Humans ; Child, Preschool ; Insulin/therapeutic use* ; Diabetes Mellitus, Type 1/drug therapy* ; Retrospective Studies ; Hypoglycemic Agents/therapeutic use* ; Diabetes Mellitus, Type 2 ; Blood Glucose

OBJECTIVES: Patients with classical type 1 diabetes mellitus (T1DM) require lifelong dependence on exogenous insulin therapy due to pancreatic beta-cell destruction and absolute insulin deficiency. T1DM accounts for about 90% of children with diabetes in China, with a rapid increase in incidence and a younger-age trend. Epidemiological studies have shown that the overall glycated haemoglobin (HbA1c) and compliance rate are low in Chinese children with T1DM. Optimal glucose control is the key for diabetes treatment, and maintaining blood glucose within the target range can prevent or delay chronic vascular complications in patients with T1DM. Therefore, this study aims to investigate the glycemic control of children with T1DM from Hunan and Henan Province with flash glucose monitoring system (FGMS), and to explore factors associated with glycemic variability. METHODS: A total of 215 children with T1DM under 14 years old were enrolled continuously in 16 hospitals from August 2017 to August 2020. All subjects wore a FGMS device to collect glucose data. Correlation of HbA1c, duration of diabetes, or glucose scan rates with glycemic variability was analyzed. Glucose variability was compared according to the duration of diabetes, HbA1c, glucose scan rates and insulin schema. RESULTS: HbA1c and duration of diabetes were positively correlated with mean blood glucose, standard deviation of glucose, mean amplitude of glucose excursions (MAGE), and coefficient of variation (CV) of glucose (all P<0.01). The glucose scan rates during FGMS wearing was significantly positively correlated with time in range (TIR) (P=0.001) and negatively correlated with MAGE and mean duration of hypoglycemia (all P<0.01). Children with duration ≤1 year had lower time below range (TBR) and MAGE when compared with those with duration >1 year (all P<0.05). TIR and TBR in patients with HbA1c ≤7.5% were higher (TIR: 65% vs 45%, TBR: 5% vs 4%, P<0.05), MAGE was lower (7.0 mmol/L vs 9.4 mmol/L, P<0.001) than those in HbA1c >7.5% group. Compared to the multiple daily insulin injections group, TIR was higher (60% vs 52%, P=0.006), MAGE was lower (P=0.006) in the continuous subcutaneous insulin infusion group. HbA1c was lower in the high scan rates (≥14 times/d) group (7.4% vs 8.0%, P=0.046), TIR was significantly higher (58% vs 47%, P<0.001), and MAGE was lower (P<0.001) than those in the low scan rate (<14 times/d) group. CONCLUSIONS The overall glycemic control of T1DM patients under 14 years old in Hunan and Henan Province is under a high risk of hypoglycemia and great glycemic variability. Shorter duration of diabetes, targeted HbA1c, higher glucose scan rates, and CSII are associated with less glycemic variability.
Adolescent ; Blood Glucose ; Blood Glucose Self-Monitoring ; Child ; Diabetes Mellitus, Type 1/drug therapy* ; Glucose ; Glycated Hemoglobin A/analysis* ; Humans ; Hypoglycemia/prevention & control* ; Hypoglycemic Agents/therapeutic use* ; Insulin/therapeutic use*

Blood Glucose ; Diabetes Mellitus, Type 1/drug therapy* ; Dietary Supplements ; Humans ; Insulin-Secreting Cells ; Vitamin D ; Vitamin D Deficiency

Exercise is vital for diabetics to improve their blood glucose level. However, the quantitative relationship between exercise modes (including types, intensity, time, etc.) and the blood glucose is still not clear. In order to answer these questions, this paper established a blood glucose metabolic model based on ordinary differential equation method. Furthermore, a silico method was adopted to study the effects of different aerobic exercise intensities (light, moderate and vigorous) on blood glucose and optimal strategies of insulin infusion for type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Additionally, the universality of proposed model and insulin infusion strategies was verified based on 1 000 virtual diabetes patients' simulation. The experimental results showed that: (1) Vigorous-intensity aerobic exercise may result in hypoglycemia (< 3.89 mmol/L), which was so harmful to health that diabetics should avoid. Compared with moderate-intensity exercise, the light-intensity aerobic exercise intuitively lowered blood glucose slowly and caused a relative long high-blood-glucose (> 6.11 mmol/L) period, however, its overall blood glucose risk index (BGRI) was lower. (2) Insulin dosage of the optimized strategies decreased by 50% and 84% for T1DM and T2DM when they did moderate intensity exercise. As for light intensity exercise, the dosage of insulin was almost the same as they didn't do exercise, but BGRI decreased significantly. (3) The simulations of 1 000 virtual diabetic patients manifested that the proposed model and the insulin infusion strategies had good universality. The results of this study can not only help to improve the quantitative understanding about the effects of aerobic exercise on blood glucose of diabetic patients, but also contribute to the regulation and management of blood glucose in exercise mode.
Blood Glucose ; metabolism ; Computer Simulation ; Diabetes Mellitus, Type 1 ; drug therapy ; metabolism ; Diabetes Mellitus, Type 2 ; drug therapy ; metabolism ; Exercise ; Humans ; Insulin ; administration & dosage ; Models, Theoretical

