Effect of hospital discharge plan for children with type 1 diabetes on discharge readiness,discharge education quality,and blood glucose control

BACKGROUND Type 1 diabetes is one of the most common chronic diseases in childhood.The number of type 1 diabetes patients in China still ranks fourth in the world.Therefore,children with type 1 diabetes in China are a group that needs attention.The management of type 1 diabetes mellitus(T1DM)involves many aspects of daily life.It is extremely challenging for children and their families.T1DM children have complex medical care needs.Despite the continuous development of therapeutic medicine and treatment technologies,blood glucose control in children with T1DM is still not ideal.They and their parents need to acquire more knowledge and skills before being discharged.AIM To explore the influence of hospital discharge plan based on parental care needs of children with T1DM on discharge readiness,quality of discharge education and blood glucose control level.METHODS In total,102 parents of children with type 1 diabetes were divided into control group and intervention group according to admission time.Fifty cases from February to June 2019 were selected as the control group,and 52 cases from July to October 2019 were selected as the intervention group to implement the discharge plan.The Readiness for Hospital Discharge Scale,Hospital Discharged Education Quality Scale and children's blood glucose metabolism indicators were used to compare the differences in discharge preparation,discharge education quality and blood glucose control between the two groups of children and their parents.RESULTS On the day of discharge,the two groups of children had the following scores of readiness for discharge:The intervention group score was 225.34±32.47,and the control group score was 208.68±29.31.The P value was 0.007,and the difference was statistically significant.The discharge education quality scores were as follows:The intervention group score was 135.11±19.86,the control group score was 124.13±15.56,the P value was 0.002 and the difference was statistically significant.Three months after discharge,the blood glucose metabolism indicator showed that the glycosylated hemoglobin value of the two groups was(7.45%±1.04%),and that of the control group was(8.04%±1.27%),P=0.012.Therefore,the improvement of parents'readiness for discharge,quality of discharge education and blood glucose metabolism indicators(glycosylated hemoglobin,fasting blood glucose and postprandial blood glucose)in the intervention group were better than those in the control group(P<0.05),and the difference was statistically significant.CONCLUSION The discharge plan for children with T1DM can help the children and their families realize the transition from hospital care to home self-management and improve the parents'readiness for discharge,thereby improving children’s blood glucose control levels.

Establishment of blood glucose control model in diabetic mice

AIM:To explore the established method of the diabetic mouse blood glucose control model and preliminar y observation of its influence on the retinas of diabetic mice.METHODS:The db/db BKS-DB(Lepr^(ko/ko))mice were randomly divided into two groups:the poor blood glucose control group(PG group,n=18)and the stable blood glucose control group(SG group,n=12),with BKS-DB(Lepr^(wt/wt))as the normal blood glucose control group(NG group,n=18).According to the blood glucose values for 5 intervals which were monitored during the period of adaption,the PG group was injected with insulin aspart twice daily,fasted for 2h and then returned to normal.The SG group was injected with insulin aspart twice and insulin glargine once daily and fed with a quantitative ration.Fundus images were collected after eight weeks.The glycosylated hemoglobin(Hb A1c),mean blood glucose level(MBG),standard deviation of blood glucose(SDBG),coefficient of variation of blood glucose(CVBG),and mean amplitude of glycemic excursion(MAGE)in each group were examined and calculated.RESULTS:The Hb A1c,MBG,SDBG,CVBG,and MAGE levels in the PG group were significantly higher than those in the NG and SG groups(all P<0.05).MBG,SDBG,CVBG,and MAGE levels in the SG group were higher than those in the NG group(all P<0.05).There was no significant difference in Hb A1c levels between the NG and SG groups(P>0.05).Preliminary observation of fundus images in the PG group and SG groups showed scattered retinal bleeding spots,while bleeding was more obvious in the PG group.CONCLUSION:The blood glucose control model of type 2 diabetes mellitus mice can be successfully established by subcutaneous injection of insulin aspart insulin glargine and rationed food,which is valuable for studying the mechanism of blood glucose fluctuations in diabetic complications in vivo.

