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Results for “Glycemic Control”

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PubMedDate not supplied

Discordance between physician and patient perceptions in the treatment of diabetes mellitus: a pilot study of the relationship to adherence and glycemic control.

Glycolsylated hemoglobin (G Hb) levels and data on adherence and patient-provider discordance in beliefs about diabetes were collected from 42 insulin-requiring patients with diabetes. Discordance was calculated for both degree of discordance (absolute amount of disagreement) and direction of discordance (degree to which physician > patient or patient < physician). Patients generally agreed with physicians in perceptions of severity, costs of adherence, and immediate and long-term benefits of adherence. Significant differences were found between these dimensions. Only discordance on long-term benefits of adherence correlated with adherence, with greater discordance related to greater adherence. Discordance on the cost dimension correlated negatively with G Hb, suggesting better glycemic control with greater disagreement. Those who underestimate the cost of adherence show greater adherence. Adherence did not correlate significantly with glycemic control.

Adult↗

PubMed2001

Increased platelet aggregation in diabetic patients with microangiopathy despite good glycemic control.

The pathogenesis of diabetic micro- and macroangiopathy cannot be fully explained by hyperglycemia alone. To clarify diabetic complications mediated by increased platelet activity, we have studied platelet aggregation and its second messenger molecules such as protein kinase C (PKC), RhoA, and phosphatidylinositol 3-kinase (PI3- kinase), in six diabetic patients with diabetic retinopathy and other diabetic complications in spite of good glycemic control. Their HbA(1c) levels throughout the observation period had been less than 6% with diet treatment alone, despite which diabetic retinopathy developed to the pre-proliferative stage during 2-8 years observation. Low-dose thrombin (< 0.5 U/ml)-stimulated platelet aggregation in the diabetic patients was enormously elevated compared with healthy control subjects. PKC, RhoA and PI3-kinase activities in the cytosol- and membrane-associated fractions were examined in the platelets from the two patients (Cases 2 and 4). Platelet membrane-associated RhoA and PI3-kinase activity in Case 2 were increased before the stimulation. Platelet RhoA and PI 3-kinase activities in Case 4 were increased after the stimulation with low-dose thrombin (0.01 U/ml). Membrane-associated immunoreactive PKC alpha, but not PKC beta in Cases 2 and 4 was elevated. Although platelet hyperactivity in these four patients was observed, PKC and RhoA in mononuclear leukocytes from these patients were not different from healthy subjects. Membrane-associated PKC alpha and RhoA immunoreactivities also increased in the other three cases. These results suggest that hyperreactivity of PKC alpha may lead to increased RhoA and PI3-kinase activities and platelet hyperfunction in diabetic patients with good glycemic control, and that raised platelet PKC alpha may be implicated in the pathogenesis of diabetic complications.

Adult↗

PubMed2005

Preliminary study of psychological factors affecting clinic attendance and glycemic control of Japanese patients with type 2 diabetes mellitus.

We studied 50 Japanese patients who were first diagnosed with type 2 diabetes mellitus. Psychological functioning was assessed by using the Rorschach test and the Yatabe-Guilford Personality test. Analysis indicated that patients who discontinued clinic attendance during the 2-yr. study period had more depression, lower general activity and less extraversion, more negative self-attitudes, and more concern about being helpless than those who continued having regular followups. This study also found that patients who had worse glycemic control 2 yr. after being first diagnosed reported more inferiority feelings, lower general activity, more need for closeness to others, and more emotional demands than those who had better glycemic control. In conclusion, understanding the psychological functioning would be helpful in the management of Japanese patients with type 2 diabetes mellitus.

Adult↗

PubMed2000

Antioxidant alpha-tocopherol ameliorates glycemic control of GK rats, a model of type 2 diabetes.

