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Results for “Glycemic Control”

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At least 307 records · Page 17Linked to original sources

PubMedDate not supplied

Association of poor glycemic control with prolonged hospital stay in patients with diabetes admitted with exacerbation of congestive heart failure.

OBJECTIVE: To establish a relationship between the control of blood glucose levels and the severity of congestive heart failure (CHF) in a retrospective review of medical records of patients with diabetes admitted with acute exacerbation of CHF and to assess the potential correlation between the number of days of hospitalization and the baseline and in-hospital glycemic status. METHODS: Medical records were reviewed to identify patients with diabetes admitted to a tertiary care center with exacerbation of CHF. Patients in whom any new complications developed that could have prolonged the hospitalization were excluded from the study. The number of days of hospitalization attributable to CHF were noted and statistically correlated with the glycemic control. RESULTS: Data on 100 patients included in the study are presented. The duration of hospitalization ranged from 1 day to 2 weeks (mean, 4.79 +/- 3.03 days). The in-hospital glycemic control strongly correlated positively with the number of days of hospitalization (r = 0.499; 95% confidence interval [CI], 0.325 to 0.643). The admission blood glucose level also showed a strong positive correlation with the days of hospitalization (r = 0.587; 95% CI, 0.426 to 0.720). The mean hemoglobin A1c (HbA1c) correlated positively with the number of days in the hospital (r = 0.653; 95% CI, 0.508 to 0.764). The 51 patients with uncontrolled diabetes (HbA1c >7%) were hospitalized for a mean period of 6.3 +/- 3.2 days, in comparison with a mean duration of 3.2 +/- 1.9 days for the 49 patients with good outpatient glycemic control (HbA1c < or =7%). CONCLUSION: Patients with diabetes admitted with exacerbation of CHF who have poor baseline or in-hospital glycemic control have a prolonged hospitalization.

Aged↗

PubMed2006

Strict glycemic control ameliorates the increase of carotid IMT in patients with type 2 diabetes.

The aim of this study was to investigate the effect of strict glycemic control on the carotid artery intima-media thickness (IMT) in type 2 diabetic patients who initially had good glycemic control (HbA1c between 5.8 and 6.4 %). The subjects were 67 patients showing deterioration of the mean HbA1c over 3 years by more than 0.2% from baseline (D group) and 33 subjects showing improvement of the mean HbA1c by more than 0.2% from baseline (A group). The clinical characteristics and annual change of IMT during the observation period were compared between the two groups in a 3-year retrospective longitudinal study. The baseline characteristics and the mean values of BMI, blood pressure, and serum lipids during the study period did not differ significantly between the two groups. However, the mean HbA1c of A group was significantly lower than that of D group (5.67 +/- 0.10 vs. 6.28 +/- 0.08, mean +/- SE, p<0.001). The adjusted annual increase rate of IMT was significantly less in A group than in D group (-0.035 +/- 0.019 vs. 0.036 +/- 0.015 mm, M +/- SEM, p<0.001). These results indicate that further improvement of glycemic control from a good HbA1c value can prevent an increase of IMT in type 2 diabetic patients.

Adult↗

PubMed1999

Effect of repaglinide addition to metformin monotherapy on glycemic control in patients with type 2 diabetes.

