgery with an acceptable number of complications.The mean Hb A1 c level in the remission group was significantly lower than that in the non-remission group.Patients with a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level were more likely to have T2 DM remission in multivariate2 analyses.In conclusion,RYGB was effective and safe for treating T2 DM patients with a BMI,28 kg/m.Complete remission can be predicted by cases having a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level.

Comparison of different gastric bypass procedures in gastric carcinoma patients with type 2 diabetes mellitus

AIM: To determine the effect of different Roux-en-Y gastric bypass procedures in gastric carcinoma patients with type 2 diabetes mellitus.

Patterns and Changes in the Treatment of Patients with Type II Diabetes Mellitus in Egypt: The DISCOVER Program

The DISCOVER study is a three-year, non-interventional prospective study conducted in 37 countries, including Egypt, to assess the treatment patterns and outcomes in patients with type 2 diabetes mellitus initiating a second-line antidiabetic therapy (add-on or switch). In this report of the Egyptian cohort of DISCOVER, baseline data were collected according to routine clinical practice at 38 study sites, using a standardized electronic case report form, in the period from December-2014 to November-2019. We enrolled 583 patients (mean age: 52.9 ± 9.8 years and median duration since diagnosis: median 36.5, IQR 18.1, 70.4 months). The mean HbA1c value at baseline was 8.6 ± 1.4%, indicating poor glycemic control. The most commonly prescribed first-line medications were metformin or sulfonylurea monotherapy. For second line-therapy, the majority of patients switched to dual therapy with metformin plus sulfonylureas or DPP-4 inhibitors. Fewer patients switched to triple therapy, treatment by four or more medications, or insulin treatment (15, 12, and 35 patients, respectively). The most commonly cited reasons for switching to second-line therapy were lack of efficacy, weight gain, hypoglycemic events, and side effects (549, 54, 25, and 21 patients, respectively). The set treatment target of enrolled patients at the initiation of second-line therapy was an HbA1c level of 6.9%. Follow-up data will assess the outcomes of such changes in the Egyptian population.

Level of Fasting C-Peptide as a Predictor of <i>β</i>-Cell Function in Sudanese Patients with Type 2 Diabetes Mellitus

Objective: In this study, we assessed the level of fasting C-peptide as a predictor of β-cell function and insulin resistance in patients with Type 2 diabetes mellitus (T2DM), Gezira State-Sudan. Methods: In this cross-sectional study, 100 T2DM patients attending the Diabetic patients care Centre were recruited, thirty five patients were males and sixty five were females, the mean age of the patients was 50.29 ± 0.456 years, and body mass index (BMI) was 26.54 ± 0.437. We estimated β-cell function using fasting C-peptide levels;homeostatic model assessment for β-cell function (HOMA-B) and insulin resistance (HOMA-IR) were calculated from C-peptide and fasting blood glucose (FBG). Results: C-peptide was significantly and positively correlated with HOMA-B and HOMA-IR. FBG also showed significant negative correlation with HOMA-B, but was positively and significantly correlated with HOMA-IR. HbA1c was negatively and significantly correlated with HOMA-B. Patients with low C-peptide levels had increased FBG and HbA1c level, while patients with high C-peptide levels were having high HOMA-IR and HOMA-B. Conclusions: Fasting C-peptide is a useful marker of pancreatic β-cell function, and its circulating levels could be used to evaluate insulin secretion and insulin resistance. Moreover, HOMA-IR is an effective index to achieve glycemic control by appropriate pharmacologic treatment of T2DM.

HFE Gene Mutation Associated with the Severity of Gestational Diabetes Mellitus in Belarusian Women

To determine whether the H63D and C282Y mutations in HFE (hemochromatosis) gene are associated with the risk of gestational diabetes mellitus (GDM), we conducted the study of 65 incident cases. The class of gestational diabetes (A1, A2, B) in pregnant women was defined based on the results of glycemic profile and 75-g oral glucose tolerance test. Two single nucleotide polymorphisms (H63D and C282Y) in HFE gene were genotyped by PCR and RFLP (Restriction Fragment Length Polymorphism). The frequencies of mutations in patients cohort were: 0.14 for H63D and 0.02 for C282Y, which are similar to the data reported for Belarusian population (0.16 and 0.04 respectively). The detailed analysis of case subjects indicated association of H63D mutation with the severity of gestational diabetes mellitus. In the frequencies of H63D mutation and genotypes between the case subjects with A1 and B gestational diabetes were detected significant differences. Our data indicated that the presence of H63D mutation in pregnant women with GDM aggravates the disease—odds ratio 7.4 (95% CI 1.8 - 30.5). Women with gestational diabetes have severe increased risk for illness progressing to class B if they are H63D mutation carriers.

