Balancing act:The dilemma of rapid hyperglycemia correction in diabetes management

The global diabetes surge poses a critical public health challenge,emphasizing the need for effective glycemic control.However,rapid correction of chronic hyperglycemia can unexpectedly trigger microvascular complications,necessitating a reevaluation of the speed and intensity of glycemic correction.Theories suggest swift blood sugar reductions may cause inflammation,oxidative stress,and neurovascular changes,resulting in complications.Healthcare providers should cautiously approach aggressive glycemic control,especially in long-standing,poorly controlled diabetes.Preventing and managing these complications requires a personalized,comprehensive approach with education,monitoring,and interdisciplinary care.Diabetes management must balance short and longterm goals,prioritizing overall well-being.This editorial underscores the need for a personalized,nuanced approach,focusing on equilibrium between glycemic control and avoiding overcorrection.

The Improving Effects of Diabetes Education on Diabetes Awareness and Management in Children and Adolescents with T1DM

Background: Diabetes education is crucial in empowering persons with Type 1 diabetes (T1DM) and their families to properly manage the condition by providing comprehensive knowledge, tools, and support. It boosts one’s belief in their ability to succeed, encourages following medical advice, and adds to the general enhancement of health. Objective: This study is to investigate the effectiveness of diabetes education in empowering individuals with Type 1 Diabetes Mellitus (T1DM) and their families to effectively manage the condition. Furthermore, it strives to improve nursing care for families whose children have been diagnosed with Type 1 Diabetes Mellitus (T1DM). Design: This research study investigates the efficacy of diabetes education in empowering individuals with Type 1 Diabetes Mellitus (T1DM) and their families to effectively handle the condition. Materials and Methods: A systematic search was conducted between the years 2000 and 2022, utilizing the Medline and Google Scholar databases. The purpose of the search was to uncover relevant papers pertaining to diabetes education, management of Type 1 Diabetes Mellitus (T1DM), nurse care, and empowerment. The search focused on peer-reviewed research, clinical trials, and scholarly articles that evaluated the efficacy of diabetes education in empowering individuals and families. Results: Diabetes education is crucial for understanding and controlling T1DM. It includes personalized sessions, webinars, group classes, and clinics that provide customized therapies. Comprehensive education enhances glycemic control and family dynamics. Nevertheless, the implementation of diabetes education for families requires specific standards, especially in the field of nursing. Conclusion: Diabetes education is essential for effectively managing Type 1 Diabetes Mellitus (T1DM), providing patients and families with crucial knowledge, resources, and confidence. It encourages independence in-home care and provides explicit guidelines for diabetic nurses to improve nursing care.

Effect of Diabetes Self-Management Education on Glycaemic Control in Sudanese Adults with Type 2 Diabetes

Research Background: The high prevalence of diabetes in Sudan, estimated at 16%, highlights the importance of effective health education in diabetes management. Diabetes self-management education has been identified as a crucial tool in enhancing the knowledge, attitudes, and abilities necessary for self-management among individuals with diabetes. Aim: To assess the impact of diabetes self-management education on medication adherence and glycemic control in Sudanese adults with type 2 diabetes before and 3 months after the DSME intervention. Method: The study was conducted in Sudan between September 2022 and March 2023, it was an interventional, one-group, pre- and post-test study that aimed to assess the impact of diabetes self-management education (DSME) on medication adherence and diabetes control in Sudanese adults with type 2 diabetes. The research was conducted in primary health care centers in six cities in Sudan and involved 244 participants. The data entry and statistical analysis were conducted using the Statistical Package for Social Sciences version 27.0. A paired t test was used for analysis. Results: The study included 244 participants, 67% of whom were males. The age mean ± SD was 48.6 ± 9.3 years, and 85.3% of participants were married. Age at onset of diabetes mean ± SD was 40.60 ± 7.81 years;44.6% had diabetes for less than 5 years;and 84.1% had a positive family history of diabetes mellitus. The levels of poor, low, and partial adherence to medication decreased by 8.2%, 4%, and 20.6%, respectively, after the intervention. The levels of good and high medication regime adherence increased by 13% and 19.8%, respectively;BMI decreased by 1.1 ± 0.73 kg/m2 (p = 0.005). The fasting blood sugar decreased by 69 ± 32.9 mg/dl (p = 0.049), and the glycated hemoglobin decreased by 1.21 ± 0.28% (p = 0.001). Conclusions: The findings of this study reinforce the importance of patient education in improving glycemic control and enhancing self-management behaviors. Patient education plays a critical role in enhancing glycemic control and self-management behaviors. It is essential for healthcare providers to adopt a patient-centered approach, taking into account the individual's beliefs, attitudes, and knowledge about their illness and treatment. Overcoming these challenges necessitates a comprehensive approach, including enhancing healthcare professionals’ knowledge and communication skills, offering accessible and culturally sensitive diabetes education programs, and addressing barriers to resources and support for self-management.

