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Model-based glycaemic control

Oscar D Sánchez, Eduardo Ruiz-Velázquez, Alma Y Alanís, Griselda Quiroz, Luis Torres-Treviño
The effect of meal on blood glucose concentration is a key issue in diabetes mellitus because its estimation could be very useful in therapy decisions. In the case of type 1 diabetes mellitus (T1DM), the therapy based on automatic insulin delivery requires a closed-loop control system to maintain euglycaemia even in the postprandial state. Thus, the mathematical modelling of glucose metabolism is relevant to predict the metabolic state of a patient. Moreover, the eating habits are characteristic of each person, so it is of interest that the mathematical models of meal intake allow to personalise the glycaemic state of the patient using therapy historical data, that is, daily measurements of glucose and records of carbohydrate intake and insulin supply...
February 2019: IET Systems Biology
K Ismail, K Stewart, K Ridge, E Britneff, R Freudenthal, D Stahl, P McCrone, C Gayle, A M Doherty
AIMS: We examined the effectiveness of a service innovation, Three Dimensions for Diabetes (3DFD), that consisted of a referral to an integrated mental health, social care and diabetes treatment model, compared with usual care in improving biomedical and health economic outcomes. METHODS: Using a non-randomized control design, the 3DFD model was offered in two inner-city boroughs in London, UK, where diabetes health professionals could refer adult residents with diabetes, suboptimal glycaemic control [HbA1c ≥ 75 mmol/mol (≥ 9...
February 1, 2019: Diabetic Medicine: a Journal of the British Diabetic Association
Awadhesh Kumar Singh, Ambika G Unnikrishnan, Abdul H Zargar, Ajay Kumar, Ashok K Das, Banshi Saboo, Binayak Sinha, Kalyan Kumar Gangopadhyay, Pradeep G Talwalkar, Samit Ghosal, Sanjay Kalra, Shashank Joshi, Surendra Kumar Sharma, Usha Sriram, Viswanathan Mohan
The current diabetes management strategies not only aim at controlling glycaemic parameters but also necessitate continuous medical care along with multifactorial risk reduction through a comprehensive management concept. The sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a group of evolving antidiabetic agents that have the potential to play a pivotal role in the comprehensive management of patients with diabetes due to their diverse beneficial effects. SGLT2i provide moderate glycaemic control, considerable body weight and blood pressure reduction, and thus have the ability to lower the risk of macrovascular and microvascular complications...
January 31, 2019: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Andrew Reynolds, Jim Mann, John Cummings, Nicola Winter, Evelyn Mete, Lisa Te Morenga
BACKGROUND: Previous systematic reviews and meta-analyses explaining the relationship between carbohydrate quality and health have usually examined a single marker and a limited number of clinical outcomes. We aimed to more precisely quantify the predictive potential of several markers, to determine which markers are most useful, and to establish an evidence base for quantitative recommendations for intakes of dietary fibre. METHODS: We did a series of systematic reviews and meta-analyses of prospective studies published from database inception to April 30, 2017, and randomised controlled trials published from database inception to Feb 28, 2018, which reported on indicators of carbohydrate quality and non-communicable disease incidence, mortality, and risk factors...
January 10, 2019: Lancet
Elisabet Stener-Victorin, Haolin Zhang, Rong Li, Cecilia Friden, Dong Li, Wei Wang, Haining Wang, Cuiqing Chang, Shi Li, ZeJun Huo, Hua Zhang, Xiaolan Ji, Angelica Linden-Hirschberg, Jie Qiao
INTRODUCTION: Polycystic ovary syndrome (PCOS) is linked to hyperinsulinemia and insulin resistance with dysfunctional glucose metabolism. Pilot studies suggests that acupuncture treatment with combined manual and low-frequency electrical stimulation (electroacupuncture (EA)) of the needles decrease circulating glycated haemoglobulin (HbA1c) and homeostatic model assessment-insulin resistance. Therefore, we here aim to investigate if acupuncture treatment or metformin together with lifestyle or lifestyle management alone improves insulin sensitivity and related symptoms in overweight/obese women with PCOS...
January 4, 2019: BMJ Open
Sofia Axia Karlsson, Stefan Franzén, Ann-Marie Svensson, Mervete Miftaraj, Björn Eliasson, Karolina Andersson Sundell
BACKGROUND: Management of type 2 diabetes mellitus (T2DM) encompasses intensive glycaemic control, along with treatment of comorbidities and complications to handle the increased risk of cardiovascular disease (CVD). Improved control of LDL-cholesterol (LDL-C) with lipid-lowering medications is associated with reduced CVD risk in T2DM patients. Thus, treatment guidelines recommend lipid-lowering medications for T2DM patients with LDL-C above risk-associated thresholds. This study aimed to assess healthcare provider adherence to guidelines regarding lipid-lowering medication prescription among T2DM patients and to analyse factors associated with lipid-lowering medication prescription...
