Routine prophylaxes every 3 months improves chronic periodontitis status in type 2 diabetes. [Cost-effectiveness of exenatide versus insulin glargine in Spanish patients with obesity and type 2 diabetes mellitus]. Pharmacodynamics of the glucagon-like peptide-1 receptor agonist lixisenatide in Japanese and Caucasian patients with type 2 diabetes mellitus poorly controlled on sulphonylureas with/without metformin Glycemic control with preprandial versus basal insulin in patients with type 2 diabetes mellitus poorly controlled by oral antidiabetes agents. Rationale and design: telephone-delivered behavioral skills interventions for Blacks with type 2 diabetes Non-surgical periodontal therapy with and without subgingival minocycline administration in patients with poorly controlled type II diabetes: a randomized controlled clinical trial Impact of Vitamin E Supplementation on Blood Pressure and Hs-CRP in Type 2 Diabetic Patients | doi: 10.5681/hpp.2012.009. Periodontal disease progression and glycaemic control among Gullah African Americans with type-2 diabetes. Impact of medication and psychological behaviour assessment by community pharmacists in type 2 diabetes mellitus patients after hospital stay. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. The effectiveness of yoga to prevent diabetes mellitus type 2 Willingness to pay for improvements in chronic long-acting insulin therapy in individuals with type 1 or type 2 diabetes mellitus. Generalizability of dietary patterns associated with incidence of type 2 diabetes mellitus. Motivational interviewing delivered by diabetes educators: does it improve blood glucose control among poorly controlled type 2 diabetes patients? Validation of economic and health outcomes simulation model of type 2 diabetes mellitus (ECHO-T2DM) Patients' education, and its impact on care outcomes, resource consumption and working conditions: data from the International Diabetes Management Practices Study (IDMPS). Factors associated with the clinical response to nonsurgical periodontal therapy in people with type 2 diabetes mellitus. Participant experiences in a smartphone-based health coaching intervention for type 2 diabetes: A qualitative inquiry Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview An educational programme for peer review groups to improve treatment of chronic heart failure and diabetes mellitus type 2 in general practice. Safety and effectiveness of biphasic insulin aspart 30 (Biasp 30) in people with type 2 diabetes mellitus in the pakistani population: results from the A1chieve study. Cost-effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: design of a cluster-randomized controlled trial Physical activity and sedentary behaviors associated with risk of progression from gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study.
BACKGROUND Periodontitis and type 2 diabetes mellitus ( T2DM ) are major health problems , especially in low-income population s with little access to dental care . Low-cost models for treatment of periodontal disease have not been tested in controlled studies in low-income population s. Dental prophylaxis , which includes removal of supragingival calculus and plaque , has been shown to arrest the progression of periodontitis . A controlled clinical trial was conducted to determine the effect of dental prophylaxis on periodontitis in T2DM . METHODS Twenty-six patients with T2DM and chronic periodontitis ( CP ) and 26 without T2DM with CP were selected .  Periodontal probing depth ( PD ) , gingival bleeding on probing ( BOP ) , clinical attachment level ( CAL ) , and surfaces with plaque were recorded at baseline and 3 , 6 , and 9 months after initial treatment . All the participants received instructions on oral hygiene and one session of dental prophylaxis at baseline and every 3 months . Glycated hemoglobin ( HbA1c ) levels were measured at baseline and every 3 months in patients with T2DM . RESULTS A significant improvement of PD , BOP , and sites with plaque was observed 3 months after treatment in patients with T2DM ( P = 0.001 ) . In controls , mean PD significantly improved after 6 months compared with baseline ( P = 0.001 ) . No significant improvement of CAL occurred in either group . No significant differences in periodontal parameters between the groups were detected , and no participant showed progression of CP during the 9-month study period . Dental prophylaxis did not influence HbA1c levels , and no association among HbA1c concentration , pretreatment metabolic status , and severity of CP was found . CONCLUSION Routine prophylaxes every 3 months significantly improve periodontal health and prevent progression of CP in both poorly controlled and well-controlled patients with T2DM BACKGROUND AND OBJECTIVES Exenatide , a GLP-1 receptor agonist for adjuvant treatment of type 2 diabetes mellitus ( T2DM ) , has been shown to be as effective as insulin glargine ( IG ) for reducing glycated hemoglobin levels combined with metformin or/ and sulphonylureas . Exenatide is associated to weight reduction and a higher incidence of gastrointestinal adverse events . The objective of this study was to assess the cost-effectiveness of exenatide as compared to IG in obese patients with T2DM not achieving an adequate blood glucose control from the perspective of the Spanish healthcare system . METHODS Pharmacoeconomic model inputs were obtained from an obese sub population ( BMI ≥ 30 k/m(2 ) ) of an international , r and omized , controlled clinical trial comparing exenatide with IG in poorly controlled T2DM patients , and were supplemented with country-specific data . RESULTS Exenatide was associated to improvements in life-years gained and quality -adjusted life years ( QALYs ) by 0.11 and 0.62 respectively versus