Application Effect of Health Management in Community Diabetic Population

Objective: This study aims to improve the health level of patients with diabetes in the community through health management measures under the concept of health management. Methods: Community residents were selected to detect, collate and analyze the social demographic information, body mass index, fasting blood glucose and blood lipid level of diabetic patients before and after health management. Results: The study showed that after the implementation of health management education in the community, the detection rate of diabetes patients increased, but the population was no longer mainly elderly patients, but mainly people under 60 years old. The levels of body mass index, fasting blood glucose, triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) were significantly decreased (all P Conclusion: Through the investigation of patients before and after health management in residential communities, this study shows that the correct implementation of health management can effectively improve the physiological indicators of diabetes patients, improve the level of health quality, and provide a reference for the prevention and treatment of diabetes patients in communities.

Study on the Clinical Application of Nutritional Management Combined with Clinical Monitoring of Glycated Albumin in Diabetic Nephropathy Dialysis Patients

Objective:To explore the clinical application of nutritional management combined with clinical monitoring of glycated albumin(GA)in diabetic nephropathy(DN)dialysis patients.Methods:A total of 20 diabetic nephropathy dialysis patients admitted to the People’s Hospital of Guandu District from January 2022 to February 2023 were included in the study.They were randomly divided into a conventional group(n=10)and an observation group(n=10).The study evaluated the blood glucose control,nutritional status,dialysis efficacy,and quality of life scores of both groups.Results:Before the intervention,there were no significant differences in fasting plasma glucose(FPG),GA,serum albumin,body mass index(BMI),dialysis efficiency values,urea clearance rate,or quality-of-life scores between the two groups(P>0.05).After the intervention,the observation group showed significantly lower FPG and GA levels,higher serum albumin,dialysis efficiency values,urea clearance rate,and improved quality-of-life scores compared to the conventional group(P<0.05),with no difference in BMI(P>0.05).Conclusion:Nutritional management combined with clinical monitoring of glycated albumin has a significant effect on the clinical application of diabetic nephropathy dialysis patients.It can effectively improve patients’blood glucose control and nutritional status,reduce the risk of complications,and enhance the quality of life,demonstrating clinical value for broader application.

Recent Advances in Glycemic Management for Hospitalized Diabetic Patients

With the increase in the number of diabetic patients,hospitalized diabetes management has become very important.During hospitalization,diabetic patients are prone to high or low blood glucose levels,which pose significant risks and challenges for treatment and recovery.Therefore,glycemic management of diabetic patients during hospitalization is critical.This article reviews the latest research progress in glycemic management of hospitalized diabetic patients from several aspects,develops individualized treatment plans,and uses various methods to manage and control blood glucose in hospitalized diabetic patients.