Investigation on Blood Glucose Control Nursing of ICU Severe Patients

Objective:To analyze the effect of blood glucose control mursing in intensive care umit (ICU)patients.Methods:The clinical data of 70 severe patients in ICU of ou hospital fom January 2019 to May 2020 were retrospectively analyzed.The climical data of 34 patients with routine intervention were divided into the control group,and the clinical data of 36 patients with routine intervention and blood glucose control mursing were divided into the observation group,all were intervened for 14 days.The blood glucose levels and prognosis of the two groups were compared before intervention and at the end of 14 days of intervention,the time required o achieve the standard blood glucose level of the two groups was recorded Results:After 14 days of intervention,the fasting blood glucose level of the observation group was lower than the control group,the difference was satisically significant(P<0.05);the time of blood glucose reaching the standard in the observation group was shorter than that in the control group,the difference was statistically significant(P<0.05);on the 14th day of intervention,the sequential organ failure asessment score(SOFA)score of the two groups was lower than before intervention,the SOFA score of the observation group was lower than control group,the difference was statistically significant(P<0.05).Conclusion:The effect of blood glucose control mursing in ICU is better,which effectively controlled the blood glucose level of patients and improved the prognosis of patients.

Can the Glucose Central Control System Dysfunctions Induce Diabetes Mellitus?

We study afresh how the glucose control system anomalies impact the organicity of the glucose homeostasis and build up events of persistent hyperglycemia and diabetes mellitus. We have used critically the state of art literature related to the subject, in order to cross, to compare, and to organize the relevant contents to create a logical and consistent support to the finds. We show that it is consistent to assume that persistent hyperglycemia and diabetes mellitus can have precursors not only in pancreas, but also in brain, mainly induced by noxious dysfunctions of hypothalamus sensor neurons circuits and external noxious elements, causing pancreas overload, and the consequent exhaustion—overburden.

Comparison of Space Glucose Control and Routine Glucose Management Protocol for Glycemic Control in Critically Ⅲ Patients： A Prospective, Randomized Clinical Study

Background：The Space Glucose Control （SGC） system is a computer-assisted device combining infusion pumps with the enhanced Model Predictive Control algorithm to achieve the target blood glucose （BG） level safely.The objective of this study was to evaluate the efficacy and safety of glycemic control by SGC with customized BG target range of 5.8-8.9 mmol/L in the critically ill patients.Methods：It is a randomized controlled trial of seventy critically ill patients with mechanical ventilation and hyperglycemia （BG 〉 9.0 mmol/L）.Thirty-six patients in the SGC group and 34 in the routine glucose management group were observed for three consecutive days.Target BG for both groups was 5.8-8.9 mmol/L.The primary outcome was the percentage time in the target range.Results：The percentage time within BG target range in the SGC group （69 ＆#177; 15%） was significantly higher than in the routine management group （52 ＆#177; 24%;P 〈 0.01）.No measurement was 〈2.2 mmol/L,and there was only one episode of hypoglycemia （2.3-3.3 mmol/L） in each group.The average BG was significantly lower in the SGC group （7.8 ＆#177; 0.7 mmol/L） than in the routine management group （9.1 ＆#177; 1.6 mmol/L,P 〈 0.001）.Target BG level was reached earlier in the SGC group than routine management group （2.5 ＆#177; 2.9 vs.12.1 ＆#177; 15.3 h,P =0.001）.However,the SGC group performed worse for daily insulin requirement （59.8 ＆#177; 39.3 vs.28.4 ＆#177; 36.7 U,P =0.001）and sampling interval （2.0 ＆#177; 0.5 vs.3.7 ＆#177; 0.5 h,P 〈 0.001） than the routine management group did.Multiple linear regression showed that the intervention group remained a significant individual predictor （P 〈 0.001） of the percentage time in target range.Conclusions：The SGC system,with a BG target of 5.8-8.9 mmol/L,resulted in effective and reliable glycemic control with few hypoglycemic episodes in critically ill patients with mechanical ventilation and hyperglycemia.However,the workload was increased.Trial Registration：http：//www.clinicaltrials.gov,NCT 02491346;https：//www.clinicaltrials.gov/ct2/show/NCT02491346？term=NCT0 2491346＆amp;cond=Hyperglycemia＆amp;cntry1=ES%3ACN＆amp;rank=1.

