Oral Antidiabetic Agents Diabetes Mellitus and Glucose as Predictors of Mortality in Primary Coronary Percutaneous Intervention Benefits of a simple glycaemic protocol in an orthopaedic surgery ward: a randomized prospective study. Prevalence and prediction of unrecognised diabetes mellitus and impaired glucose tolerance following acute stroke. Diabetes is associated with increased perioperative mortality but equivalent long-term outcome after hepatic resection for colorectal cancer Diabetes and Early Postoperative Outcomes Following Lumbar Fusion Glucose tolerance of offspring of mother with gestational diabetes mellitus in a low-risk population. Clinical and Surgical Predictors of Complications Following Surgery for the Treatment of Cervical Spondylotic Myelopathy: Results From the Multicenter, Prospective AOSpine International Study of 479 Patients. Influence of dietary protein on postprandial blood glucose levels in individuals with Type 1 diabetes mellitus using intensive insulin therapy The Diabetic Postoperative Mortality and Morbidity (DIPOM) trial: rationale and design of a multicenter, randomized, placebo-controlled, clinical trial of metoprolol for patients with diabetes mellitus who are undergoing major noncardiac surgery. Study protocol: a randomised placebo-controlled clinical trial to study the effect of vitamin D supplementation on glycaemic control in type 2 Diabetes Mellitus SUNNY trial Intensive low-glycaemic-load dietary intervention for the management of glycaemia and serum lipids among women with gestational diabetes: a randomized control trial. Effect of the diabetes outpatient intensive management programme on glycaemic control for type 2 diabetic patients. Relative risk of conversion from normoglycaemia to impaired glucose tolerance or non-insulin dependent diabetes mellitus in polycystic ovarian syndrome. Combination of a structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus. A randomised controlled trial. Glycaemic Fluctuation Predicts Mortality in Critically Ill Patients WITHDRAWN: Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cost Effectiveness of Adding Dapagliflozin to Insulin for the Treatment of Type 2 Diabetes Mellitus in the Netherlands Glycaemic index of New Zealand foods. Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial Glycaemic control in type 1 diabetic patients using optimised insulin aspart or human insulin in a randomised multinational study. Association between circulating 25-hydroxyvitamin D and incident type 2 diabetes: a mendelian randomisation study Diabetes as a risk factor for poorer early postoperative outcomes after shoulder arthroplasty.
Type 2 diabetes mellitus is a progressive and complex disorder that is difficult to treat effectively in the long term . The majority of patients are overweight or obese at diagnosis and will be unable to achieve or sustain near normoglycaemia without oral antidiabetic agents ; a sizeable proportion of patients will eventually require insulin therapy to maintain long-term glycaemic control , either as monotherapy or in conjunction with oral antidiabetic therapy . The frequent need for escalating therapy is held to reflect progressive loss of islet β-cell function , usually in the presence of obesity-related insulin resistance . Today ’s clinicians are presented with an extensive range of oral antidiabetic drugs for type 2 diabetes . The main classes are heterogeneous in their modes of action , safety profiles and tolerability . These main classes include agents that stimulate insulin secretion ( sulphonylureas and rapid-acting secretagogues ) , reduce hepatic glucose production ( biguanides ) , delay digestion and absorption of intestinal carbohydrate ( α-glucosidase inhibitors ) or improve insulin action (thiazolidinediones).The UKPDS ( United Kingdom Prospect i ve Diabetes Study ) demonstrated the benefits of intensified glycaemic control on microvascular complications in newly diagnosed patients with type 2 diabetes . However , the picture was less clearcut with regard to macrovascular disease , with neither sulphonylureas nor insulin significantly reducing cardiovascular events . The impact of oral antidiabetic agents on atherosclerosis — beyond expected effects on glycaemic control — is an increasingly important consideration . In the UKPDS , overweight and obese patients r and omised to initial monotherapy with metformin experienced significant reductions in myocardial infa rct ion and diabetes-related deaths .  Metformin does not promote weight gain and has beneficial effects on several cardiovascular risk factors . Accordingly , metformin is widely regarded as the drug of choice for most patients with type 2 diabetes . Concern about cardiovascular safety of sulphonylureas has largely dissipated with generally reassuring results from clinical trials , including the UKPDS . Encouragingly , the recent Steno-2 Study showed that intensive target-driven , multifactorial approach to management , based around a sulphonylurea , reduced the risk of both micro- and macrovascular complications in high-risk patients . Theoretical advantages of selectively targeting postpr and ial hyperglycaemia require confirmation in clinical trials of drugs with preferential effects on this facet of hyperglycaemia are currently in progress . The insulin-sensitising thiazolidinedione class of antidiabetic agents has potentially advantageous effects on multiple components of the metabolic syndrome ; the results of clinical trials with cardiovascular endpoints are awaited . The selection of initial monotherapy is based on a clinical and biochemical assessment of the patient , safety considerations being paramount . In some circumstances , for example pregnancy or severe hepatic or renal impairment , insulin may be the treatment of choice when nonpharmacological measures prove inadequate . Insulin is also required for metabolic decompensation , that is , incipient or actual diabetic ketoacidosis , or non-ketotic hyperosmolar hyperglycaemia . Certain comorbidities , for example presentation with myocardial infa rct ion during other acute intercurrent illness , may make insulin the best option . Oral antidiabetic agents should be initiated at a low dose and titrated up according to glycaemic response , as judged by measurement of  glycosylated haemoglobin  ( HbA1c ) concentration , supplemented in some patients by self monitoring of capillary blood glucose . The average glucose-lowering effect of the major classes of oral antidiabetic agents is broadly similar ( averaging a 1–2 % reduction in HbA1c ) , α-glucosidase inhibitors being rather less effective . Tailoring the treatment