Analysis of the management and therapeutic performance of diabetes mellitus employing special target

Diabetes mellitus (DM) is a chronic metabolic condition characterized predominantlyby hyperglycemia. The most common causes contributing to the pathophysiologyof diabetes are insufficient insulin secretion, resistance to insulin’stissue-acting effects, or a combination of both. Over the last 30 years, the globalprevalence of diabetes increased from 4% to 6.4%. If no better treatment or cure isfound, this amount might climb to 430 million in the coming years. The major fact-ors of the disease’s deterioration include age, obesity, and a sedentary lifestyle.Finding new therapies to manage diabetes safely and effectively without jeopardizingpatient compliance has always been essential. Among the medicationsavailable to manage DM on this journey are glucagon-like peptide-1 agonists,thiazolidinediones, sulphonyl urease, glinides, biguanides, and insulin-targetingreceptors discovered more than 10 years ago. Despite the extensive preliminarystudies, a few clinical observations suggest this process is still in its early stages.The present review focuses on targets that contribute to insulin regulation andmay be employed as targets in treating diabetes since they may be more efficientand secure than current and traditional treatments.

Diabetes self-management education:Benefits and challenges

Diabetes mellitus has spread throughout many nations of the world and is now a serious threat.A lack of patient self‑management has been linked to this drain on global health.The consequences of diabetic patients’poor self‑management have increased a variety of complications and lengthened hospital stays.Poor information and skill acquisition have been linked to poor self‑management.Participating in a co‑operative approach known as diabetes self‑management education will help diabetes patients who want to successfully self‑manage their condition and any associated conditions.Information is one of the most important components of a diabetes management strategy.In conclusion,numerous studies have shown that patients with diabetes have poor self‑management skills and knowledge in all areas,making training in diabetes self‑management necessary to minimize the complications that may result from diabetes mellitus among the patients.This review discussed the severity of diabetes mellitus,diabetes self‑management,and the benefits and challenges of diabetes self‑management,which may aid individuals in understanding the significance of diabetes self‑management and how it relates to diabetes self‑care.

Effect of Case Management for Patients with Gestational Diabetes

Objective:To explore the effect of allocating case managers for gestational diabetes patients.Methods:200 patients with gestational diabetes mellitus from December 2021 to December 2022 were included in this study,and the collection period.They were divided into groups according to the interventions received.Each patient in the observation group was managed by a case manager,while the control group were managed with conventional methods without the supervision of a case manager.There were 100 cases in each group,and the curative effects of the two groups were compared.Results:The fasting blood glucose and 2-hour postprandial blood glucose in the observation group were significantly lower than those of the control group(P<0.05).The re-admission rate of patients due to poor blood sugar control in the observation group was lower than that in the control group(P<0.05).The pregnancy outcome of the observation group was better than that of the control group(P<0.05).Conclusion:Case management of gestational diabetes can not only control the blood glucose of pregnant women,but also improve pregnancy outcomes.

Current scenario of traditional medicines in management of diabetic foot ulcers:A review

Diabetic foot infections and diabetic foot ulcers(DFU)cause significant suffering and are often recurring.DFU have three important pathogenic factors,namely,microangiopathy causing local tissue anoxia,neuropathy making the foot prone to injuries from trivial trauma,and local tissue hyperglycaemia favouring infection and delaying the wound healing.DFU have been the leading cause for non-traumatic amputations of part or whole of the limb.Western medicines focus mainly on euglycaemia,antimicrobials,debridement and wound cover with grafts,and off-loading techniques.Advances in euglycaemic control,foot care and footwear,systemic antimicrobial therapy,and overall health care access and delivery,have resulted in an overall decrease in amputations.However,the process of wound care after adequate debridement remains a major cost burden globally,especially in developing nations.This process revolves around two basic concerns regarding control/eradication of local infection and promotion of faster healing in a chronic DFU without recurrence.Wound modulation with various dressings and techniques are often a costly affair.Some aspects of the topical therapy with modern/Western medicines are frequently not addressed.Cost of and compliance to these therapies are important as both the wounds and their treatment are“chronic.”Naturally occurring agents/medications from traditional medicine systems have been used frequently in different cultures and nations,though without adequate clinical base/relevance.Traditional Chinese medicine involves restoring yin-yang balance,regulating the‘chi’,and promoting local blood circulation.Traditional medicines from India have been emphasizing on‘naturally’available products to control wound infection and promote all the aspects of wound healing.There is one more group of chemicals which are not pharmaceutical agents but can create acidic milieu in the wound to satisfy the above-mentioned basic concerns.Various natural and plant derived products(e.g.,honey,aloe vera,oils,and calendula)and maggots are also used for wound healing purposes.We believe that patients with a chronic wound are so tired physically,emotionally,and financially that they usually accept native traditional medicine which has the same cultural base,belief,and faith.Many of these products have never been tested in accordance to“evidence-based medicine.”There are usually case reports and experience-based reports about these products.Recently,there have been some trials(in vitro and in vivo)to verify the claims of usage of traditional medicines in management of DFU.Such studies show that these natural products enhance the healing process by controlling infection,stimulating granulation tissue,antimicrobial action,promoting fibroblastic activity and collagen deposition,etc.In this review,we attempt to study and analyse the available literature on results of topical traditional medicines,which are usually advocated in the management of DFU.An integrated and‘holistic’approach of both modern and traditional medicine may be more acceptable to the patient,cost effective,and easy to administer and monitor.This may also nevertheless lead to further improvement in quality of life and decrease in the rates of amputations for DFU.

