The risk variables include age, gender, race, plasma cholesterol levels, blood pressure values, diabetes and smoking status, and the use of blood pressure-lowering medications. The risk variables include age, gender, geographic region, smoking status, history of ASCVD, duration of diabetes, insulin use, systolic blood pressure, body mass index BMI , plasma cholesterol levels, HbA1c level, glomerular filtration rate eGFR and albuminuria values, cholesterol-lowering drug and anticoagulant use.
Statistical analysis Data are expressed as medians interquartile ranges. Mixed effect models were used to detect differences between the calculations of 24 h ABPM assessment 24 h, per daytime, per nighttime, systolic and diastolic blood pressure, and heart rate , postprandial triglycerides and insulin concentrations at baseline and 6 months.
The intervention was set as fixed effect whereas the time points and patient number were set as random effects. For the mixed effect model analyses, 12 measurements evenly distributed were used to assess 24 h ABPM, 12 measurements to assess daytime — and 10 measurements to assess nighttime — to compare systolic and diastolic blood pressure and MAP before and 6 months after DMR. Patients were on average 61 years old, their T2DM duration was 11 years, and used 31 units of insulin per day prior to DMR.
All baseline characteristics can be found in Additional file 1 : Table S1. Details on these clinical outcomes have been published previously [ 14 ]. We observed a significant relative reduction in VAT During the study period, one patient started with amlodipine 5 mg 3 months after DMR and one patient stopped hydrochlorothiazide 3 months after DMR.
All other patients had no changes in their blood pressure lowering medication. Daytime systolic, diastolic and MAP decreased. Heart rate increased. The other values did not show significant changes. Table 2. Table 2 Overview of variables of 24 h ambulatory blood pressure monitoring. Values are expressed as median Q1-Q3. In five patients the risk score lowered by a category. None of the patients increased in risk category.
Table 4. This risk score provides an estimate of year risk of cardiovascular events and is a recognized risk assessment for patients with T2DM [ 16 ]. Since cardiovascular complications are the leading cause of morbidity and mortality in individuals with T2DM, finding better ways to decrease this risk is desirable. The observed improvements in parameters of cardiovascular health in our patients are probably the result of two important changes that are part of our study intervention. Firstly, exogenous insulin therapy was discontinued.
Hyperinsulinemia often leads to weight gain and further deterioration of metabolic health [ 6 ]. Secondly, the DMR procedure has been found to improve insulin sensitivity, also leading to lower levels of endogenous insulin [ 12 , 13 , 14 , 18 , 19 ]. The exact mechanism behind the insulin sensitizing effect of DMR has yet to be elucidated.
We hypothesize that its insulin sensitizing effect can occur due to changes in either the gut-brain axis or local signalling to the liver and pancreas, cellular or histological changes in the duodenal mucosa, bile acid composition and microbiota diversity.
In patients included in this INSPIRE study, we observed changes in bile acid composition [ 20 ] and minor changes in gut microbiota diversity [ 21 ]. We have taken duodenal biopsies before and 3 months after DMR to assess histological changes, this data is under evaluation. Currently, there are no reference values available for VAT.
However, excessive VAT is associated with cardiovascular morbidity [ 22 , 23 ]. In a population at high risk, a lower VAT is therefore a logical positive outcome. In addition, we assessed 24 h blood pressure. We found a significant decrease in daytime values at 6 months. Other values did not change, this could be due to the small sample size and the fact that night time values were already within normal ranges.
Plasma lipid optimization is an important part of cardiovascular risk management in patients with T2DM [ 24 ]. We observed that lipid levels improved in our study population 6 months after DMR. HDL remained stable, which is a positive finding as HDL levels are inversely correlated with cardiovascular disease [ 25 ].
Next, we observed that urine microalbumin decreased significantly. Urine microalbumin is an important gauge for renovascular health. We deem it unlikely that a major effect on nephrosclerosis was established in only 6 months. This decrease in microalbumin probably results from a decrease in hyperfiltration, which is common in patients with inadequately controlled T2DM. This study has some limitations.