IG . Direct costs were € 9,306 higher as compared to IG ( € 47,010 versus € 37,704 , with increased pharmacy costs as the main driver  ) . Exenatideís  incremental cost-effectiveness ratio was € 15,068 per QALY gained versus IG . CONCLUSIONS Exenatide was associated to greater clinical benefits and higher costs in obese T2DM patients as compared to IG . Considering a willingness-to-pay threshold of € 30,000 per QALY gained in the Spanish setting  , exenatide represents an efficient option in comparison with IG The PDY6797 study evaluated efficacy , safety and pharmacodynamics of lixisenatide in Japanese and Caucasian patients with type 2 diabetes mellitus ( T2DM ) insufficiently controlled with sulphonylureas with/without metformin OBJECTIVE This study was design ed to compare glycemic control ( glycated hemoglobin [ A1C ] level ) with either once-daily basal insulin ( BI ) ( insulin glargine ) or prepr and ial insulin ( PPI ) ( Exubera ) [ insulin human ( recombinant DNA origin ) ] inhalation powder , Pfizer Inc. , New York , NY ) in patients with type 2 diabetes mellitus ( T2DM ) poorly controlled on at least two oral antidiabetes agents ( OADs ) . METHODS This was a 26-week , open-label , parallel-group , r and omized study where 257 patients ( mean A1C 8.6 % ) on OAD treatment for > or = 3 months were treated with either BI ( n = 122 ) or PPI ( n = 135 ) . Based on self-monitored blood glucose levels , PPI dose was adjusted before each major meal , whereas BI dose was titrated in the morning or before bedtime . Pre study OADs were continued , but doses could be modified . RESULTS At 26 weeks , change from baseline in A1C was greater with PPI ( -1.7 vs. -1.4 % , P = 0.0389 ) . Numerically , more patients achieved A1C < 6.5 % ( 28 % vs. 19 % ) and A1C < 7.0 % ( 63 % vs. 55 % ) with PPI compared with BI . PPI had lower postmeal glucose increments , but higher prebreakfast glucose and weight gain ( 1.1 kg ) , than BI . Mild or moderate hypoglycemic events were more frequent with PPI ( 6.2 vs. 2.9 events/months ) , but nocturnal hypoglycemic events were less frequent ( 22 % vs. 30 % ) . CONCLUSIONS PPI improved postpr and ial glucose and A1C levels significantly more than BI . More patients achieved A1C targets with PPI , at the expense of more hypoglycemia and body weight gain . These results illustrate the potential benefits and detriments of pr and ial insulin supplementation in patients with T2DM poorly controlled on OADs alone Background African Americans with Type 2 diabetes ( T2DM ) have higher prevalence of diabetes , poorer metabolic control , and greater risk for complications and death compared to American Whites . Poor outcomes in African Americans with T2DM can be attributed to patient , provider , and health systems level factors . Provider and health system factors account for < 10 % of variance in major diabetes outcomes including hemoglobin A1c ( HbA1c ) , lipid control , and re source use . Key differences appear to be at the patient level . Of the patient level factors , consistent differences between African Americans and American Whites with T2DM have been found in diabetes knowledge , self-management skills , empowerment , and perceived control . A variety of interventions to improve diabetes self-management have been tested including : 1 ) knowledge interventions ; 2 ) lifestyle interventions ; 3 ) skills training interventions ; and 4 ) patient activation and empowerment interventions . Most of these interventions have been tested individually , but rarely have they been tested in combination , especially among African Americans who have the greatest burden of diabetes related complications . This study provides a unique opportunity to address this gap in the literature . Methods / Design We describe an ongoing four-year r and omized clinical trial , using a 2 × 2 factorial design , which will test the efficacy of separate and combined telephone-delivered , diabetes knowledge/information and motivation/behavioral skills training interventions in high risk African Americans with poorly controlled T2DM ( HbA1c ≥ 9 % ) . Two-hundred thirty-two ( 232 ) male and female African-American participants , 18 years of age or older and with an HbA1c ≥ 9 % , will be r and omized into one of four groups for 12-weeks of phone interventions : ( 1 ) an education group , ( 2 ) a motivation/skills group , ( 3 ) a combined group or ( 4 ) a usual care/general health education group . Participants will be followed for 12-months to ascertain the effect of the interventions on glycemic control . Our primary hypothesis is that among African Americans with poorly controlled T2DM , patients r and omized to the combined diabetes knowledge/information and motivation/behavioral skills training intervention will have significantly greater reduction in HbA1c at 12 months of follow-up compared to the usual care/general health education group . Discussion Results from this study will provide important insight into how best to deliver diabetes education and skills training in ethnic minorities and whether combined knowledge/information and motivation/behavioral skills training is superior to the usual method of delivering diabetes education for African Americans with poorly controlled T2DM.Trial registration National Institutes of Health Clinical Trials Registry ( Clinical Trials.gov identifier # NCT00929838 ) The aim of this study was to evaluate changes in clinical parameters and levels of inflammatory biomarkers in plasma in periodontal patients with poorly controlled type 2 diabetes mellitus ( T2DM ) after non-surgical periodontal therapy . Twenty-eight poorly controlled T2DM patients were r and omly assigned to treatment with scaling and root planning ( SRP ) and SRP + subgingival minocycline