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Results for “Glycemic Control”

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At least 289 records · Page 16Linked to original sources

PubMed2002

Safety, efficacy, and effects on glycemic control of electroconvulsive therapy in insulin-requiring type 2 diabetic patients.

OBJECTIVE: To determine the safety, efficacy, and effects on glycemic control of electroconvulsive therapy (ECT) in insulin-requiring type 2 diabetic patients. METHODS: Chart review was conducted of 19 patients with insulin-requiring type 2 diabetes mellitus who underwent ECT at Mayo Clinic (Rochester, Minnesota) between 1993 and 2000. None of the patients received oral hypoglycemic drugs. Daily fasting blood glucose concentrations and daily insulin requirements were determined. For each patient, the daily insulin requirements before the first ECT treatment were compared with insulin requirements after the last ECT treatment. In addition, the insulin requirements 1 day before and 1 day after each ECT treatment (n = 143) were compared. Charts were reviewed for activity, appetite, and weight changes. RESULTS: The average change in daily insulin requirements 1 day before the initiation of ECT compared with 1 day after the completion of ECT was not statistically significant. Changes in dietary or activity levels correlated with fluctuations in insulin requirements in selected individuals. There were no significant changes in acute glycemic control associated with ECT. CONCLUSIONS: Our findings refute previous reports of dangerous hyperglycemia or improved glycemic control due to ECT in insulin-requiring type 2 diabetes, and suggest that ECT is safe and efficacious in these patients.

Adult↗

PubMed2006

Prevalence of inadequate glycemic control among patients with type 2 diabetes in the United Kingdom general practice research database: A series of retrospective analyses of data from 1998 through 2002.

BACKGROUND: Since the mid-1990s, the development of new oral antidiabetic agents (OAs) and treatment guidelines have created an opportunity to improve glycemic control in patients with type 2 diabetes. OBJECTIVES: This study aimed to assess the prevalence of good and inadequate glycemic control across a 5-year period among patients with diabetes in the United Kingdom. It also investigated the factors associated with achieving glycemic targets. METHODS: This was a retrospective, cross-sectional analysis of data from the General Practice Research Database. Three limits were used to assess glycosylated hemoglobin (HbA1c): 6.5%, 7.0%, or 7.5%. Values above the cutoffs indicated inadequate control of HbA1c; those at or below the cutoffs indicated good control. The study evaluated clinical and pharmacy data from the years 1998 to 2002 for patients with type 2 diabetes, > or =2 years of follow-up, and > or =2 HbA1c measurements during the first year. Five independent cross-sectional analyses were conducted, grouping data by year. Statistical significance was determined by Student t and chi2 tests. RESULTS: Data were analyzed for 10,663 patients aged 17 to 98 years. The number of total eligible type 2 diabetes patients increased over the course of the study period: 5674 patients in 1998, 6553 in 1999, 7314 in 2000, 7323 in 2001, and 6192 in 2002. Overall, the study population had a mean (SD) age of 66 (11.0) years, was 53% male (3033/5674), and had a body mass index of 29 kg/m(2). Seventy-six percent of patients had HbA1c >7.0% and 37% were taking > or =2 oral agents. In 1998 and 2002, 79% (4482/5674) and 76% (4732/6192) of patients, respectively, had inadequate glycemic control, defined as HbA1c >7.0%. When defined as HbA1c >7.5%, 69% (3923/5674) and 62% (3814/6192) of patients, respectively, had inadequate control. Finally, when defined as HbA1c >6.5%, 88% (5011/5674) of patients in both 1998 and 2002 had inadequate control. Compared with patients with good disease control (HbA1c < or =7.0%), patients with inadequate control were approximately 2 years younger (P < 0.001) and had been prescribed more OAs: 41% received > or =2 OAs in 1998 and 52% in 2002, compared with 23% and 34% (both, P = 0.001), respectively, of patients with good glycemic control (P < 0.02). Sex, number of diabetes complications, and number of comorbidities did not differ between groups (P = NS). CONCLUSIONS: Despite the introduction of new OAs and treatment guidelines, the prevalence of inadequate glycemic control remains high (>60%) in patients with type 2 diabetes in the United Kingdom. Regardless of the HbA1c cutoff, patients with inadequate control were younger and received prescriptions for more OAs than patients with good control.