Correlation between cerebral neurotransmitters levels by proton magnetic resonance spectroscopy and HbA1c in patients with type 2 diabetes

BACKGROUND Cognitive dysfunction is the main manifestation of central neuropathy.Although cognitive impairments tend to be overlooked in patients with diabetes mellitus(DM),there is a growing body of evidence linking DM to cognitive dysfunction.Hyperglycemia is closely related to neurological abnormalities,while often disregarded in clinical practice.Changes in cerebral neurotransmitter levels are associated with a variety of neurological abnormalities and may be closely related to blood glucose control in patients with type 2 DM(T2DM).AIM To evaluate the concentrations of cerebral neurotransmitters in T2DM patients exhibiting different hemoglobin A1c(HbA1c)levels.METHODS A total of 130 T2DM patients were enrolled at the Department of Endocrinology of Shanghai East Hospital.The participants were divided into four groups according to their HbA1c levels using the interquartile method,namely Q1(<7.875%),Q2(7.875%-9.050%),Q3(9.050%-11.200%)and Q4(≥11.200%).Clinical data were collected and measured,including age,height,weight,neck/waist/hip circumferences,blood pressure,comorbidities,duration of DM,and biochemical indicators.Meanwhile,neurotransmitters in the left hippocampus and left brainstem area were detected by proton magnetic resonance spectroscopy.RESULTS The HbA1c level was significantly associated with urinary microalbumin(mALB),triglyceride,low-density lipoprotein cholesterol(LDL-C),homeostasis model assessment of insulin resistance(HOMA-IR),and beta cell function(HOMA-β),N-acetylaspartate/creatine(NAA/Cr),and NAA/choline(NAA/Cho).Spearman correlation analysis showed that mALB,LDL-C,HOMA-IR and NAA/Cr in the left brainstem area were positively correlated with the level of HbA1c(P<0.05),whereas HOMA-βwas negatively correlated with the HbA1c level(P<0.05).Ordered multiple logistic regression analysis showed that NAA/Cho[Odds ratio(OR):1.608,95%confidence interval(95%CI):1.004-2.578,P<0.05],LDL-C(OR:1.627,95%CI:1.119-2.370,P<0.05),and HOMA-IR(OR:1.107,95%CI:1.031-1.188,P<0.01)were independent predictors of poor glycemic control.CONCLUSION The cerebral neurotransmitter concentrations in the left brainstem area in patients with T2DM are closely related to glycemic control,which may be the basis for the changes in cognitive function in diabetic patients.

Glycated hemoglobin A1C and diabetes mellitus in critically ill patients

BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.

Diabetes Mellitus in Very Elderly Russian Patients with Coronary Artery Disease

Background: Conflicting data are available on prevalence and characteristics of diabetes mellitus in very elderly patients and centenarians;therefore, we evaluated features of this pathology in patients with coronary artery disease (CAD) over 75 years old. Material and Methods: 580 patients with CAD over 75 years old were enrolled in the study on the prevalence of diabetes mellitus. 190 patients with CAD and diabetes mellitus were included in the cross-sectional study of the diabetes mellitus characteristics in old age: 153 very elderly patients (mean age—85.7 ± 4.7 years)—in the main group, 37 patients < 70 years old—in the comparison group. Toassess the condition of patients, standard clinical and laboratory methods for coronary artery disease and diabetes mellitus were used. 24-hour plasma glucose profile and hemoglobin A1c (HbA1c) level were evaluated in all patients with diabetes mellitus. Results: Diabetes mellitus or impaired glucose tolerance was found in 22.2% of very elderly patients with CAD. Glucose levels in very elderly diabetic patients were lower at all time points than in patients < 70 years old. The largest differences were recorded for the blood glucose concentration at 6 a.m. (p = 0.00005). Glucosuria was registered in 29.7% of patients aged 51 - 69 years, while among elderly patients—in 11.1% (p = 0.004). The mean levels of HbA1c were 7.3% and 8.7%, respectively (p = 0.01). Correlation analysis revealed negative correlation between the age of patients and the glucose level (r = ?0.4, p = 0.00002—for 6 AM glucose). The mean body mass in-dex in very elderly patients was 30.8 ± 5.8 kg/m2, in patients < 70 years old—33.9 ± 6.5 kg/m2 (p = 0.03). Significant differences between the groups of very elderly and younger patients were registered in terms of triglycerides (1.65 and 3.57 mmol/L, respectively, p < 0.00001), HDL-cholesterol (1.16 and 0.87 mmol/L, respectively, p = 0.03) and ath-erogenic index (3.45 and 6.73, respectively, p = 0.002). Conclusion: The study results indicate that diabetes mellitus is often diagnosed in very elderly patients with CAD. In very elderly patients, lower values of blood glucose, hemoglobin A1c and glucosuria are recorded, compared with younger patients with diabetes mellitus.