to the individual patient is an important principle . Doses are gradually titrated up according to response . However , the maximal glucose-lowering action for sulphonylureas is usually attained at appreciably lower doses ( approximately 50 % ) than the manufacturers ’ recommended daily maximum . Combinations of certain agents , for example a secretagogue plus a biguanide or a thiazolidinedione , are logical and widely used , and combination preparations are now available in some countries . While the benefits of metformin added to a sulphonylurea were initially less favourable in the UKPDS , longer-term data have allayed concern . When considering long-term therapy , issues such as tolerability and convenience are important additional considerations . Neither sulphonylureas nor biguanides are able to appreciably alter the rate of progression of hyperglycaemia in patients with type 2 diabetes . Preliminary data suggesting that thiazolidinediones may provide better long-term glycaemic stability are currently being tested in clinical trials ; current evidence , while encouraging , is not conclusive . Delayed progression from glucose intolerance to type 2 diabetes in high-risk individuals with glucose intolerance has been demonstrated with troglitazone , metformin and acarbose . However , intensive lifestyle intervention can be more effective than drug therapy , at least in the setting of interventional clinical trials . No antidiabetic drugs are presently licensed for use in prediabetic individuals Background Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infa rct ion patients , but their relative and individual role remains on debate . Objective To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infa rct ion patients su bmi tted to primary coronary percutaneous intervention .  Methods Prospect i ve cohort study including every ST segment elevation myocardial infa rct ion patient su bmi tted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012 . We collected  clinical , angiographic and laboratory data  during hospital stay , and performed a clinical follow-up 30 days after the ST segment elevation myocardial infa rct ion . We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score . Results Among the 740 patients included , reported diabetes mellitus prevalence was 18 % . On the univariate analysis , both diabetes mellitus and admission blood glucose were predictors of death in 30 days . However , after adjusting for potential confounders in the multivariate analysis , the diabetes mellitus relative risk was no longer significant ( relative risk : 2.41 , 95 % confidence interval : 0.76 - 7.59 ; p-value : 0.13 ) , whereas admission blood glucose remained and independent predictor of death in 30 days ( relative risk : 1.05 , 95 % confidence interval : 1.02 - 1.09 ; p-value ≤ 0.01 ) . Conclusion In ST segment elevation myocardial infa rct ion patients su bmi tted to primary coronary percutaneous intervention , the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes . This reinforces the important role of inflammation on the outcomes of this group of patients BACKGROUND Hyperglycaemia and diabetes mellitus are common in patients hospitalized in the orthopaedic surgery ward . However , glycaemic control obtained during hospitalization is often suboptimal . No method for achieving adequate glycaemic control in this population has been vali date d in an in-hospital setting . INTERVENTION An intervention including an intensive subcutaneous insulin protocol in the orthopaedic department . METHODS All diabetic patients admitted to the Department of Orthopaedic Surgery were prospect ively r and omized during a 6-month period . One group ( n = 30 ) received st and ard care with sliding scale insulin and the other group ( n = 35 ) received the intervention protocol . During the intervention period , the staff was briefed on the importance of glucose monitoring and control . An intensive multiple-injection protocol consisting of four daily regular/neutral protamine hagedorn ( NPH ) insulin injections was initiated in diabetic patients . The programme was followed up by a consulting diabetologist . RESULTS Mean blood glucose levels throughout the hospitalization were 161.48 ± 3.8 mg/dL in the intervention group versus 175.29 ± 2.3 mg/dL in the control group ( p < 0.0005 ) . Hospitalization was shorter by 2 days in the intervention group ( p < 0.05 ) . The number of severe hyperglycaemic events ( blood glucose level above 400 mg% ) was significantly lower ( p < 0.05 ) in the intervention group . There was no significant difference in the number of hypoglycaemic events . CONCLUSIONS The suggested four-step intervention regimen improved glycaemic control of hospitalized patients in the orthopaedic department and simplified the ' in-house ' treatment of the diabetic patient . Hospital stays were reduced on average by two days ( p < 0.05 ) BACKGROUND diabetes mellitus not only increases the risk of ischaemic stroke two- to four-fold but also adversely inXuences prognosis . The prevalence of recognised diabetes mellitus in acute stroke patients is between 8 and 20 % , but between 6 and 42 % of patients may have undiagnosed diabetes mellitus before presentation . Post-stroke hyperglycaemia is frequent and of limited diagnostic value and the oral glucose tolerance test assumes that the patient is clinical ly stable and eating normally . There is a need for a simple and reliable method to predict new diabetes mellitus in acute stroke patients . OBJECTIVES to determine the prevalence of unrecognised diabetes mellitus and impaired glucose tolerance on hospital admission and 12 weeks later in acute stroke patients with post-stroke hyperglycaemia > or = 6.1 mmol/l . To measure the accuracy of hyperglycaemia and elevated glycosylated haemoglobin concentration in predicting the presence of unrecognised diabetes mellitus at 12 weeks . DESIGN acute ( < 24 hours ) stroke patients ( cerebral infa rct ion and primary intracerebral haemorrhage ) with admission hyperglycaemia between 6.0 and 17 mmol/l and without a previous history of insulin-treated diabetes mellitus who were r and omised into the Glucose Insulin in Stroke Trial between October 1997 and May 1999 were studied . The Glucose Insulin in Stroke Trial is a r and omised controlled trial investigating the benefits of maintaining euglycaemia in acute stroke patients with mild to moderate hyperglycaemia . At 12 weeks , survivors underwent a 75 g oral glucose tolerance test . The positive predictive value and negative predictive value of admission plasma glucose > or = 6.1 mmol/l and elevated glycosylated haemoglobin