Administration, Oral↗

PubMed2006

The effectiveness of intensive glycemic control for the prevention of vascular complications in diabetes mellitus.

Obesity and type 2 diabetes mellitus have reached epidemic proportions in the US, and indeed, globally. While microvascular complications contribute to considerable morbidity, much of the excess mortality (around 70%) is due to macrovascular disease. Hyperglycemia has predictable toxic effects on multiple organs ('glucotoxicity') including the pancreas, where it impairs insulin secretion and insulin gene expression through mechanisms that lead to glucose densensitization and beta-cell exhaustion, eventually resulting in irreversible beta-cell failure. There is robust evidence to suggest that strict glycemic control reduces diabetic microvascular complications (retinopathy, nephropathy, and neuropathy) in both primary- and secondary-prevention settings. While unequivocal evidence that intensive glycemic control reduces the risk of death due to macrovascular disease is lacking, meta-analytic data and controlled clinical trial data suggest there may still be clinically significant lowering of the risk for macrovascular endpoints through strict glycemic control. Cardiovascular disease in a diabetic patient is a collusion of several factors besides hyperglycemia, such as hypertension, dyslipidemia, diffuse endothelial dysfunction, hypercoagulability, and inflammation. It is important to address lifestyle issues such as maintenance of ideal bodyweight, good dietary practice, smoking cessation, and regular exercise in the comprehensive risk management of a diabetic patient, in order to reduce the vascular complications. Large, ongoing clinical trials such as ACCORD (Action to Control Cardiovascular Risk in Diabetes) are likely to establish the potential benefits of glycemic control in preventing or postponing macrovascular complications of diabetes.

Blood Glucose↗

PubMed2006

Impact of glycemic control on survival of diabetic patients on chronic regular hemodialysis: a 7-year observational study.

OBJECTIVE: To investigate the impact of glycemic control during regular hemodialysis on the survival of diabetic patients with chronic kidney disease (CKD) in a longitudinal observational study. RESEARCH DESIGN AND METHODS: A total of 114 diabetic CKD patients on hemodialysis at Inoue Hospital (Suita, Japan) were surveyed from May 1995 to December 2002 (survey period 45.5 +/- 29.3 [means +/- SD] months). All subjects were categorized into three groups by mean HbA(1c) (A1C) level during the 3-month period on hemodialysis preceding entry, as follows: good (A1C <6.5%, 5.7 +/- 0.4%, n = 34), fair (6.5 or=8.0%, 9.2 +/- 0.9%, n = 41) A1C groups. RESULTS: There were no significant differences in age at entry, initiation of hemodialysis, duration of hemodialysis, blood pressure, cardiothoracic ratio, serum creatinine level, or hemoglobin level among the three groups. The cumulative survival of the poor A1C group during the survey was significantly lower than that of the fair and good A1C groups as determined by Kaplan-Meier estimation (P = 0.041, log-rank test). In a multivariate Cox proportional hazard model, both poor A1C group (hazard ratio 2.889, P = 0.010) and mean A1C (1.260 per 1.0%, P = 0.003) were significant predictors of survival. CONCLUSIONS: In diabetic CKD patients on regular hemodialysis, poor glycemic control is an independent predictor of prognosis. This finding indicates the importance of careful management of glycemic control even after initiation of hemodialysis.

Blood Glucose↗

PubMedDate not supplied

A quality improvement project for better glycemic control in hospitalized patients with diabetes.

PURPOSE: A quality improvement (QI) study was designed to improve nursing interventions that impact glycemic control in hospitalized patients with diabetes. The objective was to improve the timing of premeal insulin to allow a half hour lag time for regular insulin. METHODS: An interdisciplinary planning team was established that included both medical and surgical units. Data were collected by concurrent review of electronic charts, evaluated monthly by management and the diabetes clinical coordinator, and shared with staff. RESULTS: This QI study increased staff nurses' awareness of the importance of their role in achieving better glycemic control for inpatients with diabetes. By the end of the study, the nurses delivered premeal insulin correctly 82% of the time on the medical unit, 65% of the time on the cardiac unit, and 61% of the time on the surgical unit. Even with concerted effort, however, it was difficult to consistently administer regular insulin with a half hour lag time in the hospital environment. CONCLUSIONS: By working together with the patient, family, and other staff, nurses can more consistently deliver premeal insulin at appropriate times to help improve glycemic control in the hospitalized patient with diabetes.

