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Glibenclamide And MetfoRmin Versus StAndard Care In GEstational DiabeteS (GRACES): A Feasibility Open Label Randomised Trial

Glibenclamide and metfoRmin versus stAndard care in gEstational diabeteS (GRACES): a feasibility open label randomised trial

Glibenclamide and metfoRmin versus stAndard care in gEstational diabeteS (GRACES): a feasibility open label randomised trial


Metformin is widely used to treat gestational diabetes (GDM), but many women remain hyperglycaemic and require additional therapy. We aimed to determine recruitment rate and participant throughput in a randomised trial of glibenclamide compared with standard therapy insulin (added to maximum tolerated metformin) for treatment of GDM.
We conducted an open label feasibility study in 5 UK antenatal clinics among pregnant women 16 to 36weeks gestation with metformin-treated GDM. Women failing to achieve adequate glycaemic control on metformin monotherapy were randomised to additional glibenclamide or insulin. The primary outcome was recruitment rate. We explored feasibility with uptake, retention, adherence, safety, glycaemic control, participant satisfaction and clinical outcomes.
Records of 197 women were screened and 23 women randomised to metformin and glibenclamide (n=13) or metformin and insulin (n=10). Mean (SD) recruitment rate was 0.39 (0.62) women/centre/month. 9/13 (69.2%, 95%CI 38.690.9%) women adhered to glibenclamide and all provided outcome data (100% retention). There were no episodes of severe hypoglycaemia, but metformin and insulin gave superior glycaemic control to metformin and glibenclamide, with fewer blood glucose readings <3.5mmol/l (median [IQR] difference/woman/week of treatment 0.58 [0.031.87]).
A large randomised controlled trial comparing glibenclamide or insulin in combination with metformin for women with GDM would be feasible but is unlikely to be worthwhile, given the poorer glycaemic control with glibenclamide and metformin in this pilot Continue reading

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Health literacy in diabetes care: explanation, evidence and equipment

Health literacy in diabetes care: explanation, evidence and equipment


Health literacy in diabetes care: explanation, evidence and equipment
Vanderbilt University Medical Center, Division of Nephrology, Department of Medicine, 1161 21st Avenue South, Medical Center North S-3223, Nashville, TN 37232, USA
Vanderbilt University Medical Center, Division of Nephrology, Department of Medicine, 1161 21st Avenue South, Medical Center North S-3223, Nashville, TN 37232, USA
Kerri L Cavanaugh: [email protected]
See other articles in PMC that cite the published article.
The exchange of complex health information among patients, providers, health organizations and the public is often described as health literacy. Low levels of health literacy is common and associated with processes of healthcare and important health outcomes. In diabetes, health literacy is related to diabetes knowledge, self-efficacy and self-care behaviors and glycemic control. Health literacy may also provide a better understanding of racial disparities observed in patients with diabetes. Strategies to address health literacy, based upon this understanding of its role, provide a means to improve diabetes care. This article describes the concept of health literacy and its assessment and the evidence of its impact on patients with diabetes, and offers suggested methods and tools that may be implemented to improve clinical care.
In 2010, it was estimated that there were 285 million adults worldwide with diabetes, with projections that this will increase to nearly 440 million people by 2030 [ 1 ]. Despite innovative scientific discoveries to advance our understanding of Continue reading

How to Help Seniors and Caregivers Manage Diabetes at Home

How to Help Seniors and Caregivers Manage Diabetes at Home


As the rate of diabetes in American adults over age 65 continues to rise, senior care professionals can play a significant role in helping these older adults and their family caregivers manage the condition at home. According to the CDC, nearly 12 million seniors have been diagnosed with diabetes, and the rate of the condition among people between the ages of 65 and 74 rose 113 percent between 1993 and 2014. These numbers suggest that diabetes will continue to be a serious health issue among older adults for years to come.
Diabetes increases a seniors risk of developing several other comorbidities, including cardiovascular disease and kidney failure. In a recent webinar co-sponsored by the American Society on Aging and Home Instead, Inc., gerontologist Lakelyn Hogan and registered nurse Lanita Knoke discussed several ways senior care professionals can help clients manage their diabetes for improved wellness and quality of life. They also talked about tactful ways healthcare professionals can address the diabetes elephant in the room: obesity.
To provide support for seniors with diabetes and their caregivers, you might consider these four strategies.
1. Provide education as a means of empowerment
Diabetes management can feel like a complex, overwhelming thing, especially for an older adult who may have multiple comorbid conditions. You can help seniors and caregivers feel more confident and empowered to take on the task of diabetes management by arming them with key information, such as:
How to recognize the signs and symptoms of diabetes, hypoglycemia and hyperglycem Continue reading

Researchers Implicate Suspect In Heart Disease Linked To Diabetes

Researchers Implicate Suspect In Heart Disease Linked To Diabetes

People with diabetes are at high risk of developing heart disease. Despite knowing this, scientists have struggled to trace the specific biology behind that risk or find ways to intervene. Now, UNC School of Medicine researchers have hunted down a possible culprit -- a protein called IRS-1, which is crucial for the smooth muscle cells that make up veins and arteries.
According to a study published in the Journal of Biological Chemistry, too little of IRS-1 causes cells to revert to a "dedifferentiated" or stem-cell like state, and this may contribute to the buildup of plaque in the heart's arteries, a condition known as atherosclerosis, which increases the risk of heart attack, stroke, and other forms of heart disease.
"When diabetes is poorly managed, your blood sugar goes up and the amount of this protein goes down, so the cells become subject to abnormal proliferation," said senior author David R. Clemmons, MD, Sarah Graham Kenan Professor of Medicine at the UNC School of Medicine. "We need to conduct more studies, but we think this cell pathway may have significant implications for how high blood glucose leads to atherosclerosis in humans."
The research could bring scientists one step closer to finding drugs to help stave off heart disease in people with diabetes, who are twice as likely to have heart disease or experience a stroke, as compared to people without diabetes. People with diabetes also tend to experience major cardiac events at a younger age.
The study focused on the cells that form the walls of veins and arteries, known as vascular smooth muscle cells. The Continue reading

Why Plus-Size Moms Need To Look Out For Gestational Diabetes

Why Plus-Size Moms Need To Look Out For Gestational Diabetes

According to the Centers for Disease Control and Prevention, more than half of American women in the age range 22 to 44 are overweight and a third of them are considered obese.
Overweight women are more likely to experience health complications during pregnancy. What makes it all the more alarming is that excess weight can also risk the baby’s chances of a healthy development inside the uterus.
According to Dr. Vivian Dickerson, director of women’s healthcare and programs at Hoag Memorial Hospital in California, “Obesity is a disease, and as with many diseases, there’s a greater chance of problems during pregnancy”.
On your nine-month journey, your doctor will be more concerned by your BMI and not by your weight. But a high BMI score does not necessarily mean you should expect medical issues down the line. Plenty of overweight mothers had smooth pregnancies, so it is a risk, not a certainty.
If you are planning to be or are currently pregnant, knowing what to watch out for is the first step for achieving a smooth sailing pregnancy.
Gestational Diabetes
Gestational diabetes is a form of temporary high blood sugar experienced by many women during their pregnancy.
This medical issue normally affects up to 15% of obese women. If this problem is left uncontrolled, gestational diabetes can cause congenital heart problems and other risks of fetal birth defects. If your doctor says you are at risk for this problem, you have to listen and take preventative measures to stay healthy, not just for your sake but for your unborn child’s as well.
Babies who are born to mothers Continue reading

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