bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Care Delivery for Young Adults With Type 1 Diabetes via a Multi-Faceted Quality Improvement Interdisciplinary Intervention
Authors: Chan Alvita Justine , Gomer Stephanie , Dimaraki Eleni V , Lipscombe Lorraine Lucille , Mukerji Geetha 
Published: May 2021

Abstract
Background: The transition from pediatric to adult type 1 diabetes (TID) care represents a vulnerable period for young adults (YA), and many are eventually lost to follow up. This can result in lost opportunities for patient education, worsened glycemic control and increased rates of acute diabetes complications. To address this, a multi-faceted quality improvement (QI) intervention was implemented at a YA T1D program with the goal of improving patient attendance and care delivery amongst YA with T1D.
Methods: The intervention consisted of three main components: a transitional navigator, an interdisciplinary diabetes assessment flowsheet and virtual care via phone or video conference. These components were implemented at the YA T1D program using a stepwise approach beginning in 2019. The attendance of all patients seen between January 2017 and August 2020 were tracked monthly on a run chart to identify any shifts after each component was implemented. A pre-post analysis was also performed in new patients with a minimum follow up period of 12 months to compare secondary outcomes including A1c reduction at 12 months, incidence of diabetes-related ED visits/hospitalizations, incidence of severe hypoglycemia and psychosocial counselling rates.
Results: A total of 2240 scheduled appointments was included in the primary analysis. Patient attendance improved from 59% to 79% (p&lt;0.01) with virtual care, demonstrated by a shift in attendance sustained over 6 months after its implementation. Virtual care was utilized in 81.3% of appointments in the post-intervention period. Subgroup analysis showed the improvement in attendance was significant in follow up appointments (80% vs 59%, p&lt;0.01), but there was no difference in attendance for initial consultations (67% vs 58%, p=0.45).
Forty-two patients were included in the pre-post analysis (n=27 in the pre-intervention and n=15 in the post-intervention period). There were with no significant difference in baseline characteristics of the two groups. Mean patient age was 20.2±2.9 years. Males comprised of 28.5% of the study population. Mean duration of diabetes was 11.1±5.3 years, and baseline average A1c was 8.6±1.7%. Preliminary analysis demonstrated there was significant improvement in preconception counselling rate (76% vs 100%, p=0.048) following the intervention. There was no significant difference in A1c reduction at 12 months, incidence of diabetes-related ED visits/hospitalizations or incidence of severe hypoglycemia.
Conclusion: Virtual care was effective in improving attendance for follow up appointments at a YA T1D clinic. Further data analysis for patients assessed in September to December 2020 is currently underway.
Trends in Type 1 Diabetes Mortality and Disability-Adjusted Life-Years in 27 European Countries and the United Kingdom: 1990–2017
Authors: Kudzinskas Aurimas , Alazawi Andrew , Hughes Will , Goodall Richard , Harbinson Eleanor , Salciccioli Justin , Marshall Dominic , Bravis Vassiliki , Shalhoub Joseph 
Published: May 2021

Abstract
Background: Type 1 diabetes mellitus (T1DM) is a prevalent condition with significant morbidity and financial implications. This study aims to compare the temporal trends in T1DM mortality and morbidity across 27 European Union (EU) countries and the United Kingdom between 1990 and 2017. Methods: The Global Burden of Disease Study database was used to extract T1DM age-standardized mortality rates (ASMR) and disability-adjusted life-years rates (DALYs) per 100,000 for 27 EU countries and the United Kingdom. Joinpoint regression analysis was used to interpret trends. Results: All countries, excluding males from the Czech Republic (+28.5%), had relative reductions in ASMR between 1990 and 2017. The largest relative reductions in ASMR between 1990 and 2017 were observed in Slovenia for both males and females (-75.9% and -87.9%, respectively). The smallest relative reductions