The intensive intervention included caloric Glyce,ic maximum Cholesterol-balancing strategies percent calories from Glycemic control, minimum 15 percent protein, and the remainder Glycemci carbohydrates, in the form of liquid meal replacements, frozen food entrees, or structured meal plansmoderate-intensity physical activity goal minutes weeklyand weekly group or individual sessions with registered dietitians, behavioral psychologists, and exercise specialists. Exposures Time-updated cumulative exposure to HbA 1c thresholds. Contributor Disclosures.

Glycemic control -

Carry supplies for treating low blood sugar with you. If you feel shaky, sweaty, or very hungry or have other symptoms, check your blood sugar. Wait for 15 minutes and then check your blood sugar again.

If you have problems with low blood sugar, ask your doctor if your treatment plan needs to be changed. Many things can cause high blood sugar hyperglycemia , including being sick, being stressed, eating more than planned, and not giving yourself enough insulin.

Over time, high blood sugar can lead to long-term, serious health problems. Symptoms of high blood sugar include:. If you get sick , your blood sugar can be hard to manage. You may not be able to eat or drink as much as usual, which can affect blood sugar levels.

High ketones can be an early sign of diabetic ketoacidosis, which is a medical emergency and needs to be treated immediately. Ketones are a kind of fuel produced when fat is broken down for energy. When too many ketones are produced too fast, they can build up in your body and cause diabetic ketoacidosis, or DKA.

DKA is very serious and can cause a coma or even death. Common symptoms of DKA include:. If you think you may have DKA, test your urine for ketones.

Follow the test kit directions, checking the color of the test strip against the color chart in the kit to see your ketone level. If your ketones are high, call your health care provider right away.

DKA requires treatment in a hospital. Talk to your doctor about how to keep your blood sugar levels within your target range. Your doctor may suggest the following:. Carbs in food make your blood sugar levels go higher after you eat them than when you eat proteins or fats.

You can still eat carbs if you have diabetes. The amount you can have and stay in your target blood sugar range depends on your age, weight, activity level, and other factors. Find in topic Formulary Print Share.

View in. Language Chinese English. Authors: Silvio E Inzucchi, MD Beatrice Lupsa, MD Section Editor: David M Nathan, MD Deputy Editor: Katya Rubinow, MD Literature review current through: Jan This topic last updated: Jan 02, Although the benefit of glycemic control on microvascular disease in type 2 diabetes was documented in the United Kingdom Prospective Diabetes Study UKPDS , its role in reducing cardiovascular risk has not been similarly established.

CHOOSING A GLYCEMIC TARGET Selecting an appropriate target glycated hemoglobin A1C; intensive versus moderate control should be individualized based upon comorbid conditions and functional status, balancing the potential benefit of improved glycemic control with the risks of hypoglycemia and weight gain.

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It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances.

BMJ Open Diabetes Res. Care 7 1 , e Laiteerapong, N. Diabetes Care 42 3 , — Article CAS PubMed Google Scholar. Afroz, A. Macro-and micro-vascular complications and their determinants among people with type 2 diabetes in Bangladesh. de Oliveira, R. Glycemic control in elderly people with type 2 diabetes mellitus attending primary health care units.

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Schwarz, G. Estimating the dimension of a model. Article MathSciNet MATH Google Scholar. Download references. We would like to greatly acknowledge Debre Markos and Felege Hiwot Referral Hospital for allowing us to use the T2DM Patient data.

Debre Markous University is gratefully acknowledged for financially supporting this work. Department of Statistics, Debre Markos University, Debre Markos, Ethiopia.

You can also search for this author in PubMed Google Scholar. conceived the study, formulated the design, drafted the manuscript, analyzed, and interpreted the data. participated in the conception of the study and revised the manuscript critically for important intellectual content.

All authors have read and approved the manuscript for submission. Correspondence to Nigusie Gashaye Shita. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Abstract Poor glycemic control is a main public health problem among type 2 diabetes mellitus T2DM patients and a significant cause of the development of diabetic complications. Introduction Type 2 diabetes mellitus T2DM is a chronic disease. Results Characteristics of study participants A total of T2DM patients with observations were included in the analysis.

Table 1 Population characteristics for type 2 DM patients with glycimic control stataus observations at Felege Hiwot and Debre Markos Referral Hospital, December January Full size table.

Table 2 Cross tabulation and Univariate analysis of glycemic control status for patients with glycimic control status observations at DMRH and FHRH, December —January Figure 1.

Full size image. Table 3 Results of Generalized Linear Mixed model with logit link for factors associated with glycemic control for type 2 diabetes mellitus patients with glycimic control status observations.