Research Progress on Non-Drug Treatment for Blood Glucose Control of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus （T2DM） is one of the common endocrinology diseases that greatly affects the health care sector and economy. Application of hypoglycemic drugs has its own drawbacks and the use of non-drug therapy on treating T2DM has drawn much attention recently. This paper reviewed the research development of the non-pharmacological interventions on T2DM in recent years, including dietary therapy, exercise therapy, psychotherapy, acupuncture and moxibustion therapies and so on. The authors mentioned the problems in the research of non-drug treatment for blood glucose control of T2DM and put forward new ideas for the research in the future. Further well-designed trials with large sample size and long-term follow-up are needed to confirm current conclusions.

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.

Differences in metabolic improvement after metabolic surgery are linked to the gut microbiota in non-obese diabetic rats

BACKGROUND Different metabolic/bariatric surgery approaches vary in their effect on weight loss and glucose levels,although the underlying mechanism is unclear.Studies have demonstrated that the gut microbiota might be an important mechanism of improved metabolism after metabolic/bariatric surgery.AIM To investigate the relationship between the improvement in metabolic disturbances and the changes in gut microbiota after gastric or intestinal bypass.METHODS We performed sleeve gastrectomy(SG),distal small intestine bypass(DSIB)or sham surgery in nonobese rats with diabetes induced by 60 mg/kg streptozotocin(STZ-DM).RESULTS The group comparisons revealed that both SG and DSIB induced a reduction in body weight and significant improvements in glucose and lipid metabolism in the STZ-DM rats.Furthermore,DSIB exhibited a stronger glucose-lowering and lipidreducing effect on STZ-DM rats than SG.16S ribosomal RNA gene sequencing revealed the gut abundance of some Lactobacillus spp.increased in both the SG and DSIB groups after surgery.However,the DSIB group exhibited a more pronounced increase in the gut abundance of Lactobacillus spp.compared to the SG group,with more Lactobacillus spp.types increased in the gut.CONCLUSION The gut abundance of Lactobacillus was significantly correlated with the improvement in glycolipid metabolism and the change in serum fibroblast growth factor 21 levels.

Effects of glycaemic management on diabetic kidney disease

Hyperglycaemia contributes to the onset and progression of diabetic kidney disease(DKD). Observational studies have not consistently demonstrated a glucose threshold, in terms of HbA1c levels, for the onset of DKD. Tight glucose control has clearly been shown to reduce the incidence of micro-or macroalbuminuria. However, evidence is now also emerging to suggest that intensive glucose control can slow glomerular filtration rate loss and possibly progression to end stage kidney disease. Achieving tight glucose control needs to be balanced against the increasing appreciation that glucose targets for the prevention of diabetes related complications need be individualised for each patient. Recently, empagliflozin which is an oral glucose lowering agent of the sodium glucose cotransporter-2 inhibitor class has been shown to have renal protective effects. However, the magnitude of empagliflozin's reno-protective properties are over and above that expected from its glucose lowering effects and most likely largely result from mechanisms involving alterations in intra-renal haemodynamics. Liraglutide and semaglutide, both injectable glucose lowering agents which are analogues of human glucagon like peptide-1 have also been shown to reduce progression to macroalbuminuria through mechanisms that remain to be fully elucidated. Here we review the evidence from observational and interventional studies that link good glucose control with improved renal outcomes. We also briefly review the potential reno-protective effects ofnewer glucose lowering agents.