concentration in predicting the presence of diabetes mellitus were used to estimate the prevalence of unrecognised diabetes mellitus in a consecutive series of 582 acute stroke admissions . RESULTS 582 consecutive acute stroke patients were assessed for eligibility for the Glucose Insulin Stroke Trial , of whom 83 ( 14 % ) had recognised diabetes mellitus . One hundred and forty-two patients were r and omised and 62 underwent a 3-month oral glucose tolerance test , of whom 26 ( 42 % ) had normal glucose tolerance , 23 ( 37 % ) had impaired glucose tolerance and 13 ( 21 % ) had diabetes mellitus . Admission plasma glucose > or = 6.1 mmol/l and glycosylated haemoglobin > or = 6.2 % predicted the presence of previously unrecognised diabetes mellitus at 12 weeks with a positive predictive value of 80 % and negative predictive value of 96 % . The estimated prevalence of unrecognised diabetes mellitus in the total series of acute stroke admissions was 16 - 24 % . CONCLUSIONS one-third of all acute stroke patients may have diabetes mellitus . For patients presenting with post-stroke hyperglycaemia , impaired glucose tolerance or diabetes mellitus is present in two-thirds of survivors at 12 weeks . Admission plasma glucose  > or = 6.1 mmol/l combined with glycosylated haemoglobin > or = 6.2 % are good predictors of the presence of diabetes mellitus following stroke Diabetes is associated with alterations in liver metabolism and immune response that may influence post-operative recovery and long-term survival after hepatectomy for cancer . Patients with type I or type II diabetes mellitus su bmi tted to a potentially curative hepatic resection for metastatic colorectal cancer were identified from the prospect i ve data base , and compared with patients with hepatic colorectal metastases su bmi tted to resection during the same time interval , but without diabetes mellitus . Data on operative morbidity and mortality and long-term survival were analyzed . Between December 1990 and July 1999 , a total of 727 patients underwent hepatic resection , 61 of whom ( 8.1 % ) had type I and type II diabetes mellitus .  Operative mortality in the diabetic patients was significantly greater than in nondiabetic patients ( 8 % vs. 2 % , P < 0.02 ) . Among patients with diabetes mellitus , four of the five perioperative deaths were due to liver failure after major hepatic resection ( lobectomy or greater ) . All four of these patients had significant parenchymal abnormality ( three with steatosis ) . Long-term survival was identical to that in nondiabetic control subjects . We conclude that the presence of diabetes is associated with a higher incidence of perioperative mortality . In patients with diabetes mellitus and parenchymal steatosis , major hepatic resection should be undertaken with caution Study Design . Retrospective cohort study using data from the Nationwide Inpatient Sample administrative data from 1988 through 2003 . Objective . To examine perioperative morbidity and mortality for patients with and without diabetes mellitus following lumbar spinal fusion . Summary of Background Data . Diabetes has been associated with worse outcomes in a variety of orthopedic procedures including spinal surgery . There is limited evidence that diabetic patients have more complications following lumbar fusion with little published data to support this conclusion . Methods . Data from 197,461 patients who underwent lumbar fusion were included . Over 11,000 patients ( 5.6 % ) with a postoperative diagnosis of diabetes mellitus were identified . Selected variables were used for comparison of patients with and without diabetes . Bivariate statistical analyses compared postoperative complication rates while multivariate statistics were used to determine likelihood of complications with diabetes . Results . Bivariate analysis demonstrated that diabetes was significantly associated with postoperative infection , need for transfusion , pneumonia , in-hospital mortality , and nonroutine discharge ( P ≤ 0.001 ) . Adjusted multivariate regression analyses , however , suggested no difference in mortality although infection , transfusion , and nonroutine discharge continued to be highly significant ( P ≤ 0.002 ) . Significantly higher inflation adjusted total charges were also present with patients with diabetes as well as increased lengths of stay ( P < 0.001 ) . Conclusion . This nationally representative study of in patients in the United States provides evidence that diabetes is associated with increased risk for postoperative complications , nonroutine discharge , increased total hospital charges , and length of stay following lumbar fusion . Prospect i ve studies to determine causality as well as the potential impact of diabetes control on these variables have not yet been done AIMS To describe the prevalence of impaired glucose tolerance and obesity in offspring of mothers whose pregnancies were complicated by gestational diabetes mellitus ( GDM ) in a low-risk population and to investigate the effect on these outcomes of minimal intervention compared with tight control for management of GDM . METHODS Eighty-nine children ( mean age 9.1 years , 93 % Caucasian ) were recruited through a follow-up study of women previously involved in a r and omized controlled trial of minimal intervention ( control group ) vs. tight glycaemic control ( treatment group ) for GDM . Fasting blood glucose ( FBG ) and 2-h glucose tolerance tests ( 2hGTT ) were performed on offspring and body mass index ( BMI ) calculated . Glucose tolerance and BMI of treatment groups were compared using non-inferiority tests ( non-inferiority margin -15 % ) . RESULTS Of those offspring , 6.9 % ( 5/72 ) had abnormal glucose metabolism [ four children had impaired glucose tolerance ( IGT ) and one had Type 2 diabetes mellitus ( DM ) ( all Caucasian ) ] . Of the four children with IGT , three were male , three had normal BMI , and three had a family history of Type 2 diabetes . Of the 71 offspring who underwent 2hGTT , 25/25 ( 100 % ) of the control offspring and 46/46 ( 100 % ) of the treatment offspring had normal FBG ( FBG < 5.7 mmol/l ) . Twenty-five of 25 ( 100 % ) of control and 42/46 ( 91.3 % ) of the treatment offspring had normal glucose tolerance ( 2hGTT < 7.8 mmol/l ) ( % difference 8.7 , 95 % CI -5.6 , 20.3 ) . BMI < 85th percentile was found in 25/33 ( 75.8 % ) of the treatment group and 44/52 ( 84.6 % ) of the control group ( difference in percentage -8.9 , 95 % CI -27.2 , 7.8 ) . CONCLUSIONS School-age children of mothers with GDM are at risk of IGT and overweight , even if from a low-risk ethnic population . FBG was not