Firstly, this is an observational uncontrolled proof-of-concept study with a limited sample size. Besides a significant short-term reduction of glycaemia, GLP-1RA therapy has been associated with a significant reduction of cardiovascular events in patients with T2DM, but only with a hazard ratio of 0.
Since the glycaemic and some of the metabolic effects of DMR and GLP-1RA appear to act synergistically, the combination may also lead to a greater and clinically more meaningful reduction of cardiovascular events. Larger randomized controlled trials are needed to confirm these findings and to evaluate the effect of DMR alone on parameters of cardiovascular health. Thirdly, VAT was measured at the level of L2, in contrast to what is advised in literature L3-L4 , however these slices were not available.
In conclusion, multiple parameters of cardiovascular health improved significantly in our study patients, 6 months after starting the combination of DMR and GLP-1RA to eliminate exogenous insulin therapy. Individual effects of these parameters might not be very impressive, but together they show a pattern of improvement in overall cardiovascular health, supported by absolute improvements in ASCVD and DIAL scores. In patients with T2DM with high risk of developing cardiovascular disease based on the ASCVD algorithm , this combination treatment might be beneficial.
Streptomycin treatment of pulmonary tuberculosis. Br Med J ;2 — Observational studies: going beyond the boundaries of randomized controlled trials. Diabetes Res Clin Pract ;88 Suppl 1 :s3—s9. Four-year evolution of insulin regimens, glycaemic control, hypoglycaemia and body weight after starting insulin therapy in type 2 diabetes across three continents. Diabetes Res Clin Pract ;—9.
Diabetes Care ;— Glycemic control in insulin-dependent diabetes mellitus: comparison of outpatient intensified conventional therapy with continuous subcutaneous insulin infusion. Am J Med ;— An observational non-interventional study of people with diabetes beginning or changed to insulin analogue therapy in non-Western countries: the A1chieve study. Diabetes Res Clin Pract ;— Relationship of baseline HbA1c and efficacy of current glucose-lowering therapies: a meta-analysis of randomized clinical trials.
Diabet Med ;—
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Related Pages Counting carbs and the plate method are two common tools that can help you plan meals. A meal plan is your guide for when, what, and how much to eat to get the nutrition you need while keeping your blood sugar levels in your target range. A good meal plan will also: Include more nonstarchy vegetables, such as broccoli, spinach, and green beans. Include fewer added sugars and refined grains, such as white bread, rice, and pasta with less than 2 grams of fiber per serving.
Focus on whole foods instead of highly processed foods as much as possible. Carbohydrates in the food you eat raise your blood sugar levels. How fast carbs raise your blood sugar depends on what the food is and what you eat with it. For example, drinking fruit juice raises blood sugar faster than eating whole fruit. Eating carbs with foods that have protein, fat, or fiber slows down how quickly your blood sugar rises.
For more information, see Carb Counting. Eating about the same amount of carbs at each meal can be helpful. Counting carbs and using the plate method are two common tools that can make planning meals easier too. Counting Carbs Keeping track of how many carbs you eat and setting a limit for each meal can help keep your blood sugar levels in your target range.
Work with your doctor or a registered dietitian to find out how many carbs you can eat each day and at each meal, and then refer to this list of common foods that contain carbs and serving sizes. According to the American Diabetes Association, your breakfast meals should include a specific balance of one-half starchy foods, one-quarter fruit and one-quarter protein 1. Lunch Learn More Your lunch plate should consist of one-half non-starchy vegetables, one-quarter starchy foods and one-quarter protein.
You can also prepare a homemade turkey veggie burger patty. Use lean ground turkey, shredded carrots, chopped mushrooms, and peas. Other options include pea soup served with a small whole grain bun and a small mixed green salad, a tuna salad made with a mustard-yogurt dressing served on a bed of spinach, or vegetarian bean soup with a fruit-and-nut salad. You could also make whole wheat pasta with assorted chopped vegetables, tossed in lemon juice.
