Effects of five-year intensive multifactorial intervention on the serum amyloid A and macroangiopathy in patients with short-duration type 2 diabetes meUitus

Background A five-year follow-up study of intensive multifactorial intervention was undertaken to assess the changes of circulating serum amyloid A （SAA） levels and the incidence of atherosclerosis （AS） in patients with short-duration type 2 diabetes mellitus （T2DM） without macroangiopathy, and whether intensive multifactorial intervention could prevent or at least postpone the occurence of macroangiopathy. Methods Among 150 patients with short-duration T2DM, 75 were assigned to receive conventional outpatient treatment （conventional group） and the others underwent intensive multifactorial integrated therapy targeting hyperglycemia, hypertension, dyslipidemia and received aspirin simultaneously （intensive group）. Results Plasma SAA levels were higher in diabetic patients than those in healthy control subjects, and decreased obviously after intensive multifactorial intervention. The levels of SAA were positively correlated with body mass index （BMI）, waist hip ratio （WHR）, triglyceride （TG）, high sensitive C-reactive protein （hs-CRP） and common carotid intima-media thickness （CC-IMT）. The standard-reaching rates of glycemia, blood pressure and lipidemia were significantly higher in intensive group than those of conventional group. The incidence of macroangiopathy decreased by 58.96% in intensive group compared with conventional group. Conclusions Intensive multifactorial intervention may significantly reduce the SAA levels and prevent the occurrence of AS in short-duration patients with T2DM. SAA might be one of the risk factors of T2DM combined with AS.

Alphabet strategy for diabetes care:A checklist approach in the time of COVID-19 and beyond

Chronic disease management requires achievement of critical individualised targets to mitigate again long-term morbidity and premature mortality associated with diabetes mellitus.The responsibility for this lies with both the patient and health care professionals.Care plans have been introduced in many healthcare settings to provide a patient-centred approach that is both evidence-based to deliver positive clinical outcomes and allow individualised care.The Alphabet strategy(AS) for diabetes is based around such a care plan and has been evidenced to deliver high clinical standards in both well-resourced and underresourced settings.Additional patient educational resources include special care plans for those people with diabetes undertaking fasting during Ramadan,Preconception Care, Prevention and Remission of Diabetes.The Strategy and Care Plan has facilitated evidence-based,cost-efficient multifactorial intervention with an improvement in the National Diabetes Audit targets for blood pressure,cholesterol levels and glycated haemoglobin.Many of these attainments were of the standard seen in intensively treated cohorts of key randomized controlled trials in diabetes care such as the Steno-2 and United Kingdom Prospective Diabetes Study.This is despite working in a relatively under-resourced service within the United Kingdom National Health Service.The AS for diabetes care is a useful tool to consider for planning care, education of people with diabetes and healthcare professional.During the time of the coronavirus disease 2019 pandemic the risk factors for the increased mortality observed have to be addressed aggressively.The AS has the potential to help with this aspiration.