Blood Glucose↗

PubMed2005

A retrospective chart review of the clinical effects of atypical antipsychotic drugs on glycemic control in institutionalized patients with schizophrenia and comorbid diabetes mellitus.

BACKGROUND: The association between schizophrenia and onset of type 2 diabetes mellitus (DM) is well documented. It is unclear whether this association is due to inherent risk factors in individuals with schizophrenia or to treatment with antipsychotic drugs, particularly atypical antipsychotic agents. OBJECTIVES: The goals of this retrospective, observational study were the following: (1) to determine whether adequate glycemic control could be achieved in patients with schizophrenia and comorbid DM who were undergoing treatment with atypical antipsychotic drugs, (2) to identify inherent risk factors that may affect glycemic control in this patient population, and (3) to consider the possibility that combined medication and inherent risk factors may affect glycemic control. METHODS: This was a retrospective, observational chart review that evaluated institutionalized patients in a New Jersey mental institution with concurrent diagnoses of schizophrenia and type 1 or 2 DM who were being treated with atypical antipsychotic agents (ie, olanzapine, risperidone, clozapine, or quetiapine) and were referred by their hospital internists to a weekly, half-day, in-hospital DM clinic. All patients with initial and end-point data for the efficacy measure (ie, change in glycosylated hemoglobin [HbA(1c)]) were included in the analysis. Mixed-effects linear and least-squares models were used to test whether a specific comorbidity had an effect on the change in HbA(1c) adjusted for the duration of the observation. RESULTS: A total of 72 patients met entry criteria. Among the 38 patients with baseline and end-point data (20 treated with olanzapine and 18 treated with risperidone), mean (SD) HbA(1c) decreased from 8.21% (2.4%) to 7.62% (1.7%). The only baseline demographic characteristic or comorbidity that predicted significant worsening in the adjusted HbA(1c) change was hepatitis (P = 0.003). CONCLUSIONS: Using appropriate, aggressive antidiabetic therapy, glycemic control was achieved in this group of patients with schizophrenia and comorbid DM who were treated with atypical antipsychotic agents.

Adult↗

PubMed1993

Long-term glycemic control and neurological function in IDDM patients.

OBJECTIVE: To examine the relationship between sensory modalities of neurological function and antecedent glycemic control in IDDM patients. RESEARCH DESIGN AND METHODS: Examinations were conducted on 220 IDDM patients (age at onset < 25 yr, duration < 18 yr) for the presence or absence of the right or left ankle reflex and determination of vibration perception threshold at each medial malleolus and great toe using biothesiometry. These parameters were related to the concurrent HbA1 and to a mean of serial measurements (mean HbA1) over the previous 6 yr. RESULTS: Ankle reflexes were absent in 39 (right ankle) and 41 (left ankle) patients, respectively. Mean (right + left) ankle and toe VPTs were 8.7 +/- 3.6 and 6.3 +/- 4.2 (mean +/- SD) (arbitrary units), respectively. Both the mean and concurrent HbA1 were significantly different in patients with absent ankle reflexes (11.6 +/- 1.9 and 12.2 +/- 2.8%, respectively) compared with present ankle reflexes (10.3 +/- 1.7, 10.3 +/- 2.1%) (P < 0.0001). Similarly, a present ankle reflex was related to mean HbA1 arbitrarily divided into groups < 10, 10-12, > 12% (P = 0.0009). In contrast, mean ankle VPT (8.0 +/- 2.2, 8.8 +/- 3.1, and 10.3 +/- 6.2) and toe VPT (5.5 +/- 2.2, 6.1 +/- 2.9, and 8.5 +/- 8.2) did not increase significantly with poor glycemic control (P > 0.05). Age, right ankle reflex, retinopathy, 24-h urinary albumin excretion rate, and erect systolic blood pressure were the only independent variables predicting the toe VPT using linear regression analysis. CONCLUSIONS: These findings support a role for glycemic control in neurological dysfunction in IDDM patients, but also suggest that other unknown factors may be involved.

Adult↗

PubMed2004

Telecare for patients with type 1 diabetes and inadequate glycemic control: a randomized controlled trial and meta-analysis.