adequate for screening this population . Minimal intervention for glycaemic control in GDM pregnancies appears to be as effective as tight control for preventing IGT in childhood but not for preventing obesity BACKGROUND Surgery for cervical spondylotic myelopathy ( CSM ) is generally safe and effective . Nonetheless , complications occur in 11 % to 38 % of patients . Knowledge of important predictors of complications will help clinicians identify high-risk patients and institute prevention and management strategies . OBJECTIVE To identify clinical and surgical predictors of perioperative complications in CSM patients . METHODS Four hundred seventy-nine surgical CSM patients were enrolled in the prospect i ve CSM-International study at 16 sites . A panel of physicians review ed all adverse events and classified each as related or unrelated to surgery . Univariate analyses were performed to determine differences between patients who experienced a perioperative complication and those who did not . A complication prediction rule was developed using multiple logistic regression . RESULTS Seventy-eight patients experienced 89 perioperative complications ( 16.25 % ) . On univariate analysis , the major clinical risk factors were ossification of the posterior longitudinal ligament ( OPLL ) ( P = .055 ) , number of comorbidities ( P = .002 ) , comorbidity score ( P = .006 ) , diabetes mellitus ( P = .001 ) , and coexisting gastrointestinal ( P = .039 ) and cardiovascular ( P = .046 ) disorders . Patients undergoing a 2-stage surgery ( P = .002 ) and those with a longer operative duration ( P = .001 ) were at greater risk of perioperative complications . A final prediction model consisted of diabetes mellitus ( odds ratio [ OR ] = 1.96 , P = .060 ) , number of comorbidities ( OR = 1.20 , P = .069 ) , operative duration ( OR = 1.07 , P = .002 ) , and OPLL ( OR = 1.75 , P = .040 ) . CONCLUSION Surgical CSM patients have a higher risk of perioperative complications if they have a greater number of comorbidities , coexisting diabetes mellitus , OPLL , and a longer operative duration . Surgeons can use this information to discuss the risks and benefits of surgery with patients , to plan case-specific preventive strategies , and to ensure appropriate management in the perioperative period . ABBREVIATIONS BMI , body mass indexCSM , cervical spondylotic myelopathymJOA , modified Japanese Orthopaedic AssociationOPLL , ossification of the posterior longitudinal ligament Abstract Aim To determine the effects of protein alone ( independent of fat and carbohydrate ) on postpr and ial glycaemia in individuals with Type 1 diabetes mellitus using intensive insulin therapy .  Methods Participants with Type 1 diabetes mellitus aged 7–40 years consumed six 150 ml whey isolate protein drinks [ 0 g ( control ) , 12.5 , 25 , 50 , 75 and 100 ] and two 150 ml glucose drinks ( 10 and 20 g ) without insulin , in r and omized order over 8 days , 4 h after the evening meal . Continuous glucose monitoring was used to assess postpr and ial glycaemia . Results Data were collected from 27 participants .  Protein loads of 12.5 and 50 g did not result in significant postpr and ial glycaemic excursions compared with control ( water ) throughout the 300 min study period ( P > 0.05 ) . Protein loads of 75 and 100 g result ed in lower glycaemic excursions than control in the 60–120 min postpr and ial interval , but higher excursions in the 180–300 min interval . In comparison with 20 g glucose , the large protein loads result ed in significantly delayed and sustained glucose excursions , commencing at 180 min and continuing to 5 h. Conclusions Seventy‐five grams or more of protein alone significantly increases postpr and ial glycaemia from 3 to 5 h in people with Type 1 diabetes mellitus using intensive insulin therapy . The glycaemic profiles result ing from high protein loads differ significantly from the excursion from glucose in terms of time to peak glucose and duration of the glycaemic excursion . This research supports recommendations for insulin dosing for large amounts of protein BACKGROUND Recent trials suggest that perioperative beta-blockade reduces the risk of cardiac events in patients with a risk of myocardial ischemia who are undergoing noncardiac surgery . Patients with diabetes mellitus are at a high-risk for postoperative cardiac morbidity and mortality . They may , therefore , benefit from perioperative beta-blockade . METHODS The Diabetic Postoperative Mortality and Morbidity ( DIPOM ) trial is an investigator-initiated and -controlled , central ly r and omized , double-blind , placebo-controlled , multicenter trial . We compared the effect of metoprolol with placebo on mortality and cardiovascular morbidity rates in patients with diabetes mellitus who were beta-blocker naive , > or=40 years old , and undergoing noncardiac surgery . The study drug was given during hospitalization for a maximum of 7 days beginning the evening before surgery . The primary outcome measure is the composite of all-cause mortality , acute myocardial infa rct ion , unstable angina , or congestive heart failure leading to hospitalization or discovered or aggravated during hospitalization . Follow-up involves re-examination of patients at 6 months and collection of mortality and morbidity data via linkage to public data bases . The study was powered on the basis of an estimated 30 % 1-year event rate in the placebo arm and a 33 % relative risk reduction in the metoprolol arm . The median follow-up period was 18 months . RESULTS Enrollment started in July 2000 and ended in June 2002 . A total of 921 patients were r and omized , and 54 % of these patients had known cardiac disease , hypertension , or both . CONCLUSION The results of this study may have implication s for reduction of perioperative and postoperative risk in patients with diabetes mellitus who are undergoing major noncardiac surgery Background Besides the classical role of vitamin D on calcium and bone homeostasis , vitamin D deficiency has recently been identified as a contributing factor in the onset of insulin resistance in type 2 diabetes mellitus . However , it is uncertain whether vitamin D deficiency and poor glycaemic control are causally interrelated or that they constitute two independent features of type 2 diabetes mellitus . There are limited clinical trials carried out which measured the effect of vitamin D supplementation on glycaemic control . The objective of this study is to investigate the effect of vitamin D supplementation on glycaemic control and quality of life in patients with type 2 diabetes mellitus . Methods / design In