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Diabetes Care Journal: RESEARCH STUDIES in FOCUSBy Liz Ho 21 Jul 09

Assessing Glycemic Control in Maintenance Hemodialysis Patients With Type 2 DiabetesKazempour-Ardebili, Sara et al. (UK) Diabetes Care. 32(7):1137-1142, July 2009.

OBJECTIVE: The study hypothesizes that 1) 48-h continuous glucose monitoring (CGM) provides additional,clinically relevant, information to that provided by the A1C measurement and 2) glycemic profiles differsignificantly between day on and day off dialysis.

RESEARCH DESIGN AND METHODS: With the use of GlucoDay S, 48-h CGM was performed in 19 type 2diabetic subjects undergoing hemodialysis to capture consecutive 24-h periods on and off dialysis. Energyintake was calculated using food diaries. A1C was assayed by a high-performance liquid chromatographymethod.

RESULTS: 17 subjects (13 male) with a mean (range) age of 61.5 years (42-79 years) and diabetes duration of18.8 years (4-30 years) were analysed.

DialysisDay

Non-DialysisDay

Mean 24 hoursglucose

9.8(+/-3.8)

12.6(+/- 5.6)

P=0.013

6hr NocturnalGlucose

9.5(+/-4.4)

12.9(+/-7.0)

P

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Longitudinal Analysis of Depressive Symptomsand Glycemic Control in Type 2 Diabetes.Aikens, James E. et al. (US)Diabetes Care. 32(7):1177-1181, July 2009.OBJECTIVE: Compare depressive symptoms relation

to subsequent or prior glycemic control in type 2diabetes and to test whether patient characteristicsmodify these longitudinal associations.

RESEARCH DESIGN AND METHODS:-- On two occasions separated by 6 months,depressive symptoms and glycemic control wereassessed in 253 adults with type 2 diabetes.1) Examined depressive symptoms as both a predictorand outcome of glycemic control and2) Explore whether medication regimen (e.g., insulinversus oral drugs)

RESULTS and CONCLUSIONS:

Depressive symptoms do not necessarily lead to

worsened glycemic control.

In contrast, insulin-treated patients in poor

glycemic control are at moderate risk forworsening of depressive symptoms.

These patients should be carefully monitored to

determine whether depression treatment shouldbe initiated or intensified.

Hypoglycemia Unawareness Is Associated WithReduced Adherence to Therapeutic Decisions inPatients With Type 1 Diabetes: Evidence from aclinical audit.Smith, Charlotte B. et al. (UK)Diabetes Care. 32(7):1196-1198, July 2009.

OBJECTIVE: Study compared adherence to treatmentchanges by hypoglycemia awareness status.

RESEARCH DESIGN AND METHODS: Case notes of90 type 1 diabetic patients were analyzedretrospectively, identifying awareness status andinsulin regimens over four visits. The proportion ofpatients adhering to advice and percent advice takenwere calculated.

RESULTS:

31 patients with hypo awareness and 19

patients with hypo unawareness wereidentified.

74.2% in hypo awareness group and 68.4%

of hypo unawareness group had insulinregimens

Patients with hypo unawareness were older

(P = 0.001)

Unaware group had longer diabetes duration

(P = 0.002)

Unaware group had lower A1C (P = 0.007).

They also reported severe hypoglycemia (P =

0.002)

87% of Aware group is adherent and only

53.8% in the Unaware group (P = 0.046))

Aware group adherence score is 75.3

compared to 42.5 in Unaware group (P =0.001).

CONCLUSIONS: Reduced adherence to changes ininsulin regimen in hypoglycemia unawareness iscompatible with habituation to hypoglycemic stress.Therapies aimed at reversing repetitive harmfulbehaviors may be useful to restore hypoglycemia

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Insulin Analogs Versus Human Insulin in the Treatment of Patients With Diabetic Ketoacidosis: Arandomized controlled trialUmpierrez, Guillermo E. et al. (US)Diabetes Care. 32(7):1164-1169, July 2009.OBJECTIVE: Compare safety and efficacy of insulin analogs and human insulins both during acute intravenoustreatment and during the transition to subcutaneous insulin in patients with diabetic ketoacidosis (DKA).

RESEARCH DESIGN AND METHODS:Patients with DKA were randomly assigned to receive intravenous treatment with regular or glulisine insulin untilresolution of DKA.After resolution of DKA, (1) patients treated with intravenous regular insulin were transitioned to subcutaneous NPHand regular insulin twice daily (n = 34). (2) Patients treated with intravenous glulisine insulin were transitioned tosubcutaneous glargine once daily and glulisine before meals (n = 34).

RESULTS:

No differences in mean duration of treatment or amount of insulin infusion until resolution of DKA.

After transition to subcutaneous insulin, no differences in mean daily blood glucose levels

Patients treated with NPH and regular insulin had a higher rate of hypoglycemia (blood glucose