We have shown recently that oxidative stress by chronic hyperglycemia damages the pancreatic beta-cells of GK rats, a model of non-obese type 2 diabetes, which may worsen diabetic condition and suggested the administration of antioxidants as a supportive therapy. To determine if natural antioxidant alpha-tocopherol (vitamin E) has beneficial effects on the glycemic control of type 2 diabetes, GK rats were fed a diet containing 0, 20 or 500 mg/kg diet alpha-tocopherol. Intraperitoneal glucose tolerance test revealed a significant increment of insulin secretion at 30 min and a significant decrement of blood glucose levels at 30 and 120 min after glucose loading in the GK rats fed with high alpha-tocopherol diet. The levels of glycated hemoglobin A1c, an indicator of glycemic control, were also reduced. Vitamin E supplementation clearly ameliorated diabetic control of GK rats, suggesting the importance of not only dietary supplementation of natural antioxidants but also other antioxidative intervention as a supportive therapy of type 2 diabetic patients.

Animals↗

PubMed1996

Effects of Terazosin on Glycemic Control, Cholesterol, and Microalbuminuria in Patients with Non--Insulin-Dependent Diabetes Mellitus and Hypertension.

The use of antihypertensive agents that have positive or neutral effects on blood sugar, lipid profiles, and microalbuminuria can be important clinical treatment for patients with diabetes. We evaluated the effects of both terazosin, a selective alpha-one-adrenergic blocker, and hydrochlorothiazide (HCTZ), a standard mild antihypertensive agent, on glycemic control, urinary albumin excretion rate overnight total cholesterol, and other parameters in non--insulin-dependent diabetes mellitus (NIDDM) patients. A randomized, placebo-controlled, cross-over design was implemented in 25 patients. Over an 8-week treatment period fasting plasma glucose (FPG) and glycosylated hemoglobin (GHgb) improved in the terazosin group. Post-treatment FPG was 200 plus minus 85 and 187 plus minus 71 for patients who received HCTZ and terazosin, respectively. Although the GHgb improved significantly for terazosin patients (12.2 plus minus 5.8 for HCTZ versus 10.7 plus minus 4.6 for terazosin, p = 0.03), microalbuminuria did not improve in terazosin patients in this pilot study. A larger randomized study with tighter blood pressure end points are needed to assess fully the impact of terazosin on micoroalbuminuria and overall glycemic control in the NIDDM patient.

Journal Article↗

PubMed2004

[Glycemic control and the risk of preeclampsia in women with gestational diabetes mellitus].

INTRODUCTION: Gestational diabetes mellitus (GDM) is associated with an increased risk of preeclampsia and other complications throughout pregnancy. AIM: The aim of the study was to analyze the incidence of preeclampsia and other risk factors in GDM pregnant women. STUDY DESIGN AND METHODS: During 1992-2001 period, 472 consecutive unselected pregnancies were followed up in women with GDM. Glycemic control was assessed by HbA1c at the time of diagnosis. Preeclampsia was defined as blood pressure 140/90 mm Hg combined with albuminuria of >0.3 g/L. The occurrence of preeclampsia was also assessed in a control group comprising 324 unselected pregnant women. RESULTS: Preeclampsia developed in 14.4% of GDM women and 4.3% of controls. After adjustment by logistic regression, both fasting blood glucose (FBG) and profile blood glucose (PBG) and their changes during pregnancy remained significant predictors for preeclampsia. The odds for preeclampsia increased by a factor 1.2 for each 1 mmol/L increment in initial FBG level and PBG level, and decreased by factor 0.8 for each 1 mmol/L decrease of FBG or PBG level achieved during pregnancy. CONCLUSION: Improvement of the glycemic control during pregnancy reduces the risk of preeclampsia.

Blood Glucose↗

PubMed2005

Effects of abciximab and preprocedural glycemic control in diabetic patients undergoing elective coronary stenting.