November 28, 2018: BMC Health Services Research
M I Zafar, K E Mills, J Zheng, M M Peng, X Ye, L L Chen
OBJECTIVES: Low glycaemic index (GI) diets may aid in weight loss by reducing postprandial blood glucose excursions, leading to more stable blood glucose concentrations and therefore a reduction in hunger. To test this hypothesis, we conducted a systematic review and meta-analysis of randomized controlled trials comparing low GI diets with other diet types. METHODS: We included 101 studies involving 109 study arms and 8,527 participants. We meta-analysed the studies using a random-effects model and conducted subgroup analyses and meta-regression based on control diet, blood glucose control, baseline BMI and dietary GI...
November 20, 2018: Obesity Reviews: An Official Journal of the International Association for the Study of Obesity
Kent W Stewart, J Geoffrey Chase, Christopher G Pretty, Geoffrey M Shaw
BACKGROUND AND OBJECTIVE: Hyperglycaemia is commonplace in the adult intensive care unit (ICU), and has been associated with increased morbidity and mortality. Effective glycaemic control (GC) can reduce morbidity and mortality, but has proven difficult. STAR is a model-based GC protocol that uniquely maintains normoglycaemia by changing both insulin and nutrition interventions, and has been proven effective in controlling blood glucose (BG) in the ICU. However, most ICU GC protocols only change insulin interventions, making the variable nutrition aspect of STAR less clinically desirable...
November 2018: Computer Methods and Programs in Biomedicine
Adie Viljoen, Christina S Hoxer, Pierre Johansen, Samuel Malkin, Barnaby Hunt, Stephen C Bain
AIMS: Glucagon-like peptide-1 (GLP-1) receptor agonists are appealing as glucose-lowering therapy for individuals with type 2 diabetes mellitus (T2DM) as they also reduce body weight and are associated with low rates of hypoglycaemia. This analysis assessed the long-term cost-effectiveness of semaglutide 0.5 and 1 mg vs dulaglutide 1.5 mg (two once-weekly GLP-1 receptor agonists) from a UK healthcare payer perspective, based on the head-to-head SUSTAIN 7 trial, to inform healthcare decision making...
October 25, 2018: Diabetes, Obesity & Metabolism
J L Knopp, M Signal, D L Harris, G Marics, P Weston, J Harding, P Tóth-Heyn, J Hómlok, B Benyó, J G Chase
BACKGROUND: Model-based glycaemic control protocols have shown promise in neonatal intensive care units (NICUs) for reducing both hyperglycaemia and insulin-therapy driven hypoglycaemia. However, current models for the appearance of glucose from enteral feeding are based on values from adult intensive care cohorts. This study aims to determine enteral glucose appearance model parameters more reflective of premature infant physiology. METHODS: Peaks in CGM data associated with enteral milk feeds in preterm and term infants are used to fit a two compartment gut model...
October 3, 2018: Computer Methods and Programs in Biomedicine
Francesco Prattichizzo, Angelica Giuliani, Emanuela Mensà, Jacopo Sabbatinelli, Valeria De Nigris, Maria Rita Rippo, Lucia La Sala, Antonio Domenico Procopio, Fabiola Olivieri, Antonio Ceriello
Metformin is the first-choice therapy to lower glycaemia and manage type 2 diabetes. Continuously emerging epidemiological data and experimental models are showing additional protective effects of metformin against a number of age-related diseases (ARDs), e.g., cardiovascular diseases and cancer. This evidence has prompted the design of a specific trial, i.e., the Targeting Aging with Metformin (TAME) trial, to test metformin as an anti-ageing molecule. However, a unifying or prevailing mechanism of action of metformin is still debated...
December 2018: Ageing Research Reviews
Christina Bächle, Anna Peneva, Werner Maier, Katty Castillo, Anna Stahl-Pehe, Oliver Kuß, Rolf Holle, Julia M Hermann, Reinhard W Holl, Joachim Rosenbauer
PURPOSE: To analyse the association of area-level deprivation (German Index of Multiple Deprivation, GIMD 2010) with health- and disease-related quality of life (QoL) and glycaemic control (HbA1c) jointly with individual-level socioeconomic status (SES) in young patients with preschool-onset type 1 diabetes. METHODS: A total of 425 male and 414 female patients aged 11-21 years from a Germany-wide population-based survey completed the generic KINDL-R, the DISABKIDS chronic-generic module (DCGM-12), and the DISABKIDS diabetes-specific module with impact and treatment scales (QoL indicators; range 0-100 with higher scores representing better QoL)...
December 2018: Quality of Life Research
Marc Evans, Roopa Mehta, Jens Gundgaard, Barrie Chubb
BACKGROUND: Understanding which therapeutic innovations in diabetes represent the best value requires rigorous economic evaluation. Data from randomised controlled trials and observational studies indicate that insulin degludec has a hypoglycemia advantage versus insulin glargine 100 units/mL (glargine U100), the most widely prescribed basal insulin analogue in the UK. This analysis was done to more rigorously assess cost-effectiveness in a UK setting. METHODS: Data from two double-blinded, randomised, two-period crossover trials in type 1 (SWITCH 1) and type 2 (SWITCH 2) diabetes mellitus were used to assess the cost-effectiveness of degludec vs...