administration . Clinical parameters , including the probing depth ( PD ) , bleeding on probing ( BOP ) , plaque score ( PS ) , clinical attachment level ( CAL ) , and plasma interleukin (IL)-6 , soluble receptor of advanced glycation end products ( sRAGE ) , chronic reactive protein ( CRP ) , and hemoglobin A1c ( HbA1c ) were measured before and after a 6-month treatment period . Significant changes in PD , BOP , PS , and CAL were found in both groups . The latent growth curve model showed an overall reduction in the log HbA1c level in the SRP group ( −0.082 , p = 0.033 ) . Small changes in the log sRAGE level and log CRP level in plasma were found in both groups . IL-6 in the plasma increased in the SRP group , but slightly decreased in the SRP+minocycline group ( 0.469 pg/ml , p = 0.172 ) . Non-surgical periodontal therapy with or without subgingival minocycline application may achieve significant periodontal improvement and moderate improvement in HbA1c , but had no significant effect on plasma levels of IL-6 , CRP , or sRAGE in patients with poorly controlled T2DM . For patients with both periodontal diseases and diabetes , non-surgical periodontal treatments may be helpful in their diabetic control BACKGROUND Type 2 diabetes mellitus ( T2DM ) is a major public health problem worldwide . Hypertension and inflammation are well recognized as risk factors for the macrovascular complications of diabetes . The aim of this study was to assess the impact of vitamin E supplementation on blood pressure ( BP ) , serum high-sensitivity C-reactive protein ( hs-CRP ) and fasting blood glucose in patients with T2DM . METHODS In a double blind , r and omized , controlled clinical trial , 83 patients with T2DM were divided r and omly into two groups of vitamin E ( 400 mg/d , n=42 ) and placebo ( n=41 ) . All patients received the pearls for 8 weeks . Baseline and eighth week BP , serum hs-CRP , fasting blood glucose , anthropometric and dietary intake data were obtained from each patient . Data were analyzed using SPSS version 11.5 . RESULTS Vitamin E supplementation significantly increased serum levels of vitamin E  ( P < 0.001 ) and decreased mean arterial pressure and fasting blood glucose ( P = 0.047 , P = 0.028 , respectively ) in vitamin E group as compared with placebo group . A significant decrease in systolic blood pressure and diastolic blood pressure was observed in the vitamin E group comparing with baseline values ( all P < 0.01 ) . There were no significant changes in serum hs-CRP in both of the studied groups . CONCLUSION Vitamin E had beneficial effects on serum vitamin E , BP and blood glucose in patients with T2DM . Improvement in BP and glucose control may contribute to reducing complications of diabetes including cardiovascular risk in these patients AIM To evaluate associations between glycaemic control and periodontitis progression among Gullah African Americans with type-2 diabetes mellitus ( T2DM ) . MATERIAL S AND METHODS From an ongoing clinical trial among T2DM Gullah , we extracted a cohort previously in a cross-sectional study ( N=88 ) . Time from baseline ( previous study ) to follow-up ( trial enrollment , before treatment interventions ) ranged 1.93 - 4.08 years [ mean=2.99 , st and ard deviation (SD)=0.36 ] . We evaluated tooth site-level periodontitis progression [ clinical attachment loss ( CAL ) worsening of > or = 2 mm , periodontal probing depth ( PPD ) increases of > or = 2 mm and bleeding on probing ( BOP ) from none to present ] by glycaemic control status ( well-controlled = HbA(1c)<7 % , poorly-controlled = HbA(1c ) > or = 7 % ) using multivariable generalized estimating equations logistic regression , nesting tooth sites/person . RESULTS Poorly-controlled T2DM ( 68.18 % ) was more prevalent than well-controlled T2DM ( 31.82 % ) . Proportions of tooth sites/person with CAL progression between baseline and follow-up ranged 0.00 - 0.59 ( mean=0.12 , SD=0.12 ) , while PPD and BOP progression ranged 0.00 - 0.44 ( mean=0.09 , SD=0.11 ) and 0.00 - 0.96 ( mean=0.24 , SD=0.18 ) , respectively . Site-level PPD at baseline was a significant effect modifier of associations between poorly-controlled T2DM and site-level CAL and PPD progression [ adjusted odds ratios ( OR ) according to poorly-controlled T2DM among PPD at baseline=3 , 5 and 7 mm , respectively : CAL progression=1.93 , 2.64 , and 3.62 , PPD progression=1.98 , 2.76 , and 3.84 ; p<0.05 for all ] . Odds of site-level BOP progression were increased ( OR=1.24 ) for poorly-controlled T2DM , yet the results were not significant ( p=0.32 ) . CONCLUSIONS These findings from a distinct , homogenous population further support the clinical relevance of identifying patients with poor glycaemic control and periodontitis , particularly among those with disparities for both diseases BACKGROUND Drug related problem ( DRPs ) is a key factor which will affect the outcome of therapy and safety . OBJECTIVE To assess the DRPs in type 2 diabetes mellitus ( T2DM ) patients and psychological aspects of patients by community pharmacists to observe the rate of DRP . METHODS Prospect i ve r and omized controlled intervention study involved T2DM patients and conducted in two community pharmacies at Kanpur from January 2012 to December 2012 . The assessment of DRPs was based on the PCNE . Changes in glycosylated hemoglobin ( HBA1c ) , low density lipoproteins ( LDL ) , blood pressure(BP ) , foot examinations , changes medical and medication utilization were studied . Using as control group , received usual care , and interventional group provided , intervened with use of the st and ard treatment guidelines ( STG ) . Research er provided the knowledge to community pharmacists and patients . Baseline and interventional data were collected at 0,3,6,9 