BACKGROUND: In diabetic patients, the combination of abciximab with stenting has been demonstrated to be the standard of care to reduce target vessel revascularization (TVR) and mortality. Moreover, a preprocedural hyperglycemia has been associated with a higher rate of TVR after an elective stent implantation. We sought to evaluate the effects of abciximab and/or preprocedural glycemic control on 30 and 180 days of TVR and on 1-year major adverse cardiac events (MACE-cardiac mortality, TVR, and myocardial infarction) in diabetic patients undergoing elective coronary stenting. METHODS: From January 2002 through May 2003, diabetic patients undergoing elective stenting of de novo coronary artery lesions were randomized to abciximab or placebo infusion. Preprocedural hyperglycemia was defined as fasting plasma glucose >or=126 mg/dL (7.0 mmol/L) immediately before the procedure. RESULTS: A total of 122 consecutive patients with diabetes (62.4 +/- 10.2 years, 80 men) were enrolled in the study. Sixty-nine (56.5%) were randomly assigned to receive abciximab (34 with and 35 without preprocedural hyperglycemia) and 53 (43.5%) to placebo (23 with and 30 without hyperglycemia). Target vessel revascularization was significantly lower in diabetic patients who received abciximab at 30 days (2.9% and 2.8% vs 8.7% and 6.6% in nonabciximab group with or without hyperglycemia, respectively, P < .01) but not at 6 months (31.4% and 26.5% vs 30% and 28.7%, P = NS). Conversely, the cumulative incidence of MACE was significantly higher among diabetic patients with preprocedural hyperglycemia (64.7% and 65.2%) versus diabetic patients with preprocedural glycemic control (37.1% and 40%), treated with or without abciximab, respectively (P < .05). CONCLUSIONS: A preprocedural hyperglycemia is associated with a higher rate of MACE, regardless of the use of abciximab, in diabetic patients undergoing elective coronary stenting.

Abciximab↗

PubMedDate not supplied

Impact of improved glycemic control on quality of life in patients with diabetes.

OBJECTIVE: To review the current literature that examines the effects of diabetes on the health-related quality of life (HRQOL). METHODS: Three key diabetes-specific HRQOL survey instruments are described and reviewed. In addition, the findings in several recent studies that have assessed the effects of diabetes on HRQOL are discussed. RESULTS: Although the medical benefits of improved glycemic control in diabetes have gained wide recognition, less attention has been paid to the effects of diabetes on HRQOL. Both generic and diabetes-oriented measures can be used to evaluate HRQOL. Numerous studies have shown that diabetes is associated with significant reductions in HRQOL. In particular, diabetes-related complications lead to diminished quality of life. Use of intensive diabetes treatment does not appear to reduce HRQOL, and alternative therapeutic strategies, as well as education and support, may benefit the quality of life in patients with diabetes. CONCLUSION: Early and aggressive intensive therapy leading to improved glycemic control is likely to reduce the impact of diabetes on the HRQOL, by slowing the onset and progression of complications.

Diabetes Mellitus↗

PubMed1989

Diuretics and other antihypertensive drugs and glycemic control in non-insulin-dependent diabetics with hypertension. A survey by the Fukuoka Diabetes Clinic Group.

We compared the levels of fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1) in non-insulin-dependent diabetics with hypertension who were treated with monotherapy of diuretics or other antihypertensive drugs (AHD) and in those who were not given any AHD. Total 162 patients were divided into the four groups; the control group without AHD (n = 45), the diuretics group (n = 42), the beta-blocker group (n = 30) and the Ca-antagonist group (n = 45). FPG and HbA1 levels were 153 +/- 44 mg/dl and 10.0 +/- 2.3% for the control group, 145 +/- 55 mg/dl and 9.8 +/- 2.2% for the diuretics, 165 +/- 63 mg/dl and 10.2 +/- 2.1% for the beta-blocker and 158 +/- 42 mg/dl and 10.4 +/- 2.0% for the Ca-antagonist, respectively. There were no significant differences in the levels of FPG and HbA1 among the four groups. Multivariate analysis also revealed no difference in glycemic control even when anti-diabetic treatment (diet alone, oral hypoglycemic agents or insulin), body mass index, serum potassium, systolic and diastolic blood pressures and age were taken into account. Blood pressure levels did not differ among the groups except control and they were well controlled at the low doses of AHD. Our results suggest that the choice of low dose diuretics for the treatment of hypertension in non-insulin-dependent diabetics might not be necessarily excluded by the only reason of the possible deleterious influence on glycemic control.