No significant association between dipeptidyl peptidase-4 inhibitors and adverse outcomes of COVID-19

BACKGROUND Dipeptidyl peptidase-4(DPP4)is commonly targeted to achieve glycemic control and has potent anti-inflammatory and immunoregulatory effects.Recent structural analyses indicated a potential tight interaction between DPP4 and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),raising a promising hypothesis that DPP4 inhibitor(DPP4i)drugs might be an optimal strategy for treating coronavirus disease 2019(COVID-19)among patients with diabetes.However,there has been no direct clinical evidence illuminating the associations between DPP4i use and COVID-19 outcomes.AIM To illuminate the associations between DPP4i usage and the adverse outcomes of COVID-19.METHODS We conducted a multicenter,retrospective analysis including 2563 patients with type 2 diabetes who were hospitalized due to COVID-19 at 16 hospitals in Hubei Province,China.After excluding ineligible individuals,142 patients who received DPP4i drugs and 1115 patients who received non-DPP4i oral anti-diabetic drugs were included in the subsequent analysis.We performed a strict propensity score matching(PSM)analysis where age,sex,comorbidities,number of oral hypoglycemic agents,heart rate,blood pressure,pulse oxygen saturation(SpO2)<95%,CT diagnosed bilateral lung lesions,laboratory indicators,and proportion of insulin usage were matched.Finally,111 participants treated with DPP4i drugs were successfully matched to 333 non-DPP4i users.Then,a linear logistic model and mixed-effect Cox model were applied to analyze the associations between inhospital DPP4i use and adverse outcomes of COVID-19.RESULTS After rigorous matching and further adjustments for imbalanced variables in the linear logistic model and Cox adjusted model,we found that there was no significant association between in-hospital DPP4i use(DPP4i group)and 28-d allcause mortality(adjusted hazard ratio=0.44,95%CI:0.09-2.11,P=0.31).Likewise,the incidences and risks of secondary outcomes,including septic shock,acute respiratory distress syndrome,or acute organ(kidney,liver,and cardiac)injuries,were also comparable between the DPP4i and non-DPP4i groups.The performance of DPP4i agents in achieving glucose control(e.g.,the median level of fasting blood glucose and random blood glucose)and inflammatory regulation was approximately equivalent in the DPP4i and non-DPP4i groups.Furthermore,we did not observe substantial side effects such as uncontrolled glycemia or acidosis due to DPP4i application relative to the use of non-DPP4i agents in the study cohort.CONCLUSION Our findings demonstrated that DPP4i use is not significantly associated with poor outcomes of COVID-19 or other adverse effects of anti-diabetic treatment.The data support the continuation of DPP4i agents for diabetes management in the setting of COVID-19.

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.

Metabolic and functional effects of exercise training in diabetic kidney transplant recipients

BACKGROUND Physical activity levels are significantly lower in kidney transplant(KT)recipients compared to the general population.The effects of exercise training in KT recipients with diabetes mellitus remain unclear,and so little is known about the role of increased exercise on cardiovascular risk and metabolic profile of KT patients.AIM To investigate the effects of a 6-mo home-based exercise training program on functional capacity,glucose levels and lipid profile of diabetic KT patients.METHODS In total,21 type II diabetic KT recipients were randomly assigned into two groups:Exercise(n=11,aged 52.9±10.1 years)and control(n=10,aged 53.01±9.5 years).All participants at baseline and the end of the study underwent biochemical tests for fasting plasma glucose levels,glycated hemoglobin and lipid profile and cardiopulmonary exercise testing for maximum oxygen uptake[(VO2)peak]estimation.The exercise group followed a 6-mo supervised home-based aerobic and progressive resistance exercise program of moderate intensity 3 times per week,while the control group continued to receive usual care.RESULTS At the end of the 6-mo study,the exercise group had significantly lower values in fasting plasma glucose by 13.4%(from 120.6±28.9 mg/dL to 104.8±21.9 mg/dL,P=0.01),glycated hemoglobin by 1.5%(from 6.7%±0.4 to 6.6%±0.4,P=0.01)and triglycerides by 8.5%(from 164.7±14.8 mg/dL to 150.8±11.6 mg/dL,P<0.05)and higher values in high-density lipoprotein by 10.2%(from 51.4±8.8 mg/dL to 57.2±8.7 mg/dL,P<0.05)and(VO_(2))_(peak)by 4.7%(from 22.7±3.3 to 23.8±4.2,P=0.02)than the control group.There were statistically significant differences between the two groups at the end of the study for fasting plasma glucose(decreased by 9.6%,P<0.05),triglycerides(decreased by 4.5%,P=0.04)and(VO_(2))_(peak)(increased by 4.4%,P=0.01).Finally,after training,there was a moderate,positive linear relationship between(VO_(2))_(peak)and glycated hemoglobin in the exercise group(r=0.408,P=0.03).CONCLUSION The results demonstrated that a 6-mo home-based mixed type exercise training program can improve the functional capacity,levels of glucose and lipid profile of diabetic KT recipients.

