Browsing by Subject "glycemic control"

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  • Perkovic, Vlado; Agarwal, Rajiv; Fioretto, Paola; Hemmelgarn, Brenda R.; Levin, Adeera; Thomas, Merlin C.; Wanner, Christoph; Kasiske, Bertram L.; Wheeler, David C.; Groop, Per-Henrik; Conf Participants (2016)
    The prevalence of diabetes around the world has reached epidemic proportions and is projected to increase to 642 million people by 2040. Diabetes is already the leading cause of end-stage kidney disease (ESKD) in most developed countries, and the growth in the number of people with ESKD around the world parallels the increase in diabetes. The presence of kidney disease is associated with a markedly elevated risk of cardiovascular disease and death in people with diabetes. Several new therapies and novel investigational agents targeting chronic kidney disease patients with diabetes are now under development. This conference was convened to assess our current state of knowledge regarding optimal glycemic control, current antidiabetic agents and their safety, and new therapies being developed to improve kidney function and cardiovascular outcomes for this vulnerable population.
  • Tuomaala, Anna-Kaisa; Hero, Matti; Tuomisto, Martti T.; Lähteenmäki, Maria; Miettinen, Päivi J.; Laine, Tiina; Wehkalampi, Karoliina; Kiiveri, Sanne; Ahonen, Pekka; Ojaniemi, Marja; Kaunisto, Kari; Tossavainen, Päivi; Lapatto, Risto; Sarkola, Taisto; Pulkkinen, Mari-Anne (2021)
    A multicenter randomized controlled pilot trial investigated whether motivational interviewing (MI) by diabetes physicians improves glycemic control and variability in the context of follow-up for adolescent patients with poorly controlled type 1 diabetes. Patients (n = 47) aged 12 to 15.9 years who showed poor glycemic control (HbA1c >75 mmol/mol/9.0%) were randomized to standard education (SE) only or MI+SE, with study physicians randomized to employ MI+SE (N = 24 patients) or SE only (N = 23). For one year of follow-up, the main outcome measurements were obtained at three-month visits (HbA1c) or six-monthly: time in range (TIR) and glycemic variability (CV). Mean adjusted 12-month change in HbA1c was similar between the MI+SE and SE-only group (-3.6 vs. -1.0 mmol/mol), and no inter-group differences were visible in the mean adjusted 12-month change in TIR (-0.8 vs. 2.6%; P = 0.53) or CV (-0.5 vs. -6.2; P = 0.26). However, the order of entering the study correlated significantly with the 12-month change in HbA1c in the MI+SE group (r = -0.5; P = 0.006) and not in the SE-only group (r = 0.2; P = 0.4). No link was evident between MI and changes in quality of life. The authors conclude that MI's short-term use by diabetes physicians managing adolescents with poorly controlled type 1 diabetes was not superior to SE alone; however, improved skills in applying the MI method at the outpatient clinic may produce greater benefits in glycemic control.
  • Rissanen, Antti-Pekka; Tikkanen, Heikki Olavi; Koponen, Anne S.; Aho, Jyrki M.; Peltonen, Juha E. (2018)
    Adaptations to long-term exercise training in type 1 diabetes are sparsely studied. We examined the effects of a 1-year individualized training intervention on cardiorespiratory fitness, exercise-induced active muscle deoxygenation, and glycemic control in adults with and without type 1 diabetes. Eight men with type 1 diabetes (T1D) and 8 healthy men (CON) matched for age, anthropometry, and peak pulmonary O-2 uptake, completed a 1-year individualized training intervention in an unsupervised real-world setting. Before and after the intervention, the subjects performed a maximal incremental cycling test, during which alveolar gas exchange (volume turbine and mass spectrometry) and relative concentration changes in active leg muscle deoxygenated (Delta[HHb]) and total (Delta[tHb]) hemoglobin (near-infrared spectroscopy) were monitored. Peak O-2 pulse, reflecting peak stroke volume, was calculated (peak pulmonary O-2 uptake/peak heart rate). Glycemic control (glycosylated hemoglobin A(1c) (HbA(1c))) was evaluated. Both T1D and CON averagely performed 1 resistance-training and 3-4 endurance-training sessions per week (similar to 1 h/session at similar to moderate intensity). Training increased peak pulmonary O-2 uptake in T1D (p = 0.004) and CON (p = 0.045) (group x time p = 0.677). Peak O-2 pulse also rose in T1D (p = 0.032) and CON (p = 0.018) (group x time p = 0.880). Training increased leg Delta[HHb] at peak exercise in CON (p = 0.039) but not in T1D (group x time p = 0.052), while no changes in leg Delta[tHb] at any work rate were observed in either group (p > 0.05). HbA(1c) retained unchanged in T1D (from 58 +/- 10 to 59 +/- 11 mmol/mol, p = 0.609). In conclusion, 1-year adherence to exercise training enhanced cardiorespiratory fitness similarly in T1D and CON but had no effect on active muscle deoxygenation or glycemic control in T1D.