a r and omised double-blind placebo-controlled trial conducted in five general practice s in the Netherl and s three hundred patients with type 2 diabetes mellitus treated with lifestyle advises or metformin or sulphonylurea-derivatives are r and omised to receive either placebo or 50,000 IU Vitamin D3 at monthly intervals . The primary outcome measure is the change in glycated haemoglobin level between baseline and six months . Secondary outcome measures include blood pressure , anthropometric parameters , lipid profile , insulin resistance , quality of life , advanced glycation end products and safety profiles . Quality of life will be measured by The Short Form ( SF-36 ) Health Survey question naire . Advanced glycation end products are measured by an AGE-reader . Discussion This trial will be the first study exploring the effect of vitamin D supplementation on both glycaemic control and quality of life in patients with type 2 diabetes mellitus . Our findings will contribute to the knowledge of the relationship between vitamin D status and insulin resistance in patients with type 2 diabetes mellitus . Trial registration The Netherl and s trial register : OBJECTIVE The present study aim ed to compare the effects of a general dietary intervention and an intervention with low glycaemic load ( GL ) on glycaemic control , blood lipid metabolism and pregnancy outcomes in women with gestational diabetes mellitus . DESIGN Participants were r and omly assigned to two groups , receiving either an individualized general dietary intervention ( Control group ) or an intensive low-GL intervention ( Low-GL group ) every two weeks , from 24 - 26 weeks of gestation to delivery . SETTING The Center of Maternal Primary Care in Guangdong General Hospital , China . SUBJECTS Ninety-five women with gestational diabetes mellitus were enrolled from June 2008 to July 2009 . RESULTS After the intervention , both groups significantly decreased their dietary intakes of energy , fat and carbohydrate . The Low-GL group had significantly lower values for GL ( 122 v. 136 ) and glycaemic index ( 50 v. 54 ) but greater dietary fibre intake ( 33 v. 29 g/d ) than did the Control group ( all P<0·01 ) . Significantly greater decreases in fasting plasma glucose ( -0·33 v. -0·02 mmol/l , P<0·01 ) and 2 h postpr and ial glucose ( -2·98 v. -2·51 mmol/l , P<0·01 ) , significantly lower increases in total cholesterol ( 0·12 v. 0·23 mmol/l ) and TAG ( 0·41 v. 0·56 mmol/l ) and a significantly lower decrease in HDL cholesterol ( -0·01 v. -0·11 mmol/l ) were also observed in the Low-GL group compared with the Control group ( all P<0·05 ) . There were no significant differences in body weight gain , birth weight or other maternal-fetal perinatal outcomes between the two groups . CONCLUSIONS The low-GL targeted dietary intervention outperformed the general dietary intervention in glycaemic control and the improvement of blood lipid levels in women with gestational diabetes mellitus AIM The purpose of this study was to examine the effect of the diabetes outpatient intensive management programme ( DOIMP ) on glycaemic control over a 12 week follow-up period for type 2 diabetic patients in Korea . BACKGROUND Diabetic complications can be prevented if the glycaemic status of diabetes patients is maintained within a nearly normal range . Patient education is critical in controlling blood glucose levels of patients with diabetes within the optimal range . METHODS DOIMP was composed of multidisciplinary education , complication monitoring and telephone counselling .  Twenty-five patients in the intervention group participated in the DOIMP and 24 patients in the control group were briefed on the conventional description of diabetes mellitus by diabetes education nurses . RESULTS Patients in the intervention group had a mean decrease of 2.3 % , which those in the control group having a mean decrease 0.4 % in glycosylated haemoglobin ( HbA(1)c ) . There was no difference between the two groups in the change in fasting blood glucose ( FBG ) and two-hour postpr and ial blood glucose ( 2-h PBG ) . The proportion of the patients with HbA(1)c < 7 % was higher in the intervention group than in the control group at the post-test compare with the pretest . CONCLUSION DOIMP can reduce HbA(1)c in type 2 diabetes patients . RELEVANCE TO CLINICAL PRACTICE These findings indicated that DOIMP could be effective in glycaemic control in type 2 diabetes patients BACKGROUND Cross-sectional studies have shown a high frequency of impaired glucose tolerance ( IGT ) and non-insulin dependent diabetes mellitus ( NIDDM ) in women with polycystic ovarian syndrome ( PCOS ) . However , little is known about the change in glucose tolerance that occurs over a period of several years in women with PCOS . METHODS Sixty-seven women with PCOS received a 75 g glucose tolerance test and measurement of lipids at baseline and at follow-up after an average time of 6.2 years . All women followed prospect ively had normal glucose tolerance ( n = 54 ) or IGT ( n = 13 ) at the start of the study . RESULTS Change in glycaemic control from baseline was frequent , with 5/54 ( 9 % ) of normoglycaemic women at baseline developing IGT and a further 4/54 ( 8 % ) moving directly from normoglycaemic to NIDDM . For women with IGT at baseline , 7/13 ( 54 % ) had NIDDM at follow-up . Body mass index ( BMI ) at baseline was an independent significant predictor of adverse change in glycaemic control . CONCLUSIONS Women with PCOS , particularly those with a high BMI , should be review ed regularly with respect to IGT or NIDDM , as the frequency of impaired glycaemic control is high , and that the rate of conversion from normal glucose tolerance to IGT or NIDDM , or from IGT to NIDDM is substantial PROBLEM Gestational diabetes mellitus , defined as any carbohydrate intolerance first diagnosed during pregnancy , is associated with a variety of adverse outcomes , both for the mother and her child . AIM To investigate the impact of a structured exercise programme which consisted of aerobic and resistance exercises on the parameters of glycaemic control and other health-related outcomes in pregnant women diagnosed with gestational diabetes mellitus . METHODS Thirty-eight pregnant women diagnosed with gestational diabetes mellitus were r and omised to two groups . Experimental group was treated with st and ard antenatal care for gestational diabetes mellitus , and regular supervised exercise programme plus daily brisk walks of at least 30min . Control group received only st and ard antenatal care for gestational diabetes mellitus . The exercise programme was started from the