in ASMR between 1990 and 2017 were seen in Malta for males (-5.9%) and Czech Republic for females (-12.5%). For all years from 1999 to 2017, males in all countries had higher T1DM ASMRs compared to females. Similarly, T1DM DALYs have decreased across all countries excluding males from the Czech Republic and Malta (+10.4% and +5.3%, respectively). The largest relative reductions in DALYs between 1990 and 2017 were observed in Poland for both males and females (-46.4% and -70.4%, respectively). The smallest relative reductions in DALYs were seen in Greece for both males and females (-4.1% and -17.0%, respectively). From all years from 2006 to 2017, males in all countries had higher T1DM DALYs compared to females. Joinpoint regression analysis demonstrated that over the time period covered by the most recent trends (2013/14–2017), small increases in T1DM ASMRs were observed in Malta, Germany, and Denmark, for males, and in the UK, Netherlands, Germany, and Denmark for females. Furthermore, the UK also observed increases in DALY rates for both males and females between 2013 and 2017 (estimated annual percentage increases: males +0.6%, females +0.5%). Discussion: We identified improvements in both the mortality and morbidity from T1DM in European Union Countries between 1990 and 2017. Both the incidence and prevalence of T1DM is known to be increasing, therefore the observed improvements in mortality and morbidity reflect continent wide improvements in disease management. Our data do suggest, however, that the improvements in mortality and DALYs appear to be plateauing in the UK over the time periods covered by the most recent trends.
A Pilot Study of External Counterpulsation on Reactive Hyperemia, Levels of Glycemia and Metabolic Parameters in Type 2 Diabetes Mellitus
Authors: Shan Hoong Caroline Wei , Tan Maudrene , Kao Shih Ling , Khoo Eric Yin Hao 
Published: May 2021

Abstract
Introduction: External counter-pulsation (ECP) involves cuff inflation over the lower extremities to generate sheer stress, thereby improving endothelial function and anginal symptoms in coronary artery disease. Endothelial dysfunction is also involved in the pathogenesis of T2DM. We hypothesized that 1) ECP will be associated with an improvement in endothelial function in T2DM as measured by peripheral artery tonometry, and 2) explored whether this would vary with different dose and frequency regimens. A shorter or less intensive regimen could potentially reduce cost and improve patient compliance if a similar therapeutic response is achieved.
Methods: This single-center prospective study in a tertiary institute in Singapore involving 46 adults with T2DM of HbA1c between 7 to 10%, who were randomly assigned to receive 35 sessions of ECP at different regimens and duration. Subjects in arm 1 received 1-hour daily sessions 5x per week for 7 consecutive weeks, subjects in arm 2 received 0.5-hour sessions 5x per week for 7 consecutive weeks, and subjects in arm 3 received 1-hour sessions 3x per week for 12 consecutive weeks. Endothelial function was evaluated by reactive hyperemia index (RHI) via peripheral arterial tonometry measured at the start, midpoint and end of study. Other secondary outcomes included fasting glucose, homeostatic model assessment of insulin resistance (HOMA-IR), HbA1c, blood pressure, lipid profile, weight and vibration sense.
Results: 42 subjects completed the 35-session course of ECP. Mean age was 56.1±9.3 years, duration of diabetes 8.8±4.7 years, baseline RHI 2.0 (1.3–3.7) and baseline HOMA-IR was 3.1 (0.5–18.7). All regimes of ECP were well-tolerated. There was no change in RHI across all 3 regimens of ECP individually or collectively at the end of the study (ΔRHI +0.01%, p=0.458). Glycaemic markers of fasting glucose, HbA1c and HOMA-IR, as well as blood pressure, lipid profile, weight and vibration sense also remained unchanged at endpoint. Subgroup analysis showed a significant improvement in RHI (ΔRHI +20.6%, p=0.0178) in 7 subjects with more severe endothelial dysfunction (defined by RHI&lt;1.67) at baseline who had a trend to having a longer duration of diabetes, however there was no improvement in fasting glucose, HbA1c, HOMA-IR or metabolic parameters in this group.