Your lunch plate should consist of one-half non-starchy vegetables, one-quarter starchy foods and one-quarter protein. Dinner For dinner, one-half your plate should include non-starchy vegetables, one-quarter should include starchy foods and one quarter should include protein. You could also make stuffed peppers, filling them with baby spinach, tomatoes, brown rice and shredded non-fat mozzarella cheese. Two other options include baked ham with sweet potato and green beans or a stir fry with tofu as your protein.
Additional menu ideas include a salad topped with strips of grilled sirloin and boiled red potatoes or black beans served with brown rice, chopped tomatoes, green pepper and fresh salsa. For dinner, one-half your plate should include non-starchy vegetables, one-quarter should include starchy foods and one quarter should include protein.
Snacks Learn More Your 7 day diabetes diet plan menu should also include healthy snacks.
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The Transforming Your Primary Care Group Practice into a Center of Excellence in Type 2 Diabetes Care live, hands-on workshops were designed to provide the multidisciplinary team with an in-depth understanding of type 2 diabetes and practical approaches for combating the clinical inertia that often ensues with chronic disease management.
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| Multi order forex exchange | Although they are as effective as other older anti-diabetic agents in comparison trials, data about their long term safety, effects on mortality and weight reduction is lacking [ 89 ]. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Preliminary cinical studies show that GLP-1 decreases post-ischemic left ventricular dysfunction in patients with coronary heart disease [ 57, 58 ]. Since malfunction of incretin hormones has been found to have role in Continue reading DM pathogenesis, incretin based therapies have been developed. Thioredoxin TRXthe thiol oxidoreductase is an important intracellular anti-oxidant. Electronic properties of the casein-methylglyoxal complex. Exenatide versus insulin glargine in patients with suboptimally controlled type 2 diabetes: a randomized trial. |
| Forex scalping strategies 2022 olympics | Reducing sugars trigger oxidative modification and apoptosis in pancreatic beta-cells by provoking oxidative stress through the glycation reaction. Summary The role of comperatively older drugs such as insulin, insulin secretagogues, metformin, thiazolidinediones and alpha glucosidase inhbitors in the management of diabetes are familiar aspects of diabetes therapy. Glucagon-like peptide 1 inhibition of gastric emptying outweighs its insulinotropic effects in healthy humans. Effect of renal insufficiency on the pharmacokinetics of sitagliptin, a dipeptidyl peptidase-4 inhibitor. Pre- and PPG checks can be useful to indicate the number of insulin units required for a given number of carbohydrate grams ingested. However, a consensus was reached and while the outcomes may not include everything IDF and the NCD Alliance were calling for, the political declaration represents a significant turning point for diabetes and NCDs. Characterization of advanced glycation end products: mass changes in correlation to side chain modifications. |
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| Dain s place menu for diabetics | IDF is committed in the long term to action to achieve its three main objectives — improving the health outcomes of people with diabetes, preventing the development of type 2 diabetes, and stopping discrimination against people with diabetes — and delivering the outcomes from the UN Summit on NCDs. Short-acting insulin analogues vs. Out data reinforce the importance of certain dietary fats as potential risk factors associated with DM2 and its associated plurimetabolic nature. Expression of GIP is widely distributed in the body, but the functions are not well understood at these locations. We found a significant decrease in daytime values at 6 months. |
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| Aintree betting tips friday | Recordings were programmed for every 30 min during the day Horm Metab Res. HDL remained stable, which is a positive finding as HDL levels are inversely correlated with cardiovascular disease [ 25 ]. The cost of diabetes is placing a massive and mounting burden on healthcare systems and economies, many of which are already at breaking point. Although there is a variety of effective oral glucose lowering drugs, eventually treatment with exogenous insulin is necessary in many patients with T2DM. |
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