Discussion In this study, a generalized linear mixed model with autoregressive order one analysis was used to identify the determinant factors that affected good glycemic control among T2DM patients in two of the major hospitals in North West Ethiopia.

Conclusions and recommendations This study revealed that the overall prevalence of poor glycemic control was high at Debre Markos and Felege Hiwot Referral Hospital.

Methods Study design, study area, and study period An institutional-based retrospective follow-up study design was conducted at Felege-Hiwot and Debre Markos Referral Hospital with type 2 diabetes mellitus patients who were enrolled from December to December Source and study population The source population was all T2DM patients who were found at Felege-Hiwot and Debre Markos Referral Hospitals, whereas the study population was all type 2 diabetic patients aged 18 years or older who came to the hospital for diagnosis and follow-up from December to December Inclusion and exclusion criteria T2DM patients with three fasting blood glucose measurements within three months and above the age of 18 years were included in the study, whereas the patient chart would not be available during the data collection period and patients with missing key predictor variables were excluded from the study.

Figure 2. Summary of study participants recruiting flow chart. Table 4 Summarized value of Information criteria for type 2 diabetes mellitus patients with glycimic control status observations at DMRH and FHRH, December —December Data availability The data sets analyzed in this study are available from the corresponding author on reasonable request.

Abbreviations ADA: America Diabetes Association AIC: Akaike information criteria AOR: Adjusted odds ratio BIC: Bayesian information criteria CHD: Coronary heart disease CI: Confidence interval COR: Crude odds ratio DBP: Diastolic Blood pressure DM: Diabetes Mellitus DMRH: Debre Markos Referral Hospital FHRH: Felege-Hiwot Referral Hospital GLMM: Generalized linear mixed model IDF: International Diabetes Federation PAD: Peripheral arterial disease SBP: Systolic Blood pressure T2DM: Type 2 Diabetes Mellitus.

References IDF. Article Google Scholar IDF. Article CAS PubMed PubMed Central Google Scholar Nigussie, S. Article CAS PubMed PubMed Central Google Scholar Yosef, T.

Article PubMed PubMed Central Google Scholar Demoz, G. Article CAS Google Scholar Feleke, B. Article CAS Google Scholar Shita, N. Article ADS Google Scholar Andargie, A. Article Google Scholar Aniley, T. Article Google Scholar Lozovey, N.

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Article Google Scholar Al-Kaabi, J. Article PubMed PubMed Central Google Scholar Al-Ibrahim, A. Google Scholar Fseha, B. Article Google Scholar Abebe, S.

Article PubMed PubMed Central Google Scholar Fiseha, T. Article Google Scholar Supiyev, A. Article PubMed Google Scholar Borgharkar, S.

Gaster BHirsch Contro. The Cholesterol-balancing strategies of Improved Glycemic Conrol on Complications in Type 2 Conrrol. Arch Intern Cholesterol-balancing strategies. From dontrol Glycemic control of General Internal Medicine Dr Gaster and Cotrol, Endocrinology, and Cholesterol-balancing strategies Dr Hirsch Power-packed nutrition, Department of Medicine, University of Washington, Seattle. Type 2 diabetes is 8 to 10 times more common than type 1 diabetes, but no single large trial has established that improved glycemic control can prevent complications in type 2 diabetes. We have reviewed the results of the existing epidemiologic and clinical trial studies and have arrived at the following conclusions: 1 Strong evidence exists that improved glycemic control is effective at lessening the risks of retinopathy, neuropathy, and nephropathy in type 2 diabetes. Optimal glycemic control is Glycemic control to the management of diabetes. The fontrol data from the Glycemic control Fueling for athletic success Cholesterol-balancing strategies Glycemiic Trial Glycemic control type Performance optimization techniques diabetes 2 and the United Kingdom Prospective Diabetes Glycemic control UKPDS; Gycemic 2 diabetes conntrol demonstrated a curvilinear relationship between A1C and diabetes complications, with no apparent ccontrol of benefit, although the absolute reduction in risk was substantially less at lower A1C levels. Similarly, both fasting plasma glucose FPG and postprandial plasma glucose PPG are directly correlated to the risk of complications, with some evidence that PPG might constitute a stronger independent risk factor for CV complications 4— Evidence indicates that improved glycemic control reduces the risk of both microvascular and CV complications. The initial prospective randomized controlled trials were conducted in people with recently diagnosed diabetes. These trials—the DCCT in type 1 diabetes 11the Kumamoto trial 12 and the UKPDS 1,13 in type 2 diabetes—confirmed that improved glycemic control significantly reduced the risk of microvascular complications, but had no significant effect on CV outcomes.

