Vol.
1 | Issue 6 | 2020
Dear Doctor,
Greetings from Micro Labs Limited. We are happy to bring you “DIABETES UPDATE” which contains latest and interesting
news in the field of Diabetes and Endocrinology.
Persistent Poor Glycaemic Control in Individuals With Type 2 Diabetes in Developing Countries
Prevalence of Insomnia and Association With Metabolic Parameters in T2D
Association of small dense LDL_C with CV outcome in patients with CAD and diabetes
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Medical Team, Micro Labs Limited
Page 1 of 6
Vol 1 | Issue 6| 2020
Persistent Poor Glycaemic Control in Individuals With
Type 2 Diabetes in Developing Countries
Diabetes is a significant health 66,088 individuals with type 2
burden. In anticipation of diabetes from seven waves of data
increasing disease awareness, collection; of these, 42,171 (63.8%)
better care standards and received OGLD only, 14,529
technological advancements, the (22.0%) received OGLD + insulin
International Diabetes and 7566 (11.4%) received insulin
Management Practices Study only. Patients treated with meal
(IDMPS) was designed to plan/physical activity alone
document and track patient (n = 1685, 2.5%) and those who did
profiles and patterns of care across not use OGLD, insulin or diet for
time in developing countries, their diabetes (n = 137, 0.2%) were
where data are limited. The IDMPS excluded from this analysis. A total
is the largest international of 49 countries were included in
observational study with the the seven waves of data collection,
participation of over 6000 grouped into regions with the
physicians from 49 countries composition of each region varying
across Africa, the Middle East, by wave depending on logistic
South Asia, Latin America, Asia and availability.
Eurasia. Data were collected using
In developing A total of 66,088 individuals with
structured case report forms in a
countries, type 2 diabetes were recruited by
glycaemic control series of yearly ‘waves’, with each
6099 physicians from 49 countries.
in individuals with wave recruiting a different cohort
type 2 diabetes The proportion of participants
of participants. The first wave of
remained with HbA1c <53 mmol/mol (<7%)
data collection began in 2005 and
suboptimal over a decreased from 36% in wave 1
12 year period. the most recent wave (wave 7) was
(2005) to 30.1% in wave 7 (2017)
completed in 2017.
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Vol 1 | Issue 6| 2020
(p < 0.0001). Compared with wave (wave 1) to 0.33 ± 0.19 U/kg (wave
1, the adjusted ORs of attaining 7) for basal regimen and
HbA1c ≤64 mmol/mol (≤8%) 0.70 ± 0.34 U/kg (wave 1)
decreased significantly in waves 2,
to 0.77 ± 0.33 (wave 7) U/kg for
5, 6 and 7 (p < 0.05). Over 80% of
basal–bolus regimen. An increasing
participants
received oral
glucose-
lowering
drugs, with
declining use
of
sulfonylureas.
Insulin use
increased
from 32.8%
(wave 1) to
41.2% (wave
7)
(p < 0.0001).
The
correspondin
The proportion of participants attaining HbA1c goal defined
g time to as: (a) <53 mmol/mol or <7%; and (b) <64 mmol/mol or
insulin <8%, between 2005 and 2017
proportion of participants had ≥2
initiation (mean ± SD) changed
HbA1c measurements within 12
from 8.4 ± 6.9 in wave 1 to 8.3 ± 6.6
months of enrolment (from 61.8%
years in
to 92.9%), and the proportion of
wave 7, while daily insulin dosage participants receiving diabetes
ranged from 0.39 ± 0.21 U/kg education (mainly delivered by
Page 3 of 6
Vol 1 | Issue 6| 2020
physicians) also increased from Source: Aschner P et al. Diabetologia.
59.0% to 78.3%. In conclusion, in 2020;63(4):711–721.
this 12 year study, poor and doi:10.1007/s00125-019-05078-3
worsening glycaemic control was
observed in individuals with type 2
diabetes.
Prevalence of Insomnia and Association With Metabolic
Parameters in T2D
Insomnia is defined as chronic metabolic parameters and
difficulty of falling asleep, staying glycemic control in people with
asleep or waking up early, despite T2D in a systematic review and
opportunity to sleep, at least 3 meta-analysis
times a week during 1 month,
A total of 11 329 titles/abstracts
resulting
in daytime
impairme
nt. The
aim of this
study is to
determine
The prevalence of
insomnia in the the
T2D population prevalenc
may be associated e of
with deleterious
glycemic control. insomnia
and Prevalence, 95% Confidence Intervals (CI) and I2 Statistic Overall
insomnia and for Several Sensitivity Analyses
were screened and 224 were read
symptoms and its association with
full text in duplicate, of which 78
Page 4 of 6
Vol 1 | Issue 6| 2020
studies were included. The pooled [0.1–0.4]) and higher fasting
prevalence of insomnia glucose levels (mean difference,
(symptoms) in people with T2D 0.40 mmol/L [0.2–0.7]), with a low
was 39% (95% confidence interval, GRADE of evidence. The relative
34–44) with I2 statistic of 100% (P low methodological quality and
< 0.00001), with a very low GRADE high heterogeneity of the studies
of evidence. Sensitivity analyses included in this meta-analysis
identified no clear sources of complicate the interpretation of
heterogeneity. Meta-analyses our results.
showed that in people with T2D,
Source: Koopman ADM, Glycemic Control:
insomnia (symptoms) were Meta-Analysis. J Clin Endocrinol Metab.
associated with higher hemoglobin 2020;105(3):dgz065.
A1c levels (mean difference, 0.23%
Association of small dense LDL_C with CV outcome in
patients with CAD and diabetes
Low-density lipoprotein incidence of coronary artery
cholesterol (LDL-C) is one of the disease (CAD). The aim of the
major risk factors of coronary present study was to investigate
artery disease (CAD). Achieving the prognostic value of plasma
lower levels of LDL-C for sdLDL level in patients with
patients with very high risk has stable CAD and DM.
Elevated levels of been recommended by various
A total of 4148 consecutive
plasma sdLDL guidelines. Elevation in small
were associated patients with stable CAD were
dense low-density lipoprotein
with increased prospectively enrolled into the
risk of MACEs (sdLDL) is common in patients
study and followed up for major
among DM with diabetes mellitus (DM),
patients. cardiovascular events (MACEs)
which has already been
up to 8.5 years. Plasma sdLDL
reported to be associated with
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Vol 1 | Issue 6| 2020
level was measured in each value of high sdLDL was
patient by a direct method using assessed in different glucose
automated chemistry analyzer. metabolism status, the results
The patients were subsequently showed that the high sdLDL
divided into four groups by the plus DM was associated with
quartiles of sdLDL and the worse outcome after
association of sdLDL level with
MACEs in different status of
glucose metabolism [DM, Pre-
DM, normal glycaemia
regulation (NGR)] was
evaluated.
A total of 464 MACEs were
documented. Both Kaplan-Meier adjustment of confounding risk
analysis and Cox regression factors (hazard ratio: 1.83, 95%
analysis indicated that the confident interval: 1.24-2.70, p
patients in quartile 4 but not < 0.05). However, no significant
quartile 2 or 3 of sdLDL level association was observed for
had significantly higher rate of high sdLDL plus Pre-DM or NGR.
MACEs than that in lowest Source: Jin JL et al. Cardiovasc
quartile. When the prognostic Diabetol. 2020;19(1):45
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