Conclusion: ECP did not show a beneficial effect on endothelial function, glycemic control or metabolic parameters in this South-East Asian population with T2DM at any of the three regimens. This may partly be explained by less severe endothelial dysfunction and less insulin resistance in our population at baseline. Future studies of ECP may investigate its potential benefits in a larger population of T2DM with more severe endothelial dysfunction, higher insulin resistance and/or longer duration of diabetes at baseline.
Association of NOS3 Genetic Polymorphism With the Predisposition to Diabetes and Pre-Diabetes, Retrospective Study
Authors: Ayesh Hazem , Ayesh Sajida S , Beran Azizullah , Ayesh Suhail 
Published: May 2021

Abstract
Background: Endothelial nitric oxide synthetase (eNOS) encoded by NOS3 gene has an important role in modulating vascular endothelial function. Many studies reported a possible role of NOS3 in the pathogenesis of diabetes mellitus (DM). This study investigated the association of NOS3 (G&gt;T) rs1799983 genetic polymorphism with DM, pre-diabetes (pre-DM), and insulin resistance (IR).
Methods: A random sample of 220 subjects (DM & pre-DM) compared with 220 healthy subjects. Sample obtained from Palestinian adults who consented to genetic and biochemical testing. All subjects genotyped for NOS3 (G &gt; T) rs1799983 SNP using ARMS PCR. Fasting blood sugar (FBS) and triglyceride (TGA) levels were obtained for all subjects. Triglyceride glucose index (TyG) was used as a surrogate marker for IR. Regression analysis adjusted for age and body mass index (BMI) was performed to investigate the association between DM & Pre-DM status, FBS, and TyG with NOS3 genetic polymorphism.
Results: NOS3 minor allele frequency positively correlated with FBS levels after controlling for age and BMI (P-value 0.006). DM & pre-DM were more frequent in homozygous NOS3 subjects with an odds ratio of 2.04 (P = 0.05). NOS3 minor allele frequency positively correlated with TyG but not statistically significant association (P = 0.061).
Discussion: Many studies reported a potential role of NOS3 genetic polymorphism in DM and IR pathogenesis. In this study, NOS3 minor allele frequency positivity correlated with FBS levels. Homozygous NOS3 was associated with a 2-fold increase in the prevalence of DM & pre-DM. NOS3 genetic polymorphism didn’t show a statistically significant correlation with TyG (P = 0.061). With the increasing availability of genetic testing, NOS3 may serve as an early screening tool to identify subjects with a high risk for elevated FBS. Further studies are required to understand the exact role of NOS3 genetic polymorphism in the pathogenesis of DM, and to evaluate the clinical efficacy and cost-effectiveness of genetic testing.
Conclusion: NOS3 genetic polymorphism has a statistically significant relationship with the FBS level. Further studies are required to confirm the association between NOS3 and DM.
Clinical And Biochemical Outcomes Of Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitors In Type 2 Diabetes Mellitus Patients
Authors: Saleem Muhammad , Ram Nanik , Khan Sajjad Ali , Suchal Zafar Aleem , Mehdi Khan Muhammad Mustansir 
Published: May 2021

Abstract
Background: SGLT-2 inhibitors are a group of oral medications that work independently of insulin working as anti-diabetics by enhancing the excretion of glucose. The purpose of our study was to assess the improvement in terms of HbA1c, weight, blood pressure and BMI and the hepatics and renal effect in terms of SGPT and Creatinine in patients already on three oral glucose lowering agents when SGLT-2 inhibitor was added to their medications. Methods: This retrospective, real world, single center study included 99 patients (mean age [Standard Deviation]: 53.8 [9.63] years) with poorly control type 2 diabetes. Data was recorded at three times, before the addition of SGLT-2 inhibitor and then at 3 and 6 month follow up after the drug had been added in patient’s medications. Physical parameters namely weight, BMI and blood pressure were recorded in the clinic while HbA1c, SGPT and Creatinine were checked by laboratory. Results: Improvement was seen in