Initiation of Basal Insulin in Patients with Uncontrolled Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is a growing health problem, characterized by insulin resistance progressing to beta cell dysfunction and insulin deficiency, most of these patients will need intensification of treatment and initiation of insulin to delay or prevent diabetic complications. Glycemic control is the most important aspect of management, and in reducing morbidity and mortality of the diseases. Control of plasma glucose in patients with diabetes can be assessed by HbA1c, FPG, PPG, but still HbA1c% remains the gold standard for assessment of glycemic control and follow up of diabetic patients. The aim of this study is to assess HbA1c% in patients on oral anti-diabetic drugs, with poor glycemic control before and after adding basal insulin, with titration of the dose of insulin depending on fasting blood sugar. 82 patients with uncontrolled type 2 diabetes (43.9% male, 56.1% female), with HbA1c more than 9%, on two types of oral diabetic medication or more, were started on basal insulin (glargine, lantus) and followed for three to six months. Overall 82 patients with type 2 diabetes mellitus were included in the study. The mean age of the study population was 58.4 years, the mean duration of the disease range was 13.4 years. All patients with HbA1c more than 9%, without organ failure, were included in the study. The mean HbA1c overall had decreased from mean of 11.15% before starting basal insulin to the mean of 8.43% within 3 to 6 month, after initiating basal insulin, this difference was significant at p < 0.001. There was no adverse effect on this medication in any of the study group. The addition of basal insulin to oral anti-diabetic medication in uncontrolled insulin-naïve type 2 diabetic patients resulted in significant improvement of glycemic control, with improved HbA1c level, without adverse effects.

Association of Dyslipidemia and Glycated Haemoglobin in Gestational Diabetes Mellitus

Background: GDM is a condition where there is an onset of carbohydrate intolerance during pregnancy. In this condition many changes will take place in carbohydrate metabolism and other metabolic pathways especially in lipid metabolism. These metabolic changes associated with insulin resistance and dyslipidemia. We have aim to study the association between dyslipidemia and glycated haemoglobin. Materials and Methods: The study was conducted in 80 pregnant women of rural population of Puducherry in two groups. Group 1 includes 40 newly diagnosed GDM patients by DIPSI and Group II with 40 normal pregnant women, age group were between 20 to 40 years. Fasting blood glucose, 2-hour post glucose and lipid profile were estimated by auto analyzer. HbA1c was analysis by HPLC method. For comparisons of means student t-test was used to determine the significance between GDM and controls. Results: There was statistically significant difference in lipid profiles (P = 0.05), HDL (P = 0.04), VLDL (P = 0.00), LDL (P = 0.04) HDL (P = 0.04) in GDM groups. HbA1c (P = 0.02) levels were statistically significant with GDM pregnant women. There was no statically significant difference between FG (P = 0.23), TG (P = 0.30) and lipids profiles ratio levels in GDM. Conclusion: This study was found to be associations between lipids profiles and Gestational diabetes mellitus in GDM groups.

Analysis on blood glucose excursions in well-controlled patients with type 2 diabetes mellitus

