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 Glycaemic Fluctuation Predicts Mortality in Critically Ill Patients WITHDRAWN: Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus.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. The effect of diabetes mellitus on patients undergoing coronary surgery: a risk-adjusted analysis. Is Diabetes a Risk Factor for Patients Undergoing Open Abdominal Aortic Aneurysm Repair? Multidisciplinary intervention for control of diabetes in patients undergoing coronary artery bypass graft (CABG). Three-year data from 5 HARMONY phase 3 clinical trials of albiglutide in type 2 diabetes mellitus: Long-term efficacy with or without rescue therapy. Diabetes control and complications in private primary healthcare in Malaysia. Resistance exercise and glycemic control in women with gestational diabetes mellitus. Cardiovascular disease risk factors prior to the diagnosis of impaired glucose tolerance and non-insulin-dependent diabetes mellitus in a community of older adults. Effect of a low glycaemic index diet on blood glucose in women with gestational hyperglycaemia. Effect of pump versus pen treatment on glycaemic control and kidney function in long-term uncomplicated insulin-dependent diabetes mellitus (IDDM). UKPDS 50: Risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis The effect of empagliflozin on arterial stiffness and heart rate variability in subjects with uncomplicated type 1 diabetes mellitus A comparison of glyburide and insulin in women with gestational diabetes mellitus. Effect of short term intensive multitherapy on carotid intima-media thickness in patients with newly diagnosed type 2 diabetes mellitus. Decrease in blood pressure, body mass index and glycemia after aerobic training in elderly women with type 2 diabetes. Eicosapentaenoic acid improves insulin sensitivity and blood sugar in overweight type 2 diabetes mellitus patients: a double-blind randomised clinical trial. Comparison of conventional twice daily subcutaneous insulin administration and a multiple injection regimen (using the NovoPen) in insulin-dependent diabetes mellitus. Medication non-adherence and poor glycaemic control in patients with type 2 diabetes mellitus. Predictors of new-onset diabetes mellitus in hypertensive patients: the VALUE trial Haemoglobin A1c (HbA1C) in non-diabetic and diabetic vascular patients. Is HbA1C an independent risk factor and predictor of adverse outcome? Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention Need for large scale randomised evidence about lowering LDL cholesterol in people with diabetes mellitus: MRC/BHF heart protection study and other major trials Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Randomized Study of Basal-Bolus Insulin Therapy in the Inpatient Management of Patients With Type 2 Diabetes Undergoing General Surgery (RABBIT 2 Surgery) Effects of pinitol isolated from soybeans on glycaemic control and cardiovascular risk factors in Korean patients with type II diabetes mellitus: a randomized controlled study Long-term effects of a structured intensive diabetes education programme (SIDEP) in patients with Type 2 diabetes mellitus--a 4-year follow-up study. Trial protocol to compare the efficacy of a smartphone-based blood glucose management system with standard clinic care in the gestational diabetic population Cost-utility analysis in a UK setting of self-monitoring of blood glucose in patients with type 2 diabetes Efficacy and safety of once‐weekly glucagon‐like peptide 1 receptor agonist albiglutide (HARMONY 1 trial): 52‐week primary endpoint results from a randomized, double‐blind, placebo‐controlled trial in patients with type 2 diabetes mellitus not controlled on pioglitazone, with or without metformin Efficacy of inhaled human insulin in type 1 diabetes mellitus: a randomised proof-of-concept study Body weight and subsequent diabetes mellitus. Relationships between the perceived impact of gestational diabetes mellitus and treatment adherence. Blood glucose self-monitoring in type 2 diabetes: a randomised controlled trial. Glycaemic index methodology. Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial Intensified versus conventional management of gestational diabetes. Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Effect of culturally appropriate health education on glycaemic control and knowledge of diabetes in British Pakistani women with type 2 diabetes mellitus. Pravastatin and the Development of Diabetes Mellitus: Evidence for a Protective Treatment Effect in the West of Scotland Coronary Prevention Study Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. Risk prediction for Staphylococcus aureus surgical site infection following cardiothoracic surgery; A secondary analysis of the V710-P003 trial Efficacy and safety of vildagliptin in patients with type 2 diabetes mellitus inadequately controlled with dual combination of metformin and sulphonylurea Mood and cognitive functions during acute euglycaemia and mild hyperglycaemia in type 2 diabetic patients. Influences on control in diabetes mellitus: patient, doctor, practice, or delivery of care? Effect of daily supplementation of fruits on oxidative stress indices and glycaemic status in type 2 diabetes mellitus. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes.
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 BACKGROUND Surgical case-mix is seriously worsening , and the results of surgical revascularization on high-risk cohorts should be continuously evaluated . This study investigates the influence of diabetes mellitus on the short and midterm outcome in the modern era of coronary surgery . METHODS AND RESULTS Patients who underwent first-time coronary artery bypass grafting from April 1996 to October 2003 were classified into diabetic and nondiabetic groups . Data were prospect ively collected and retrospectively analyzed . A total of 5259 patients were studied , and of these 877 ( 17 % ) were diabetic . Patients with diabetes were more likely to be female , have a higher body mass index , be in an advanced New York Heart Association class and Canadian Cardiovascular Society class , have a history of congestive heart failure , have a poor ejection fraction , renal failure , and more extensive coronary artery disease than the nondiabetic group ( P < .001 for all ) . In-hospital mortality was 2.2 % and 1 % for diabetic and nondiabetic patients , respectively ; however , diabetes was not found to be an independent risk factor for in-hospital mortality ( odds ratio = 1.63 ; 95 % confidence interval 0.92 - 2.88 ; P = .089 ) . Postoperative complications were comparable in the two groups , with only renal , neurologic , and gastrointestinal complications significantly associated with diabetes ( all P < or = .05 ) . There was no association between diabetes mellitus and postoperative infective complications . Diabetes remained an independent predictor of 5-year mortality ( hazard ratio 1.55 ; 95 % confidence interval 1.22 - 1.96 ; P < .001 ) and of lower 5-year cardiac-related event-free survival . CONCLUSION Despite a worsening cohort , diabetic patients could be surgically revascularized with low morbidity and mortality , comparable with control patients . The negative effect of diabetes mellitus on the longer-term mortality and morbidity remains a problem A number of studies have compared results after aortic procedures in diabetics vs nondiabetics but few have focused specifically on abdominal aortic aneurysm surgery . An analysis of prospect i ve data was carried out in the Vascular Surgery Registry ( Beth Israel Deaconess Medical Center , Boston , MA ) and identified 421 patients ( 422 grafts ) who underwent elective open repair of an abdominal aortic aneurysm between 1990 and 1999 . The influence of diabetes mellitus on outcome was assessed by dividing the patients into two groups : 52 diabetic and 370 nondiabetic patients .  Postoperative mortality was 1.7 % overall ( n = 7 ) and proportionally higher in the diabetic population , although this did not reach statistical significance ( 3.8 % vs 1.4 % , p = 0 . 19 ) . However , cumulative survival at 1 year and 3 years was essentially identical for diabetic vs nondiabetic patients ( 91.0 % vs 92.6 % and 70.0 % vs 73.5 % , respectively ) and did not diverge until 5 years after surgery ( 25.0 % vs 50.9 % respectively [ p>0.05 ] ) . Overall , major complications occurred in 1 1 diabetics ( 21.2 % ) vs 58 nondiabetics ( 15.7 % , p = 0.32 ) . Specific complications that were increased in the diabetic population included pancreatitis ( 5.8 % vs 1.1 % , p = 0.01 ) and pneumonia ( 1 1.5 % vs 3.2 % , p = 0.006 ) . Notably , overall cardiac morbidity was not higher in patients with diabetes mellitus ( 1.9 % vs 4.3 % , p = 0.41 ) . Our data suggest that after elective open abdominal aortic aneurysm repair , patients with diabetes mellitus may have a higher rate of certain complications when compared to patients without diabetes mellitus . These differences however , do not preclude the expectation of excellent results of open abdominal aortic aneurysm repair in patients with diabetes mellitus In Israel , as elsewhere , diabetes mellitus is highly prevalent among patients undergoing coronary artery bypass graft ( CABG ) .  