and 12 months . RESULTS Over the 12 month study , participants ' average HBA1C reduced from 8.9 % at initial visit to 7.5 % . During this time , the eye examination rate was raised from 31 % to 48 % , and the foot examination rate was raised from 35 % to 50 % . CONCLUSION The intervention of pharmacists showed little influence on any of the intermediate health outcomes in T2DM OBJECTIVES To determine the efficacies of 2 weight-reducing operations on diabetic control and the role of duodenum exclusion . DESIGN Double-blind r and omized controlled trial . SETTING Department of Surgery of the Min-Sheng General Hospital , National Taiwan University . PATIENTS We studied 60 moderately obese patients ( body mass index > 25 and < 35 ) aged > 30 to < 60 years who had poorly controlled type 2 diabetes mellitus ( T2DM ) ( hemoglobin A(1c ) [ HbA(1c ) ] > 7.5 % ) after conventional treatment ( > 6 months ) from September 1 , 2007 , through June 30 , 2008 . Patients and observers were masked during the follow-up , which ended in 2009 , 1 year after final enrollment . INTERVENTIONS Gastric bypass with duodenum exclusion ( n = 30 ) vs sleeve gastrectomy without duodenum exclusion ( n = 30 ) . MAIN OUTCOME MEASURES The primary outcome was remission of T2DM ( fasting glucose < 126 mg/dL and HbA(1c ) < 6.5 % without glycemic therapy ) . Secondary measures included weight and metabolic syndrome . Analysis was by intention to treat . RESULTS Of the 60 patients enrolled , all completed the 12-month follow-up . Remission of T2DM was achieved by 28 ( 93 % ) in the gastric bypass group and 14 ( 47 % ) in the sleeve gastrectomy group ( P = .02 ) . Participants assigned to gastric bypass had lost more weight , achieved a lower waist circumference , and had lower glucose , HbA(1c ) , and blood lipid levels than the sleeve gastrectomy group . No serious complications occurred in either group . CONCLUSIONS Participants r and omized to gastric bypass were more likely to achieve remission of T2DM . Duodenum exclusion plays a role in T2DM treatment and should be assessed . Trial Registration clinical trials.gov Identifier : NCT00540462 ( http://www . clinical trials.gov ) Background : Type 2 diabetes mellitus ( T2DM ) is becoming a leading problem worldwide . Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached p and emic levels . Despite the significant incidence , there are limited reliable data re sources and comprehensive systematic review and meta- analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM . Objective : The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM . Methods : The articles enrolled in the study will be retrieved from the online data bases between 2002 and the date the search es are executed . The search es will be repeated just before the final analyses and further relevant studies for inclusion . We will conduct a bibliographic search in data bases : Medline / PubMed , Scopus , Cochrane Library , EBSCO , and IndMED using keywords including prediabetes state , high risk for diabetes , metabolic syndrome , and yoga . A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies . This study protocol was prepared according to the Preferred Reporting Items for Systematic Review s and Meta- Analysis for Protocol s 2015 guidelines . There will be no language restrictions . Ethics and dissemination : The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee . We published an outline of the protocol in the International Prospect i ve Register of Systematic Review s ( PROSPERO ) in 2018 . We plan to disseminate the findings of this systematic review and meta- analysis through publication in a peer- review ed journal and presentation at relevant conference proceedings . In addition , we believe the results of the systematic review will have implication s for policy and practice . We will prepare policymaker summary using a vali date d format , disseminate through social media and email discussion groups . Review registration number : PROSPERO registration number CRD BACKGROUND Long-acting insulin treatments with varying clinical benefits are currently available for patients with type 1 diabetes mellitus ( T1DM ) and type 2 diabetes mellitus ( T2DM ) . The current evidence base demonstrates the efficacy of treatments , but it is critical also to underst and patient preferences regarding treatments and how they are determined . OBJECTIVE This study aim ed to measure the willingness to pay ( WTP ) of individuals with diabetes in the United Kingdom for different attributes of long-acting insulin therapy . METHODS A survey based on discrete choice experiment methodology was developed to elicit the preferences and values of adults with T1DM or insulin-dependent T2DM regarding different aspects of their therapy . Participants were presented with a series of 27 paired choices and asked which they preferred . WTP values were calculated for relevant attribute levels . RESULTS A total of 252 participants completed the question naire ( 52 % response rate ) ; 143 had T1DM and 109 had insulin-treated T2DM . The highest WTP values in participants with T1DM were avoiding 2-kg or 4-kg weight gain ( £ 29 and £ 58 , respectively ) , avoiding major difficulties with the injection device ( £ 49 ) , increasing the number of days per week when blood glucose levels are in the target range from 2 to 6 ( £ 40 ) , reducing the number of daily injections from 3 to 1 ( £ 39 ) , and avoiding nighttime hypoglycemia ( £ 33 ) . In participants with T2DM , similar factors had the highest WTP . CONCLUSIONS This is the first study to assess WTP  for long-acting insulin therapy and could have implication s for future guidelines on diabetes management , however some limitations , notably in sample selection , could affect generalizability