OBJECTIVE: To compare the effect of repaglinide in combination with metformin with monotherapy of each drug on glycemic control in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 83 patients with type 2 diabetes who had inadequate glycemic control (HbA1c > 7.1%) when receiving the antidiabetic agent metformin were enrolled in this multicenter, double-blind trial. Subjects were randomized to continue with their prestudy dose of metformin (n = 27), to continue with their prestudy dose of metformin with the addition of repaglinide (n = 27), or to receive repaglinide alone (n = 29). For patients receiving repaglinide, the optimal dose was determined during a 4- to 8-week titration and continued for a 3-month maintenance period. RESULTS: In subjects receiving combined therapy, HbA1c was reduced by 1.4 +/- 0.2%, from 8.3 to 6.9% (P = 0.0016) and fasting plasma glucose by 2.2 mmol/l (P = 0.0003). No significant changes were observed in subjects treated with either repaglinide or metformin monotherapy in HbA1c (0.4 and 0.3% decrease, respectively) or fasting plasma glucose (0.5 mmol/l increase and 0.3 mmol/l decrease respectively). Subjects receiving repaglinide either alone or in combination with metformin, had an increase in fasting levels of insulin between baseline and the end of the trial of 4.04 +/- 1.56 and 4.23 +/- 1.50 mU/l, respectively (P < 0.02). Gastrointestinal adverse events were common in the metformin group. An increase in body weight occurred in the repaglinide and combined therapy groups (2.4 +/- 0.5 and 3.0 +/- 0.5 kg, respectively; P < 0.05). CONCLUSIONS: Combined metformin and repaglinide therapy resulted in superior glycemic control compared with repaglinide or metformin monotherapy in patients with type 2 diabetes whose glycemia had not been well controlled on metformin alone. Repaglinide monotherapy was as effective as metformin monotherapy.

Australia↗

PubMed2004

Fine-tuning therapy with basal insulin for optimal glycemic control in type 2 diabetes: a review.

OBJECTIVE: To review results from clinical studies utilizing basal insulin therapy and discuss the impact of intensive glycemic control using forced-titration algorithms to fine-tune insulin dosing in patients with type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS: A Medline and PubMed search was undertaken for the years 1991-2004 using the following search terms: insulin, diabetes therapy, forced titration, glycemic control, and intensive insulin therapy. RESULTS: The United Kingdom Prospective Diabetes Study demonstrated that the great majority of patients with type 2 diabetes will eventually require insulin and have provided level IA evidence that intensive glycemic control improves patient outcomes. Several recently published studies in patients with type 2 diabetes showed that forced titration of basal insulin shows promise in reaching glycemic goals. Forced-titration algorithms employ a structured approach in helping patients achieve glycemic targets: doses are adjusted until glycemic goals (predefined glycosylated hemoglobin concentrations and/or blood glucose levels) are met. CONCLUSION: Studies have indicated that forced-titration regimens using insulin analogs to attain aggressive glycemic targets have the potential to improve outcomes in patients with type 2 diabetes without compromising patient safety. These forced-titration algorithms are straightforward and designed to be adaptable to individual needs, which may help overcome barriers to insulinization of patients with type 2 diabetes.

Blood Glucose↗

PubMed2004

Association between self-monitoring of blood glucose and glycemic control in patients with type 2 diabetes mellitus.

PURPOSE: The relationship between the self-monitoring of blood glucose (SMBG) and glycemic control in patients with type 2 diabetes mellitus in a Veterans Affairs (VA) medical center was studied. METHODS: Laboratory, inpatient, outpatient, and demographic data for patients with type 2 diabetes mellitus who were seen for three years continuously or receiving their care regularly from a single Texas VA facility between October 1, 1999, and September 30, 2002, were obtained. Local pharmacy data were used to identify patients who received blood-glucosemonitoring strips. Patients were assigned to one of four mutually exclusive groups: those who did not receive monitoring strips at all, those who received strips in fiscal year (FY) 2002 only, those who received strips in FYs 2001 and 2002, and those who received strips during all three years (FYs 2000, 2001, and 2002). Frequency of monitoring and case-mix scores were measured. Nonparametric statistics were used to compare the demographic and clinical characteristics of the four groups. Robust regression was used to analyze the relationships between SMBG and glycemic control in FY 2002. RESULTS: Of the 1185 patients who received oral hypoglycemic medications during all three fiscal years, 976 patients met the criteria for inclusion in one of the four groups. There were no significant differences among the four groups in baseline hemoglobin A1c (HbA1c) values, body mass index, or case-mix scores. The Kruskal-Wallis test found no significant difference among the four groups in the number of laboratory blood glucose tests conducted, but there were significant differences in the number of HbA1c tests conducted among the groups. CONCLUSION: SMBG was not associated with glycemic control in VA patients with type 2 diabetes mellitus managed on oral hypoglycemic medications.

Aged↗

PubMed2003

C-reactive protein and glycemic control in adults with diabetes.