The bulk of evidence , derived retrospectively , suggests that poor control of diabetes predisposes to complications of CABG and increases mortality ; but the findings in a number of studies fail to support that impression . Anticipating a prospect i ve investigation design ed to resolve this issue , we have carried out a preliminary study of 147 consecutive patients with diabetes who were hospitalized for elective CABG during 1998 . Our objective was to determine how well and how often diabetes could be controlled in accordance with selected metabolic goals in the brief interval between hospital admission and surgery and during the operation itself and in the postoperative period . The task was undertaken by a multidisciplinary team , in cooperation with the Department of Cardiac Surgery . The metabolic goals were : fasting blood glucose consistently between 65 - 140 mg/dl before and after surgery and 120 - 180 mg/dl at the time of surgery ; and postpr and ial blood glucose consistently < 180 mg/dl . These goals were achieved in 18.1 % of fasting blood glucose measurements before and after surgery , 22.1 % of prepr and ial and 14.6 % of postpr and ial blood glucose levels consistently < 180 mg/dl . There were no clinical episodes of hypoglycemia . Due to the low incidence of major infection related complications ( deep sternal wound infection in only 3 patients ( 2.0 % ) ) no significant statistical conclusions on the relations between glucose control and these complications could be drawn . The means of all values of FBG and of hemoglobin A1c were significantly higher among patients with complications ( n=49 ) than in those without ( P=0.01 ) AIMS Diabetes therapies that provide durable glycaemic control for people with type 2 diabetes mellitus ( T2DM ) are needed . We present efficacy results of albiglutide , a glucagon-like peptide-1 receptor agonist , in people with T2DM over a 3-year period . METHODS Five of the 8 HARMONY phase 3 trials , comparing albiglutide with other therapies or placebo across a spectrum of clinical care , lasted for a preplanned 3years . Participants with uncontrolled hyperglycaemia who met predetermined criteria could receive rescue medication . The ability to remain on study medication without needing additional rescue was an efficacy measure . Glycaemic measures and body weight were analysed in 2 population s : those who remained rescue-free and all participants . RESULTS Participants ( n=3132 ) were r and omised to albiglutide or comparator . A greater proportion of participants who received albiglutide remained rescue-free ( 55 - 71 % ) compared with placebo ( 35 - 51 % ; p<0.001 to p=0.002 ) . The proportion of rescue-free participants with albiglutide did not differ from glimepiride or insulin glargine , was higher than with sitagliptin ( p=0.013 ) , and lower than with pioglitazone ( p=0.045 ) . At 3years , albiglutide was associated with clinical ly significant reductions in hyperglycaemia ( eg , rescue-free participants : HbA1c -0.52 % [ SE0.11 ] to -0.98 % [ 0.12 ] ; -5.7mmol/mol [ 1.2 ] to -10.7mmol/mol [ 1.3 ] and all participants : HbA1c -0.29 % [ 0.11 ] to-0.92 % [ 0.13 ] ; -3.2mmol/mol [ 1.2 ] to -10.1mmol/mol [ 1.4 ] ) . Albiglutide was also associated with modest reductions in body weight vs pioglitazone , glimepiride , and insulin glargine , which were associated with weight gain . CONCLUSION These 3-year efficacy data support long-term use of albiglutide in the management of people with T2DM . Clinical Trials.gov NCT00849056 , NCT00849017 , NCT00838903 , NCT00838916 , NCT00839527 This Diabcare-Asia project was initiated to study the status of diabetes care and prevalence of diabetic complications in Asia and this study was done to evaluate the above in primary private healthcare in Malaysia . A total of 49 private clinics participated in this study from which a total of 438 patients were included and analysed . The majority of patients ( 96.5 % ) had type 2 diabetes mellitus and 81.4 % had BMI > or = 23 kg/m2 . Only 12.0 % of the patients had their HbA1c measured in the preceding 12 months . As for glycaemic control only 20 % of the patients had HbA1c < 7 % and 11 % had FPG < 6.7 mmol/L. As for lipid levels , only 12.3 % of the patients had total cholesterol < 4.8 mmol/L ; 30.9 % had HDL-cholesterol > 1.2 mmol/L and 49.8 % had triglycerides < 1.7 mmol/L. Despite the high proportion of patients having dyslipidaemia . only 12.4 % of the patients were on lipid lowering therapy . As for blood pressure , 55.9 % of the patients had systolic pressure > or = 140 mmHg and 40.9 % had diastolic pressure > or = 90 mmHg . However , only 32.4 % of the patients were on  antihypertensive medication .  Only 37.4 % of the patients admitted to adhering to diabetic diet regularly  and 32.0 %  exercised regularly . As for glucose monitoring only 6.9 % of the patients did  home blood glucose monitoring  and 6.2 % did  home urine glucose .  There was also a high complication rate with the commonest being neuropathy ( 30.1 % ) followed by background retinopthy ( 23.5 % ) , albuminuria ( 22.9 % ) and microalbuminuria ( 20.4 % ) . In conclusion , the majority of diabetic patients treated at the primary care level were not satisfactorily controlled and this was associated with a high prevalence of complications . There is an urgent need to educate both patients and health care personnel on the importance of achieving the clinical targets and greater effort must be made to achieve these targets OBJECTIVE The objective of the study was to evaluate the effect of a resistance exercise program with an elastic b and on insulin requirement and glycemic control in patients with gestational diabetes mellitus ( GDM ) . STUDY DESIGN Sixty-four patients with gestational diabetes mellitus were r and omly assigned into 2 groups : an exercise group ( EG ; n = 32 ) and a control group not su bmi tted to the exercise program ( CG ; n = 32 ) . RESULTS A significant reduction in the number of patients who required insulin was observed in the EG ( 7/32 ) compared with the CG group ( 18/32 ) ( P = .005 ) . The percentage of time spent within the proposed target glucose range ( of at least 80 % of weekly measurements below the limits preestablished for the disease ) was significantly higher in EG compared with the CG group ( EG = 0.63 ± 0.30 ; CG = 0.41 ± 0.31 ; P = .006 ) . CONCLUSION The resistance exercise program was effective in reducing the number of patients with GDM who required insulin and in improving capillary glycemic control in this population Cardiovascular disease risk factors were measured 10 - 15 years ( mean , 11.9 years ) prior to the diagnosis of impaired glucose tolerance and non-insulin-dependent diabetes mellitus in Rancho Bernardo , California . There were 1,847 men and women aged 40 - 79 years who had no known diabetes or fasting hyperglycemia at baseline ( 1972 - 1974 ) . At the follow-up examination ( 1984 - 1987 ) , 1,115 men and women ( 60.4 % ) had normal glucose tolerance , 513 ( 27.8 % ) had impaired glucose tolerance , and 219 ( 11.9 % ) had non-insulin-dependent diabetes mellitus as defined by World Health Organization criteria . Rates of impaired glucose tolerance and non-insulin-dependent diabetes mellitus increased with age , and impaired glucose tolerance was approximately twice as common as non-insulin-dependent diabetes mellitus . Those with non-insulin-dependent diabetes mellitus were older and more overweight and had higher levels of blood pressure , fasting plasma glucose , and triglyceride at baseline than those whose glucose tolerance remained normal ; those with impaired glucose tolerance generally had intermediate levels of the same risk factors . When it was examined in a prospect i ve fashion , in general , the age-adjusted risk of non-insulin-dependent diabetes mellitus increased with increasing quartile of each risk factor , and the risk of non-insulin-dependent diabetes mellitus in a given quartile was greater than that for impaired glucose tolerance . Logistic regression analyses showed these factors to be positively associated with a subsequent diagnosis of impaired glucose tolerance as well as non-insulin-dependent diabetes mellitus in women , and to a lesser degree in men , independent of baseline age and body mass index ( weight (kg)/height (m)2 ) . These data illustrate that a less favorable cardiovascular risk factor profile precedes the diagnosis of both non-insulin-dependent diabetes mellitus and impaired glucose tolerance AIM The objectives of this pilot study were to determine the feasibility and effect on glycaemic control of a low-glycaemic-index ( GI ) diet in women with gestational diabetes or impaired glucose tolerance of pregnancy . METHODS participants , recruited from the Diabetes-in-Pregnancy Clinic of an inner-city teaching hospital serving a predominantly non-Caucasian population , were r and omized to a low-GI ( n=23 ) or control ( n=24 ) diet and followed from 28 weeks gestation until delivery .  Self-monitored-blood-glucose ( SMBG ) , maternal and infant weight were collected from medical charts .  Dietary intakes were assessed using diet records and question naires . RESULTS diet GI on control ( 58 , 95 % CI : 56,60 ) was significantly higher than on low-GI ( 49 , 95 % CI : 47,51 ; p=0.001 ) . Glycaemic control improved on both diets , but more postpr and ial glucose values were within target on low-GI ( 58.4 % of n=1891 ) than control ( 48.7 % of n=1834 ; p<0.001 ) . SMBG post-breakfast was directly related to pre-pregnancy BMI in the control , but not the low-GI group ( BMI * diet interaction ; p=0.021 ) . Participants accepted the study foods and were willing to consume them post-intervention . CONCLUSIONS a low-GI diet was feasible and acceptable in this sample and facilitated control of postpr and ial glucose . A larger study is needed to determine the effect of a low-GI diet on maternal and infant outcomes Glycaemic control on pump versus pen treatment was evaluated and the effects of optimised metabolic control on kidney function was studied in very long-term uncomplicated insulin-dependent diabetes mellitus ( IDDM ) . Ten otherwise healthy patients participated , age : 36.5 yr + /- 7.9 , diabetes duration : 23.7 yr + /- 2.9 , urinary albumin excretion ( UAE ) : 5.8 micrograms/min x/ divided by 2.2 , se-creatinine and blood pressure were normal and only background retinopathy was present . A 2 x 6 months r and omised cross-over study was performed using continuous subcutaneous insulin infusion ( CSII ) and multiple injection technique ( MIT ) .  