The Effect of Baihu Decoction (白虎汤) on Blood Glucose Levels in Treating Systemic Inflammatory Response Syndrome

In this paper we investigated the mechanisms of Baihu Decoction （白虎汤, BH） and Baihu with Radix Ginseng （BHG） in treating systemic inflammatory response syndrome （SIRS） and sepsis in humans and animals. By reviewing published data on the effects of BH and BHG and the control of blood glucose in treating SIRS and sepsis, we found that （1） BH and BHG were beneficial in the treatment of SIRS and sepsis in humans and animals; （2） BH and BHG also had great effect in lowering blood glucose level; and （3） the tight control of blood glucose during critical illness substantially improved the outcome. Considering these data together, we hypothesize that one of the major mechanisms of BH and BHG in treating SIRS and sepsis is to lower the blood glucose level. The findings also suggest that the application of BH and BHG can extend to many acute illnesses and injuries, which commonly cause hyperglycemia.

Glucose-responsive erythrocyte-bound nanoparticles for continuously modulated insulin release

Glucose-responsive closed-loop insulin delivery systems represent a promising treatment strategy for diabetes,but current systems generally cannot achieve long-term effects.In this study,we designed an erythrocyte-biomimetic glucose-responsive system(EGRS)by coupling glucose-responsive nanoparticles(GRNs)to red blood cells;these nanoparticles exhibited the dual functions of glucose-responsiveness and persistent presence in circulation.GRNs are generated by encapsulating with insulin through ion crosslinking,followed by coloading with glucose oxidase(GOx)and catalase(CAT),a process that endows the nanoparticles with glucose-responsiveness.Simultaneously,the GRNs are coupled with red blood cells to camouflage them from the immune system,therefore,these erythrocyte-coupled GRNs can circulate in the blood for a long time.Under conditions of hyperglycemia,GOx acts on blood glucose to produce gluconic acid,which causes the rupture of GRNs and efficient release of insulin.Conversely,insulin is only released at the basic rate during hypoglycemia.Thus,EGRS can efficiently and continuously respond to hyperglycemia to maintain blood glucose levels within the normal range.

Recent advances in glucose-responsive insulin delivery systems:novel hydrogels and future applications

Over the past several decades,there have been major advancements in the field of glucose sensing and insulin delivery for the treatment of type I diabetes mellitus.The introduction of closed-loop insulin delivery systems that deliver insulin in response to specific levels of glucose in the blood has shifted significantly the research in this field.These systems consist of encapsulated glucose-sensitive components such as glucose oxidase or phenylboronic acid in hydrogels,microgels or nanoparticles.Since our previous evaluation of these systems in a contribution in 2004,new systems have been developed.Important improvements in key issues,such as consistent insulin delivery over an extended period of time have been addressed.In this contribution,we discuss recent advancements over the last 5 years and present persisting issues in these technologies that must be overcome in order for these systems to be applicable in patients.