all parameters at both 3 and 6 month follow up interval. The reduction in HbA1c was statistically significant (P-value &lt; 0.001) with (Mean Reduction [Standard Deviation)) 0.81[1.02] % at 3 months and 1.07[1.11] % at 6 months. Weight was also significantly reduced (P-value &lt; 0.001) with (MR [SD]) 1.83[2.32] kg at 3 and 4.02[6.04] kg at 6 months. Statistically significant reduction (P-value &lt; 0.001) in BMI was also seen with 0.69[0.95] kgm-2 at 3 months and 2.13[3.41] kgm-2 at 6 months of follow up. The systolic blood pressure showed significant reduction (P-value &lt; 0.05) of 5.9[15.76] mmHg at 3 months and 6.37[18.33] mmHg at 6 months. The creatinine and SGPT values of the patient showed minimal variation over the course of these 6 months of follow up. Conclusion: Our study showed that SGPT-2 can be reliably used in patients in which diabetes is not being controlled by other glucose lowering agents and is safe for use in patients in which hepatic and renal function needs to be preserved. Keywords: SGLT-2 inhibitors, Type 2 Diabetes Mellitus, Pakistan
HbA1c Is Not Potent Glucose Control Assessment Tool in Type 2 Diabetes Patients Treated With Insulin
Authors: Totomirova Tzvetelina , Arnaudova Mila 
Published: May 2021

Abstract
Glycated haemoglobin (HbA1c) is used for defining of glucose control in diabetic patients nevertheless its insufficiency to present overall control in some specific cases. Continuous Glucose Monitoring (CGM) is usually used for adjustment of insulin doses but the derived data are helpful for exact glucose control. We assess the potency of HbAc for defining of real glucose control in subgroup of type 2 diabetes patients treated with different insulin regimens. We studied 54 diabetic patients (33 men, 21 women; age 60.23±5.99 years, disease duration 12.64±5.02 years) - 33 with type 2 diabetes on pre-mixed insulin, 21 with type 2 on multiple insulin injection (MII). Patients performed multiple daily blood glucose measurements of fasting and prandial blood glucose for three months period. HbA1c was measured and CGM by using iProTM for seven days was performed at the end of this period. In pre-mixed insulin treated group and in intensified regimen group, moderate positive correlation was found between HbA1c and mean blood glucose derived from CGM (7.64±1.40% and 7.69±1.23%, respectively 7.64±1.48mmol/l and 7.60±1.30mmol/l), with r1=0.642 (p&lt;0.01) and r2=0.570 (p&lt;0.05). Even lower was correlation between HbA1c and time-in-range (r1=0.431 and r2 =0.401). There were no correlations between HbA1c and percentage of time spent below the target and number of hypoglycemic episodes in each group. Same trend of correlations was found comparing HbA1c and mean BG level in eight-point profile. Based on HbA1c assessment 36.36% of patients on premixed insulin, 19.05% of type 2 patients on MII were with good control. After estimation of results from SMBG these percentage were respectively 28.14% and 12.11%. CGM defined 27.27% of patients on premixed insulin, 13.80% of type 2 patients on MII as well controlled. We conclude that in insulin treated type 2 patients HbA1c gives relative information about overall control with no precise presenting of glucose fluctuations and out-of-range values of blood glucose with no information about hypoglycemic episodes. Nevertheless, short observed period CGM data could give much information that is comparable to three months blood glucose measurement and could replace the use of HbA1c for assessment of overall control. Reference: (1) Chehregosha H, et al. Diabetes Ther. 2019; 10, 853–863 (2) Beyond A1c Writing Group. Diab Care. 2018; 41: e92-e94 (3) Hirsch I et al. Diabetes Tech Ther 2017, 19 (3): S38-S48
Online Education Improves Knowledge and Confidence Related to CGM and the AGP
Authors: Larkin Amy , LaCouture Michael , Le Anne 
Published: May 2021

Abstract