Glycaemic control was evaluated by a six point profile every two weeks and by measuring HbA1c monthly . At 0 , 6 and 12 months , glomerular filtration rate ( GFR ) and renal plasma flow ( RPF ) were measured by the constant infusion technique , and UAE by radioimmunoassay . Glycaemic control was significantly better on CSII as compared to MIT ( p = 0.01 ) or pre- study conventional treatment ( CT ) , p = 0.03 , whereas there was no difference between MIT and CT . There was no change in kidney function during either treatment . Thus , in these very long-term uncomplicated patients , glycaemic control was significantly improved during CSII . In spite of this , no change was found in GFR , which might suggest that in long-st and ing diabetes , kidney function is unaltered by changes in metabolic control Aims /hypothesis . To determine risk factors related to the incidence and progression of diabetic retinopathy over 6 years from diagnosis of Type II ( non-insulin-dependent ) diabetes mellitus . Methods . This report describes 1919 patients from within the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) , with retinal photographs taken at diagnosis and 6 years later and with complete data available . Photographs were central ly grade d for lesions of diabetic retinopathy using the modified Early Treatment of Diabetic Retinopathy Study Final scale . Risk factors were assessed after 3 months diet from the time of diagnosis of diabetes . Patients were seen every 3 months in a hospital setting . Biochemical measurements  were done by a central laboratory . End points of vitreous haemorrhage and photocagulation were confirmed by independent adjudication of systematic ally collected clinical data . The main outcome measures were incidence and progression of retinopathy defined as a two-step Early Treatment of Diabetic Retinopathy Study ( ETDRS ) final scale change . Results . Of the 1919 patients , 1216 ( 63 % ) had no retinopathy at diagnosis . By 6 years , 22 % of these had developed retinopathy , that is microaneurysms in both eyes or worse . In the 703 ( 37 % ) patients with retinopathy at diagnosis , 29 % progressed by two scale steps or more . Development of retinopathy ( incidence ) was strongly associated with baseline glycaemia , glycaemic exposure over 6 years , higher blood pressure and with not smoking . In those who already had retinopathy , progression was associated with older age , male sex , hyperglycaemia ( as evidence d by a higher HbA1 c ) and with not smoking . Conclusion /interpretation . The findings re-emphasise the need for good glycaemic control and assiduous treatment of hypertension if diabetic retinopathy is to be minimised . [ Diabetologia ( 2001 ) 44 : 156–163 Background Individuals with type 1 diabetes mellitus are at high risk for the development of hypertension , contributing to cardiovascular complications . Hyperglycaemia-mediated neurohormonal activation increases arterial stiffness , and is an important contributing factor for hypertension . Since the sodium glucose cotransport-2 ( SGLT2 ) inhibitor empagliflozin lowers blood pressure and HbA1c in type 1 diabetes mellitus , we hypothesized that this agent would also reduce arterial stiffness and markers of sympathetic nervous system activity . Methods Blood pressure , arterial stiffness , heart rate variability ( HRV ) and circulating adrenergic mediators were measured during clamped euglycaemia ( blood glucose 4–6 mmol/L ) and hyperglycaemia ( blood glucose 9–11 mmol/L ) in 40 normotensive type 1 diabetes mellitus patients . Studies were repeated after 8 weeks of empagliflozin ( 25 mg once daily ) . Results In response to empagliflozin during clamped euglycaemia , systolic blood pressure ( 111 ± 9 to 109 ± 9 mmHg , p = 0.02 ) and augmentation indices at the radial ( -52 % ± 16 to -57 % ± 17 , p = 0.0001 ) , carotid ( + 1.3 ± 1 7.0 to -5.7 ± 17.0 % , p < 0.0001 ) and aortic positions ( + 0.1 ± 13.4 to -6.2 ± 14.3 % , p < 0.0001 ) declined . Similar effects on arterial stiffness were observed during clamped hyperglycaemia without changing blood pressure under this condition . Carotid-radial pulse wave velocity decreased significantly under both glycemic conditions ( p ≤ 0.0001 ) , while declines in carotid-femoral pulse wave velocity were only significant during clamped hyperglycaemia ( 5.7 ± 1.1 to 5.2 ± 0.9 m/s , p = 0.0017 ) . HRV , plasma noradrenalin and adrenaline remained unchanged under both clamped euglycemic and hyperglycemic conditions . Conclusions Empagliflozin is associated with a decline in arterial stiffness in young type 1 diabetes mellitus subjects . The underlying mechanisms may relate to pleiotropic actions of SGLT2 inhibition , including glucose lowering , antihypertensive and weight reduction effects . Trial registration Clinical trial registration : Objective To compare the use of glyburide and insulin in the treatment of gestational diabetes . Design R and omized controlled trial . Setting Maternal health clinics in San Antonio , Texas . Patients Women with mild gestational diabetes ( n = 404 ) at 11 - 33 weeks gestation . Only women with a singleton pregnancy were eligible . Intervention Glyburide ( starting dose 2.5 mg , increased as necessary to achieve target glycaemic control to a maximum of 20 mg ) or insulin ( 0.7 U per kg body weight , three times daily , increased as necessary ) . If blood glucose goals were not met after 2 weeks of treatment with the maximal dose of glyburide , treatment was switched to insulin . Main outcome measures Primary outcome was achievement of a desirable level of glycaemic control ( strict target ranges were set for mean , fasting , prepr and ial and postpr and ial blood glucose , measured by frequent home monitoring ) . Neonatal outcomes were also assessed . Main results Eighty-two percent of women in the glyburide group and 88 % of women in the insulin group achieved the target blood glucose values ( difference = -6 % , 95 % confidence interval ( CI ) -13 % to + 1 % , P = 0.07 ) . Considerably less women in the glyburide group had blood glucose values below 40 mg ( 2.2 mmol/l ) per decilitre ( 2 % vs. 20 % , difference -18 % , 95 % CI -24 % to -13 % , P < 0.0001 ) . In the glyburide group , 4 % of women were switched to insulin as the maximal dose failed to produce target blood glucose values . There were no significant differences in neonatal outcomes , including cord serum insulin . Conclusion Treatment of women with gestational diabetes , after the first trimester of pregnancy , with glyburide rather than insulin can achieve similar glycaemic control , with less hypoglycaemia BACKGROUND Controlling plasma glucose levels , blood pressure and lipid levels is proven to reduce the risk of vascular complications in patients with type 2 diabetes mellitus . This has prompted intensive multitherapy targeted at several macrovascular risk factors . Carotid intima-media thickness ( cIMT ) is a reliable measure of early atherosclerosis . We sought to determine whether a 6-month intensive mutiltherapy program result ed in better goal attainment than usual care and its effect on the development of cIMT among patients with newly diagnosed type 2 diabetes mellitus . METHODS The study r and omly assigned 220 patients with newly diagnosed type 2 diabetes mellitus to intensive or traditional therapy groups . The clinical parameters , such as fasting plasma glucose , total cholesterol , triglyceride , blood pressure , body weight and insulin were assessed at the baseline and after the 6-month therapy . cIMT of the patients was also obtained . RESULTS The average levels of fasting plasma glucose , hemoglobin A1c , total cholesterol ( TC ) and low-density lipoprotein cholesterol ( LDL-C ) in the intensive group were significantly lower than those in the control group at the end of 6-month treatment . By 6 months , a higher proportion of patients in the intensive therapy group than in the control group attained goals for fasting plasma glucose ( FPG ) , TC , LDL-C and hemoglobin A1c . With intensive multherapy the level of carotid intima-media thickness in the intensive therapy group was lower than that in the control group ( ( 0.88 + /- 0.26 ) mm vs ( 0.96 + /- 0.22 ) mm , P < 0.01 ) . CONCLUSIONS The evidence from this clinical trial demonstrates that intensive glucose , lipid and blood pressure control in patients with newly diagnosed type 2 diabetes is associated with diabetic macrovascular benefits . Intensive multitherapy allows more patients to achieve aims of control and may reduce macrovascular complications and delay disease progression BACKGROUND The aging process is associated with the development of several diseases , which can be attenuated by the practice of physical activities . Aerobic training is an effective method to maintain and improve cardiovascular function . Additionally , it has a crucial role in the prevention and treatment of several chronic-degenerative diseases , especially diabetes mellitus . } OBJECTIVE To verify the effect of a 13-week aerobic training program on blood pressure ( BP ) , body mass index ( BMI ) and glycemia levels in elderly women with type-2 diabetes mellitus ( DM2 ) . METHODS Eleven sedentary elderly women with DM2 , aged 61.0 ± 9.1 years , were su bmi tted a 13-week aerobic training program , constituting group G2 . Eleven controlled elderly women ( aged 60.2 ± 6.8 years ) were not su bmi tted to the aerobic training , constituting the control group ( G1 ) . G1 attended educational lectures once a week , whereas G2 walked three times a week . RESULTS Both groups presented a significant decrease in glycemia and diastolic blood pressure levels . No significant decreases in BMI were observed after the aerobic training in either group . CONCLUSION The 13-week aerobic training program was enough to promote significant decrease in the diastolic blood pressure and glycemia levels ; therefore , this type of exercise training decreases the risk factors for cardiovascular and metabolic diseases INTRODUCTION Diabetes mellitus is the most common metabolic disorder in humans , and its incidence is increasing rapidly worldwide . Although polyunsaturated fatty acids have beneficial effects on diabetes mellitus , previous data regarding the possible positive effects of n-3 fatty acids on glycaemic indices were inconclusive . We conducted a double-blind r and omised clinical trial to determine the effects of eicosapentaenoic acid ( EPA ) , an n-3 polyunsaturated fatty acid , on overweight patients with type 2 diabetes mellitus ( T2DM ) . METHODS This double-blind , placebo-controlled r and omised clinical trial was conducted on a total of 67 overweight patients with T2DM for a duration of three months . Of these 67 patients , 32 received 2 g purified EPA daily , while 35 received a placebo of 2 g corn oil daily . The patients ' fasting plasma glucose ( FPG ) , serum insulin , glycated haemoglobin ( HbA1c ) and insulin sensitivity indices were assessed . RESULTS After three months of EPA supplementation , the group that received EPA showed significant decreases in FPG ( p < 0.001 ) , HbA1c ( p = 0.01 ) and homeostasis model assessment of insulin resistance ( HOMA-IR ) ( p = 0.032 ) , when compared to the placebo group . EPA supplementation result ed in decreased serum insulin levels , with the levels between the EPA and placebo groups showing a significant difference ( p = 0.004 ) . CONCLUSION The results of our study indicate that EPA supplementation could improve insulin sensitivity . It was able to decrease serum insulin , FPG , HbA1c and HOMA-IR .  