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Diabetes: Management and Pharmacotherapy01:15

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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Carbohydrates are polymers composed of molecules containing atoms of carbon, hydrogen and oxygen. One gram of carbohydrate can provide four kilo-calories of energy, which makes it the most efficient instant energy source.
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Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Continuous Glucose Monitoring With Low-Carbohydrate Nutritional Coaching to Improve Type 2 Diabetes Control:

Dina H Griauzde1,2,3, Grace Ling4, Daniel Wray5

  • 1VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.

Journal of Medical Internet Research
|February 2, 2022
PubMed
Summary

A combined approach using continuous glucose monitoring and low-carbohydrate nutrition counseling improved glycemic control in type 2 diabetes mellitus (T2DM) patients. This enhanced care group showed better hemoglobin A1c (HbA1c) reduction compared to usual care.

Keywords:
continuous glucose monitoringlow-carbohydrate counselingtype 2 diabetes mellitus

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Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Primary Care Research

Background:

  • Type 2 diabetes mellitus (T2DM) poses significant global health challenges due to hyperglycemia.
  • Suboptimal glycemic control affects up to 60% of T2DM patients despite guidelines and interventions.
  • Multilevel barriers impede effective management of T2DM.

Purpose of the Study:

  • To compare changes in hemoglobin A1c (HbA1c) levels in T2DM patients with suboptimal control.
  • To evaluate an enhanced care (EC) intervention including continuous glucose monitoring (CGM) and low-carbohydrate counseling versus usual care (UC).

Main Methods:

  • A 12-month pragmatic randomized quality improvement program involving 1584 T2DM patients.
  • Subgroups of high-risk patients (HbA1c >7.5%) were randomized to EC (CGM + nutrition counseling) or UC.
  • Intention-to-treat analysis compared HbA1c changes between EC-HR and UC-HR groups.

Main Results:

  • The EC-HR group showed a greater HbA1c decrease (0.41%) compared to the UC-HR group (P=.04).
  • Only 32.9% of EC-HR participants engaged with the program.
  • Engaged EC-HR participants using CGM achieved a 1.1% HbA1c reduction from baseline (P<.001).

Conclusions:

  • A combined CGM and low-carbohydrate nutrition approach improves glycemic control in T2DM.
  • This enhanced care strategy is more effective than standard care for suboptimally controlled T2DM.
  • Patient engagement remains a critical factor for intervention success.