OBJECTIVE: Recent evidence suggests that poor glycemic control is significantly associated with the development of macrovascular complications of diabetes. Studies have indicated that C-reactive protein (CRP) is an important risk factor for cardiovascular disease. The purpose of this study was to determine the relation between CRP and HbA(1c) in a large national sample of individuals with diabetes. RESEARCH DESIGN AND METHODS: A nationally representative sample of noninstitutionalized U.S. adults aged 17 years and over with nongestational diabetes was derived from the National Health and Nutrition Examination Survey III (1988-1994) (n = 1,018). Respondents with diabetes were stratified by HbA(1c) level. The main outcome measure was elevated (>0.30 mg/dl) CRP. RESULTS: In unadjusted analyses, respondents with diabetes who had elevated HbA(1c) levels (> or =9.0%) had a significantly higher percent of elevated CRP than people with low (<7%) HbA(1c) levels (P < 0.001). In adjusted regression analysis, after controlling for age, race, sex, smoking, length of time with diabetes, insulin, and BMI, HbA(1c) was significantly associated with an increased likelihood of elevated CRP for HbA(1c) >9.0% (OR 2.15, 95% CI 1.07-4.32) and for HbA(1c) >11.0% (4.40, 1.87-10.38). Higher HbA(1c) also predicted elevated CRP in the regression model when HbA(1c) was analyzed as a continuous variable (1.20, 1.07-1.34). CONCLUSIONS: In this study, the likelihood of elevated CRP concentrations increased with increasing HbA(1c) levels. These findings suggest an association between glycemic control and systemic inflammation in people with established diabetes.

Adolescent↗

PubMed2001

Flexible meal-related dosing with repaglinide facilitates glycemic control in therapy-naive type 2 diabetes.

OBJECTIVE: This double-blind randomized placebo-controlled parallel group study assessed the efficacy and safety (with particular regard to body weight and hypoglycemia) of repaglinide when used in a flexible mealtime dosing regimen in a situation close to everyday clinical practice. RESEARCH DESIGN AND METHODS: A total of 408 patients with type 2 diabetes considered poorly controlled by diet, but without a history of previous antidiabetic medication, were randomized to receive 0.5 mg repaglinide at mealtimes (increased to 1 mg after 4 weeks depending on blood glucose response) or placebo for 16 weeks. Patients were free to choose a flexible meal pattern, adjusting the dosing schedule from two to four preprandial doses per day in accordance with a "one meal, one dose; no meal, no dose" principle. Additional snacks were not a requirement of the treatment schedule. RESULTS: Treatment with repaglinide significantly improved glycemic control with respect to baseline and placebo, reducing HbA1c by 1.14% from baseline and fasting plasma glucose by 1.8 mmol/l. Improvement in glycemic control was independent of the meal pattern adopted by patients, including those most commonly taking two or four meals daily, with no correlation between meal pattern and risk of hypoglycemia. The improvement in glycemic control was also independent of degree of obesity and age < or =65 or >65 years. There was no significant body weight increase in the repaglinide group. CONCLUSIONS: Mealtime dosing with repaglinide is effective in improving overall glycemic control in type 2 diabetic patients for which control is suboptimal using diet alone. Patients are able to vary their meal pattern from a conventional regimen of three meals daily without compromising control or increasing the risk of adverse events.

Aged↗

PubMed1999

Effect of glycemic control on plasma plant sterol levels and post-heparin diamine oxidase activity in type 1 diabetic patients.