EPA could have beneficial effects on glycaemic indices in patients with T2DM Thirty-seven stable insulin-dependent diabetic patients receiving twice daily premixed porcine soluble and isophane insulins ( Mixtard or Initard , Nordisk Laboratories ) were enrolled in a trial to compare the effects of this regimen and an intensified regimen on glycaemic control and flexibility of lifestyle . After a two month run-in period patients were r and omized to continue taking premixed insulin ( n = 18 ) or to change to Human Actrapid ( three times daily pre-pr and ial doses using a NovoPen ) plus Human Ultratard ( n = 19 : " pen " group , Novo Laboratories ) . Diabetic control was assessed at monthly intervals for six months by glycosylated haemoglobin assay ( HbA1 ) , 7-point blood glucose profiles and frequency of hypoglycaemic episodes . At r and omization , glycaemic control had significantly improved in the group as a whole and patients were well matched with respect to body mass index ( BMI ) and glycaemic control . No significant changes in BMI , HbA1 , mean 7-point glucose profiles or hypoglycaemic episodes were found after six months either within or between groups . Hypoglycaemic episodes were common during the study . There were no technical problems with the NovoPen . Patients using the NovoPen felt it added greater flexibility to their lifestyle . From our study results the main indication to start a multiple injection regimen is to improve the flexibility of the patient 's lifestyle and not to improve glycaemic control AIMS Our main aim was to analyse gender differences in the association of adherence and poor glycaemic control ( PGC ) in a cohort of patients with type 2 diabetes mellitus in Germany . METHODS Baseline data of the DIANA- study , a prospect i ve cohort study of type 2 diabetes mellitus patients in South-West Germany , were analysed . Information on medication adherence and factors related to PGC was obtained by self-administered question naire . PGC was defined as HbA(1c)≥7.5 % . Bivariate and multivariate analyses using log-binomial regression were employed to assess overall and gender-specific associations of non-adherence and PGC . RESULTS 624 men and 518 women were included in the analyses . In total , 147 men ( 24 % ) and 114 women ( 23 % ) reported non-adherence to medication . In men , PGC was found in 37 % of the participants reporting non-adherence and in 19 % reporting adherence ( adjusted prevalence ratio (PR)=1.90 , 95%-CI : 1.46 - 2.49 ) . In women , PGC was found in 19 % of the participants reporting non-adherence and in 18 % reporting adherence ( adjusted PR=0.97 , 95%-CI : 0.65 - 1.46 ) . CONCLUSIONS Our results show gender-specific differences in the association of adherence and PGC . This underlines the need for efforts to improve glycaemic control in patients with type 2 diabetes mellitus with a particular focus on men Diabetes mellitus often develops in patients with hypertension . We investigated predictors of diabetes mellitus development in hypertensives at risk of developing the disease in the VALUE trial population . Among the 9995 non-diabetic hypertensive patients at baseline , 1298 patients developed diabetes mellitus during the average follow-up of 4.2 years . New-onset diabetes mellitus was defined from adverse event reports , information about  new antidiabetic medication  and /or a fasting glucose ⩾7.0 mmol l−1 at the end of trial . Twenty-five potential baseline predictors of new-onset diabetes mellitus were analysed by univariate logistic regression and 14 of 25 predictors were found to be statistically significant with a P-value < 0.05 . The predictors were in order of decreasing significance ; glucose , body mass index ( BMI ) , age , uric acid , non-Caucasian race , haemoglobin , heart rate , r and omized study treatment , history of coronary heart disease ( CHD ) , gender , total cholesterol , proteinuria , potassium and creatinine . Multivariate stepwise logistic regression analyses were used and potential baseline predictors of new-onset diabetes mellitus were considered significant by four different models ( P-value < 0.001 ) . The final multivariate model selected included all patients , but not treatment group as a potential predictor , and the six significant predictors identified from this model were glucose , BMI , non-Caucasian race , age , heart rate and history of CHD . In conclusion , glucose and BMI were the most important predictors of new-onset diabetes mellitus in hypertensive patients at high cardiovascular risk , and easily accessible clinical characteristics strongly predict patients at risk of developing diabetes mellitus BACKGROUND Plasma Haemoglobin A1c ( HbA1c ) reflects ambient mean glycaemia over a 2 - 3 months period . Reports indicate that patients , with and without diabetes , with an elevated HbA1c have an increased risk of adverse outcome following surgical intervention . Our aim was to determine whether elevated plasma HbA1c level was associated with increased postoperative morbidity and mortality in patients undergoing vascular surgical procedures . METHODS Plasma HbA1c was measured prospect ively in 165 consecutive patients undergoing emergency and elective vascular surgical procedures over a 6-month period . Patients were categorized into four groups depending on whether their plasma HbA1c was < or = 6 % , 6.1 - 7 % , 7.1 - 8 % or > 8 % and clinical data was entered into a prospect ively maintained data base . Patients were also classified by diabetic status with suboptimal HbA1c in a patient without diabetes being > 6 to < or = 7 % and suboptimal HbA1c in a patient with diabetes being > 7 % . Patients with plasma HbA1c > 7 % were reclassified as having undiagnosed diabetes mellitus . Composite primary endpoints were all cause 30-day morbidity and mortality and all cause 6-month mortality . Composite secondary endpoints were procedure specific complications , adverse cardiac events , stroke , infection and mean length of hospital stay . RESULTS Of the 165 patients studied , 43 ( 26.1 % ) had diabetes and the remaining 122 ( 73.9 % ) did not . The mean age was 72 years and 59 % were male . Suboptimal HbA1c levels were found in 58 % patients without diabetes and in 51 % patients with diabetes . In patients without diabetes those with suboptimal HbA1c levels ( 6 - 7 % ) had a significantly higher incidence of overall 30-day morbidity compared to patients with HbA1c levels < or = 6 % ( 56.5 vs 15.7 % , p<0.001 ) . Similarly , for patients with diabetes those with suboptimal HbA1c levels ( HbA1c > 7 % ) had a significantly higher incidence of 30-day morbidity compared to those with HbA1c levels < or = 7 % ( 59.1 % vs 19 % , p=0.018 ) . Multivariate analysis revealed that a plasma HbA1c level of > 6 to < or = 7 % was a significant independent predictor of overall 30-day morbidity in patients without diabetes undergoing vascular surgical procedures . No difference in mortality , composite secondary endpoints , procedure specific complications , stroke or mean length of hospital stay was observed between any of the groups in the study . CONCLUSION Suboptimal HbA1c levels may hold prognostic significance in patients without diabetes undergoing vascular surgery Purpose This study was undertaken to determine the incidence of and risk factors for urinary retention after surgery for benign anorectal disease . Methods We review ed 2,011 consecutive surgeries performed under spinal anesthesia for benign anorectal disease from January through June 2003 to identify potential risk factors for postoperative urinary retention . In addition , we prospect ively investigated the preventive effect of perioperative fluid restriction and pain control by prophylactic analgesics on postoperative urinary retention . Results The number of procedures and the urinary retention rates were as follows :  hemorrhoidectomy  , 1,243 , 21.9 % ; fistulectomy , 349 , 6.3 % ; incision/drainage , 177 , 2.3 % ; and sliding skin graft/lateral subcutaneous internal sphincterotomy , 64 , 17.2 % . The overall urinary retention rate was 16.7 % . With hemorrhoidectomy , female sex , presence of preoperative urinary symptoms , diabetes mellitus , need for postoperative analgesics , and more than three hemorrhoids resected were independent risk factors for urinary retention as assessed by multivariate analysis . With fistulectomy , female sex , diabetes mellitus , and intravenous fluids > 1,000 ml were independent risk factors for urinary retention . Perioperative fluid restriction , including limiting the administration of intravenous fluids , significantly decreased the incidence of urinary retention ( 7.9 vs 16.7 % , P<0.0001 ) . Furthermore , prophylactic analgesic treatment significantly decreased the incidence of urinary retention ( 7.9 vs 25.6 % , P=0.0005 ) . Conclusions Urinary retention is a common complication after anorectal surgery . It is linked to several risk factors , including increased intravenous fluids and postoperative pain . Perioperative fluid restriction and adequate pain relief appear to be effective in preventing urinary retention in a significant number of patients after anorectal surgery Diabetes mellitus contributes substantially to the global burden of disease , with an estimated 100 million people affected worldwide , and its prevalence is increasing rapidly.1 Macrovascular complications are among the chief causes of major morbidity in people with diabetes , and most of their deaths are attributed to cardiovascular causes.2 3 In type 2 ( “ non-insulin dependent ” ) diabetes , blood triglyceride concentrations tend to be raised and high density lipoprotein ( HDL ) cholesterol concentrations reduced even with good metabolic control , whereas a similar pattern tends to emerge in type 1 ( “ insulin dependent ” ) diabetes mellitus only when glycaemic control is poor.4 5 Typically in both type 1 and type 2 diabetes , however , blood concentrations of total and low density lipoprotein ( LDL ) cholesterol are similar to those in the general population . This may have contributed to the belief that LDL cholesterol is of little relevance to the risk of cardiovascular disease in diabetes4 6 and , apart from those with pronounced dyslipidaemia or pre-existing coronary heart disease ( CHD ) , most people with diabetes do not receive cholesterol lowering treatment despite their increased risk . Prospect i ve epidemiological studies in the general population show that there is a positive association between CHD risk and blood total cholesterol concentration , which continues down at least to 3 mmol/l ( that is , well below the range commonly seen in western population s)7 without any evidence of a “ threshold ” below which lower cholesterol is not associated with lower risk . In these observational studies , the continuous association is roughly linear between CHD risk plotted on a doubling scale and the concentration of total or LDL cholesterol . This implies that the proportional