Adrenergic beta-Antagonists↗

PubMed1990

Variables associated with weight loss and improvements in glycemic control in type II diabetic patients in behavioral weight control programs.

Because weight loss is difficult to achieve, it would be helpful to determine whether there are subgroups of obese type II diabetic patients who benefit most from participation in a behavioral weight loss program. We studied 178 obese patients with type II diabetes, who participated in a 12-20 week behavioral weight loss program and were followed for 1 year after the program to determine whether age, gender, percent overweight, medication, duration of diabetes or fasting glucose were related to weight loss and/or to the magnitude of improvement in glycemic control experienced with weight loss. Gender was the only variable related to weight loss; males lost more weight and had greater decreases in percent overweight than females. The variable most strongly related to improvement in glycemic control was pretreatment fasting glucose level; patients with higher initial glucose levels experienced the greatest improvements in control. There was no evidence to support the belief that patients on insulin have poorer weight losses or that patients with long-duration diabetes benefit less from weight reduction than those with recent-onset diabetes.

Behavior Therapy↗

PubMed2001

Glycemic control among diabetic patients.

OBJECTIVE: This study was carried out to assess control of blood glucose among diabetic patients attending Primary Health Care Centers in Riyadh. METHODS: It is a retrospective study where fasting blood glucose reading for all diabetic patients attending 3 randomly selected Primary Health Care Centers in Riyadh was taken during the months of March and April 2000. The patients were divided into 3 categories: those with excellent, those with acceptable and those with poor glycemic control (Fasting blood sugar 4-7, 7-10 and more than 10 mmol/litres). RESULTS: A total of 991 diabetic patients were involved in the study (83% men and 62% women). Those with excellent glycemic control represent 21% of patients in the first reading and 25% of the patients in the second readings, while those with poor control represent 49% and 44% of the patients in the two readings. The remaining are in the acceptable category. CONCLUSION: Diabetes mellitus is poorly controlled in a large proportion of diabetic patients attending Primary Health Care Centers in Riyadh. Public education and awareness programs should be encouraged. Such programs must include the importance of appropriate life style changes and of self monitoring of blood glucose at home.

Blood Glucose↗

PubMed1999

Effects of insulin therapy and glycemic control on distribution of HDL alpha and pre-beta subfractions in non insulin-dependent diabetic subjects.

BACKGROUND AND AIM: The heterogeneous population of HDL particles can be separated into six classes which may provide a more sensitive index of cardiovascular risk than HDL cholesterol. The aim of this study was therefore to evaluate HDL distribution in NIDDM. METHODS AND RESULTS: Twenty-five individuals were treated with diet and sulfonylurea and 14 with insulin; both groups had similar plasma lipid profiles and BMI, but the insulin-treated subjects were older and their diabetes was of longer duration. The major findings were a greater proportion of apoA1 in alpha 1-HDL in the insulin-treated group (24.3 +/- 5.2% vs 20.8 +/- 4.0%), which is a desirable profile, and a greater proportion of pre-beta 1-HDL, which are the initial acceptors of cellular cholesterol. CONCLUSIONS: Our results suggest a beneficial influence of insulin treatment on reverse cholesterol transport. Moreover, glycemic control (HbA1c) also related to alpha 3-HDL significantly (r = 0.51; p < 0.01), indicating an association between poorer glycemic control and an adverse HDL profile.

Administration, Oral↗

PubMed1998

The role of amylin in the physiology of glycemic control.

Amylin is a 37-amino acid peptide hormone, discovered in 1987, which is co-located and co-secreted with insulin by the pancreatic beta-cells in response to nutrient stimuli. Like insulin, there is a deficiency of amylin in people with type 1 diabetes, while the changes in plasma amylin concentrations in people with impaired glucose tolerance and type 2 diabetes parallel those of insulin. It is well established that insulin regulates glycemic control by promoting glucose disposal. This paper reviews evidence from studies in animals and people with diabetes that amylin regulates the inflow of glucose to the circulation by delaying nutrient delivery and, thus, the appearance of meal-derived glucose, and also suppresses glucagon secretion in the postprandial period. It is suggested, therefore, that the actions of amylin complement those of insulin, and that the problems of glycemic control which continue to exist in people with diabetes, despite insulin replacement therapy, may be attributable to a deficiency in amylin. Preclinical and clinical studies with pramlintide, a synthetic analogue of human amylin, are also included in this brief review.