We examined the effect of glycemic control on the plasma plant sterol levels (a measure of cholesterol absorption efficacy) and the plasma post-heparin diamine oxidase (DAO) activity (a measure of intestinal mucosal mass) in type 1 diabetes. The plasma plant sterol levels (mmol/mol of cholesterol) and the DAO activities after 30 U/kg of intravenous heparin were determined in age- and sex-matched three groups (12 type 1 diabetic patients undergoing conventional insulin therapy, ten patients undergoing intensive insulin therapy, and ten normal subjects). All patients continued their indicated insulin regimen for 14 days with a weight-maintaining energy restricted diet. The conventional group showed a significant higher (p < 0.001) level of the fasting plasma glucose (FPG) or the glycated albumin (GA), a higher (P < 0.01) DAO activity (2-fold of the peak level), which was observed 10-30 min after the heparin injection, and a higher (P < 0.01) plasma plant sterol levels (1.5-fold) compared with those in the other two groups, respectively. The DAO activity 30 min after the heparin injection significantly correlated with either the glycated albumin (GA) concentration or the plant sterol levels in all subjects. Furthermore, the acute glycemic control by the changes of insulin regimen from conventional to intensive showed a significant reduction of the DAO activity and plant sterols in the same patients. These results suggest that glycemic control in part relates to the intestinal adaptation to cholesterol absorption efficacy in type 1 diabetes.

Adolescent↗

PubMed2004

Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events.

BACKGROUND: This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium (GIK) solution in diabetic coronary artery bypass graft (CABG) patients would improve perioperative outcomes. METHODS AND RESULTS: One hundred forty-one diabetic patients undergoing CABG were prospectively randomized to tight glycemic control (serum glucose, 125 to 200 mg/dL) with GIK or standard therapy (serum glucose <250 mg/dL) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery. GIK patients had lower serum glucose levels (138+/-4 versus 260+/-6 mg/dL; P<0.0001), a lower incidence of atrial fibrillation (16.6% versus 42%; P=0.0017), and a shorter postoperative length of stay (6.5+/-0.1 versus 9.2+/-0.3 days; P=0.003). GIK patients also showed a survival advantage over the initial 2 years after surgery (P=0.04) and decreased episodes of recurrent ischemia (5% versus 19%; P=0.01) and developed fewer recurrent wound infections (1% versus 10%, P=0.03). CONCLUSIONS: Tight glycemic control with GIK in diabetic CABG patients improves perioperative outcomes, enhances survival, and decreases the incidence of ischemic events and wound complications.

Atrial Fibrillation↗

PubMedDate not supplied

Effect of major improvement in glycemic control on results of cardiovascular function tests in patients with insulin-dependent diabetes mellitus.

OBJECTIVE: To evaluate the effect of major improvement in glycemic control on cardiovascular function tests in patients with insulin-dependent diabetes mellitus (IDDM). METHODS: Eight men with chronic, poorly controlled IDDM (serum fructosamine >300 mmol/L and mean fasting blood glucose >200 mg/dL), who were 24 +/- 6 years of age and had a mean duration of diabetes of 8 +/- 1 years, were studied. No patient had microalbuminuria, was taking medication other than insulin, or had evidence of heart disease. Patients underwent baseline continuous ambulatory blood pressure monitoring, echocardiographic studies, and cardiovascular autonomic function tests, which were repeated after 4 weeks of an intensified insulin treatment program (IITP), during which they reached and maintained blood glucose concentrations and serum fructosamine levels in near-normal, nondiabetic ranges. RESULTS: Substantial changes in glycemic control had no significant influence on results of ambulatory blood pressure monitoring, cardiovascular autonomic function tests, and echocardiographic studies. CONCLUSION: Major improvement in glycemic control during a 1-month period in patients with IDDM had no significant influence on cardiovascular function tests. We cannot exclude the possibility that, after a longer duration of an IITP or in patients with clinically evident heart disease or evidence of major complications of diabetes, different responses might be observed.

Journal Article↗

PubMed1997

Antibodies to GAD and glycemic control in recent-onset IDDM.