reduction in CHD risk associated with a particular prolonged absolute difference in cholesterol is similar throughout the range studied . Hence , the absolute size of the reduction in CHD produced by lowering LDL cholesterol by BACKGROUND Diabetes mellitus is a risk factor for deep sternal wound infection after open heart surgical procedures . We previously showed that elevated postoperative blood glucose levels are a predictor of deep sternal wound infection in diabetic patients . Therefore , we hypothesized that aggressive intravenous pharmacologic control of postoperative blood glucose levels would reduce the incidence of deep sternal wound infection . METHODS In a prospect i ve study of 2,467 consecutive diabetic patients who underwent open heart surgical procedures between 1987 and 1997 , perioperative blood glucose levels were recorded every 1 to 2 hours . Patients were classified into two sequential groups : the control group included 968 patients treated with sliding-scale-guided intermittent subcutaneous insulin injections ( SQI ) ; the study group included 1,499 patients treated with a continuous intravenous insulin infusion in an attempt to maintain a blood glucose level of less than 200 mg/dL. There were no differences between these groups with respect to age , sex , procedure , bypass time , antibiotic prophylaxis , or skin preparation methods . RESULTS Compared with subcutaneous insulin injections , continuous intravenous insulin infusion induced a significant reduction in perioperative blood glucose levels , which led to a significant reduction in the incidence of deep sternal wound infection in the continuous intravenous insulin infusion group ( 0.8 % [ 12 of 1,499 ] ) versus the intermittent subcutaneous insulin injection group ( 2.0 % [ 19 of 968 ] , p = 0.01 by the chi2 test ) . Multivariate logistic regression revealed that continuous intravenous insulin infusion induced a significant decrease in the risk of deep sternal wound infection ( p = 0.005 ; relative risk , 0.34 ) , whereas obesity ( p < 0.03 ; relative risk , 1.06 ) and use of an internal thoracic artery pedicle ( p = 0.1 ; relative risk , 2.0 ) increased the risk of deep sternal wound infection . CONCLUSIONS Use of perioperative continuous intravenous insulin infusion in diabetic patients undergoing open heart surgical procedures significantly reduces major infectious morbidity and its associated socioeconomic costs OBJECTIVE The optimal treatment of hyperglycemia in general surgical patients with type 2 diabetes mellitus is not known . RESEARCH DESIGN AND METHODS This r and omized multicenter trial compared the safety and efficacy of a basal-bolus insulin regimen with glargine once daily and glulisine before meals ( n = 104 ) to sliding scale regular insulin ( SSI ) four times daily ( n = 107 ) in patients with type 2 diabetes mellitus undergoing general surgery . Outcomes included differences in daily blood glucose ( BG ) and a composite of postoperative complications including wound infection , pneumonia , bacteremia , and respiratory and acute renal failure . RESULTS The mean daily glucose concentration after the 1st day of basal-bolus insulin and SSI was 145 ± 32 mg/dL and 172 ± 47 mg/dL , respectively ( P < 0.01 ) . Glucose readings < 140 mg/dL were recorded in 55 % of patients in basal-bolus and 31 % in the SSI group ( P < 0.001 ) . There were reductions with basal-bolus as compared with SSI in the composite outcome [ 24.3 and 8.6 % ; odds ratio 3.39 ( 95 % CI 1.50–7.65 ) ; P = 0.003 ] . Glucose < 70 mg/dL was reported in 23.1 % of patients in the basal-bolus group and 4.7 % in the SSI group ( P < 0.001 ) , but there were no significant differences in the frequency of BG < 40 mg/dL between groups ( P = 0.057 ) . CONCLUSIONS Basal-bolus treatment with glargine once daily plus glulisine before meals improved glycemic control and reduced hospital complications compared with SSI in general surgery patients . Our study indicates that a basal-bolus insulin regimen is preferred over SSI in the hospital management of general surgery patients with type 2 diabetes Objective : To assess the effects of soybean-derived pinitol on glycaemic control and cardiovascular risk factors in Korean patients with type II diabetes mellitus . Design : R and omized , double-blind , placebo-controlled , parallel-group trial . Setting : Pusan Paik Hospital , Pusan , Republic of Korea . Interventions : A total of 30 patients with type II diabetes received an oral dose of 600 mg soybean-derived pinitol or placebo twice daily for 13 weeks . Results : Pinitol significantly decreased mean fasting plasma glucose , insulin , fructosamine , HbA1c , and the homeostatic model assessment insulin resistance index ( HOMA-IR , P<0.001 ) . Pinitol significantly decreased total cholesterol , LDL-cholesterol , the LDL/HDL-cholesterol ratio , and systolic and diastolic blood pressure and increased HDL-cholesterol ( P<0.05 ) . Conclusions : These data suggest that soybean-derived pinitol may be beneficial in reducing cardiovascular risk in Korean type II diabetes . Sponsorship : This study was supported by a grant of the Korea Health 21 R&D Project , Ministry of Health & Welfare , Republic of Korea ( HMP 02-PJ1-PG3 - 22005 - 0011 ) AIMS Patient education is a very important part of diabetes care . However , until now , little data has been presented about the long-term effectiveness of structured intensive diabetes education programmes ( SIDEP ) for people with Type 2 diabetes mellitus . METHODS People with Type 2 diabetes ( n = 547 ) hospitalized from December 1999 to December 2000 were r and omly assigned to two groups . Two hundred and nineteen patients undertook an inpatient SIDEP and the remaining patients received conventional glycaemic control without intensive education . After discharge , all patients were monitored regularly . Laboratory data were obtained , and adherence to self-care behaviour was determined on a five-point scale by question naires completed annually . RESULTS Of the patients who completed the SIDEP , 160 ( 73.1 % ) were followed up for more than 4 years . The mean HbA(1c ) ( 7.9 + /- 1.2 vs. 8.7 + /- 1.6 % ; P < 0.05 ) and the frequency of hospitalization related to diabetes per patient per year ( 0.3 + /- 0.6 vs. 0.8 + /- 0.9 ; P < 0.05 ) was significantly lower in the SIDEP group than in the control group . The SIDEP group adhered more closely to self-care behaviour than the control group over 4 years ( P < 0.05 ) . People with Type 2 diabetes mellitus of longer duration and those treated with insulin had poorer HbA(1c ) at follow-up . CONCLUSIONS A well- design ed , intensive patient education programme is necessary for people with diabetes . However , regular and sustained reinforcement with encouragement is also required to maintain optimal glycaemic control , especially in insulin-treated patients Introduction The prevalence of gestational diabetes mellitus ( GDM ) is rising in the UK . Good glycaemic control improves maternal and neonatal outcomes . Frequent clinical review of patients with GDM by healthcare professionals is required owing to the rapidly changing physiology of pregnancy and its unpredictable course . Novel technologies that allow home blood glucose ( BG ) monitoring with results transmitted in real time to a healthcare professional have the potential to deliver good- quality healthcare to women more conveniently and at a lower cost to the patient and the healthcare provider compared to the conventional face-to-face or telephone-based consultation . We have developed an integrated GDm-health management system and aim to test the impact of using this system on maternal glycaemic control , costs , patient satisfaction and maternal and neonatal outcomes compared to st and ard clinic care in a single large publicly funded ( National Health Service ( NHS ) ) maternity unit . Methods and analysis Women with confirmed gestational diabetes in a current pregnancy are individually r and omised to either the GDm-health system and half the normal clinic visits or normal clinic care . Primary outcome is mean BG in each group from recruitment to delivery calculated , with adjustments made for number of BG measurements , proportion of prepr and ial and postpr and ial readings and length of time in study , and compared between the groups . The secondary objective will be to compare the two groups for compliance to the allocated BG monitoring regime , maternal and neonatal outcomes , glycaemic control using glycated haemoglobin ( HbA1c ) and other BG metrics , and patient attitudes to care assessed using a question naire and re source use . Ethics and dissemination Thresholds for treatment , dietary advice and clinical management are the same in both groups . The results of the study will be published in a peer- review ed journal and disseminated electronically and in print . Trial registration number NCT01916694 ; Pre- results ABSTRACT Background : Self-monitoring of blood glucose ( SMBG ) in type 2 diabetes patients has been shown in meta-analyses of r and omized trials to improve HbA1c by ∼0.4 % when compared to no SMBG . However , the cost of testing supplies is high , improvements in health utility due to improved glycaemic control may be possible and cost-effectiveness has not been evaluated . Methods : A peer- review ed vali date d model projected improvements in lifetime quality -adjusted life years ( QALYs ) , long-term costs and cost-effectiveness of SMBG versus no SMBG . Markov/Monte Carlo modelling simulated the progression of complications ( cardiovascular , neuropathy , renal and eye disease ) . Transition probabilities and HbA1c-dependent adjustments came from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) and other major studies . Effects of SMBG on HbA1c came from clinical studies , meta-analyses and population studies , but can only be considered ‘ moderate ’ levels of evidence . Costs of complications were retrieved from published sources . Direct costs of diabetes complications and SMBG were projected over patient lifetimes from a UK National Health Service perspective . Outcomes were discounted at 3.5 % annually . Extensive sensitivity analyses were performed . Results : Depending on the type of diabetes treatment ( diet and exercise/oral medications/insulin ) , improvements in glycaemic control with SMBG improved discounted QALYs anywhere from 0.165 to 0.255 years , with increased total costs of £ 1013–£2564/patient , giving incremental cost-effectiveness ratios of £ 4508:£15 515/QALY gained , well within current UK willingness-to-pay limits . Results