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Intensive glycemic control

Thomas H Inge, Lori M Laffel, Todd M Jenkins, Marsha D Marcus, Natasha I Leibel, Mary L Brandt, Morey Haymond, Elaine M Urbina, Lawrence M Dolan, Philip S Zeitler
Importance: Because of the substantial increase in the occurrence of type 2 diabetes in the pediatric population and the medical complications of this condition, therapies are urgently needed that will achieve better glycemic control than standard medical management. Objective: To compare glycemic control in cohorts of severely obese adolescents with type 2 diabetes undergoing medical and surgical interventions. Design, Setting, and Participants: A secondary analysis of data collected by the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) consortia was performed...
March 12, 2018: JAMA Pediatrics
Mahmoudreza Taghizadeh, Sajad Ahmadizad, Mahmood Naderi
BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with thrombotic events due to platelets' defects. OBJECTIVE: The aim of this study was to investigate the effects of endurance training on expressions of platelet hsa-miR-223 and P2RY12 receptor, as well as platelet function in T2DM patients. METHODS: Twenty female T2DM patients (age, 62.25±3.81 yr; weight, 73.53±9.04 kg; height, 154.7±4.3 cm) were randomly divided into two groups (Control (CONT) and endurance training (ET))...
March 7, 2018: Clinical Hemorheology and Microcirculation
Helen Phelan, Bruce King, Donald Anderson, Patricia Crock, Prudence Lopez, Carmel Smart
BACKGROUND: Young children with type 1 diabetes (T1D) present unique challenges for intensive diabetes management. We describe an intensive diabetes program adapted for young children and compare glycemic control, anthropometry, dietary practices and insulin regimens before and after implementation. METHODS: Cross sectional data from children with T1D aged ≥0.5 to <7.0 years attending the John Hunter Children's Hospital (JHCH), Australia in 2004, 2010 and 2016 were compared...
March 4, 2018: Pediatric Diabetes
Lvlin Chen, Tiangui Li, Fang Fang, Yu Zhang, Andrew Faramand
BACKGROUND: Hyperglycemia is prevalent in patients in the pediatric intensive care unit. The purpose of this study was to describe the benefits and risks of tight glucose control (TGC) in critically ill children. METHODS: A systemic review and meta-analysis of the literature was carried out on randomized controlled trials of TGC in critically ill children admitted to the pediatric intensive care unit. The databases searched were Medline, Embase, and CENTRAL databases until May 1, 2017...
March 4, 2018: Critical Care: the Official Journal of the Critical Care Forum
Laura Gandrud, Aylin Altan, Paul Buzinec, Jesse Hemphill, Jayne Chatterton, Tina Kelley, Deneen Vojta
OBJECTIVE: While frequent contact with diabetes care providers may improve glycemic control among patients with type 1 diabetes (T1D), in-person visits are labor-intensive and costly. This study was conducted to assess the impact of an intensive remote therapy (IRT) intervention for pediatric patients with T1D. METHODS: Pediatric patients with T1D were randomized to IRT or conventional care (CC) for 6 months. Both cohorts continued routine quarterly clinic visits and uploaded device data; for the IRT cohort, data were reviewed and patients were contacted if regimen adjustments were indicated...
February 21, 2018: Pediatric Diabetes
Joeri Jan Pen, Galina Khorosheva, Ursule Van de Velde, Corinne Debroye, André Huyghebaert, Raoul Rottiers, Bart Keymeulen
BACKGROUND & AIMS: Sweetening agents are sugar substitutes with a low glycemic index, used to obtain a better glycemic control in diabetes patients. However, they also may have a role in other subjects, as a high glycemic index is thought to cause many pathological conditions. Unfortunately, not all artificial sweeteners are perceived as sweet as sugar by patients. Consumers refer often to an after taste present in foods sweetened with intensive sweeteners. The objective of this study was to explore whether Zùsto® had a low glycemic index, to replace glucose as a sweetener...
February 2018: Clinical Nutrition ESPEN
Adam B King, Clark D Kensinger, Yaping Shi, Matthew S Shotwell, Seth J Karp, Pratik P Pandharipande, J Kelly Wright, Liza M Weavind
BACKGROUND: Liver transplant recipients continue to have high perioperative resource utilization and prolonged length of stay despite improvements in perioperative care. Enhanced recovery pathways have been shown in other surgical populations to produce reductions in hospital resource utilization. METHODS: A prospective, observational study was performed to examine the effect of an enhanced recovery pathway for postoperative care after liver transplantation. Outcomes from patients undergoing liver transplantation from November 1, 2013, to October 31, 2014, managed by the pathway were compared to transplant recipients from the year before pathway implementation...