Remission of type 2 diabetes mellitus

The surge in type 2 diabetes mellitus(T2DM)is tightly linked to obesity,leading to ectopic fat accumulation in internal organs.Weight management has become a cornerstone of T2DM treatment,with evidence suggesting that significant weight loss can induce remission.Remission,defined as sustained hemoglobin(HbA1c)below 6.5% for at least 3 months without medication,can be achieved through various approaches,including lifestyle,medical,and surgical interventions.Metabolic bariatric surgery offers significant remission rates,particularly for patients with severe obesity.Intensive lifestyle modifications,including lowcalorie diets and exercise,have also demonstrated significant potential.Medications like incretin-based agents show robust results in improving beta-cell function,achieving glycemic control,and promoting weight loss.While complete remission without medication may not be attainable for everyone,especially those with severe insulin resistance or deficiency,early and aggressive glycemic control remains a crucial strategy.Maintaining HbA1c below 6.5%from the time of diagnosis reduces the risk of long-term complications and mortality.Moreover,considering a broader definition of remission,encompassing individuals with sustained control on medication,could offer a more comprehensive and inclusive approach to managing this chronic disease.

Issues and challenges in diabetic neuropathy management:A narrative review

Diabetic neuropathy(DN)is a devastating disorder with an increasing prevalence globally.This epidemic can pose a critical burden on individuals and communities,subsequently affecting the productivity and economic output of a country.With more people living a sedentary lifestyle,the incidence of DN is escalating worldwide.Many researchers have relentlessly worked on ways to combat this devastating disease.Their efforts have given rise to a number of commercially available therapies that can alleviate the symptoms of DN.Unfortunately,most of these therapies are only partially effective.Worse still,some are associated with unfavorable side effects.This narrative review aims to highlight current issues and challenges in the management of DN,especially from the perspective of molecular mechanisms that lead to its progression,with the hope of providing future direction in the management of DN.To improve the approaches to diabetic management,the suggested resolutions in the literature are also discussed in this review.This review will provide an in-depth understanding of the causative mechanisms of DN,apart from the insights to improve the quality and strategic approaches to DN management.

Diabetic Nephropathy and Management

Chronic kidney disease affects people worldwide. Approximately 1 out of 3 adults with diabetes have kidney disease. Among several etiological factors for CKD, diabetes mellitus (DM) and hypertension are the main factors. These factors not only cause CKD but are also responsible for several complications related to CKD. In this article, we have reviewed Diabetic Nephropathy (DN) in terms of etiology, pathophysiology, diagnosis, management, current guidelines for diabetic nephropathy management, and some of the research study findings. Diabetic nephropathy (DN) is the chief factor for end-stage renal disease (ESRD) development across the globe. The primary cause of DN is Diabetes Mellitus, which is an autoimmune lifestyle disorder having several etiological factors. Checking for urine albuminuria, estimated GFR (eGFR), and blood glucose are unswerving tests for DN diagnosis and subsequent monitoring. Controlling hyperglycemia, blood pressure, and proteinuria are critical in stopping the progression of DKD. Clinical practice and evidence-based medicine demonstrated that early diagnosis followed by treatment can prevent or halt DKD progression.