OBJECTIVE: To determine the efficacy of telecare (modem transmission of glucometer data and clinician feedback) to support intensive insulin therapy in patients with type 1 diabetes and inadequate glycemic control. RESEARCH DESIGN AND METHODS: Thirty-one patients with type 1 diabetes on intensive insulin therapy and with HbA1c >7.8% were randomized to telecare (glucometer transmission with feedback) or control (glucometer transmission without feedback) for 6 months. The primary end point was 6-month HbA1c. To place our findings in context, we pooled HbA1c change from baseline reported in randomized trials of telecare identified in a systematic review of the literature. RESULTS: Compared with the control group, telecare patients had a significantly lower 6-month HbA1c (8.2 vs. 7.8%, P = 0.03, after accounting for HbA1c at baseline) and a nonsignificant fourfold greater chance of achieving 6-month HbA1c < or =7% (29 vs. 7%; risk difference 21.9%, 95% CI -4.7 to 50.5). Nurses spent 50 more min/patient giving feedback on the phone with telecare patients than with control patients. Meta-analysis of seven randomized trials of adult patients with type 1 diabetes found a 0.4% difference (95% CI 0-0.8) in HbA1c mean change from baseline between the telecare and control groups. CONCLUSIONS: Telecare is associated with small effects on glycemic control in patients with type 1 diabetes on intensive insulin therapy but with inadequate glycemic control.

Adult↗

PubMed2006

Intensive glycemic control in diabetic pregnancy with intrauterine growth restriction is detrimental to fetus.

Hyperglycemia during early pregnancy can lead to congenital malformations and/or spontaneous abortion while in the last few days of pregnancy it causes neonatal metabolic complications. Macrosomia is the most common complication and is due to maternal hyperglycemia in second and third trimester of pregnancy. In view of all these, intensive glycemic control of the mother is recommended throughout pregnancy. Intrauterine growth restriction (IUGR) is a well known complication of pre-gestational diabetic patients due to vasculopathy and is also seen in gestational diabetes mellitus (GDM) due to overinsulinisation. Hitherto there are no separate recommendations for glycemic targets in pregnant diabetic patients with IUGR. In presence of IUGR due placental vascular insufficiency, intensive glycemic control may deprive fetus of nutrition. Secondly frequent hypoglycemias which are inevitable complication of insulin treatment may further worsen the IUGR. In presence of IUGR, macrosomia is a rare possibility, and in such situation intensive glycemic control throughout pregnancy may not be justifiable and may actually be detrimental. Neonatal metabolic complications can be avoided by strict glycemic control during last two weeks of pregnancy.

Female↗

PubMed2006

Community center-based resistance training for the maintenance of glycemic control in adults with type 2 diabetes.

OBJECTIVE: The purpose of this study was to determine whether beneficial effects on glycemic control of an initial laboratory-supervised resistance training program could be sustained through a community center-based maintenance program. RESEARCH DESIGN AND METHODS: We studied 57 overweight (BMI >or=27 kg/m2) sedentary men and women aged 40-80 years with established (>6 months) type 2 diabetes. Initially, all participants attended a twice-weekly 2-month supervised resistance training program conducted in the exercise laboratory. Thereafter, participants undertook a resistance training maintenance program (2 times/week) for 12 months and were randomly assigned to carry this out either in a community fitness and recreation center (center) or in their domestic environment (home). Glycemic control (HbA1c [A1C]) was assessed at 0, 2, and 14 months. RESULTS: Pooling data from the two groups for the 2-month supervised resistance training program showed that compared with baseline, mean A1C fell by -0.4% [95% CI -0.6 to -0.2]. Within-group comparisons showed that A1C remained lower than baseline values at 14 months in the center group (-0.4% [-0.7 to -0.03]) but not in the home group (-0.1% [-0.4 to 0.3]). However, no between-group differences were observed at each time point. Changes in A1C during the maintenance period were positively associated with exercise adherence in the center group only. CONCLUSIONS: Center-based but not home-based resistance training was associated with the maintenance of modestly improved glycemic control from baseline, which was proportional to program adherence. Our findings emphasize the need to develop and test behavioral methods to promote healthy lifestyles including increased physical activity in adults with type 2 diabetes.