time of diagnosis of diabetes until birth . It was performed two times per week and sessions lasted 50 - 55min . FINDINGS The experimental group had lower postpr and ial glucose levels at the end of pregnancy ( P<0.001 ) . There was no significant difference between groups in the level of fasting glucose at the end of pregnancy . Also , there were no significant differences in the rate of complications during pregnancy and birth , need for pharmacological therapy , maternal body mass and body fat percentage gains during pregnancy , and neonatal Apgar scores , body mass and ponderal index . Neonatal body mass index was higher in the experimental group ( P=0.035 ) . CONCLUSION The structured exercise programme had a beneficial effect on postpr and ial glucose levels at the end of pregnancy Growing evidence suggests that glycaemic variability increases diabetic complications . However , the significance of glycaemic variability in critically ill patients remains unclear . We evaluated the predictors of glycaemic fluctuation and its association with critical care outcomes . This is a nested-cohort study within a clinical trial in which 523 patients at a medical surgical intensive care unit were r and omised to either intensive insulin therapy ( target glycaemic control : 4.4 to 6.1 mmol/l ) or conventional insulin therapy ( target control : 10.0 to 11.1 mmol/l ) . Glycaemic fluctuation was defined as the mean difference between the highest and lowest daily blood glucose . Patients were divided into wide and narrow fluctuation groups according to the median glycaemic fluctuation ( 6.0 mmol/l ) . The association between glycaemic fluctuation and different intensive care unit outcomes was studied . Predictors of glycaemic fluctuation were age ( odds ratio for each year increment 1.03 , 95 % confidence interval 1.02 to 1.05 ) , diabetes mellitus ( odds ratio 3.00 , 95 % confidence interval 1.74 to 5.17 ) , and daily insulin dose ( odds ratio for each unit increment 1.04 , 95 % confidence interval 1.03 to 1.05 ) . Similar levels of glucose fluctuation were observed in intensive insulin therapy and conventional insulin therapy patients . Wide glycaemic fluctuation was associated with higher mortality ( 22.2 vs 8.4 % , P < 0.001 ) . Glycaemic fluctuation was identified as an independent predictor of intensive care unit mortality ( odds ratio per mmol 1.08 , 95 % confidence interval 1.00 to 1.18 ) and hospital mortality ( odds ratio per mmol 1.09 , 95 % confidence interval 1.02 to 1.17 ) using multivariate logistic regression analysis . In conclusion , wide glycaemic fluctuation is an independent predictor of mortality  in critically ill patients . Whether reducing glycaemic fluctuation would lead to better outcomes needs further evaluation Background Patients with type 2 diabetes mellitus ( T2D ) have an increased risk of cardiovascular disease and mortality compared to the background population . Observational studies report an association between reduced blood glucose and reduced risk of both micro- and macrovascular complications in patients with T2D . Our previous systematic review of intensive glycaemic control versus conventional glycaemic control was based on 20 r and omised clinical trials that r and omised 29 , 986 participants with T2D . We now report our up date d review . Objectives To assess the effects of targeted intensive glycaemic control compared with conventional glycaemic control in patients with T2D . Search methods Trials were obtained from search es of The Cochrane Library , MEDLINE , EMBASE , Science Citation Index Exp and ed , LILACS , and CINAHL ( all until December 2012 ) . Selection criteria We included r and omised clinical trials that prespecified targets of intensive glycaemic control versus conventional glycaemic control targets in adults with T2D . Data collection and analysis Two authors independently assessed the risk of bias and extracted data . Dichotomous outcomes were assessed by risk ratios ( RR ) and 95 % confidence intervals ( CI ) . Health-related quality of life and costs of intervention were assessed with st and ardized mean differences ( SMD ) and 95 % Cl . Main results Twenty-eight trials with 34,912 T2D participants r and omised 18,717 participants to intensive glycaemic control  versus 16,195 participants to  conventional glycaemic control . Only two trials had low risk of bias on all risk of bias domains assessed . The duration of the intervention ranged from three days to 12.5 years . The number of participants in the included trials ranged from 20 to 11,140 . There were no statistically significant differences between targeting intensive versus conventional glycaemic control for all-cause mortality ( RR 1.00 , 95 % CI 0.92 to 1.08 ; 34,325 participants , 24 trials ) or cardiovascular mortality ( RR 1.06 , 95 % CI 0.94 to 1.21 ; 34,177 participants , 22 trials ) . Trial sequential analysis showed that a 10 % relative risk reduction could be refuted for all-cause mortality . Targeting intensive glycaemic control did not show a statistically significant effect on the risks of macrovascular complications as a composite outcome in the r and om-effects model , but decreased the risks in the fixed-effect model ( r and om RR 0.91 , 95 % CI 0.82 to 1.02 ; and fixed RR 0.93 , 95 % CI 0.87 to 0.99 ; P = 0.02 ; 32,846 participants , 14 trials ) . Targeting intensive versus conventional glycaemic control seemed to reduce the risks of non-fatal myocardial infa rct ion ( RR 0.87 , 95 % CI 0.77 to 0.98 ; P = 0.02 ; 30,417 participants , 14 trials ) , amputation of a lower extremity ( RR 0.65 , 95 % CI 0.45 to 0.94 ; P = 0.02 ; 11,200 participants , 11 trials ) , as well as the risk of developing a composite outcome of microvascular diseases ( RR 0.88 , 95 % CI 0.82 to 0.95 ; P = 0.0008 ; 25,927 participants , 6 trials ) , nephropathy ( RR 0.75 , 95 % CI 0.59 to 0.95 ; P = 0.02 ; 28,096 participants , 11 trials ) , retinopathy ( RR 0.79 , 95 % CI 0.68 to 0.92 ; P = 0.002 ; 10,300 participants , 9 trials ) , and the risk of retinal photocoagulation ( RR 0.77 , 95 % CI 0.61 to 0.97 ; P = 0.03 ; 11,212 participants , 8 trials ) . No statistically significant effect of targeting intensive glucose control could be shown on non-fatal stroke , cardiac revascularization , or peripheral revascularization . Trial sequential analyses did not confirm a reduction of the risk of non-fatal myocardial infa rct ion but confirmed a 10 % relative risk reduction in favour of intensive glycaemic control on the composite outcome of microvascular diseases . For the remaining microvascular outcomes , trial sequential analyses could not establish firm evidence