OBJECTIVE: To analyze the effect of antibodies to glutamic acid decarboxylase (GAD65Ab) and islet cells (ICA512Ab) on glycemic control early in IDDM. RESEARCH DESIGN AND METHODS: GAD65Ab and ICA512Ab were measured twice in 35 patients (10 male, 25 female; age 10-40 years) initially within 2 years of diagnosis and again 1 year later. The glycosylated hemoglobin was measured one to four times each year, and the average glycosylated hemoglobin for the preceding year was calculated each time the antibodies were measured. RESULTS: The mean HbA1 at the time of the initial evaluation was 8.04 +/- 0.30 (reference range 4.7-7.3% for nondiabetic patients), the average GAD65Ab index was 0.735 +/- 0.306, and the mean ICA512Ab index was 1.94 +/- 0.65. The GAD65Ab index correlated with HbA1 (r = 0.41, P < 0.025), whereas the ICA512Ab index did not (r = 0.13). One year later, the mean GAD65Ab index was 0.94 +/- 0.34, the mean ICA512Ab index was 1.04 +/- 0.40, and the mean HbA1 was 9.03 +/- 0.30. The GAD65Ab index correlated with HbA1 (r = 0.61 P < 0.001), whereas the ICA512Ab index did not (r = -0.06). Stratification of patients into tertiles according to the average GAD65 index revealed, at the follow-up evaluation, that the better glycemic control in the lowest GAD65Ab tertile was accomplished with significantly less insulin (0.43 +/- 0.08 U/kg for the lowest tertile vs. 0.71 +/- 0.09 and 0.64 +/- 0.09 for the middle and highest tertiles, respectively; P < 0.05). CONCLUSIONS: In summary, patients with IDDM and low GAD65Ab have better glycemic control even though they require less insulin. The ICA512Ab index, however, fails to correlate with glycemia.

Adolescent↗

PubMed1998

Family environment, glycemic control, and the psychosocial adaptation of adults with diabetes.

OBJECTIVE: To evaluate whether the family system variables of adults with diabetes relate to the adequacy of metabolic control or the psychosocial adaptation to the illness. RESEARCH DESIGN AND METHODS: A total of 150 insulin-requiring adults were assessed on a single occasion. They completed two family system measures (the Family Environment Scale [FES] and the Diabetes Family Behavior Checklist [DFBC]), two quality-of-life measures (the Diabetes Quality of Life Scale and the Medical Outcomes Study Health Survey-36), and one measure of cognitive appraisal (the Appraisal of Diabetes Scale). Glycemic control was assessed using HbA1c results. Demographic data (age, sex, diabetes type, duration of diabetes, and number of diabetes-related medical complications) were gathered from the patients' charts. RESULTS: Concerning glycemic control, none of the family system measures were significant predictors of HbA1c. Older age and longer duration of diabetes predicted higher HbA1c values. For psychosocial adaptation, when family members behaved in ways that supported the diabetes care regimen (measured by the DFBC), the individual with diabetes was more satisfied with his or her adaptation to the illness and reported less interference in role function due to emotional problems. Family cohesion (measured by the FES) also related to better physical function. Women reported higher levels of diabetes satisfaction. The Appraisal of Diabetes Scale predicted glycemic control and psychosocial adaptation. CONCLUSIONS: For insulin-treated adults with diabetes, family system variables do not relate to glycemic control, but they do relate to psychosocial adaptation. Future work should explore the impact of family-centered interventions on adaptation, sex differences in adaptation, and the use of the Appraisal of Diabetes Scale as a first-line clinical screening tool.

Adaptation, Psychological↗

PubMed1988

Effects of omega-3 fish oils on lipid metabolism, glycemic control, and blood pressure in type II diabetic patients.

We investigated the effects of omega-3 fish oil (FO) supplementation on lipid metabolism, glycemic control, and blood pressure (BP) in patients with type II diabetes mellitus. In 22 diabetic patients without overt hyperlipidemia, serum triglyceride, total cholesterol, high density lipoprotein (HDL)-cholesterol, HDL2-cholesterol, HDL3-cholesterol, and apolipoprotein A-I (apo A-I) levels did not change during omega-3 FO supplementation for 8 weeks. The mean serum apo B concentration increased significantly [baseline, 2.56 +/- 0.11 (+/- SEM) mmol/L; 4 weeks, 2.82 +/- 0.13 mmol/L; 8 weeks, 2.80 +/- 0.13 mmol/L; P less than 0.01]. The mean plasma postheparin lipoprotein lipase activity increased transiently during the fourth week (baseline, 168 +/- 17 U/mL; 4 weeks, 182 +/- 18 U/mL; P less than 0.05), whereas postheparin hepatic triglyceride lipase activity did not change. Glycemic control worsened transiently during the fourth week, (baseline, 7.7 +/- 0.4%; 4 weeks, 8.4 +/- 0.3%; P less than 0.05). Both systolic and diastolic BP decreased significantly throughout the study (systolic BP: baseline, 142 +/- 5 mm Hg; 8 weeks, 128 +/- 5 mm Hg; diastolic BP: baseline, 88 +/- 4 mm Hg; 8 weeks, 80 +/- 3 mm Hg; P less than 0.01). These findings suggest that in type II diabetics without overt hyperlipidemia, omega-3 FO supplementation does not improve either the glycemic control or serum lipids, and it is associated with a potentially detrimental rise in serum apo B concentrations. Until more information is available, use of such supplementation should be discouraged.