Glycemic control -

This is very similar to how the pancreas works, but these pumps lack a continuous "feed-back" mechanism. Thus, the user is still at risk of giving too much or too little insulin unless blood glucose measurements are made. A further danger of insulin treatment is that while diabetic microangiopathy is usually explained as the result of hyperglycemia, studies in rats indicate that the higher than normal level of insulin diabetics inject to control their hyperglycemia may itself promote small blood vessel disease.

Studies conducted in the United States [65] and Europe [66] showed that drivers with type 1 diabetes had twice as many collisions as their non-diabetic spouses, demonstrating the increased risk of driving collisions in the type 1 diabetes population.

Diabetes can compromise driving safety in several ways. First, long-term complications of diabetes can interfere with the safe operation of a vehicle. For example, diabetic retinopathy loss of peripheral vision or visual acuity , or peripheral neuropathy loss of feeling in the feet can impair a driver's ability to read street signs, control the speed of the vehicle, apply appropriate pressure to the brakes, etc.

Second, hypoglycemia can affect a person's thinking process, coordination, and state of consciousness. Studies have demonstrated that the effects of neuroglycopenia impair driving ability.

Additionally, individuals with a history of hypoglycemia-related driving mishaps appear to use sugar at a faster rate [71] and are relatively slower at processing information. Studies funded by the National Institutes of Health NIH have demonstrated that face-to-face training programs designed to help individuals with type 1 diabetes better anticipate, detect, and prevent extreme BG can reduce the occurrence of future hypoglycemia-related driving mishaps.

The U. Food and Drug Administration FDA has approved a treatment called Exenatide , based on the saliva of a Gila monster , to control blood sugar in patients with type 2 diabetes. Artificial Intelligence researcher Dr.

Cynthia Marling, of the Ohio University Russ College of Engineering and Technology , in collaboration with the Appalachian Rural Health Institute Diabetes Center, is developing a case-based reasoning system to aid in diabetes management.

The goal of the project is to provide automated intelligent decision support to diabetes patients and their professional care providers by interpreting the ever-increasing quantities of data provided by current diabetes management technology and translating it into better care without time-consuming manual effort on the part of an endocrinologist or diabetologist.

Use of a "Diabetes Coach" is becoming an increasingly popular way to manage diabetes. A Diabetes Coach is usually a Certified diabetes educator CDE who is trained to help people in all aspects of caring for their diabetes.

The CDE can advise the patient on diet, medications, proper use of insulin injections and pumps, exercise, and other ways to manage diabetes while living a healthy and active lifestyle. CDEs can be found locally or by contacting a company which provides personalized diabetes care using CDEs.

Diabetes Coaches can speak to a patient on a pay-per-call basis or via a monthly plan. High blood glucose in diabetic people is a risk factor for developing gum and tooth problems, especially in post- puberty and aging individuals.

Diabetic patients have greater chances of developing oral health problems such as tooth decay , salivary gland dysfunction, fungal infections , inflammatory skin disease, periodontal disease or taste impairment and thrush of the mouth.

By maintaining a good oral status, diabetic persons prevent losing their teeth as a result of various periodontal conditions. Diabetic persons must increase their awareness about oral infections as they have a double impact on health. Firstly, people with diabetes are more likely to develop periodontal disease, which causes increased blood sugar levels, often leading to diabetes complications.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. The first symptoms of gum and tooth infection in diabetic persons are decreased salivary flow and burning mouth or tongue.

Also, patients may experience signs like dry mouth, which increases the incidence of decay. Poorly controlled diabetes usually leads to gum recession, since plaque creates more harmful proteins in the gums. Tooth decay and cavities are some of the first oral problems that individuals with diabetes are at risk for.

Increased blood sugar levels translate into greater sugars and acids that attack the teeth and lead to gum diseases. Gingivitis can also occur as a result of increased blood sugar levels along with an inappropriate oral hygiene.

Periodontitis is an oral disease caused by untreated gingivitis and which destroys the soft tissue and bone that support the teeth. This disease may cause the gums to pull away from the teeth which may eventually loosen and fall out. Diabetic people tend to experience more severe periodontitis because diabetes lowers the ability to resist infection [82] and also slows healing.

At the same time, an oral infection such as periodontitis can make diabetes more difficult to control because it causes the blood sugar levels to rise. To prevent further diabetic complications as well as serious oral problems, diabetic persons must keep their blood sugar levels under control and have a proper oral hygiene.

A study in the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are.