October 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Lindokuhle Patience Mabuza, Mlindeli Wilkinson Gamede, Sanam Maikoo, Irvin Noel Booysen, Phikelelani Siphosethu Ngubane, Andile Khathi
Pre-diabetes is a condition that precedes type 2 diabetes mellitus (T2DM) that is characterised by elevated glycated haemoglobin (HbA1c). The management of pre-diabetes includes the combination of dietary and pharmacological interventions to increase insulin sensitivity. However, poor patient compliance has been reported with regard to dietary interventions, therefore, new alternative drugs are required that can be effective even without the dietary intervention. In our laboratory, we have synthesised a novel ruthenium complex that has been shown to have elevated biological activity...
July 14, 2018: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
David G Bruce, Wendy A Davis, Timothy M E Davis
AIM: To investigate whether tight glycaemic control achieved with metformin, insulin or sulphonylurea-based pharmacotherapy increases all-cause mortality in older people with type 2 diabetes. MATERIALS AND METHODS: We conducted a prospective cohort study of individuals with known diabetes recruited between 2008 and 2011 and followed until 2016. The impact of baseline glycated haemoglobin (HbA1c) on mortality hazards was investigated in participants aged ≥75 years...
July 13, 2018: Diabetes, Obesity & Metabolism
Theresa J Allain, Grieves Mang'anda, Marrianne Kasiya, Patricia Khomani, Ndaziona P Banda, Andrew Gonani, Ingrid Peterson, Gavin Dreyer
The Malawian health sector has a strong tradition of systematic data collection for monitoring and evaluation of large-scale services. A highly successful adapted Directly Observed Treatment, Short course "DOTS" framework, based on patient registers and paper-based mastercards was introduced to facilitate the management and monitoring of the scale up of antiretroviral therapy. Subsequently, a simple, touch-screen based electronic medical record system (EMRs) was effectively introduced at high burden ART sites...
December 2017: Malawi Medical Journal: the Journal of Medical Association of Malawi
A Cabrera, M Vives, A Molina, M París, E Raga, A Sánchez, F Sabench, D Del Castillo
AIM: Laparoscopic gastric plication (LGP) is a bariatric surgical technique based on the anatomical principles of laparoscopic sleeve gastrectomy (LSG), but its effects on the metabolic profile are still uncertain. The aim of our study is to compare the changes in weight, metabolic parameters and gastric histology following intervention by gastric plication (GP) and sleeve gastrectomy (SG) in an experimental model of obesity. METHODS: To conduct the study, 32 8-week-old male Sprague-Dawley rats (Charles River®) were fattened by means of a cafeteria diet and randomly assigned to the following experimental groups: group 1: GP (n = 12); group 2: SG (n = 12) and group 3: sham (n = 8)...
October 2018: Obesity Surgery
Xin Liu, Wei Gan, Chuqi Gao, Xin Qi, Xia Liao, Jing Lin, Yaling Zhao
PURPOSE: High-protein diets were popular in weight control. However, the role of protein intake in adiposity and related metabolic conditions among general populations is not clear. We aimed to evaluate the associations of protein intake with adiposity and glycaemic control among adult Chinese in a nationwide population-based survey. METHODS: The data were from China Health and Nutrition Survey 2009. A total of 9360 men and women aged 18 years or older were included...
June 13, 2018: European Journal of Nutrition
Jennifer L Knopp, Adrienne M Lynn, Geoffrey M Shaw, J Geoffrey Chase
OBJECTIVE: Previous studies examine clinical outcomes of insulin therapy in neonatal intensive care units (NICUs), without first developing safe and effective control protocols. This research quantifies the safety and performance of a computerised model-based control algorithmSTAR-GRYPHON (Stochastic TARgeted Glucose Regulation sYstem to Prevent Hyper- and hypO-glycaemia in Neonates). DESIGN: Retrospective observational study of glycaemic control in very/extremely low birthweight infants treated with insulin from Christchurch Women's Hospital NICU between January 2013 and June 2017...
June 21, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
Rosie Dobson, Robyn Whittaker, Yannan Jiang, Ralph Maddison, Matthew Shepherd, Catherine McNamara, Richard Cutfield, Manish Khanolkar, Rinki Murphy
OBJECTIVE: To determine the effectiveness of a theoretically based and individually tailored, text message based, diabetes self management support intervention (SMS4BG) in adults with poorly controlled diabetes. DESIGN: Nine month, two arm, parallel randomised controlled trial. SETTING: Primary and secondary healthcare services in New Zealand. PARTICIPANTS: 366 participants aged 16 years and over with poorly controlled type 1 or type 2 diabetes (HbA1c ≥65 mmol/mol or 8%) randomised between June 2015 and November 2016 (n=183 intervention, n=183 control)...
May 17, 2018: BMJ: British Medical Journal
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