Adipose Tissue↗

PubMed2002

Long-term glycemic control measurements in diabetic patients receiving hemodialysis.

Cardiovascular morbidity is increased in patients with diabetes mellitus and there is a great prevalence of diabetes and cardiovascular disease among patients with end-stage renal disease (ESRD). Control of glycemia can decrease cardiovascular and end-organ damage. Because the validity of glycemic control tests have not been rigorously studied in patients with ESRD, we evaluated the value of various measures in these patients. The overall clinical goal was to investigate whether hemoglobin A1C (A1C) accurately reflects actual glycemic control as compared with other measures in light of the importance of attaining appropriately controlled blood glucose (BG). The commonly used tests of total glycated hemoglobin (GHb) and A1C may be unreliable in patients with ESRD because of the presence of anemia, shortened red blood cell (RBC) survival, and assay interferences from uremia. The primary aim of this study was to assess the relationship of capillary BG measurements to A1C, GHb, total glycated plasma proteins (GPP), and fructosamine (Fr) in diabetic patients receiving hemodialysis. Twenty-three patients were instructed to obtain BG evaluations twice daily for 7 days by using the Elite glucometer (Bayer Corporation, Elkhart, IN). These determinations included 6 fasting, 6 preprandial, and 3 separate 2-hour postprandial levels. Blood was obtained on day 7 for measurement of A1C, GHb, GPP, and Fr. A1C was analyzed by an immunoassay, GPP and GHb were assayed by affinity high-performance liquid chromatography (HPLC), and Fr by automated nitroblue colorimetric assay. Scatter plots were generated by plotting the average BG versus A1C, GHb, GPP, or Fr. Linear regression was performed for each plot showing the following relationships: A1C = 0.0174 (BG) + 4.76 (r = 0.58; P < 0.05): GHb = 0.0371 (BG) + 3.57 (r = 0.584; P < 0.05): GPP = 0.0083 (BG) + 26.13 (r = 0.065; P = 0.77): Fr = 0.6865 (BG) + 250 (r = 0.345; P = 0.11). Despite anemia and shortened RBC lifespan in patients with ESRD, A1C in the range of 6% to 7% estimates glycemic control similarly to patients without severe renal impairment. A1C values above 7.5% may overestimate hyperglycemia in patients with ESRD. Thus, diabetic patients receiving hemodialysis may have long-term BG that are more properly controlled than previously determined, reducing their risks of the macro- and microvascular complications of diabetes mellitus.

Blood Glucose↗

PubMed2004

Effects of a low-fat diet compared with those of a high-monounsaturated fat diet on body weight, plasma lipids and lipoproteins, and glycemic control in type 2 diabetes.

BACKGROUND: An important therapeutic goal for patients with type 2 diabetes is weight loss, which improves metabolic abnormalities. Ad libitum low-fat diets cause weight loss in nondiabetic populations. Compared with diets higher in monounsaturated fat, however, eucaloric low-fat diets may increase plasma triacylglycerol concentrations and worsen glycemic control in persons with type 2 diabetes. OBJECTIVE: We investigated whether, in type 2 diabetes patients, an ad libitum low-fat diet would cause greater weight loss than would a high-monounsaturated fat diet and would do this without increasing plasma triacylglycerol concentrations or worsening glycemic control. DESIGN: Eleven patients with type 2 diabetes were randomly assigned to receive an ad libitum low-fat, high-carbohydrate diet or a high-monounsaturated fat diet, each for 6 wk. The diets offered contained 125% of the estimated energy requirement to allow self-selection of food quantity. The response variables were body weight; fasting plasma lipid, lipoprotein, glucose, glycated hemoglobin A(1c), and fructosamine concentrations; insulin sensitivity; and glucose disposal. RESULTS: Body weight decreased significantly (1.53 kg; P < 0.001) only with the low-fat diet. Plasma total, LDL-, and HDL-cholesterol concentrations tended to decrease during both diets. There were no interaction effects between diet and the lipid profile response over time. Plasma triacylglycerol concentrations, glycemic control, and insulin sensitivity did not differ significantly between the 2 diets. CONCLUSION: Contrary to expectations, the ad libitum, low-fat, high-fiber diet promoted weight loss in patients with type 2 diabetes without causing unfavorable alterations in plasma lipids or glycemic control.