were robust under a wide range of plausible assumptions . Conclusions : Based on the moderate level of clinical evidence available to date , improvements in glycaemic control with interventions , including SMBG , can improve patient outcomes , with acceptable cost-effectiveness ratios in the UK setting To show that albiglutide , a glucagon‐like peptide‐1 receptor agonist , is an effective and generally safe treatment to improve glycaemic control in patients with type 2 diabetes mellitus whose hyperglycaemia is inadequately controlled with pioglitazone ( with or without metformin ) BACKGROUND Effective glycaemic control in type 1 diabetes mellitus usually requires two or more insulin injections daily . Inhaled intrapulmonary delivery of insulin offers a potential new way to deliver meal-related insulin , eliminating the need for prepr and ial injections . METHODS 73 patients with type 1 diabetes mellitus were studied in an open-label , proof-of-concept , parallel-group r and omised trial . Patients in the experimental group received prepr and ial inhaled insulin plus a bedtime subcutaneous ultralente insulin injection . Patients in the control group received their usual insulin regimen of two to three injections per day . Participants monitored their blood glucose four times daily , and adjusted insulin doses weekly to achieve prepr and ial glucose targets of 5.6 - 8.9 mmol/L. The primary outcome measure was change in glycosylated haemoglobin ( HbA1c ) after 12 weeks . Secondary outcomes were fasting and postpr and ial glucose response to a mixed meal ; hypoglycaemia frequency and severity ; pulmonary function ; and patients ' satisfaction . FINDINGS Changes in HbA1c were indistinguishable between groups ( difference 0.2 % [ 95 % CI -0.2 to 0.5 ] ) . Changes in fasting and postpr and ial glucose concentrations , and occurrence and severity of hypoglycaemia were also similar between groups . Inhaled insulin was well tolerated and had no effect on pulmonary function ( ie , spirometry , lung volumes , diffusion capacity , and oxygen saturation ) . INTERPRETATION This proof-of-concept study shows that prepr and ial insulin can be given by inhalation in individuals with insulin-deficient type 1 diabetes as a less invasive alternative to conventional prepr and ial insulin injections The ten- to 16-year predictive value of body weight for diabetes mellitus was evaluated prospect ively in two groups of women with initially normal results of glucose tolerance tests . The incidence of diabetes in 602 high-risk ( previous transient gestational glucose intolerance ) participants was significantly higher for overweight subjects ( 46.7 % ) than for those of normal weight ( 25.6 % ) . In 328 concurrently selected negative control subjects ( without previous intolerance ) , the difference was not significant ( 4.5 % v 1.9 % ) . Another definition of diabetes , indicating further deterioration , gave similar results , although high-risk overweight women had disproportionately higher incidence rates . Being overweight had no substantial predictive value for diabetes mellitus during this period unless the additional evidence for a high-risk classification was present . Among such persons at high risk , excess weight also predicted the severity of the subsequent diabetic condition OBJECTIVE To examine the relationship between women 's perceptions of the impact of the diagnosis and treatment of gestational diabetes mellitus and treatment adherence . DESIGN Longitudinal and prospect i ve , extending from the time of diagnosis of gestational diabetes mellitus through delivery . SETTING An urban university-based tertiary perinatal center in Philadelphia . PARTICIPANTS A sub sample of women enrolled in a larger study of early discharge and nurse specialist transitional care . The 29 women in the sample met the study criteria of diagnosis with gestational diabetes mellitus , English speaking , less than 36 weeks gestation , and telephone access at home . MAIN OUTCOME MEASURE Perceived impact of gestational diabetes mellitus was measured with the Impact of Event Scale . Treatment adherence  included the percentage of recommended blood glucose self-monitoring , incidence of hypo- and hyperglycemia , obstetric visits kept , and dietary adherence .  RESULTS Descriptive and correlational analyses were used . Negative correlations between impact and blood glucose self-monitoring ( r = -.38 , p = .04 ) and impact and hypoglycemia ( r = -.31 , p = .10 ) were found . Positive correlation between obstetric visits and blood glucose self-monitoring ( r = .34 , p = .07 ) was found . CONCLUSIONS Women who perceive gestational diabetes mellitus to have a great impact on their lives may be less adherent to the behavioral tasks that can influence blood glucose control , potentially increasing risk OBJECTIVES To determine whether self-monitoring of blood glucose ( SMBG ) , either alone or with additional instruction in incorporating the results into self-care , is more effective than usual care in improving glycaemic control in non-insulin-treated diabetes . DESIGN An open , parallel group r and omised controlled trial . SETTING 24 general practice s in Oxfordshire and 24 in South Yorkshire , UK . PARTICIPANTS Patients with non-insulin-treated type 2 diabetes , aged > or = 25 years and with glycosylated haemoglobin ( HbA1c ) > or = 6.2 % . INTERVENTIONS A total of 453 patients were individually r and omised to one of : ( 1 ) st and ardised usual care with 3-monthly HbA1c ( control , n = 152 ) ; ( 2 ) blood glucose self-testing with patient training focused on clinician interpretation of results in addition to usual care ( less intensive self-monitoring , n = 150 ) ; ( 3 ) SMBG with additional training of patients in interpretation and application of the results to enhance motivation and maintain adherence to a healthy lifestyle ( more intensive self-monitoring , n = 151 ) . MAIN OUTCOME MEASURES The primary outcome was HBA1c at 12 months , and an intention-to-treat analysis , including all patients , was undertaken . Blood pressure , lipids , episodes of hypoglycaemia and quality of life , measured with the EuroQol 5 dimensions ( EQ-5D ) , were secondary measures . An economic analysis was also carried out , and question naires were used to measure well-being , beliefs about use of SMBG and self-reports of medication taking , dietary and physical activities , and health-care re source use . RESULTS The differences in 12-month HbA1c between the three groups ( adjusted for baseline HbA1c ) were not statistically significant ( p = 0.12 ) . The difference in unadjusted mean change in HbA1c from baseline to 12 months between the control and less intensive self-monitoring groups was -0.14 % [ 95 % confidence interval ( CI ) -0.35 to 0.07 ] and between the control and more intensive self-monitoring groups was -0.17 % ( 95 % CI -0.37 to 0.03 ) . There was no evidence of a significantly different impact of self-monitoring on glycaemic control when comparing subgroups of patients defined by duration of diabetes , therapy , diabetes-related complications and EQ-5D score . The economic analysis suggested that SMBG result ed in extra health-care costs and was unlikely to be cost-effective if used routinely . There appeared to be an initial negative impact of SMBG on quality of life measured on the EQ-5D , and the potential additional lifetime gains in quality -adjusted life-years , result ing from the lower levels of risk factors achieved at the end of trial follow-up , were outweighed by these initial impacts for both SMBG groups compared with control . Some patients felt that SMBG was helpful , and there was evidence that those using more intensive self-monitoring perceived diabetes as having more serious consequences . Patients using SMBG were often not clear about the relationship between their behaviour and the test results . CONCLUSIONS While the data do not exclude the possibility of a clinical ly important benefit for specific subgroups of patients in initiating good glycaemic control , SMBG by non-insulin-treated patients , with or without instruction in incorporating findings into self-care , did not lead to a significant improvement in glycaemic control compared with usual care monitored by HbA1c levels . There was no convincing evidence to support a recommendation for routine self-monitoring of all patients and no evidence of improved glycaemic control in predefined subgroups of patients The glycaemic index ( GI ) concept was originally introduced to classify different sources of carbohydrate (CHO)-rich foods , usually having an energy content of > 80 % from CHO , to their effect on post-meal glycaemia . It was assumed to apply to foods that primarily deliver available CHO , causing hyperglycaemia . Low-GI foods were classified as being digested and absorbed slowly and high-GI foods as being rapidly digested and absorbed , result ing in different glycaemic responses . Low-GI foods were found to induce benefits on certain risk factors for CVD and diabetes . Accordingly it has been proposed that GI classification of foods and drinks could be useful to help consumers make ' healthy food choices ' within specific food groups . Classification of foods according to their impact on blood glucose responses requires a st and ardised way of measuring such responses . The present review discusses the most relevant method ological considerations and highlights specific recommendations regarding number of subjects , sex , subject status , inclusion and exclusion criteria , pre-test conditions , CHO test dose , blood sampling procedures , sampling times , test r and omisation and calculation of glycaemic response area under the curve . All together , these technical recommendations will help to implement or reinforce measurement of GI in laboratories and help to ensure quality of results . Since there is current international interest in alternative ways of expressing glycaemic responses to foods , some of these methods are discussed Background Gestational Diabetes Mellitus ( GDM ) increases risks for type 2 diabetes and weight management is recommended to reduce the risk . Conventional dietary recommendations ( energy-restricted , low fat ) have limited success in women with previous GDM . The effect of lowering Glycaemic Index ( GI ) in managing glycaemic variables and body weight in women post-GDM is unknown . Objective To evaluate the effects of conventional dietary recommendations administered with and without additional low-GI education , in the management of glucose tolerance and body weight in Asian women