February 9, 2018: Anesthesia and Analgesia
Finlay A McAlister, Brendan Cord Lethebe, Caitlin Lambe, Tyler Williamson, Mark Lowerison
BACKGROUND: To examine the intensity of glycemic and blood pressure control in British adults with diabetes mellitus and whether control levels or treatment deintensification rates differ across health states. METHODS: Retrospective cohort study using primary care electronic medical records (the United Kingdom Health Improvement Network Database) for adults with diabetes diagnosed at least 6 months before the index HbA1C and systolic blood pressure (SBP) measurements (to give their primary care physicians time to achieve treatment goals)...
February 12, 2018: Cardiovascular Diabetology
Ricardo Rodrigues, Luciana Alves de Medeiros, Lucas Moreira Cunha, Mario da Silva Garrote-Filho, Morun Bernardino Neto, Paulo Tannus Jorge, Elmiro Santos Resende, Nilson Penha-Silva
OBJECTIVES: This study aimed to evaluate the correlations of glycemic variability with erythrocyte membrane stability parameters and oxidative stress markers in patients with DM1 under intensive treatment. MATERIAL AND METHODS: 90 patients with DM1 and under intensive treatment of the disease were evaluated in relation to anthropometric indices, records of glycemic averages and parameters of glycemic variability, biochemical dosages (glucose, uric acid, lipidogram, glycated hemoglobin, microalbuminuria, creatinine and iron) reticulocyte count, erythrocyte membrane stability parameters and oxidative stress markers (thiobarbituric acid reactive substances, TBARS, and glutathione reductase, GR)...
February 7, 2018: Diabetes Research and Clinical Practice
Xiaofei Huang, Sha Li, Mei Yang, Xuquan Fu, Huaqi Li, Tong Yan, Yidong Liu, Lihong Chen, Lingsheng Lan, Libo Li, Xiaowei Zhong
OBJECTIVE: Early short-term intensive insulin therapy in newly diagnosed type 2 diabetes patients shows benefit in glycemic control and β-cell function. Glucagon-like peptide-1 (GLP-1) plays an important role in glucose metabolism and development of type 2 diabetes. We did a study to observe the changes of GLP-1 and β-cell function after short-term continuous subcutaneous insulin infusion (CSII) treatment. METHODS: A total of 66 subjects were enrolled, including 30 normal glucose tolerance controls (NGT) and 36 patients with newly diagnosed type 2 diabetes between October, 2015 and July, 2016...
February 3, 2018: Diabetes Research and Clinical Practice
Marian Sue Kirkman, Hussain Mahmud, Mary T Korytkowski
People with type 2 diabetes mellitus are at high risk of morbidity and mortality from cardiovascular disease (CVD). Based on observed relationships between hyperglycemia and CVD, several large clinical trials have investigated the ability of treatment strategies to achieve hemoglobin A1c less than 7% (53 mmol/mol) as a way of reducing this risk. These studies demonstrate that intensified glycemic therapy may reduce CVD risk in younger patients with recent-onset type 2 diabetes mellitus but not in high-risk older individuals with established disease...
March 2018: Endocrinology and Metabolism Clinics of North America
Savitha Subramanian, Irl B Hirsch
Type 1 diabetes mellitus, an autoimmune disorder characterized by beta-cell destruction and absolute insulin deficiency, is associated with significantly increased cardiovascular disease risk but the mechanisms underlying this enhanced risk are unclear. Results of the pivotal Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study have shown that compared to conventional therapy, intensive glycemic control results in decreased cardiovascular morbidity and mortality...
March 2018: Endocrinology and Metabolism Clinics of North America
Klemens Wallner, Rene G Pedroza, Isaac Awotwe, James M Piret, Peter A Senior, A M James Shapiro, Christopher McCabe
BACKGROUND: Although current beta cell replacement therapy is effective in stabilizing glycemic control in highly selected patients with refractory type 1 diabetes, many hurdles are inherent to this and other donor-based transplantation methods. One solution could be moving to stem cell-derived transplant tissue. This study investigates a novel stem cell-derived graft and implant technology and explores the circumstances of its cost-effectiveness compared to intensive insulin therapy...
January 30, 2018: BMC Endocrine Disorders
Ravi Retnakaran, Haysook Choi, Chang Ye, Caroline K Kramer, Bernard Zinman
AIMS: To test the hypothesis that "induction" intensive insulin therapy (IIT) needs to be followed by "maintenance therapy" to preserve β-cell function, and to evaluate the impact on β-cell function over 2 years of two approaches to maintenance therapy: intermittent short-term IIT every 3 months vs daily metformin. MATERIALS AND METHODS: In this trial, 24 adults with a mean type 2 diabetes mellitus (T2DM) duration of 2.0 ± 1.7 years and glycated haemoglobin (HbA1c) levels 6...