of the results . In both T1DM and T2DM , the highest WTP values were for avoidance of weight gain , and reduction in the number of injections and hypoglycemia BACKGROUND Reduced rank regression ( RRR ) has been used to derive dietary pattern scores that predict linear combinations of disease biomarkers . The generalizability of these patterns to independent population s remains unknown . OBJECTIVE The goal was to examine the generalizability of  dietary patterns  from the following prior studies using RRR to predict  type 2 diabetes mellitus ( T2DM ) :  the Nurses ' Health Study ( NHS ) , European Prospect i ve Investigation into Cancer and Nutrition Germany ( EPIC ) , and Whitehall II Study ( WS ) . DESIGN The relative weights of food groups of each dietary pattern were used to generate each dietary pattern score in the Framingham Offspring Study ( n = 2879 ) . Each of the external scores ( confirmatory scores ) was examined to determine whether it could predict incident T2DM during 7 y of follow-up as well as scores developed internally in the Framingham Offspring Study using a Cox-proportional hazard model adjusted for T2DM risk factors . RESULTS Intakes of meat products , refined grains , and soft drinks ( caloric and noncaloric ) were found to be common predictive components of all confirmatory scores , but fried foods , eggs , and alcoholic beverages were predictive in some , but not in all , confirmatory scores . On the basis of a continuous increase in the score by 1 SD , the NHS-based confirmatory score predicted T2DM risk ( hazard ratio : 1.44 ; 95 % CI : 1.25 , 1.66 ) . However , T2DM risk was only weakly predicted by the EPIC-based score ( hazard ratio : 1.14 ; 95 % CI : 0.99 , 1.32 ) and the WS-based score ( hazard ratio : 1.16 ; 95 % CI : 1.00 , 1.35 ) . CONCLUSIONS The study suggested that dietary patterns that predict T2DM risk  in different population s may not be generalizable to different population s. Additional dietary pattern studies should be conducted with regard to generalizability AIM To determine whether glycemic control is improved when motivational interviewing ( MI ) , a patient-centered behavior change strategy , is used with diabetes self management education ( DSME ) as compared to DSME alone . METHODS poorly controlled type 2 diabetes ( T2DM ) patients ( n=234 ) were r and omized into 4 groups : MI+DSME or DSME alone , with or without use of a computerized summary of patient self management barriers . We compared HbA1c changes between groups at 6 months and investigated mediators of HbA1c change . RESULTS study patients attended the majority of the four intervention visits ( mean 3.4 ) , but drop-out rate was high at follow-up research visits ( 35 % ) . Multiple regression showed that groups receiving MI had a mean change in HbA1c that was significantly lower ( less improved ) than those not receiving MI ( t=2.10 ; p=0.037 ) . Mediators of HbA1c change for the total group were diabetes self-care behaviors and diabetes distress ; no between-group differences were found . CONCLUSIONS DSME improved blood glucose control , underlining its benefit for T2DM management . However , MI+DSME was less effective than DSME alone . Overall , weak support was found for the clinical utility of MI in the management of T2DM delivered by diabetes educators Abstract Objective : This study constructed the Economic and Health Outcomes  Model for type 2 diabetes mellitus ( ECHO-T2DM )  , a long-term stochastic microsimulation model , to predict the costs and health outcomes in patients with T2DM . Naturally , the usefulness of the model depends upon its predictive accuracy . The objective of this work is to present results of a formal validation exercise of ECHO-T2DM . Methods : The validity of ECHO-T2DM was assessed using criteria recommended by the International Society for Pharmacoeconomics and Outcomes Research /Society for Medical Decision Making ( ISPOR/SMDM ) . Specifically , the results of a number of clinical trials were predicted and compared with observed study end-points using a scatterplot and regression approach . An F-test of the best-fitting regression was added to assess whether it differs statistically from the identity ( 45 ° ) line defining perfect predictions . In addition to testing the full model using all of the validation study data , tests were also performed of microvascular , macrovascular , and survival outcomes separately . The validation tests were also performed separately by type of data ( used vs not used to construct the model , economic simulations , and treatment effects ) . Results : The intercept and slope coefficients of the best-fitting regression line between the predicted outcomes and corresponding trial end-points in the main analysis were −0.0011 and 1.067 , respectively , and the R2 was 0.95 . A formal F-test of no difference between the fitted line and the identity line could not be rejected ( p = 0.16 ) . The high R2 confirms that the data points are closely ( and linearly ) associated with the fitted regression line . Additional analyses identified that disagreement was highest for macrovascular end-points , for which the intercept and slope coefficients were 0.0095 and 1.225 , respectively . The R2 was 0.95 and the estimated intercept and slope coefficients were 0.017 and 1.048 , respectively , for mortality , and the F-test was narrowly rejected ( p = 0.04 ) . The sub-set of microvascular end-points showed some tendency to over-predict ( the slope coefficient was 1.095 ) , although concordance between predictions and observed values could not be rejected ( p = 0.16 ) . Limitations : Important study limitations include : ( 1 ) data availability limited one to tests based on end-of- study outcomes rather than time-varying outcomes