Blood Glucose↗

PubMedDate not supplied

Psychosocial predictors of self-care behaviors (compliance) and glycemic control in non-insulin-dependent diabetes mellitus.

This study assessed potential psychosocial correlates of self-care behaviors (compliance) and of glycemic control in a community sample of 184 people diagnosed as having non-insulin-dependent (type II) diabetes mellitus. Four different diabetes self-care behaviors were studied (medication taking, glucose testing, diet, and exercise), and glycemic control was assessed by glycosylated hemoglobin analyses. Multiple measures were collected within each of several categories of psychosocial variables including knowledge, stress, depression, anxiety, diabetes-specific health beliefs, and social support. Findings indicate that approximately 25% of the variance in self-care behaviors can be explained by psychosocial and demographic variables. In contrast, psychosocial variables were not significant predictors of level of glycemic control. The diabetes-specific psychosocial measures of health beliefs and social support were the most consistent and strongest predictors of self-care behavior across the different regimen areas studied. Possible reasons for these findings, limitations of the study, and directions for future research are discussed.

Adult↗

PubMedDate not supplied

Frequency and impact of SMBG on glycemic control in patients with NIDDM in an urban teaching hospital clinic.

Few published reports have documented the value of SMBG on glycemic control in patients with non-insulin-dependent diabetes mellitus (NIDDM), and no reports have evaluated predominantly African American patients who are at high risk for NIDDM and associated complications. In this study a 13-item survey was given to 98 patients with NIDDM to assess the frequency of self-monitoring of blood glucose (SMBG) and its impact on glycemic control. Sixty-one patients performed SMBG and 37 did not. More SMBG testers were taking insulin compared with the nontesters. GHb was comparable between groups. Among the testers there was no difference in mean GHb values based on the frequency of SMBG. Most testers performed SMBG before meals (93%) and recorded their values (85%); many had difficulty obtaining a good blood sample (30%). The most common reason for not testing was cost of supplies (77%). Performance of SMBG in these NIDDM patients was not associated with better glycemic control. Cost was a prohibitive factor for the nontesters.

Adult↗

PubMed2005

Effects of exenatide (exendin-4) on glycemic control and weight over 30 weeks in metformin-treated patients with type 2 diabetes.

OBJECTIVE: This study evaluates the ability of the incretin mimetic exenatide (exendin-4) to improve glycemic control in patients with type 2 diabetes failing to achieve glycemic control with maximally effective metformin doses. RESEARCH DESIGN AND METHODS: A triple-blind, placebo-controlled, 30-week study at 82 U.S. sites was performed with 336 randomized patients. In all, 272 patients completed the study. The intent-to-treat population baseline was 53 +/- 10 years with BMI of 34.2 +/- 5.9 kg/m(2) and HbA(1c) of 8.2 +/- 1.1%. After 4 weeks of placebo, subjects self-administered 5 microg exenatide or placebo subcutaneously twice daily for 4 weeks followed by 5 or 10 microg exenatide, or placebo subcutaneously twice daily for 26 weeks. All subjects continued metformin therapy. RESULTS: At week 30, HbA(1c) changes from baseline +/- SE for each group were -0.78 +/- 0.10% (10 microg), -0.40 +/- 0.11% (5 microg), and +0.08 +/- 0.10% (placebo; intent to treat; adjusted P < 0.002). Of evaluable subjects, 46% (10 microg), 32% (5 microg), and 13% (placebo) achieved HbA(1c) < or =7% (P < 0.01 vs. placebo). Exenatide-treated subjects displayed progressive dose-dependent weight loss (-2.8 +/- 0.5 kg [10 microg], -1.6 +/- 0.4 kg [5 microg]; P < 0.001 vs. placebo). The most frequent adverse events were gastrointestinal in nature and generally mild to moderate. Incidence of mild to moderate hypoglycemia was low and similar across treatment arms, with no severe hypoglycemia. CONCLUSIONS: Exenatide was generally well tolerated and reduced HbA(1c) with no weight gain and no increased incidence of hypoglycemia in patients with type 2 diabetes failing to achieve glycemic control with metformin.

Adult↗

PubMed1993

Psychophysical visual function, retinopathy, and glycemic control in insulin-dependent diabetics with normal visual acuity.