January 27, 2018: Diabetes, Obesity & Metabolism
Maria L Stewart, Meredith L Wilcox, Marjorie Bell, Mary A Buggia, Kevin C Maki
Resistant starch (RS) is a type of dietary fiber that has been acknowledged for multiple physiological benefits. Resistant starch type 4 (RS4) is a subcategory of RS that has been more intensively studied as new types of RS4 emerge in the food supply. The primary aim of this randomized, double-blind, controlled study was to characterize the postprandial glucose response in healthy adults after consuming a high fiber scone containing a novel RS4 or a low fiber control scone without RS4. Secondary aims included assessment of postprandial insulin response, postprandial satiety, and gastrointestinal tolerance...
January 26, 2018: Nutrients
Yuka Omura, Yoshiki Kusama, Noriko Takeuchi, Naruhiko Ishiwada
We report a case of mediastinal subcutaneous and multiple muscular abscesses caused by group B streptococcus serotype VIII in a type 2 diabetes mellitus patient. The patient arrived at the hospital with the chief complaint of immobility, and blood examination results suggested an acute infection and poorly controlled diabetes mellitus. Group B streptococcal bacteria were cultured from the patient's blood, and identified as serotype VIII upon further analysis. The patient recovered without any sequelae after percutaneous drainage, antibiotic therapy, and intensive glycemic control...
January 17, 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Gili Bisker, Naveed Ali Bakh, Michael A Lee, Jiyoung Ahn, Minkyung Park, Ellen B O'Connell, Nicole Iverson, Michael S Strano
Corona Phase Molecular Recognition (CoPhMoRe) is a technique whereby an external, adsorbed phase around a colloidal nanoparticle is selected such that its molecular conformation or interaction recognizes a specific target analyte. In this work, we employ a high-throughput screening of a library of poly(ethylene glycol) (PEG)-conjugated lipids adsorbed onto near-infrared fluorescent single-walled carbon nanotubes to discover a corona phase selective for insulin. We find that a C16-PEG(2000kDa)-Ceramide causes a 62% fluorescent intensity decrease of the (10,2) chirality nanotube in 20 µg/ml insulin concentration...
January 23, 2018: ACS Sensors
Tsutomu Namikawa, Masaya Munekage, Tomoaki Yatabe, Hiroyuki Kitagawa, Kazuhiro Hanazaki
Surgical stress induces hyperglycemia and gives rise to glucose toxicity, which causes infectious diseases, resulting in unfavorable surgical outcomes. Intensive insulin treatment can control short- and long-term complications in patients with not only diabetes mellitus, but also surgical diabetes; however, it is associated with an increased risk of hypoglycemia. The wearable artificial pancreas was originally developed to control glucose levels in patients with type 1 diabetes, progressing to a device with enhanced stability and safety for these patients...
January 22, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Scott J Pilla, Hsin-Chieh Yeh, Stephen P Juraschek, Jeanne M Clark, Nisa M Maruthur
BACKGROUND: The decision to initiate insulin in patients with type 2 diabetes is a challenging escalation of care that requires an individualized approach. However, the sociodemographic and clinical factors affecting insulin initiation are not well understood. OBJECTIVE: We sought to identify patient factors that were independent predictors of insulin initiation among participants in the Look AHEAD (Action for Health in Diabetes) clinical trial. DESIGN: Retrospective analysis of a randomized clinical trial...
January 19, 2018: Journal of General Internal Medicine
Naoya Toriu, Masayuki Yamanouchi, Rikako Hiramatsu, Noriko Hayami, Junichi Hoshino, Akinari Sekine, Masahiro Kawada, Eiko Hasegawa, Tatsuya Suwabe, Keiichi Sumida, Toshiharu Ueno, Naoki Sawa, Kenichi Ohashi, Takeshi Fujii, Kenmei Takaichi, Motoko Yanagita, Tetsuro Kobayasi, Yoshifumi Ubara
We report the case of a 67-year-old Japanese woman with type 1 diabetes mellitus. At 47 years of age, her hemoglobin A1c (HbA1c) was 10.0%, and she had overt nephropathy. The first renal biopsy yielded a diagnosis of diabetic nephropathy. Intensive glycemic control was initiated and her HbA1c improved to 6.0%. Renal dysfunction showed no progression for 15 years. At 62 years of age, a second renal biopsy was performed. Glomerular lesions did not show progression but tubulointerstitial fibrosis and vascular lesions showed progression compared with the first biopsy...
2018: Endocrinology, Diabetes & Metabolism Case Reports
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