with previous GDM . MethodS eventy seven Asian , non-diabetic women with previous GDM , between 20- 40y were r and omised into Conventional healthy dietary recommendation ( CHDR )  and  low GI  ( LGI ) groups . CHDR received conventional dietary recommendations only ( energy restricted , low in fat and refined sugars , high-fibre ) . LGI group received advice on lowering GI in addition . Fasting and 2-h post-load blood glucose after 75 g oral glucose tolerance test ( 2HPP ) were measured at baseline and 6 months after intervention . Anthropometry and dietary intake were assessed at baseline , three and six months after intervention . The study is registered at the Malaysian National Medical Research Register ( NMRR ) with Research ID : 5183 . Results After 6 months , significant reductions in body weight , BMI and waist-to-hip ratio were observed only in LGI group ( P<0.05 ) . Mean BMI changes were significantly different between groups ( LGI vs. CHDR : -0.6 vs. 0 kg/m2 , P= 0.03 ) . More subjects achieved weight loss ≥5 % in LGI compared to CHDR group ( 33 % vs. 8 % , P=0.01 ) . Changes in 2HPP were significantly different between groups ( LGI vs. CHDR : median ( IQR ) : -0.2(2.8 ) vs. + 0.8 ( 2.0 ) mmol/L , P=0.025 ) . Subjects with baseline fasting insulin≥2 μIU/ml had greater 2HPP reductions in LGI group compared to those in the CHDR group ( −1.9±0.42 vs. + 1.31±1.4 mmol/L , P<0.001 ) . After 6 months , LGI group diets showed significantly lower GI ( 57±5 vs. 64±6 , P<0.001 ) , GL ( 122±33 vs. 142±35 , P=0.04 ) and higher fibre content ( 17±4 vs.13±4 g , P<0.001 ) . Caloric intakes were comparable between groups . Conclusion In women post-GDM , lowering GI of healthy diets result ed in significant improvements in glucose tolerance and body weight reduction as compared to conventional low-fat diets with similar energy prescription OBJECTIVE We tested the hypothesis that intensified management of gestational diabetes mellitus on the basis of stringent glycemic control , verified glucose data , and adherence to an established criterion for insulin initiation results in near normoglycemia control and reduction of adverse outcomes . STUDY DESIGN A prospect i ve , population -based study compared the effect on perinatal outcome of conventional  ( n = 1316 )  and intensified  ( n = 1145 )  management . Group assignment was based on availability of memory-based reflectance meters at entry to the program . A contemporaneous r and omized control group ( nondiabetic , n = 4922 ) was selected . RESULTS The diabetic groups were comparable in demographic characteristics and in factors associated with higher risk for adverse pregnancy outcome , such as  previous macrosomia , previous gestational diabetes mellitus , and family history of diabetes . The control group was younger , less obese , and had a lower rate of previous macrosomia .  The intensified management group had rates of macrosomia , cesarean section , metabolic complications , shoulder dystocia , stillbirth , neonatal intensive care unit days , and respiratory complications lower than those in the conventional management group and comparable to those of the nondiabetic controls . Other maternal complication rates , such as for preeclampsia , chronic hypertension , and infection , were similar for the three groups . Mean blood glucose levels were a good predictor of perinatal outcome . Gestational age at delivery , previous history of macrosomia , and overall mean blood glucose levels were the only significant predictors of birth weight percentile in both diabetic groups ( logistic regression ) . CONCLUSION The intensified management approach is significantly associated with enhanced perinatal outcome . This management strategy clarifies the relationship between glycemic control and neonatal outcome OBJECTIVE To describe the main findings of the Portl and Diabetic Project , which eluci date s the adverse relationship between hyperglycemia and outcomes of cardiac surgical procedures in patients with diabetes and delineates the protective effects of intravenous insulin therapy in reducing those adverse outcomes . RESULTS In this ongoing 17-year prospect i ve , nonr and omized , interventional study of 4,864 patients with diabetes who underwent an open-heart surgical procedure , we investigated the effects of hyperglycemia , and its subsequent reduction by continuous intravenous insulin ( CII ) therapy , on in-hospital outcomes . Increasing blood glucose levels were found to be directly associated with increasing rates of death , deep sternal wound infections ( DSWI ) , length of hospital stay ( LOS ) , and hospital cost . In separate multivariate analyses , increasing hyperglycemia was found to be independently predictive of increasing mortality ( P<0.0001 ) , DSWI ( P = 0.017 ) , and LOS ( P<0.002 ) . Conversely , CII therapy , design ed to achieve predetermined target blood glucose levels , independently reduced the risks of death and DSWI by 57 % and 66 % , respectively ( P<0.0001 for both ) . Target blood glucose levels of less than 150 mg/dL and a 3-day postoperative duration of CII therapy are both important variables that determine the effect of the CII therapy on improved outcomes . Coronary artery bypass grafting-related mortality ( 2.5 % ) and DSWI rates ( 0.8 % ) in patients with diabetes were normalized to those of the nondiabetic population by the use of the Portl and CII Protocol . CONCLUSION Perioperative hyperglycemia in patients undergoing a cardiac surgical procedure affects biochemical and physiologic functions , which , in turn , adversely alter mortality , LOS , and infection rates . The Portl and CII Protocol is a cost-efficient method that effectively eliminates hyperglycemia and reduces postoperative morbidity and mortality in patients with diabetes undergoing an open-heart operation . CII protocol s should be the st and ard care for glycometabolic control in all patients undergoing cardiac surgical procedures Type 2 diabetes is a growing problem in people of South Asian origin . It is associated with severe complications if it is not adequately controlled . This paper is a secondary assessment of 105 British Pakistani women within a larger r and omized controlled trial of 200 Pakistani patients with diabetes . The trial used one-to-one structured diabetes health education , delivered by a linkworker with pictorial flashcards as a visual aid . Earlier published results from this study have shown that the women in the study knew less about diabetes and had poorer glycaemic control than men , which is why this assessment was performed to see what happened to them when they received appropriate health education . All patients were assessed before and 6 months after intervention by question naire and haemoglobin A1c blood tests to measure their overall blood sugar control .  Nearly everyone improved their knowledge scores after 6 months in the intervention group , with women showing a catch-up improvement such that they equalled men . Multiple regression analysis found that glycaemic control improved in women receiving health education . Although this method of health education improved knowledge and glycaemic control in women in this sample , illiterate women did not do as well as their literate peers , continuing to score less on knowledge parameters . They also did not show an improvement in glycaemic control . Further work is needed to discover methods that will reach this sizeable subsection of the community Background We examined the development of new diabetes mellitus in men aged 45 to 64 years during the West of Scotl and Coronary Prevention Study . Methods and Results Our definition of diabetes mellitus was based on the American Diabetic Association threshold of a blood glucose level of ≥7.0 mmol/L. Subjects who self-reported diabetes at baseline or had a baseline glucose level of ≥7.0 mmol/L were excluded from the analyses . A total of 5974 of the 6595 r and omized subjects were included in the analysis , and 139 subjects became diabetic during the study . The baseline predictors of the transition from normal glucose control to diabetes were studied . In the univariate model , body mass index , log triglyceride , log white blood cell count , systolic blood pressure , total and HDL cholesterol , glucose , and r and omized treatment assignment to pravastatin were significant predictors . In a multivariate model , body mass index , log triglyceride , glucose , and pravastatin therapy were retained as predictors of diabetes in this cohort . Conclusions We concluded that the assignment to pravastatin therapy result ed in a 30 % reduction ( P = 0.042 ) in the hazard of becoming diabetic . By lowering plasma triglyceride levels , pravastatin therapy may favorably influence the development of diabetes , but other explanations , such as the anti-inflammatory properties of this drug in combination with its endothelial effects , can not be excluded with these analyses The Diabetes Control and Complications Trial has demonstrated that intensive diabetes treatment delays the onset and slows the progression of diabetic complications in subjects with insulin-dependent diabetes mellitus from 13 to 39 years of age . We examined whether the effects of such treatment also occurred in the subset of young diabetic subjects ( 13 to 17 years of age at entry ) in the Diabetes Control and Complications Trial . One hundred twenty-five adolescent subjects with insulin-dependent diabetes mellitus but with no retinopathy at baseline ( primary prevention cohort ) and 70 adolescent subjects with mild retinopathy ( secondary intervention cohort ) were r and omly assigned to receive either ( 1 ) intensive therapy with an external insulin pump or at least three daily insulin injections , together with frequent daily blood-glucose monitoring , or ( 2 ) conventional therapy with one or two daily insulin injections and once-daily monitoring .  