for a 10 % relative risk reduction . Targeting intensive glycaemic control significantly increased the risk of mild hypoglycaemia , but substantial heterogeneity was present ; severe hypoglycaemia ( RR 2.18 , 95 % CI 1.53 to 3.11 ; 28,794 participants , 12 trials ) ; and serious adverse events ( RR 1.06 , 95 % CI 1.02 to 1.10 ; P = 0.007 ; 24,280 participants , 11 trials ) . Trial sequential analysis for a 10 % relative risk increase showed firm evidence for mild hypoglycaemia and serious adverse events and a 30 % relative risk increase for severe hypoglycaemia when targeting intensive versus conventional glycaemic control . Overall health-related quality of life , as well as the mental and the physical components of health-related quality of life did not show any statistical significant differences . Authors ' conclusions Although we have been able to exp and the number of participants by 16 % in this up date , we still find paucity of data on outcomes and the bias risk of the trials was mostly considered high . Targeting intensive glycaemic control compared with conventional glycaemic control did not show significant differences for all-cause mortality and cardiovascular mortality . Targeting intensive glycaemic control seemed to reduce the risk of microvascular complications , if we disregard the risks of bias , but increases the risk of hypoglycaemia and serious adverse events Background and Objective Many patients with type 2 diabetes mellitus ( T2DM ) on insulin therapy  have inadequate glycaemic control . In such cases , Dutch guidelines recommend unlimited up-titration of insulin , yet in practice many patients never reach their glycaemic target . Clinical evidence shows that dapagliflozin — a highly selective sodium – glucose cotransporter 2 inhibitor — meets a need for these patients , i.e. by reducing glycated haemoglobin levels and bodyweight . We estimated the cost effectiveness and cost utility of adding dapagliflozin to insulin compared with not adding dapagliflozin in patients with T2DM who have inadequate glycaemic control while on insulin . Methods The cost effectiveness of dapagliflozin was estimated using the Cardiff Diabetes Model , using direct comparative efficacy data from a r and omized placebo-controlled trial ( Clinical Trials.gov identifier NCT00673231 ) . In this trial , up-titration of insulin was allowed in case of severe glycaemic imbalance . Risk factor progression and the occurrence of future vascular events were estimated using the United Kingdom Prospect i ve Diabetes Study 68 risk equations . Costs and utilities were derived from the literature . The analysis was conducted from the societal perspective , simulating the remaining lifetime of the patients . Results The overall incidence of macro- and microvascular complications was lower , and life expectancy was greater ( 19.43 versus 19.35 life-years [ LYs ] ) in patients receiving dapagliflozin than in those not receiving dapagliflozin . Patients in the dapagliflozin arm obtained an incremental benefit of 0.42 quality -adjusted life-years ( QALYs ) . The lifetime incremental cost per patient in the dapagliflozin arm was € 2,293 , result ing in an incremental cost-effectiveness ratio of € 27,779 per LY gained and an incremental cost – utility ratio of € 5,502 per QALY gained . Sensitivity and scenario analyses showed that the results were insensitive to variations in modelling assumptions and input variables . Conclusion Dapagliflozin in combination with insulin was estimated to be a cost-effective treatment option for patients with T2DM whose insulin treatment regimen does not provide adequate glycaemic control in a Dutch healthcare setting AIM To determine the glycaemic index values to a range of foods that are unique to New Zeal and , and those that are grown and /or manufactured locally . METHODS We determined the glycaemic index of 28 carbohydrate foods in both healthy subjects and those with type 2 diabetes . Venous blood sample s were collected over two to three hours , and the incremental area under the blood glucose curve was used to calculate glycaemic index values . RESULTS AND CONCLUSIONS This study has identified the glycaemic index values for a range of New Zeal and foods which will be clinical ly useful in the nutritional management of individuals with diabetes mellitus . People with diabetes are recommended to choose foods with a low glycaemic index which is associated with optimal blood glucose control and lipid levels Objectives To assess the effect of self monitoring of blood glucose concentrations on glycaemic control and psychological indices in patients with newly diagnosed type 2 diabetes mellitus . Design Prospect i ve r and omised controlled trial of self monitoring versus no monitoring ( control ) . Setting Hospital diabetes clinics . Participants 184 ( 111 men ) people aged < 70 with newly diagnosed type 2 diabetes referred to the participating diabetes clinics . Major exclusion criteria were secondary diabetes , insulin treatment , previous self monitoring of blood glucose . Interventions Participants were r and omised to self monitoring or no monitoring ( control ) groups for one year with follow-up at three monthly intervals . Both groups underwent an identical structured core education programme . The self monitoring group received additional education on monitoring . Main outcome measures Between group differences in HbA1c , psychological indices , use of oral hypoglycaemic drugs , body mass index ( BMI ) , and reported hypoglycaemia rates . Results 96 patients ( 55 men ) were r and omised to monitoring and 88 ( 56 men ) to control . There were no baseline differences in mean ( SD ) age ( 57.7 ( 11.0 ) in monitoring group v 60.9 ( 11.5 ) in control group ) or HbA1c ( 8.8 (2.1)% v 8.6 (2.3)% , respectively ) . Those in the monitoring group had a higher baseline BMI ( 34 ( 7 ) v 32 ( 6.2 ) ) . There were no significant differences between groups at any time point ( 12 months values given ) in HbA1c ( 6.9 (0.8)% v 6.9 (1.2)% , P=0.69 ; 95 % confidence interval for difference −0.25 % to 0.38 % ) , BMI ( 33.1 ( 6.4 ) v 31.8 ( 6.0 ) ; adjusted for baseline BMI , P=0.32 ) , use of oral hypoglycaemic drugs , or reported incidence of hypoglycaemia . Monitoring was associated with a 6 % higher score on the depression subscale of the well-being question naire ( P=0.01 ) . Conclusions In patients with newly diagnosed type 2 diabetes self monitoring of blood glucose concentration has no effect on glycaemic control but is associated with higher scores on a depression subscale . Trial registration IS RCT N 49814766 Insulin aspart ( IAsp ) , is a rapid-acting