Objective:To probe glycemic excursions in type 2 diabetic patients whose hemoglobin A1c(HbA1c) was kept ≤6.0%.Methods:Totally 36 cases with type 2 diabetes(T2DM) with HbA1c≤6.0% and 30 cases with normal glucose tolerance(NGT) from December 2005 to December 2007 in our department were subjected prospectively.Continuous glucose monitoring system(CGMS) was employed to record their continuous blood glucose level for 3 d.The blood glucose profiles including the mean blood glucose(MBG),standard differentiation(SD),mean amplitude of glycemic excursions(MAGE) and absolute means of daily differences(MODD) were analyzed.Results:T2DM group had obviously postprandial hyperglycemia,in about 2 h after meal,especially after breakfast.Fifty-two hypoglycemic episodes occurred during the monitoring period in T2DM groups,of which 73.1%(38 episodes) were absence of symptomatic hypoglycemia with the lowest value of blood glucose only 2.0 mmol/L.And 20 episodes took place during the day hours,while 32 episodes observed during the night hours.Compared with NGT groups,SD,MAGE and MODD were all significantly higher in T2DM groups.MBG was significantly correlated with HbA1c in T2DM groups,but SD,MAGE,NGE and MODD were all independent of HbA1c.MAGE was independent of MODD.Conclusion:The amplitude of glycemic excursions is higher in normol-controlled T2DM groups than the NGT groups.Thus ideally glycemic control is not only to make HbA1c reach standard,but also to lessen glycemic excursions and reduce hypoglycemia episodes.

Acetylsalicylic Acid Administered in Patients with Type 2 Diabetes Mellitus and Its Effect on the Antioxidant Enzyme System

Type 2 diabetes mellitus and its complications are associated with oxidative stress and the depletion of antioxidant defenses. The influence of acetylsalicylic acid on reversing the decrease in antioxidants, insulin resistance, glucose homeostasis, and inflammatory cascade can help prevent diabetes complications. Purpose: The aim of the study was to evaluate the effect of acetylsalicylic acid on the antioxidant enzymatic system in patients with diabetes. Methods: A randomized, double-blind, placebo-controlled clinical trial was carried out in 21 patients of both sexes with Type 2 diabetes for less than five years at the time of diagnosis, without pharmacological treatment, and randomly selected. Acetylsalicylic acid (300 mg) was administered orally for three months to the study group (n = 11) compared to the placebo control group (n = 10). Before and after the intervention, anthropometric and metabolic measurements were taken, fasting plasma glucose, glycated hemoglobin A1c, lipid profile panel, glutathione peroxidase, superoxide dismutase, catalase, and antioxidant capacity/activity were determined;values are presented as mean ± standard deviation. Intra- and intergroup differences were tested by Wilcoxon signed rank and Mann-Whitney U test, respectively;p-value ≤ 0.05 was considered statistically significant. Results: The acetylsalicylic acid group showed a decrease in weight (85.6 ± 19.3 vs. 84.1 ± 19.0 kg p = 0.01), cholesterol (205.9 ± 16.6 vs. 186.0 ± 23.2 mg/dL p = 0.02), and glycated hemoglobin A1c (7.8% ± 0.9% vs. 7.0% ± 0.7% p = 0.02). The placebo group exhibited reduction in weight (76.1 ± 14.9 vs. 74.9 ± 15.0 kg p = 0.04), glycated hemoglobin A1c (6.9% ± 0.6% vs. 6.2% ± 0.4% p = 0.004), and total antioxidant capacity (4.1 ± 0.5 vs. 4.8 ± 0.3 mmol/L p = 0.002). Conclusion: The administration of acetylsalicylic acid did not modify the antioxidant enzyme system.

Potential new metabolic approach for treatment of diabetes mellitus: converting glucose to ascorbic acid (vitamin C)

Through changing in lifestyle and increasing the global prevalence of diabetes mellitus, its crucial to find new approaches for treatment of this disease. This metabolic disease is characterized by hyperglycemia, insulin de ficiency or insulin resistance. This disorder categorized into type 1 and type 2 diabetes. Type 1 usually initiate from childhood, have an autoimmune background and associated with destroying of beta cells of pancreas. Type 2 diabetes is defined as insulin resistance, hyperglycemia and usually appears in adulthood. In the process of diabetes, hyperglycemia and oxidative stress can induce diabetic retinopathy, nephropathy, neuropathy and cardiovascular disease. According to literature, oxidative stress and chronic inflammation play an essential role in initiation and development of the complications of diabetes. Hence, inhibition of chronic inflammation and oxidative stress besides with glycemic control is important to prevent from these clinical complications. Some researches explained the antioxidant and anti- inflammatory property of vitamin C in patients with diabetes mellitus. Moreover, ascorbic acid can help to better glycemic control in these patients. Thus, we propose a new idea to convert excess amount of glucose to vitamin C for treatment of patients with diabetes mellitus. By performing this idea, we can achieve to better clinical management of diabetes in terms of glycemic control and prevention of oxidative stress which lead to significant decrease in clinical complications.