during the studies analyzed ; ( 2 ) complex inclusion and exclusion criteria in two studies were difficult to replicate ; ( 3 ) some of the studies were older and reflect out date d treatment patterns ; and ( 4 ) the authors were unable to identify published data on re source use and costs of T2DM suitable for testing the validity of the economic calculations . Conclusions : Using conventional methods , ECHO-T2DM simulated the treatment , progression , and patient outcomes observed in important clinical trials with an accuracy consistent with other well-accepted models . Macrovascular outcomes were over-predicted , which is common in health-economic models of diabetes ( and may be related to a general over-prediction of event rates in the United Kingdom Prospect i ve Diabetes Study [ UKPDS ] Outcomes Model ) . Work is underway in ECHO-T2DM to incorporate new risk equations to improve model prediction AIM To evaluate the impact of diabetes education provided to patients with type 2 diabetes mellitus ( T2DM ) in non-controlled studies ( " real-world conditions " ) on quality of care , re source consumption and conditions of employment . METHODS This cross-sectional study and longitudinal follow-up describe the data ( demographic and socioeconomic profiles , clinical characteristics , treatment of hyperglycaemia and associated cardiovascular risk factors , re source consumption ) collected during the second phase ( 2006 ) of the International Diabetes Management Practice s Study ( IDMPS ) . Patients received diabetes education directly from the practice nurse , dietitian or educator , or were referred to ad hoc group-education programmes ; all programmes emphasized healthy lifestyle changes , self-care and active participation in disease control and treatment . Educated vs non-educated T2DM patients ( n=5692 in each group ) , paired by age , gender and diabetes duration , were r and omly recruited for the IDMPS by participating primary -care physicians from 27 countries in Eastern Europe , Asia , Latin America and Africa . Outcome measures included clinical ( body weight , height , waist circumference , blood pressure , foot evaluation ) , metabolic ( HbA(1c ) levels , blood lipid profile ) and biochemical control measures . Treatment goals were defined according to American Diabetes Association guidelines . RESULTS T2DM patients ' education significantly improved the percentage of patients achieving target values set by international guidelines . Educated patients increased their insulin use and self-care performance , had a lower rate of chronic complications and a modest increase in cost of care , and probably higher salaries and slightly better productivity . CONCLUSION Diabetes education is an efficient tool for improving care outcomes without having a major impact on healthcare costs BACKGROUND Type 2 diabetes mellitus ( T2DM ) is a growing health problem worldwide . People with T2DM are at risk of experiencing periodontitis and likely require treatment . Using data from the national multicenter Diabetes and Periodontal Therapy Trial ( DPTT ) , the authors assessed patient-based characteristics associated with the clinical response to nonsurgical therapy . METHODS The DPTT investigators r and omly assigned adults with T2DM ( hemoglobin A1c [ HbA1c ] ≥ 7 percent and < 9 percent ) and moderate to advanced periodontitis to  receive immediate or delayed therapy ( scaling and root planing , oral hygiene instruction , chlorhexidine rinse ) . The investigators assessed probing depth ( PD ) , clinical attachment level ( CAL ) , bleeding on probing ( BOP ) , and medical conditions at baseline , three months and six months . Six-month changes in mean PD , CAL and BOP defined the treatment response . Complete data were available for 473 of 514 DPTT participants . The authors used multiple regression models to evaluate participant-level factors associated with the response . RESULTS More severe baseline PD , CAL and BOP were associated with greater improvements in these same measurements ( P < .0001 ) . Hispanic participants experienced greater improvements in PD and CAL than did non-Hispanic participants ( P < .0001 ) . Obese participants ( those with a body mass index > 30 kilograms per square meter ) experienced greater reductions in PD and BOP than did participants who were not obese ( P < .001 ) . Age , sex , HbA1c values , diabetes duration , and smoking were not associated with change in any outcome ( P > .1 ) . CONCLUSIONS In patients with T2DM , baseline disease severity was associated with the clinical response to nonsurgical periodontal therapy . Body mass index and Hispanic ethnicity-but not glycemic control , diabetes duration or smoking-also may be useful in predicting clinical changes in this population Introduction We investigated the experience of individuals diagnosed with type 2 diabetes mellitus ( T2DM ) who participated in an intervention in which the key elements were the provision of a smartphone and self-monitoring software .  