Amyloid↗

PubMedDate not supplied

Renal handling of uric acid in patients with type 1 diabetes in relation to glycemic control.

BACKGROUND: The aim of the study was to compare the renal handling of uric acid (UA) in 16 patients with type 1 diabetes without renal failure (age 34.8 +/- 13.3 years) and in 15 healthy subjects (age 34.9 +/- 12.6 years). METHODS: Creatinine clearance (Cr-Cl), clearance of uric acid (UA-Cl), fractional excretion of uric acid (UA-FE), and 24-h urinary UA excretion (UA-U) were determined. Glycemic control was assessed using fasting glucose, glycated hemoglobin and fructosamine tests. RESULTS: Patients with diabetes had significantly (p < 0.0001) lower serum UA concentrations compared to control group (2.8 +/- 0.7 vs. 5.7 +/- 0.8 mg/dl), and higher urinary UA excretion (813 +/- 107 vs. 423 +/- 40 mg/day), UA clearance (21.9 +/- 7.1 vs. 5.2 +/- 0.9 mL/min) and fractional UA excretion (17.1 +/- 5.5 vs. 4.8 +/- 1.3%), with higher creatinine clearance (129 +/- 16 vs. 111 +/- 12 mL/min, p < 0.005). In patients with diabetes there was a strong negative correlation between serum UA concentration and UA 24-h excretion (R = -0.79; p < 0.001). Fractional UA excretion correlated with fasting glycemia and HbA1c (R = +0.51 and +0.53; p < 0.05). CONCLUSIONS: In type 1 diabetes there is significant UA renal clearance increase, which is higher with poor glycemic control. It leads to hypouricemia despite an approximately twofold UA excretion increase and therefore despite increased UA synthesis.

Adult↗

PubMed1988

Major malformations in infants of IDDM women. Vasculopathy and early first-trimester poor glycemic control.

From animal and in vitro studies, it has been suggested that high environmental glucose, ketone, or insulin concentrations and low glucose or insulin concentrations may be etiologic factors for congenital malformations (CMs) in infants of diabetic mothers (IDMs). Transplacental passage of antibody-bound insulin has been demonstrated in humans. Controversy exists regarding the pathophysiology of CMs in human insulin-dependent diabetes mellitus (IDDM) pregnancies. We hypothesized that CMs in IDMs are associated with maternal vasculopathy, poor first-trimester glycemic control (i.e., hyper- and/or hypoglycemia), advanced White class, and high insulin requirements. We studied 165 first pregnancies of women with IDDM from 1978 to 1986. The goals of glucose control were a fasting blood glucose of less than 100 mg/dl and a 90-min postprandial blood glucose of less than 140 mg/dl. Insulin requirements, body weight, and pre- and postprandial blood glucose were recorded at weekly clinic visits. Maternal blood HbA1 was measured on entry and every 4 wk to confirm that adequate glycemic control was achieved. Women who enrolled in the project were interviewed during gestation by a geneticist/dysmorphologist who obtained genetic and environmental histories using a standard questionnaire. All live-born infants and stillbirths were examined. Each live-born infant was assessed systematically by two independent examiners, a neonatologist and a geneticist/dysmorphologist; examination with standardized checklists was performed in the newborn nursery as soon after birth as was practical. In first pregnancies in the study, there were 13 IDMs with major CMs (7.9%).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗

PubMed2003

Strict glycemic control in diabetic pregnancy-implications for second-trimester screening for Down syndrome.