Apolipoproteins↗

PubMed1995

ASHP therapeutic position statement on strict glycemic control in selected patients with insulin-dependent diabetes mellitus.

ASHP supports strict glycemic control in selected patients with IDDM on the basis of studies demonstrating that strict glycemic control delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy. Because of the increased risk of hypoglycemia, intensive treatment regimens may not be appropriate in patients with poor perception of hypoglycemic symptoms and those with a history of frequent, severe hypoglycemic episodes. The pharmacist can play a key role in implementing and monitoring this therapy by collaborating with other members of the health care team and by counseling patients.

Blood Glucose↗

PubMedDate not supplied

Glycemic control in the diabetic pregnancy: is tighter always better?

Glucose is the principal nutrient that the mother supplies to the fetus through the placenta by way of concentration-dependent mechanisms. In the presence of maternal hypoglycemia, with limited glucose supply, fetal hypoglycemia and hypoinsulinism ensue. This may be viewed as an adaptive mechanism to increase the chances of fetal survival in the face of limited maternal supply, albeit of a growth-restricted fetus. Fetal nutrient deprivation and the resulting hypoinsulinism may have both short- and long-term consequences. Intrauterine growth failure is associated with higher rates of gestational age-specific neonatal mortality and with long-term cognitive deficits. Furthermore, epidemiologic data suggest that diabetes, coronary artery disease, and hypertension are more common among adults who were small for gestational age at birth. Thus, pancreatic failure in adulthood may be either a response to excessive exposure to glucose as a result of maternal hyperglycemia, or as a result of hypoglycemia where nutrient deprivation leads to fetal growth restriction and reduced islet cell proliferation. Because low mean concentrations of maternal glucose in gestational diabetes are associated with an increased risk of fetal growth restriction, overzealous glycemic control during pregnancy may raise concerns regarding the possible effects on the infant. In the mother with Type 1 diabetes, strict glycemic control is often associated with an increased incidence of severe hypoglycemia. Up to 40% of women report at least one episode of severe hypoglycemia during pregnancy, requiring assistance by another person or professional intervention. It is quite possible that in some patients striving to optimize pregnancy outcome by maintaining the best possible glycemic control jeopardizes the well-being of the mother and the fetus. Thus, with respect to tight glycemic control of pregnant women with diabetes, the question arises: How tight is too tight? Is there a threshold below which the trade-off in terms of maternal morbidity as well as fetal growth restriction and its consequences outweighs the benefits of preventing the effects of maternal hyperglycemia?

Adult↗

PubMed1998

Long-term glycemic control influences the onset of limited joint mobility in type 1 diabetes.

BACKGROUND: Limited joint mobility (LJM) in childhood insulin-dependent (type 1) diabetes is associated with a substantially increased risk of microvascular complications. Cross-sectional studies have not demonstrated a relationship between LJM and metabolic control. This study was designed to determine whether glycemic control, as measured by glycohemoglobin (hgbA1C) levels from the onset of diabetes, is associated with the occurrence of LJM. METHOD: Probands (n = 18) had hgbA1C values and recorded observation of joint function from soon after onset of their diabetes. Controls (n = 40) were matched to probands for gender and age at diagnosis and had follow-up beyond the age at which the proband was found to have LJM. RESULTS: The odds ratio for occurrence of LJM for the mean hgbA1C from diabetes onset was 1.46, 95% confidence limits 1.07 to 2.00. Thus, for every unit increase in average hgbA1C, there was approximately a 46% increase in the risk of LJM. When hgbA1C was dichotomized, the OR for hgbA1C of more than 8% was 2.55, and the OR was 4.54 if the hgbA1C was greater than 12%. Age at diagnosis and duration of diabetes were not independent prognostic factors for LJM. CONCLUSION: Glycemic control from onset of diabetes is strongly associated with occurrence of LJM.