Intermittent energy restriction in type 2 diabetes: A short discussion of medication management

AIM To discuss type 2 diabetes mellitus(T2DM) medication changes required during the popular 5:2 intermittent energy restriction(IER) diet. METHODS A search was conducted in MEDLINE, EMBASE, AMED, CINAHL and Cochrane library for original research articles investigating the use of very low calorie diets(VLCD) in people with T2 DM. The search terms used included "VLCD" or "very low energy diet" or "very low energy restriction" or "IER" or "intermittent fasting" or "calorie restriction" or "diabetes mellitus type 2" and "type 2 diabetes". Reference lists of selected articles were also screened for relevant publications. Only research articles written in English, which also included an explanation of medication changes were included. A recent pilot trial using the 5:2 IER method, conducted by our research group, will also be summarized.RESULTS A total of 8 studies were found that investigated the use of VLCD in T2 DM and discussed medication management. Overall these studies indicate that the use of a VLCD for people with T2 DM usually require the cessation of medication to prevent hypoglycemia. Therefore, the 5:2 IER method will also require medication changes, but as seen in our pilot trial, may not require total cessation of medication, rather a cessation on the 2 IER days only. CONCLUSION Guidelines outlined here can be used in the initial stages of a 2-d IER diet, but extensive blood glucose monitoring is still required to make the necessary individual reductions to medications in response to weight loss.

Alphabet Strategy for diabetes care: A multi-professional, evidence-based, outcome-directed approach to management

With the rising global prevalence in diabetes, healthcare systems are facing a growing challenge to provide efficient and effective diabetes care management in the face of spiralling treatment costs. Diabetes is a major cause of premature mortality and associated with devastating complications especially if managed poorly. Although diabetes care is improving in England and Wales, recent audit data suggests care remains imperfect with wide geographical variations in quality. Diabetes care is expensive with a sizeable amount of available expenditure used for treating the complications of diabetes. A target driven, long-term, multifactorial intervention in patients with type 2 diabetes has been shown to reduce mortality and morbidity. The alphabet strategy is a novel approach to effective diabetes care provision, aiming to address patient education and empowerment, provide consistent comprehensive care delivered in a timely fashion, and allowing multidisciplinary team work.

WJD 5^(th) Anniversary Special Issues(2): Type 2 diabetes Structured SMBG in early management of T2DM: Contributions from the St Carlos study

Diabetes mellitus type 2(T2DM)is a global pandemic that will affect 300 million people in the next decade.It has been shown that early and aggressive treatment of T2DM from the onset decreases complications,and the patient’s active role is necessary to achieve better glycemic control.In order to achieve glycemic control targets,an active attitude in patients is needed,and selfmonitoring of blood glucose(SMBG)plays a significant role.Nowadays,SMBG has become an important component of modern therapy for diabetes mellitus,and is even more useful if it is performed in a structured way.SMBG aids physicians and patients to achieve a specific level of glycemic control and to prevent hypoglycemia.In addition,SMBG empowers patients to achieve nutritional and physical activity goals,and helps physicians to optimize the different hypoglycemic therapies as demonstrated in the St Carlos study.This article describes the different ways of using this educational and therapeutic tool from the medical point of view as well as from the patient’s perspective.

Effectiveness of cognitive behavior therapy for sleep disturbance and glycemic control in persons with type 2 diabetes mellitus:A community-based randomized controlled trial in China

BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus(T2DM),and often negatively related with glycemic control.Cognitive behavioral therapy(CBT)may improve sleep quality and reduce blood sugar levels in patients with T2DM.However,it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China.Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care.Glycosylated hemoglobin A1c(HbAlc)and sleep quality[Pittsburgh Sleep Quality Index(PSQI)]were assessed.Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.RESULTS The CBT group had 0.64,0.50,and 0.9 lower PSQI scores than the control group at 2 mo,6 mo,and 12 mo,respectively.The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo.The intervention on meanΔHbAlc values was significant at 12 mo(t=3.68,P<0.01)and that meanΔPSQI scores were closely related toΔHbAlc values(t=7.02,P<0.01).Intentionto-treat analysis for primary and secondary outcomes showed identical results with completed samples.No adverse events were reported.CONCLUSION CBT delivered by general practitioners,as an effective and practical method,could reduce glycemic levels and improve sleep quality for patients with T2DM in community.