analogue of human insulin ( HI ) , for use in the meal related treatment of diabetes mellitus . The degree of glycaemic control achieved by IAsp in comparison with HI after algorithm-driven dose optimisation was tested over 3 months . The prospect i ve , multicentre , r and omised , open-label study with parallel groups was performed in 48 centres in 11 countries and included 423 basal-bolus treated patients with Type 1 diabetes . Main outcome measures were blood glucose control assessed by HbA1c , nine-point self-monitored blood glucose profiles , insulin dose , quality of life , hypoglycaemia and adverse events . An algorithm-driven increase occurred in the dose and number of daily injections of basal insulin , particularly in the IAsp group . After 12 weeks of treatment , HbA1c was significantly lower in IAsp compared to HI treated subjects by 0.17 ( 95 % CI 0.30 - 0.04 ) ( P<0.05 ) . Comparison of the blood glucose profiles showed lower blood glucose levels with IAsp after breakfast ( mean 8.4 vs 10.1 mmol/l ; P<0.0001 ) and dinner ( 8.2 vs 9.3 mmol/l ; P<0.01 ) . There were no differences between treatments in the incidence of hypoglycaemic episodes or in the adverse event profiles . The WHO Diabetes Treatment Satisfaction Question naire score for perceived hyperglycaemia was lower with Iasp ( P=0.005 ) , and patients found the insulin aspart treatment more flexible ( P=0.022 ) . The current study underlines the need for optimising the basal insulin regimen in order to take full advantage of the pharmacodynamics of IAsp Summary Background Low circulating concentrations of 25-hydroxyvitamin D ( 25[OH]D ) , a marker of vitamin D status , are associated with an increased risk of type 2 diabetes  , but whether this association is causal remains unclear . We aim ed to estimate the unconfounded , causal association between 25(OH)D concentration and risk of type 2 diabetes using a mendelian r and omisation approach . Methods Using several data sources from population s of European descent , including type 2 diabetes cases and non-cases , we did a mendelian r and omisation analysis using single nucleotide polymorphisms ( SNPs ) within or near four genes related to 25(OH)D synthesis and metabolism : DHCR7 ( related to vitamin D synthesis ) , CYP2R1 ( hepatic 25-hydroxylation ) , DBP ( also known as GC ; transport ) , and CYP24A1 ( catabolism ) . We assessed each SNP for an association  with circulating 25(OH)D concentration ( 5449 non-cases ; two studies ) , risk of type 2 diabetes ( 28 144 cases , 76 344 non-cases ; five studies ) , and glycaemic traits ( concentrations of fasting glucose , 2-h glucose , fasting insulin , and HbA1c  ; 46 368 non-cases ; study consortium ) . We combined these associations in a likelihood-based mendelian r and omisation analysis to estimate the causal association of 25(OH)D concentration with type 2 diabetes and the glycaemic traits , and compared them with that from a meta- analysis of data from observational studies ( 8492 cases , 89 698 non-cases ; 22 studies ) that assessed the association between 25(OH)D concentration and type 2 diabetes . Findings All four SNPs were associated with 25(OH)D concentrations ( p<10−6 ) . The mendelian r and omisation-derived unconfounded odds ratio for type 2 diabetes was 1·01 ( 95 % CI 0·75–1·36 ; p=0·94 ) per 25·0 nmol/L ( 1 SD ) lower 25(OH)D concentration . The corresponding ( potentially confounded ) relative risk from the meta- analysis of data from observational studies was 1·21 ( 1·16–1·27 ; p=7·3 × 10−19 ) . The mendelian r and omisation-derived estimates for glycaemic traits were not significant ( p>0·25 ) . Interpretation The association between 25(OH)D concentration and type 2 diabetes is unlikely to be causal . Efforts to increase 25(OH)D concentrations might not reduce the risk of type 2 diabetes as would be expected on the basis of observational evidence . These findings warrant further investigations to identify causal factors that might increase 25(OH)D concentration and also reduce the risk of type 2 diabetes . Funding UK Medical Research Council Epidemiology Unit and European Union Sixth Framework Programme BACKGROUND Although diabetes has been associated with increased perioperative morbidity and mortality after hip and knee arthroplasty , its impact on early postoperative outcomes after shoulder replacement remains relatively unexplored . The purpose of the study was to determine the association of diabetes with in-hospital death , complications , length of stay , non-homebound disposition , and cost in patients undergoing shoulder arthroplasty . METHODS By use of the Nationwide Inpatient Sample data base for the year 2011 , an estimated 66,485 patients having undergone shoulder arthroplasty were identified and separated into groups with ( 21 % ) and without ( 79 % ) diabetes mellitus . Comparisons of specific outcome measures between diabetic and nondiabetic cohorts were performed by bivariate and multivariable analyses with logistic regression modeling . RESULTS Diabetes mellitus was independently associated with in-hospital death , a number of perioperative complications , prolonged hospital stay , and increased non-homebound disposition after shoulder arthroplasty . The presence of diabetes was not associated with increased hospital cost . CONCLUSION Patients with preexisting diabetes are at higher risk for perioperative morbidity and mortality after shoulder arthroplasty . Future prospect i ve research should explore in more detail the relationship between diabetes and shoulder arthroplasty outcomes
None of the trials examined the effects of the interventions in terms of costs .
AUTHORS ' CONCLUSIONS The included trials did not demonstrate significant differences for most of the outcomes when targeting intensive perioperative glycaemic control compared with conventional glycaemic control in patients with diabetes mellitus .
However , posthoc analysis indicated that intensive glycaemic control was associated with an increased number of patients experiencing hypoglycaemic episodes .
BACKGROUND Patients with diabetes mellitus are at increased risk of postoperative complications .
Data from r and omised clinical trials and meta-analyses point to a potential benefit of intensive glycaemic control , targeting near-normal blood glucose , in patients with hyperglycaemia ( with and without diabetes mellitus ) being su bmi tted to surgical procedures .
However , there is limited evidence concerning this question in patients with diabetes mellitus undergoing surgery .
OBJECTIVES To assess the effects of perioperative glycaemic control for diabetic patients undergoing surgery .