Case-Control Studies↗

PubMed2004

Glycemic control in diabetic patients after bariatric surgery.

BACKGROUND: Morbid obesity is associated with a high prevalence of diabetes mellitus, and weight loss is fundamental to improve glycemic control. The aim of the present study was to evaluate the impact of weight reduction during the late postoperative period (> or = 12 months) after gastric bypass on the glycemic control of diabetic patients. METHODS: Fasting glycemia (glucose oxidase) and glycohemoglobin A1c (enzymatic fluorescence, reference value: 4-6%) were determined before and after surgery. Results were compared by the Student t-test for paired samples (P <0.05). RESULTS: 23 women and 8 men with diabetes, with a mean follow-up of 27.2 months and a mean age of 42.5 years (30-68), were studied. Before surgery, mean +/- SD weight, BMI, excess weight, glycemia and glycohemoglobin were 135.9+/-11.6 kg, 51.8+/-6.4 kg/m2, 68.3+/-14.5 kg, 173+/-71.2 mg/dl, and 7.4+/-1.9%, respectively. After surgery, mean weight, BMI, excess weight, percent weight loss, percent excess weight loss, glycemia and glycohemoglobin were 89.7+/-8.8 kg, 35+/-4.5 kg/m2, 24.6+/-11.6 kg, 32.6%+/-1.8 (12.6-46.5%), 64.7+/-18.3%, 98+/-17.3 mg/dl (P <0.01), and 5.4+/-1.0% (P <0.05), respectively. Oral anti-diabetic drug and/or insulin treatment was discontinued in 89.2% of the patients. After surgery, 90.3% of the patients maintained glycohemoglobin A1c levels <7.0%. CONCLUSION: Weight loss led to a significant and sustained improvement of glycemic control in these patients submitted to bariatric surgery.

Adult↗

PubMed2003

Relationship between glycemic control, ethnicity and socioeconomic status in Hispanic and white non-Hispanic youths with type 1 diabetes mellitus.

OBJECTIVES: To determine if there is a disparity in glycemic control between Hispanic and white non-Hispanic children and adolescents with type 1 diabetes mellitus (DM) and to delineate the factors associated with glycemic control in these populations. STUDY DESIGN: This cross-sectional study included 183 youths with type 1 DM (99 white non-Hispanics and 84 Hispanics) and their parents/guardians cared for in a well-defined, private pediatric endocrine diabetes clinic, where the same physician and diabetes educators treat all patients. The youths were invited to participate if they had been diagnosed with diabetes at least 3 months before the study and were < 21 yr of age. Self-report questionnaires and chart reviews were used to assess individual familial and sociodemographic variables. OUTCOMES MEASURED: Mean hemoglobin A1c (HbA1c) levels, compliance with home monitoring of blood sugar, level of parental supervision of treatment, and socioeconomic status of Hispanic and white non-Hispanic families in the study. RESULTS: Hispanic youths with type 1 DM were in poorer metabolic control than their white non-Hispanic counterparts (0.45% difference in HbA1c levels, p = 0.02). Hispanic youths exhibited lower compliance with home monitoring of blood sugar but their parents reported greater supervision of their diabetes treatment. Hispanic families were found to have significantly lower income, rate of health insurance, father's educational attainment, and mother's educational attainment. Lower family socioeconomic status, but not ethnicity or educational attainment of parents, was associated with a significantly higher HbA1c, regardless of ethnicity. CONCLUSIONS: This study suggests that Hispanic youths with type 1 diabetes may be at greater risk for poor glycemic control because of their lower socioeconomic status rather than their ethnicity.

Adolescent↗