OBJECTIVES: Studies in the early 1990s showed that the normal levels of the biochemical markers used to screen for Down syndrome in the second trimester of pregnancy differ between healthy women and women with insulin-dependent diabetes mellitus (IDDM). Thereafter, most laboratories adopted correcting factors to adjust for these differences. However, the current validity of these factors in light of the recent improvements in glycemic control in diabetic pregnancy has not been investigated. METHODS: The sample consisted of 35 pregnant women with strictly controlled IDDM and 40 healthy controls matched for age and gestational week. All women had singleton pregnancies and were followed till delivery. RESULTS: Comparison of the triple test results between the two groups after adjustment with the traditional corrective factors yielded no significant differences in serum levels of any of the markers (unconjugated estriol, human chorionic gonadotrophin, alpha-fetoprotein). CONCLUSIONS: These results suggest that the recent improvement in glycemic control of pregnant women with IDDM changes the metabolic milieu that might cause the biochemical differences with healthy pregnant patients.

Adult↗

PubMed2004

Leucine 7 to proline 7 polymorphism in the preproneuropeptide Y is associated with proteinuria, coronary heart disease, and glycemic control in type 1 diabetic patients.

OBJECTIVE: Neuropeptide Y is a potent vasoconstrictor thought to enhance the development of atherosclerosis. The leucine 7 to proline 7 (Leu7Pro) polymorphism, located in the signal peptide part of the human preproneuropeptide Y, has been associated with serum lipid levels, intima-media thickness of the common carotid arteries, and diabetic retinopathy in type 2 diabetic patients. Therefore, we investigated the impact of the Leu7Pro polymorphism on diabetic nephropathy, cardiovascular risk factors, and cardiovascular disease in type 1 diabetic patients. RESEARCH DESIGN AND METHODS: A total of 996 patients from the Finnish Diabetic Nephropathy study were studied in a case-control, cross-sectional study. The carrier frequency of the Pro7 substitution was 13% in the entire study population. RESULTS: The Pro7 substitution was more common in patients with proteinuria than in those with a normal albumin excretion rate (16 vs. 11%, P < 0.05). Patients with the Pro7 allele had worse glycemic control (HbA(1c) 8.8 vs. 8.5%, P < 0.005), more coronary heart disease (CHD) (14 vs. 8%, P < 0.05), and higher serum triglycerides (1.65 vs. 1.35 mmol/l, P < 0.005) than patients with the wild-type genotype. There were no differences in the plasma neuropeptide Y levels between the patients with Pro7 compared with those with the wild-type genotype. The Leu7Pro polymorphism was independently associated with HbA(1c) (P < 0.001), proteinuria (P < 0.01), and CHD (P < 0.01) in multiple regression analyses. CONCLUSIONS: We conclude that the Leu7Pro polymorphism may contribute to the genetic susceptibility to diabetic nephropathy and CHD in type 1 diabetic patients, possibly by influencing glycemic control and triglycerides.

Adult↗

PubMed2006

Vascularized tissue-engineered chambers promote survival and function of transplanted islets and improve glycemic control.

We have developed a chamber model of islet engraftment that optimizes islet survival by rapidly restoring islet-extracellular matrix relationships and vascularization. Our aim was to assess the ability of syngeneic adult islets seeded into blood vessel-containing chambers to correct streptozotocin-induced diabetes in mice. Approximately 350 syngeneic islets suspended in Matrigel extracellular matrix were inserted into chambers based on either the splenic or groin (epigastric) vascular beds, or, in the standard approach, injected under the renal capsule. Blood glucose was monitored weekly for 7 weeks, and an intraperitoneal glucose tolerance test performed at 6 weeks in the presence of the islet grafts. Relative to untreated diabetic animals, glycemic control significantly improved in all islet transplant groups, strongly correlating with islet counts in the graft (P<0.01), and with best results in the splenic chamber group. Glycemic control deteriorated after chambers were surgically removed at week 8. Immunohistochemistry revealed islets with abundant insulin content in grafts from all groups, but with significantly more islets in splenic chamber grafts than the other treatment groups (P<0.05). It is concluded that hyperglycemia in experimental type 1 diabetes can be effectively treated by islets seeded into a vascularized chamber functioning as a "pancreatic organoid."

Animals↗