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.

Impact of spiritual beliefs and faith-based interventions on diabetes management

Management of diabetes constitutes significant social and economic burdens worldwide.There is a shortage of empirical studies on the management of diabetes and the associated mental health issues through spiritual beliefs and faith-based interventions(FBIs).It is not also clear how spiritual beliefs and FBIs account for the effective management of diabetic conditions.This article discusses the impact of spiritual beliefs and FBIs in the management of diabetes,from relationship and efficacy studies that report outcomes from experimental procedures of related interventions.The majority of the relationship studies showed positive relationships,while efficacy studies showed a high efficacy of interventions in faith-based approaches.However,none of the studies clearly reported the mechanisms of change or modality of operation in a FBI that can serve as a model across culture and context.Possible mechanisms of change were discussed for further development of a standard faith-based model,and finally,suggestions for future research were also highlighted by the authors.

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.

Impact of chronic disease self-management programs on type 2 diabetes management in primary care

AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls whoreceived usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life(HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6%(P < 0.0001), but the reductions did not differ significantly between the two groups(P = 0.885). Few significant differences were observed in participants' diabetes self-care activities. No significant differences were observed in the participants' HRQOL, pain, or fatigue measures.CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.

Intensive diabetes management and goal setting are key aspects of improving metabolic control in children and young people with type 1 diabetes mellitus

Diabetes control in children remains poor in spite of advances in treatment for last 10 years. The aim of this review was to look at various aspects of intensive therapy in the management of type 1 diabetes such as insulin regimes, role of target setting, psycho-educational approaches and self-management. To achieve good metabolic control, clear goal setting with adequate support for self-management are essential. Psycho-educational and behavioural interventions aimed at specific areas of management have shown significant improvement in quality of life and diabetes control.

Effectiveness of Clinical Pharmacist Directed-Diabetes Management

Objective: The main aim of the study is predominately utilizing clinical pharmacist in the provision of continuing diabetic education programs to emphasize and re-emphasize the importance of risk factors, prevention, adherence to medication and behavioral changes to prevent recurrences of the disease, their progression, and ultimately minimize hospitalization. Specific goals are to improve clinical outcomes for patients with diabetes—to maintain optimal plasma glucose concentrations Fasting, Postprandial Plasma Glucose, and Glycated Hemoglobin. Study design: A prospective interventional study in the Outpatient General Medicine Department, for a period of six months from October 2018 to March 2019. Results: HbA1c levels were reduced from baseline by &minus;1.107 ± 0.8634, Fasting Plasma Glucose levels and Postprandial blood glucose levels were reduced from baseline by &minus;24.2218 ± 5.70352 and &minus;30.1891 ± 1.40592 respectively. Conclusion: A trained clinical pharmacist by providing diabetes education and care can significantly reduce hyperglycemia, thereby improving the quality of life in diabetes patients and ultimately reducing health care costs associated with these morbidities.

Identifying Gaps in Real-World Management of Diabetes in Nigeria: A Subset Analysis of Cross-Sectional Wave-7 Data from the International Diabetes Management Practices Study

Background/Purpose: Poor glycemic control in Nigeria necessitates assessment and standardization of diabetes care. This study aimed to assess real-world management of people with type 2 diabetes mellitus (T2DM) and type 1 diabetes mellitus (T1DM) in Nigeria. Methods: This cross-sectional phase of the seventh wave of International Diabetes Management Practices Study, conducted between 22nd August and 30th September 2016, included adults with T1DM or T2DM during a two-week recruitment period. Results: Of 304 people with T2DM, 187 received oral glucose lowering drugs (OGLDs) only;88 received OGLDs + insulin;27 received insulin only. Metformin + sulfonylureas (128/187;68.45%) and premix only (76/115;66.09%) were the most used OGLD and insulin regimens respectively. Of 77 people with TIDM, all received insulin;six (7.79%) received OGLDs. Insulin initiation was noted around five years after diabetes diagnosis in T2DM (diabetes duration: 8.69 + 7.16 years;duration of insulin treatment: 3.17 ± 4.49 years). Proportion of people achieving glycemic targets (HbA1c Conclusion: Early insulinization and subsidized healthcare can improve long-term diabetes outcomes in Nigeria.

I must eat what I want: A roadblock to type 2 diabetes management

Globally,type 2 diabetes mellitus(T2DM)is considered as one of the most common diseases,which is associated with irreversible risk factors such as age,gene,race,ethnicity,and reversible factors such as diet,physical activity,and smoking.Noncompliance to dietary regimen is the major factors for rapidly rising incidence of T2DM among developing countries.Recently,elevated HbA1c level has also been considered as one of the leading risk factors for developing microvascular and macrovascular complications.Improvement in the elevated HbA1c level can be achieved through diet management;thus,this study found that improvement in patients’dietary knowledge,attitude toward,and compliance to diet regimen will promote a better control of the disease.In conclusion,the stakeholders(health-care providers,health facilities,agencies involved in T2DM care)should educate the patients on the importance of dietary modification in the disease management.Similarly,there is a need for nurses and other health care professionals to advocate and promote a better holistic management that will encourage patients participation and family involvement in the care.

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.

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.

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.

Effect of COVID-19 on management of type 1 diabetes:Pushing the boundaries of telemedical healthcare

The new coronavirus disease 2019(COVID-19)pandemic posed a great burden on health care systems worldwide and is an enormous and real obstacle in providing needed health care to patients with chronic diseases such as diabetes.Parallel to COVID-19,there have been great advances in technology used for management of type 1 diabetes,primarily insulin pumps,sensors,integrated and closed loop systems,ambulatory glucose profile software,and smart phone apps providing necessary essentials for telemedicine implementation right at the beginning of the COVID-19 pandemic.The results of these remote interventions are reassuring in terms of glycemic management and hemoglobin A1c reductions.However,data on long-term outcomes and cost reductions are missing as well as proper technical infrastructure and government health policy support.

Prediabetes in children and adolescents:An updated review

Prediabetes,the precursor of type 2 diabetes mellitus,is an intermediate stage between normal glucose homeostasis and overt diabetes.This asymptomatic metabolic state is increasingly prevalent in pediatric population and is very difficult to detect without appropriate screening.Studies have shown that a certain proportion of children with prediabetes will develop diabetes in a few years.Even more alarming is the evidence that youth-onset diabetes has a more aggressive clinical course with progressive beta-cell decline and accelerated endorgan damage.Despite its importance,several aspects involving prediabetes in childhood are disputed or unknown.This review presents the latest insights into this challenging entity and outlines a simplified screening approach to aid clinical practice.In summary,childhood prediabetes is an important clinical condition indicating the need for proper screening and timely intervention.

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.