We sought to determine if online continuing medical education (CME) could improve the knowledge and confidence of primary care physicians (PCPs) and diabetologists/endocrinologists (D/Es) related to CGM and AGP. The CME activity was a 30-minute online video panel discussion with synchronized slides. A repeated pairs pre-/post-assessment study design and chi-square test (P &lt;.05 is considered significant) assessed educational effect. The activity launched March 23, 2020 and data were collected through May 19, 2020. In total, 338 PCPs and 189 D/Es were included in the analysis. Overall, there were knowledge and confidence improvements seen among all groups from pre- to post-assessment: • 14% of PCPs (P=.NS) 14% of D/Es (P&lt;.05) improved at identifying benefits of an AGP report • 20% of PCPs (P&lt;.01) 11% of D/Es (P=.NS) improved at recognizing importance of time in range in diabetes management • 13% of PCPs (P&lt;.05) 3% of D/Es (P=.NS) improved at recognizing target blood glucose levels for time in range • 43% of PCPs and 36% of D/Es had a measurable increase in confidence in ability to explain results from an AGP to patients Continued educational gaps: • 60% of PCPs and 47% of D/Es failed to identify benefits of an AGP report • 35% of PCPs and 12% of D/Es failed to recognize importance of time in range in diabetes management This study demonstrates the success of online 30-minute video panel discussion CME on improving knowledge and confidence of PCPs and D/Es related to CGM and the AGP. Continued gaps were identified for future educational targets.
Racial/Ethnic Differences in Leisure-Time Physical Activity Among United States Adults With and Without Diabetes
Authors: Visaria Aayush , Kethidi Nikhit , Chilakapati Rachana , Shahani Jai , Modak Anurag , Shah Megh 
Published: May 2021

Abstract
Background: Physical activity (PA) is a key lifestyle recommendation for diabetes mellitus (DM) prevention and management. The purpose of this study was to describe the patterns of leisure-time, aerobic & muscle-strengthening PAs across races/ethnicities and DM status.
Methods: We included 91,386 adults ≥18 years from the 2011–2018 National Health Interview Surveys who were able to participate in light-moderate PA. Aerobic PA was classified per 2008 guidelines as inactive (0 minutes/week [min/wk] of moderate or vigorous activity), insufficiently active (0–150 moderate-equivalent min/wk, defined as sum of moderate-level and 2*vigorous-level PA), sufficiently active (150–300 moderate-equivalent min/wk), and highly active (&gt;300 min/wk of moderate-level PA, &gt;150 min/wk of vigorous-level PA, or &gt;300 moderate-equivalent min/wk). We also classified aerobic PA continuously in terms of metabolic equivalents (METs; 4 METs for moderate and 8 METs for vigorous PA). Muscle-strengthening PA was dichotomized into ≥3 times/wk (adequate) and &lt;3 times/wk (inadequate). Race/ethnicity was categorized as non-Hispanic White (NHW), non-Hispanic Black (NHB), Asian Indian (AI), Other Asian (OA), and Hispanic/Other (H/O). We used self-reported DM-stratified multivariable logistic and linear regression to assess racial/ethnic differences in PA. All analyses accounted for the survey design and weights to obtain nationally representative estimates.
Results: Among the 91,386 participants, 45,676 (53%) were male, 11,835 (10%) were ≥65 years, and 5,106 (5.2%) had DM. Asian groups had lower adequate muscle-strengthening PA than others (%[SE]: NHW, 35[0.3]%; NHB, 35[0.7]%; AI, 27[1.6]%; OA, 30[1.3]%; H/O, 34[0.8]%; p&lt;0.0001). AIs also had a lower proportion of ‘highly active’ individuals (%[SE]: NHW, 67[0.2]%; NHB, 65[0.7]%; AI, 57[1.8]%; OA, 61[1.5]%; H/O, 67[0.8]%; p&lt;0.0001). Non-DM AIs had mean (SE) 622 (133) lower METs than NHWs (covariate adjusted mean METs [SE]: NHW, 3,568 [305]; NHB, 3,873 [309]; AI, 2,946 [333]; OA, 3,107 [321]; H/O, 3,736 [325]; p&lt;0.001). This difference was also present in those with DM (adjusted mean METs [SE]: NHW, 2,231 [314]; NHB, 2,231 [379]; AI, 1,366 [456]; OA, 1,847 [495]; H/O, 2,454 [401]; p=0.013). Non-DM AIs and OAs had ~30% lower odds of being at least ‘sufficiently active’ relative to NHWs (aOR [95% CI]: AI, 0.70 [0.56, 0.87]; OA, 0.72 [0.61, 0.85]). All races/ethnicities had lower odds of adequate muscle-strengthening PA compared to NHWs (aOR [95% CI]: NHB, 0.94 [0.90, 0.99]; AI, 0.68 [0.60, 0.79]; OA, 0.75 [0.68, 0.84]; H/O, 0.73 [0.69, 0.77]). These inverse associations persisted in DM-diagnosed OAs, but not AIs.