Objective To assess the efficiency and safety of a novel sodium-glucose co-transporter 2 (SGLT2) inhibitor-SGLT2 inhibitors, in combination with insulin for type 1 diabetes mellitus (T1DM). Methods We searched Medline, Embase, and the Cochrane Collaboration Library to identify the eligible studies published between January 2010 and July 2016 without restriction of language. The Food and Drug Administration (FDA) data and ClinicalTrials (http://www.clinicaltrials.gov) were also searched. The included studies met the following criteria: randomized controlled trials; T1DM patients aged between 18 and 65 years old; patients were treated with insulin plus SGLT2 inhibitors for more than 2 weeks; patients' glycosylated hemoglobin (HbA1c) levels were between 7% and 12%. The SGLT2 inhibitors group was treated with SGLT2 inhibitors plus insulin, and the placebo group received placebo plus insulin treatment. The outcomes should include one of the following items: fasting blood glucose, HbA1c, glycosuria, or adverse effects. Data were analyzed by two physicians independently. The risk of bias was evaluated by using the Cochrane Collaboration's Risk of Bias tool and heterogeneity among studies was assessed using Chi-square test. Random effect model was used to analyze the treatment effects with Revman 5.3.Results Three trials including 178 patients were enrolled. As compared to the placebo group, SGLT2 inhibitor absolutely decreased fasting blood glucose [mean differences (MD) -2.47 mmol/L, 95% confidence interval (CI) -3.65 to -1.28, P<0.001] and insulin dosage (standardized MD -0.75 U, 95%CI -1.17 to -0.33, P<0.001). SGLT2 inhibitors could also increase the excretion of urine glucose (MD 131.09 g/24 h, 95%CI 91.79 to 170.39, P<0.001). There were no significant differences in the incidences of hyperglycemia [odds ratio (OR) 1.82, 95%CI 0.63 to 5.29, P=0.27], urinary tract infection (OR 0.95, 95%CI 0.19 to 4.85, P=0.95), genital tract infection (OR 0.27, 95%CI 0.01 to 7.19, P=0.43), and diabetic ketoacidosis (OR 6.03, 95%CI 0.27 to 135.99, P=0.26) between the two groups.Conclusion SGLT2 inhibitors combined with insulin might be an efficient and safe treatment modality for T1DM patients.
Adolescent ; Adult ; Aged ; Blood Glucose ; metabolism ; Diabetes Mellitus, Type 1 ; blood ; drug therapy ; Drug Therapy, Combination ; methods ; Fasting ; blood ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Hypoglycemic Agents ; adverse effects ; therapeutic use ; Insulin ; adverse effects ; therapeutic use ; Male ; Middle Aged ; Randomized Controlled Trials as Topic ; Sodium-Glucose Transporter 2 ; antagonists & inhibitors