Psychometric properties and characteristics of the Diabetes Self Management Scale

Objective:Assessing diabetes self care management is essential for nursing care for diabetes.There is a need to have valid and reliable scales that assess the actual performance of diabetes self management,The purpose of this study was to revise and conduct psychometric testing and analysis of the Diabetes Self Management Scale(DSMS).Methods:A cross-sectional methodological design was used.A convenience sample was used and 78 adults with diabetes and taking insulin from five sites in the Midwest area of the U.S participated in the study.Reliability analysis was done using Ferketich techniques to make decisions about whether any given item should be retained or deleted.Results:A descriptive analysis for the 60 items of the scale was conducted;several items had low variability compared to the other items on the scale.The correlation matrices showed that a total of 20 items had poor item characteristics.These 20 items were deleted resulting in developing 40-item version of the scale.The 40-item scale had high level of internal consistency(Cronbach'sα=0.947).The validity testing of the 40-item scale was guided by the Research Model for Diabetes Self Care Management;results were congruent with the model and showed strong correlation with self efficacy,moderate correlation with self care agency,and weak correlation with diabetes knowledge.Conclusion:The items and the scale(DSMS)have undergone careful psychometric testing.The 40-item DSMS is a reliable and valid instrument to measure diabetes self care management among people with diabetes.

Diabetes Management, Quality of Life and Treatment Satisfaction in Adult Population in Jordan and Lebanon, Observations from the SIMPLIFY Study

Introduction: Type 2 Diabetes Mellitus (T2DM) has witnessed a rise in its prevalence worldwide and in the Middle East region. The overall burden associated with the disease is well characterized, but little is known about patient satisfaction in the region. The purpose of the study is to evaluate the quality of life (QoL) and treatment satisfaction of patients T2DM. Methods: The SIMPLIFY study was an observational, cross-sectional, multicenter, regional study that used patient-reported outcomes of T2DM patients in Jordan and Lebanon. Results: Patients were more satisfied when they were treated exclusively with oral medications, mainly metformin alone or combined with either sulfonylurea or dipeptidyl peptidase-4 inhibitor. Targets for glycated hemoglobin (HbA1c) values were better reached in patients treated with oral medications. Occurrence of comorbidities did not seem to be affected by oral or injectable medications or to affect patients’ satisfaction. Data highlighted a suboptimal screening for albuminuria and showed that most patients were overweight or obese and around 30% suffered from hypoglycemia episodes. Conclusion: Data shed the light on the management of T2DM in Jordan and Lebanon and suggested the need for a more comprehensive approach to T2DM management and selection of medications that would support weight control and a lower hypoglycemia incidence.

Difficulties in Recruitment for a Randomised Controlled Trial of Lifestyle Intervention for Type 2 Diabetes: Implications for Diabetes Management

Objective: To report our experience of attempting a randomised controlled trial of an intensive lifestyle intervention for early type 2 diabetes delivered in a residential setting. Methods: We established a trial requiring 84 participants (46 standard care and 38 intervention) to detect a 1% difference in HbA1c between intervention and control groups at 12 months, allowing for attrition. Ethics approval was obtained from Monash University. Results: The study was abandoned after five months of consistent promotion due to recruitment failure (four subjects recruited). Conclusion: It appears to be difficult for patients with diabetes to commit to a live-in period of education regarding lifestyle modification as a means of treating the illness. We recommend better education of patients and their doctors about the potential health benefits of lifestyle change to manage type 2 diabetes, and further research into novel methods of delivering lifestyle advice which are both effective and sustainable.