Conclusion: Among those with and without DM, there exist racial/ethnic differences in strength-related and aerobic activities. Asian groups may benefit from aggressive counseling and PA interventions to both prevent and manage DM.
Study of the Effect of Early Insulin Therapy on Inflammation and Its Correlation With Glucotoxicity in Newly Diagnosed T2DM
Authors: Ramesh Jayanthy , Mudimela Madhubabu , Makineni Ashok Chakravarthy , Madhira Srivalli 
Published: May 2021

Abstract
Diabetes is a chronic metabolic and inflammatory disorder resulting in long term vascular complications. Glucotoxicity has been proposed to aggravate inflammatory stress. In this background,effect of early insulin therapy on inflammatory markers in relation to the glycemic status could be relevant in the newly diagnosed Type 2DM patients. Clinical studies highlighting this pathophysiologic aspect are sparse. Objective: To determine the effect of early insulin therapy in newly diagnosed patients with type 2 diabetes mellitus on inflammatory markers and glucotoxicity. Methods: 40 newly diagnosed type 2 diabetes patients, attending the endocrinology OPD at a tertiary teaching hospital were enrolled in this treatment related follow up study after institutional ethical committee clearance, conducted between May 2019 to February 2020. Patients with HbA1C &gt; 8.5% to &lt;12.5% were included in the study. Metabolic (FPG, PPG, HbA1c), and inflammatory parameters (Serum IL-6, Serum TNF alpha levels) were assessed both at baseline and after 9 months of insulin treatment. A simple,conventional twice daily premixed insulin was initiated at a starting dose of insulin at 0.5 U/kg/day and the dose was titrated according to FPG and 2 hr PPG in order to maintain glycemic goals as per ADA standards. Results: The study included 40 subjects with a mean age of 43.9 years and a mean BMI of 26.46 kg/m2. At the end of 9 months of the study, mean FPG, PPG, HbA1C were significantly reduced [FPG (118.45± 24.74mg/dl), PPG (152± 25 mg/dl), HbA1c (6.67± 0.42%)] as compared to baseline [FPG, (218.4± 37.84mg/dl), PPG (307±62mg/dl), HbA1C (9.95± 1.39%) (p &lt;0.001). A statistically significant decrease in inflammatory markers like IL6, TNF alpha, from baseline to 9 months [.IL6 5.365±1.465 to 2.819±0.697 pg/ml, S.TNF alpha 36.476±16.902 to 11.274±3.712 pg/ml.] (p &lt;0.001) was observed. Correlation studies revealed at 9 months, a highly significant positive correlation between FPG, PPG and IL6 and TNF alpha levels (p&lt;0 .001), in comparison with baseline (p&lt; 0.05). However IL6 levels significantly correlated with HBA1c both at baseline and at 9 months (p&lt;0.05), whereas only a non significant positive correlation with TNF alpha was observed. Conclusion: Early Insulin treatment has beneficial effect on both Inflammation and glucotoxicity in newly diagnosed Type2 DM. Effective, simple and early insulin regimen offers a pathophysiologic based therapeutic perspective aiming at improving the natural course of diabetes.