Dietary fiber improves hyperglycemia in patients with type 2 diabetes through its physicochemical properties and possible modulation of gut hormone secretion, such as glucagon-like peptide 1 (GLP-1). We assessed the effect of dietary fiber-enriched cereal flakes (DC) on postprandial hyperglycemia and gut hormone secretion in patients with type 2 diabetes. Thirteen participants ate isocaloric meals based on either DC or conventional cereal flakes (CC) in a crossover design. DC or CC was provided for dinner, night snack on day 1 and breakfast on day 2, followed by a high-fat lunch. On day 2, the levels of plasma glucose, GLP-1, glucose-dependent insulinotropic polypeptide (GIP), and insulin were measured. Compared to CC, DC intake exhibited a lower post-breakfast 2-hours glucose level (198.5±12.8 vs. 245.9±15.2 mg/dL, P<0.05) and a lower incremental peak of glucose from baseline (101.8±9.1 vs. 140.3±14.3 mg/dL, P<0.001). The incremental area under the curve (iAUC) of glucose after breakfast was lower with DC than with CC (P<0.001). However, there were no differences in the plasma insulin, glucagon, GLP-1, and GIP levels. In conclusion, acute administration of DC attenuates postprandial hyperglycemia without any significant change in the representative glucose-regulating hormones in patients with type 2 diabetes (ClinicalTrials.gov. NCT 01997281).
Adult ; Aged ; Area Under Curve ; Blood Glucose/*analysis ; Cross-Over Studies ; Diabetes Mellitus, Type 2/complications/diagnosis/*diet therapy ; Dietary Fiber/*therapeutic use ; Female ; Gastric Inhibitory Polypeptide/blood ; Glucagon/blood ; Glucagon-Like Peptide 1/*blood ; Hemoglobin A, Glycosylated/analysis ; Humans ; Hyperglycemia/complications/diagnosis ; Insulin/blood ; Intestines/metabolism ; Male ; Middle Aged ; ROC Curve

PURPOSE: To examine the psychometric properties of a Turkish version of the Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ). METHODS: Forward-backward translation of the D-FISQ from English into Turkish was conducted. Original English and translated forms were examined by a panel group. Validity was investigated using content, confirmatory factor analysis, and divergent validity. Reliability was assessed using Cronbach α values, item-total correlations, and intraclass correlations. The sample comprised 350 patients with diabetes. Data were analyzed using SPSS 15.0 for Windows and LISREL 8. RESULTS: The content validity index for the panel members was .90, which indicated perfect content validity; items in D-FISQ were clear, concise, readable, and distinct. Confirmatory factor analysis confirmed the original construct of the D-FISQ. All items had factor loadings higher than the recommended level of .40. The D-FISQ scores were discriminated by the level of anxiety. Reliability results were also satisfactory. Cronbach α values were within ideal limits. Item-total correlation coefficient ranged from .72 to .86. In terms of test-retest reliability, intraclass correlation coefficient was found to be over .90. CONCLUSIONS: D-FISQ is a valid and reliable questionnaire in assessing needle-prick fear among Turkish patients with diabetes. We recommend performing the Turkish D-FISQ in determining and screening patients with diabetes who have fear related to self-insulin injection and finger-prick test. Thus, health care professionals should be aware of the potential consequences of injection fear such as insulin misuse and poor self-monitoring of blood glucose, which may have unfavorable effects on optimal diabetes management.
Anxiety/etiology ; Blood Glucose Self-Monitoring/psychology ; Diabetes Mellitus, Type 1/drug therapy/*psychology ; Diabetes Mellitus, Type 2/drug therapy/*psychology ; *Fear ; Female ; Humans ; Hypoglycemic Agents/administration & dosage ; Injections/psychology ; Insulin/administration & dosage ; Male ; Middle Aged ; Psychometrics ; Reproducibility of Results ; Self Care/psychology ; Surveys and Questionnaires/standards ; Translations ; Turkey

OBJECTIVE: To observe the clinical efficacy of sitagliptin plus insulin on patients with brittle diabetes and to determine the effect of the combined therapy on glucagon secretion.
 METHODS: This randomized, double-blinded and placebo-controlled trial included 30 patients with brittle diabetes. Participants were randomly assigned (1:1) to receive the treatment of either sitagliptin plus insulin or placebo plus insulin for 12 weeks. The blood glucose, hemoglobin A1c, insulin dose, C-peptide, glucagon, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP) and other parameters were determined.
 RESULTS: After 12 weeks of treatment, blood glucose was controlled better by sitagliptin plus insulin (P<0.01). The patients had significantly lower glucose variability indices, lower daily insulin requirement and hemoglobin A1c in the group of sitagliptin plus insulin (P<0.01). After steamed bun test, past-meal GLP-1 levels at 30 min were higher (P<0.01) while GIP levels were lower (P<0.01), with glucagon suppression in the sitagliptin plus insulin group. No significant change was observed at any time point in placebo plus insulin group.
 CONCLUSION Sitagliptin significantly decreases blood glucose level and blood glucose fluctuation, which may contribute to the ability of sitagliptin in decreasing glucagon secretion.
Blood Glucose ; analysis ; C-Peptide ; blood ; Diabetes Mellitus, Type 1 ; drug therapy ; Dipeptidyl-Peptidase IV Inhibitors ; Double-Blind Method ; Drug Therapy, Combination ; Gastric Inhibitory Polypeptide ; blood ; Glucagon ; blood ; Glucagon-Like Peptide 1 ; blood ; Glycated Hemoglobin A ; analysis ; Humans ; Hypoglycemic Agents ; administration & dosage ; therapeutic use ; Insulin ; administration & dosage ; therapeutic use ; Sitagliptin Phosphate ; administration & dosage ; therapeutic use