Subjects were followed for a mean of 7.4 years ( 4 to 9 years ) . In the primary prevention cohort , intensive therapy decreased the risk of having retinopathy by 53 % ( 95 % confidence interval : 1 % to 78 % ; p = 0.048 ) in comparison with conventional therapy . In the secondary intervention cohort , intensive therapy decreased the risk of retinopathy progression by 70 % ( 95 % confidence interval : 25 % to 88 % ; p = 0.010 ) and the occurrence of microalbuminuria by 55 % ( 95 % confidence interval : 3 % to 79 % ; p = 0.042 ) . Motor and sensory nerve conduction velocities were faster in intensively treated subjects . The major adverse event with intensive therapy was a nearly threefold increase of severe hypoglycemia . We conclude that intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy and nephropathy when initiated in adolescent subjects ; the benefits outweigh the increased risk of hypoglycemia that accompanies such treatment Background Identifying patients undergoing cardiothoracic surgery at high risk of Staphylococcus aureus surgical site infection ( SSI ) is a prerequisite for implementing effective preventive interventions . The objective of this study was to develop a risk prediction model for S. aureus SSI or bacteremia after cardiothoracic surgery based on pre-operative variables . Material s/ Methods Data from the Merck Phase IIb/III S. aureus vaccine ( V710-P003 ) clinical trial were analyzed . In this r and omized placebo-controlled trial , the effect of preoperative vaccination against S. aureus was investigated in patients undergoing cardiothoracic surgery . The primary outcome was deep/superficial S. aureus SSI or S. aureus bacteremia through day 90 after surgery . Performance , calibration , and discrimination of the final model were assessed . Results Overall 164 out of 7,647 included patients ( 2.1 % ) developed S. aureus infection ( 149 SSI , 15 bacteremia , 28 both ) . Independent risk factors for developing the primary outcome were pre-operative colonization with S. aureus ( OR 3.08 , 95 % confidence interval [ CI ] 2.23–4.22 ) , diabetes mellitus ( OR 1.87 , 95 % CI 1.34–2.60 ) , BMI ( OR 1.02 per kg/m2 , 95 % CI 0.99–1.05 ) , and CABG ( OR 2.67 , 95 % CI 1.91–3.78 ) . Although vaccination had a significant ( albeit modest ) protective effect , it was omitted from the model because its addition did not significantly change the coefficients of the final model and V710-vaccine development has been discontinued due to insufficient efficacy . The final prediction model had moderate discriminative accuracy ( AUC-value , 0.72 ) . Conclusion Pre-operative S. aureus colonization status , diabetes mellitus , BMI , and type of surgical procedure moderately predicted the risk of S. aureus SSI and /or bacteremia among patients undergoing cardiothoracic surgery Aim The broadly used combination of metformin and sulphonylurea ( SU ) often fails to bring patients to glycaemic goal . This study assessed the efficacy and safety of vildagliptin as add-on therapy to metformin plus glimepiride combination in patients with type 2 diabetes mellitus ( T2DM ) who had inadequate glycaemic control . Methods A multicentre , double-blind , placebo-controlled study r and omized patients to receive treatment with vildagliptin 50 mg bid ( n = 158 ) or  placebo ( n = 160 ) for 24 weeks . Results After 24 weeks , the adjusted mean change in haemoglobin A1c ( HbA1c ) was −1.01 % with vildagliptin ( baseline 8.75 % ) and −0.25 % with placebo ( baseline 8.80 % ) , with a between-treatment difference of −0.76 % ( p < 0.001 ) . Significantly more patients on vildagliptin  achieved the HbA1c target < 7 % ( 28.3 % vs. 5.6 % ; p < 0.001 ) . The difference in fasting plasma glucose reduction  between vildagliptin and placebo was −1.13 mmol/l ( p < 0.001 ) . In subgroup of patients with baseline HbA1c ≤8 % , vildagliptin  reduced HbA1c by 0.74 % from baseline 7.82 % ( between-treatment difference : –0.97 % ; p < 0.001 ) with significantly more patients achieving the HbA1c target < 7 % ( 38.6 % vs. 13.9 % ; p = 0.014 ) . Vildagliptin was well tolerated with low incidence of hypoglycaemia , slightly higher than with placebo ( 5.1 % vs. 1.9 % ) and no clinical ly relevant weight gain . Conclusions Vildagliptin significantly improved glycaemic control in patients with T2DM inadequately controlled with metformin plus glimepiride combination . The addition of vildagliptin was well tolerated with low risk of hypoglycaemia and weight gain . This makes vildagliptin an attractive treatment option for patients failing on metformin plus SU particularly in patients with baseline HbA1c ≤8 % INTRODUCTION Hyperglycaemia at levels above 15 mmol/l has been shown to impair cognitive functions in type 2 diabetic patients , while effects of mild hyperglycaemia and acute euglycaemia on mood and cognition have rarely been compared . We examined mood and cognitive functions in patients with T2DM during acute euglycaemia in comparison with moderate hyperglycaemia . METHODS One euglycaemic ( 5 mmol/l ) and one hyperglycaemic clamp ( 10.5 mmol/l ) of 90 min each were performed in 15 T2DM patients in a balanced , single-blind , within-subject comparison . Mood , cognitive functions ( assessed via short-term memory and attention tests ) and symptoms related to glycaemic changes were assessed during a baseline period and during both glycaemic plateaus . In addition , patients estimated their blood glucose level and counterregulatory hormones were measured . RESULTS None of the assessed aspects of cognitive functions differed between conditions ( all p > or = 0.2 ) . Patients rated higher on the well-being scale ( p=0.04 ) and tended to feel less anger ( p=0.08 ) during hyperglycaemia . Self-estimated blood glucose levels were higher during the hyper- than euglycaemic condition ( 8.6 + /- 2.5 vs 7.2 + /- 1.2 mmol/l ; p<0.05 ) although most individual estimations did not match the actual glucose levels . Counterregulatory hormone levels did not differ ( all p>0.25 ) . CONCLUSIONS Data indicate that T2DM patients are not cognitively impaired by moderate hyperglycaemia ( 10.5 mmol/l ) , pointing to the possibility of a glycaemic threshold for cognitive impairments at higher glycaemic levels OBJECTIVE --To assess patient , doctor , practice , and process of care variables for their effect on glycaemic control in diabetes mellitus , and to quantify their relative effects . DESIGN -- Search of general practice medical records , patient question naires and examination , doctor question naire , videotaping and analysis of consultations , and practice question naire . SETTING --12 practice s with 32 participating general practitioners in Nottinghamshire . SUBJECTS--318 patients r and omly selected from those with diabetes in each practice , 10 for each participating doctor . MAIN OUTCOME MEASURE -- Glycaemic control as measured by r and om glycated haemoglobin A1c estimation ( r and om haemoglobin A1 measurement ) . RESULTS --Glycaemic control was significantly related to the disease process as measured by years since diagnosis , treatment group , and number of diabetes related clinical events . Females had significantly worse control than males . Other patient factors , such as age , social class , lifestyle , attitudes , satisfaction , and knowledge , had no association with glycaemic control . Of all the doctor factors examined , only doctors who professed a special interest in diabetes achieved significantly better glycaemic control . Bigger and better equipped practice s and those with a diabetic miniclinic had patients with significantly better glycaemic control , as did those with access to dietetic advice . Patients attending hospital clinics had worse glycaemic control , but this seemed to be attributable to the case mix and practice characteristics . Shared care did not contribute to the multiple linear regression model . CONCLUSION --Glycaemic control among diabetic patients in the community is related to such factors as treatment group , sex , and years since diagnosis ; it is also related to the organisation and process of care . The findings support concentrating diabetic care on partners with special interests in diabetes in well equipped practice s with adequate dietetic support This study sought to examine whether consumption of two low-calorie fruit/day for 3-months can effectively improve oxidative stress , anthropometry , blood pressure and glycaemic control in type 2 diabetes mellitus . Study involved 123 patients who were assigned to receive either st and ard care or with additional dietary therapy .  Dietary intervention result ed in significant reduction in malondialdehyde , plasma glucose , glycated haemoglobin and improvement in antioxidants like vitamin C and reduced glutathione when compared to controls . Mean plasma levels of vitamin C increased by 64 % ( p < 0.001 ) . There were no differences in waist circumference , waist-to-hip ratio , blood pressure , vitamin E and superoxide dismutase in the intervention group at follow-up . Diet rich in fruits can improve some antioxidants which are likely to reduce oxidative stress in type 2 diabetes . Regular consumption of fruits can lower the glycaemic status in these patients . The study supports the usefulness of plasma vitamin C as a biomarker for fruit intake OBJECTIVE Although hyperglycemia is hypothesized to increase the short-term risk of infection , this hypothesis has not been well tested in a clinical setting . This study was design ed to assess the relationship of perioperative glycemic control to the subsequent risk of infectious complications . RESEARCH DESIGN AND METHODS A total of 411 adults with diabetes who underwent coronary artery surgery from 1990 to 1995 in the cardiac surgery service of an urban university hospital were included in a nonconcurrent prospect i ve cohort study based on chart review . Perioperative glycemic control was characterized by the mean of six capillary glucose measurements taken during the 36-h interval following surgery . The major outcomes studied were infections of leg and chest wounds , pneumonia , and urinary tract infections . RESULTS Mean postoperative glucose levels ranged from 121 to 352 mg/dl and were divided into quartiles : quartile 1 ( 121 - 206 mg/dl ) , quartile 2 ( 207 - 229 mg/dl ) , quartile 3 ( 230 - 252 mg/dl ) , and quartile 4 ( 253352 mg/dl ) . After simultaneous adjustment for age , sex , race , underlying comorbidity , acute severity of illness , and the length of the stay in the surgical intensive care unit , patients with higher mean capillary glucose readings were at increased risk of developing infections . Compared with people in the lowest quartile of postoperative glucose , those in quartiles 2 ( relative odds of infection [ 95 % CI ] = 1.17 [ 0.57 - 2.40 ] ) , 3 ( 1.86 [ 0.94 - 3.68 ] ) , and 4 ( 1.78 [ 0.86 - 3.47 ] ) were at progressively higher risk for infection ( P = 0.05 for trend ) . CONCLUSIONS In patients with diabetes who undergo coronary artery surgery , postoperative hyperglycemia is an independent predictor of short-term infectious complications . Physicians should consider a glucose concentration target of < or = 200 mg/dl to reduce the risk of infection
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 .