The interviews focused on use of a smartphone and the effects on motivation for health behavior change . Methods This was a qualitative evaluation of participants in a larger T2DM self-management r and omized controlled trial ( RCT ) conducted at the Black Creek Community Health Centre ( BCCHC ) in Toronto , Canada ( Clinical Trials.gov Identifier : NCT02036892 ) . The study is based on semi-structured interviews ( n = 11 ) that were audio taped and analyzed with a thematic analytic approach . The RCT compared the effectiveness of six months of smartphone-based self-monitoring and health coaching with a control group who received health coaching without internet or smartphone-based assistance . Results Qualitative data analyses result ed in derivation of four major themes that describe participant experience : ( a ) ‘ smartphone and software ’ , describes smartphone use in relation to health behavior change ; ( b ) ‘ health coach ’ describes how client/health coach relationships were assisted by smartphone use ; ( c ) ‘ overall experience ’ describes perceptions of the overall intervention ; and ( d ) ‘ frustrations in managing chronic conditions ’ describes difficulties with the complexities of T2DM management from a patient perspective . Discussion Findings suggest that interventions with T2DM assisted by smartphone software and health coaches actively engage individuals in improved hemoglobin A1c ( HbA1c ) control This systematic overview summarizes the relevant evidence from multiple systematic review s of the benefits of nonpharmacological interventions for preventing  type 2 diabetes mellitus ( T2MD ) in women diagnosed with gestational diabetes mellitus ( GDM ) . A comprehensive search using the Cochrane Library , CINAHL , EMBASE and MEDLINE via Ovid SP , and PubMed data bases was completed on 18 November 2015 . Any systematic review s that evaluated r and omized controlled trials ( RCTs ) with defined nonpharmacological interventions for preventing T2DM in women diagnosed with GDM were eligible for inclusion . The authors independently performed critical appraisal s and quality assessment s of the included review s using the AMSTAR tool , and extracted data were converted to coherent values for tabular summarization . Six eligible review s of diet and /or exercise , breastfeeding , and reminder interventions were identified ; however , the method ologies of the review s varied greatly , and the majority of the evidence suggested unclear bias . We found inconsistent reporting on the rates at which diet and exercise interventions reduced the risk of T2DM progression , but these interventions were found to be effective at reducing glycemic load . Combined diet , exercise , and breastfeeding interventions proved to be effective at returning women to their postpartum weight . Neither diet alone nor exercise alone proved to be effective at lowering the risk of T2DM . Overall , there was no robust evidence to support the hypothesis that nonpharmacological interventions are effective at lowering the risk of T2DM in women diagnosed with GDM , and there was no consistent evidence showing that these interventions improved the predictor outcomes of T2DM , such as glycemic load or anthropometric changes RATIONALE , AIMS AND OBJECTIVES Peer review groups are considered helpful for quality improvement in primary care . An interactive educational programme for small peer groups was developed , focusing on the implementation of newly developed treatment guidelines . The aim is to evaluate the effect of the programme on adherence to treatment guidelines in general practice . METHODS A cluster r and omized trial using a balanced incomplete block design was used ; one arm received a programme on treatment of chronic heart failure ( CHF ) , the other on hypertension treatment in diabetes mellitus type 2 ( T2DM ) . A r and om sample of 10 CHF and 10 T2DM patients per GP was drawn , for whom data were extracted from electronic patient records 1 years before and 6 months after the intervention . The outcomes were prescribing of ACE inhibitors , and antihypertensive treatment in T2DM . The effect was analysed separately for both programmes using multilevel regression models . RESULTS All 27 peer review groups in one region in the Netherl and s were r and omized , of which 16 participated . No significant effects were observed in the CHF group or in the T2DM group . The opportunity for change was limited , as only 53 % of the CHF patients and 60 % of the T2DM patients had a contact with their GP between the intervention and follow-up measurement . CONCLUSION The peer review programme was not successful for changing the treatment of chronic patients , although the programme focused on dealing with barriers perceived by the participants . Not all problems perceived can be solved in a peer group discussion OBJECTIVE To explore the safety and effectiveness of treatment with the insulin analogue , biphasic insulin aspart 30 ( BIAsp 30 ) , in people with type 2 diabetes mellitus ( T2DM ) in a subgroup of a Pakistani population from the A1chieve study . METHODS A1chieve was a 24-week , international , prospect i ve , multicentre , open label , observational , non-interventional study design ed to evaluate the safety and clinical effectiveness of 66,726 people with T2DM who were initiated with basal insulin detemir , fast actinginsulin aspart , and BIAsp 30 ( 30 % soluble insulin aspart , 70 % protamine-crystallized insulin aspart ) . The study was conducted in 28 countries across Asia , Africa , Latin America , and Europe . Here , we report data from a subgroup of 762 people with T2DM from the Pakistani cohort ( insulin naïve and insulin users ) who were treated withpremix insulin ( BIAsp 30 ) + /- oral antidiabetic drugs ( OADs ) . RESULTS The decrease in HbAlc at week 24 was statistically significant in the entire cohort , the insulin naïve , and insulin users ( 1.7 + /- 1.1 % , 1.8 + /- 1.3 % and 1.7 + /- 0.9 % , respectively , p<0.001 for all).There was a statistically significant decrease in the mean fasting plasma glucose ( FPG ) and postpr and ial plasma glucose ( PPG ) from baseline toweek 24 in the entire cohort , in the insulin naïve and in the insulin users with BIAsp 30 treatment ( p<0.001 for all).No major hypoglycaemic events were reported during the entire study period . There was a statistically significant decrease in the systolic blood pressure ( SBP ) in all groups ( p<0.001 ) . The improvement in the quality of life score (QoL)was statistically