We studied relations between psychophysical visual function and grade of retinopathy, glycemic control and clinical background data in 51 insulin-dependent diabetic patients, aged 17-47 years. Three separate qualities of visual function were examined, macular recovery time (nyctometry; 2 min adaptation), contrast sensitivity (Vistech 6000 chart; between 1.5 and 18 cycles per degree (cpd)) and colour vision (Fletcher DS8; protan/deutan and tritan). Only contrast sensitivity of 6 cpd was associated with the grade of retinopathy; reduced function was found in patients with retinopathy compared to those without. No correlations between macular recovery, contrast sensitivity and colour vision were found. None of the visual functions was significantly related to glycemic control, age, duration of diabetes, blood pressure, intraocular pressure, or urinary albumin excretion. Our data suggests that the neurosensory function of contrast sensitivity correlates more sensitively to the grade of diabetic retinopathy than macular recovery and colour vision. Cross-sectional assessments of different psychophysical visual functions seem to be of restricted clinical value as indicators of preceding glycemic control in diabetic patients with no or mild nonproliferative retinopathy.

Adolescent↗

PubMed2004

Testing a self-determination theory process model for promoting glycemic control through diabetes self-management.

A longitudinal study tested the self-determination theory (SDT) process model of health behavior change for glycemic control within a randomized trial of patient activation versus passive education. Glycosylated hemoglobin for patients with Type 2 diabetes (n=159) was assessed at baseline, 6 months, and 12 months. Autonomous motivation and perceived competence were assessed at baseline and 6 months, and the autonomy supportiveness of clinical practitioners was assessed at 3 months. Perceptions of autonomy and competence were promoted by perceived autonomy support, and changes in perceptions of autonomy and competence, in turn, predicted change in glycemic control. Self-management behaviors mediated the relation between change in perceived competence and change in glycemic control. The self-determination process model fit the data well.

Adult↗

PubMed1984

Effects of caloric restriction and weight loss on glycemic control, insulin release and resistance, and atherosclerotic risk in obese patients with type II diabetes mellitus.

This study was designed to determine: (1) the effectiveness and safety of protein-sparing fast and gastric bypass surgery for achieving weight reduction in obese patients with type II diabetes mellitus (non-insulin-dependent diabetes mellitus); (2) the effects of these interventions on glycemic control; (3) the effects of weight loss on insulin secretion and action; and (4) the effects of treatment on atherosclerotic risk factors. Six patients consumed only a protein supplement (1.4 g/kg ideal body weight) for up to six months until a final weight below 120 percent of ideal body weight was achieved or weight loss ceased. Six patients underwent gastric bypass surgery. Both groups of patients were studied before and after treatment while consuming a balanced weight-maintaining diet. Both protein-sparing fast and gastric bypass surgery were safe and successful in the short term in producing weight loss. Both treatments improved glycemic control. Mean fasting plasma glucose values fell from 287 to 168 mg/dl (p less than 0.01). Mean total glycosylated hemoglobin values declined from 11.9 to 8.2 percent (p less than 0.01) (normal reference interval 5.85 to 8.85 percent). Patients who achieved a final weight below 125 percent of ideal body weight had significantly better post-treatment fasting plasma glucose values (130 versus 196 mg/dl, p less than 0.05) and total glycosylated hemoglobin values (6.8 versus 9.0, p less than 0.02) than those whose weight remained above 125 percent of ideal. In diet-treated patients, improved glycemic control occurred with caloric restriction alone prior to significant weight loss. Improved glycemic control was accompanied by decreased insulin resistance. Mean steady-state plasma glucose values fell from 377 to 208 mg/dl (p less than 0.008), and mean fasting insulin values fell from 31.0 to 17.0 microU/ml (p less than 0.004). Acute-phase insulin release, which was markedly impaired before treatment, did not improve even in patients who had post-treatment fasting plasma glucose values below 130 mg/dl. Significant improvements in atherosclerotic risk factors occurred. Mean high-density lipoprotein cholesterol values increased from 33.8 to 40.5 mg/dl (0.006 less than p less than 0.008), and factor VIII coagulant activity decreased from 194 to 140 percent (p less than 0.005). Serum fibrinogen also decreased (393 to 347 mg/dl, p = 0.08), although the decrease did not reach clinical significance.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