OBJECTIVEChromium is an essential mineral that is thought to be necessary for normal glucose homeostasis. Numerous studies give evidence that chromium picolinate can modulate blood glucose and insulin resistance. The main ingredient of Tianmai Xiaoke (TMXK) Tablet is chromium picolinate. In China, TMXK Tablet is used to treat type 2 diabetes. This study investigated the effect of TMXK on glucose metabolism in diabetic rats to explore possible underlying molecular mechanisms for its action.

METHODSDiabetes was induced in rats by feeding a high-fat diet and subcutaneously injection with a single dose of streptozotocin (50 mg/kg, tail vein). One week after streptozotocin-injection, model rats were divided into diabetic group, low dose of TMXK group and high dose of TMXK group. Eight normal rats were used as normal control. After 8 weeks of treatment, skeletal muscle was obtained and was analyzed using Roche NimbleGen mRNA array and quantitative polymerase chain reaction (qPCR). Fasting blood glucose, oral glucose tolerance test and homeostasis model assessment of insulin resistance (HOMA-IR) index were also measured.

RESULTSThe authors found that the administration of TMXK Tablet can reduce the fasting blood glucose and fasting insulin level and HOMA-IR index. The authors also found that 2 223 genes from skeletal muscle of the high-dose TMXK group had significant changes in expression (1 752 increased, 471 decreased). Based on Kyoto encyclopedia of genes and genomes pathway analysis, the most three significant pathways were "insulin signaling pathway", "glycolysis/gluconeogenesis" and "citrate cycle (TCA)". qPCR showed that relative levels of forkhead box O3 (FoxO3), phosphoenolpyruvate carboxykinase 2 (Pck2), and protein tyrosine phosphatase 1B (Ptp1b) were significantly decreased in the high-dose TMXK group, while v-akt murine thymoma viral oncogene homolog 1 (Akt1) and insulin receptor substrate 2 (Irs2) were increased.

CONCLUSIONOur data show that TMXK Tablet reduces fasting glucose level and improves insulin resistance in diabetic rats. The mechanism may be linked to the inactivation of PTP1B and PCK enzymes, or through intracellular pathways, such as the insulin signaling pathway.

Animals ; Blood Glucose ; analysis ; Chromium ; administration & dosage ; Diabetes Mellitus, Type 2 ; drug therapy ; metabolism ; Insulin ; physiology ; Insulin Resistance ; Male ; Medicine, Chinese Traditional ; Phosphoenolpyruvate Carboxykinase (ATP) ; antagonists & inhibitors ; Protein Tyrosine Phosphatase, Non-Receptor Type 1 ; antagonists & inhibitors ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; Signal Transduction ; drug effects ; Tablets

AIM: To examine the possible protective effect of Satureja khuzistanica essential oil (SKE) on antioxidant enzyme activity in alloxan-induced Type 1 diabetic rats. METHOD: Thirty Sprague-Dawley male rats were divided into three groups randomly; group one as control, group two diabetic, with no treatment, and group three treatment with SKE at 500 ppm in drinking water, respectively. Diabetes was induced in the second and third groups by alloxan injection subcutaneously. After eight weeks, animals were anaesthetized. Blood samples were also collected before killing to measure antioxidant enzymes activity. RESULTS: SKE significantly increased the serum level of glutathione and the serum activity of glutathione peroxidase, superoxide dismutase, and catalase in the treated group compared with the diabetic untreated group. CONCLUSION The findings showed that SKE exerts beneficial effects on the antioxidant enzymes activity in alloxan-induced Type 1 diabetic rats.
Animals ; Antioxidants ; metabolism ; pharmacology ; therapeutic use ; Blood Glucose ; metabolism ; Catalase ; metabolism ; Diabetes Mellitus, Experimental ; drug therapy ; enzymology ; Diabetes Mellitus, Type 1 ; drug therapy ; enzymology ; Glutathione ; metabolism ; Glutathione Peroxidase ; metabolism ; Male ; Oils, Volatile ; pharmacology ; therapeutic use ; Oxidative Stress ; drug effects ; Phytotherapy ; Plant Extracts ; pharmacology ; therapeutic use ; Rats, Sprague-Dawley ; Satureja ; chemistry ; Superoxide Dismutase ; metabolism