significant in all groups ( p<0.001 for all ) . CONCLUSION BIAsp 30 treatment appeared to be well tolerated and effective as indicated byimproved glycaemiccontrol and QoL in people with T2DM in the Pakistani population after 24 weeks Background Co-morbid major depression is a significant problem among patients with type 2 diabetes mellitus and /or coronary heart disease and this negatively impacts quality of life . Subthreshold depression is the most important risk factor for the development of major depression . Given the highly significant association between depression and adverse health outcomes and the limited capacity for depression treatment in primary care , there is an urgent need for interventions that successfully prevent the transition from subthreshold depression into a major depressive disorder . Nurse led stepped-care is a promising way to accomplish this . The aim of this study is to evaluate the cost-effectiveness of a nurse-led indicated stepped-care program to prevent major depression among patients with type 2 diabetes mellitus and /or coronary heart disease in primary care who also have subthreshold depressive symptoms . Methods / design An economic evaluation will be conducted alongside a cluster-r and omized controlled trial in approximately thirty general practice s in the Netherl and s. R and omization takes place at the level of participating practice nurses . We aim to include 236 participants who will either receive a nurse-led indicated stepped-care program for depressive symptoms or care as usual .  The stepped-care program consists of four sequential but flexible treatment steps : 1 ) watchful waiting , 2 ) guided self-help treatment , 3 ) problem solving treatment and 4 ) referral to the general practitioner . The primary clinical outcome measure is the cumulative incidence of major depressive disorder as measured with the Mini International Neuropsychiatric Interview . Secondary outcomes include severity of depressive symptoms , quality of life , anxiety and physical outcomes . Costs will be measured from a societal perspective and include health care utilization , medication and lost productivity costs . Measurements will be performed at baseline and 3 , 6 , 9 and 12 months . Discussion The intervention being investigated is expected to prevent new cases of depression among people with type 2 diabetes mellitus and /or coronary heart disease and subthreshold depression , with subsequent beneficial effects on quality of life , clinical outcomes and health care costs . When proven cost-effective , the program provides a viable treatment option in the Dutch primary care system . Trial registration Dutch Trial Register IMPORTANCE Women with a history of gestational diabetes mellitus ( GDM ) are at substantially increased risk of type 2 diabetes mellitus ( T2DM ) . The identification of important modifiable factors could help prevent T2DM in this high-risk population . OBJECTIVE To examine the role of physical activity and television watching and other sedentary behaviors  , and changes in these behaviors in the progression from GDM to T2DM . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study of 4554 women from the Nurses ' Health Study II who had a history of GDM , as part of the ongoing Diabetes & Women 's Health Study . These women were followed up from 1991 to 2007 . EXPOSURES Physical activity and television watching and other sedentary behaviors  were assessed in 1991 , 1997 , 2001 , and 2005 . MAIN OUTCOMES AND MEASURE Incident T2DM identified through self-report and confirmed by supplemental question naires . RESULTS We documented 635 incident T2DM cases during 59,287 person-years of follow-up . Each 5-metabolic equivalent hours per week ( MET-h/wk ) increment of total physical activity , which is equivalent to 100 minutes per week of moderate-intensity physical activity , was related to a 9 % lower risk of T2DM ( adjusted relative risk [ RR ] , 0.91 ; 95 % CI , 0.88 - 0.94 ) ; this inverse association remained significant after additional adjustment for body mass index ( BMI ) . Moreover , an increase in physical activity was associated with a lower risk of developing T2DM . Compared with women who maintained their total physical activity levels , women who increased their total physical activity levels by 7.5 MET-h/wk or more ( equivalent to 150 minutes per week of moderate-intensity physical activity ) had a 47 % lower risk of T2DM ( RR , 0.53 ; 95 % CI , 0.38 - 0.75 ) ; the association remained significant after additional adjustment for BMI . The multivariable adjusted RRs ( 95 % CIs ) for T2DM associated with television watching of 0 to 5 , 6 to 10 , 11 to 20 , and 20 or more hours per week were 1 ( reference ) , 1.28 ( 1.04 - 1.59 ) , 1.41 ( 1.11 - 1.79 ) , and 1.77 ( 1.28 - 2.45 ) , respectively ( P value for trend < .001 ) ; additional adjustment for BMI attenuated the association . CONCLUSIONS AND RELEVANCE Increasing physical activity may lower the risk of progression from GDM to T2DM . These findings suggest a hopeful message to women with a history of GDM , although they are at exceptionally high risk for T2DM , promoting an active lifestyle may lower the risk
Subgroup analyses suggested that organisational interventions and interventions on those with baseline HbA1c over 9.5 % had better improvements in HbA1c .
Interventions had a modest improvement of blood pressure and lipids , although baseline levels of control were generally good .
Conclusions This review suggests that interventions for T2DM , in primary care , are better targeted at individuals with very poor glycaemic control and that organisational interventions may be more effective
Objectives Poorly controlled type 2 diabetes mellitus ( T2DM ) is a major international health problem .