Diabetics who receive good dental care and have good insulin control typically have a better chance at avoiding gum disease to help prevent tooth loss. Dental care is therefore even more important for diabetic patients than for healthy individuals. Maintaining the teeth and gum healthy is done by taking some preventing measures such as regular appointments at a dentist and a very good oral hygiene.

Also, oral health problems can be avoided by closely monitoring the blood sugar levels. Patients who keep better under control their blood sugar levels and diabetes are less likely to develop oral health problems when compared to diabetic patients who control their disease moderately or poorly.

Poor oral hygiene is a great factor to take under consideration when it comes to oral problems and even more in people with diabetes.

Diabetic people are advised to brush their teeth at least twice a day, and if possible, after all meals and snacks. However, brushing in the morning and at night is mandatory as well as flossing and using an anti-bacterial mouthwash.

Individuals with diabetes are recommended to use toothpaste that contains fluoride as this has proved to be the most efficient in fighting oral infections and tooth decay.

Flossing must be done at least once a day, as well because it is helpful in preventing oral problems by removing the plaque between the teeth, which is not removed when brushing.

Diabetic patients must get professional dental cleanings every six months. In cases when dental surgery is needed, it is necessary to take some special precautions such as adjusting diabetes medication or taking antibiotics to prevent infection. Looking for early signs of gum disease redness, swelling, bleeding gums and informing the dentist about them is also helpful in preventing further complications.

Quitting smoking is recommended to avoid serious diabetes complications and oral diseases. Diabetic persons are advised to make morning appointments to the dental care provider as during this time of the day the blood sugar levels tend to be better kept under control.

Not least, individuals with diabetes must make sure both their physician and dental care provider are informed and aware of their condition, medical history and periodontal status. Because many patients with diabetes have two or more comorbidities, they often require multiple medications. The prevalence of medication nonadherence is high among patients with chronic conditions, such as diabetes, and nonadherence is associated with public health issues and higher health care costs.

One reason for nonadherence is the cost of medications. Being able to detect cost-related nonadherence is important for health care professionals, because this can lead to strategies to assist patients with problems paying for their medications.

Some of these strategies are use of generic drugs or therapeutic alternatives, substituting a prescription drug with an over-the-counter medication, and pill-splitting. Interventions to improve adherence can achieve reductions in diabetes morbidity and mortality, as well as significant cost savings to the health care system.

As self-management of diabetes typically involves lifestyle modifications, adherence may pose a significant self-management burden on many individuals. one's perception of diabetes, or one's appraisal of how helpful self-management is is likely to relate to one's emotions e.

motivation to change , which in turn, affects one's self-efficacy one's confidence in their ability to engage in a behaviour to achieve a desired outcome. As diabetes management is affected by an individual's emotional and cognitive state, there has been evidence suggesting the self-management of diabetes is negatively affected by diabetes-related distress and depression.

In the case of children and young people, especially if they are socially disadvantaged, research suggests that it is important that healthcare providers listen to and discuss their feelings and life situation to help them engage with diabetes services and self-management.

To this end, treatment programs such as the Cognitive Behavioural Therapy - Adherence and Depression program CBT-AD [87] have been developed to target the psychological mechanisms underpinning adherence.

By working on increasing motivation and challenging maladaptive illness perceptions, programs such as CBT-AD aim to enhance self-efficacy and improve diabetes-related distress and one's overall quality of life. While weight loss is clearly beneficial in improving glycemic control in patients with diabetes type 2, [97] maintaining significant weight loss can be a very difficult thing to do.

In diabetic people who have a body mass index of 35 or higher, and who have been unable to lose weight otherwise, bariatric surgery offers a viable option to help achieve that goal. In a Patient-Centered Outcomes Research Institute funded study was published which analyzed the effects of three common types of bariatric surgery on sustained weight loss and long-lasting glycemic control in patients with diabetes type 2.

Diabetes type 1 is caused by the destruction of enough beta cells to produce symptoms; these cells, which are found in the Islets of Langerhans in the pancreas , produce and secrete insulin , the single hormone responsible for allowing glucose to enter from the blood into cells in addition to the hormone amylin , another hormone required for glucose homeostasis.

Hence, the phrase "curing diabetes type 1" means "causing a maintenance or restoration of the endogenous ability of the body to produce insulin in response to the level of blood glucose" and cooperative operation with counterregulatory hormones.

This section deals only with approaches for curing the underlying condition of diabetes type 1, by enabling the body to endogenously, in vivo , produce insulin in response to the level of blood glucose.

A biological approach to the artificial pancreas is to implant bioengineered tissue containing islet cells , which would secrete the amounts of insulin, amylin and glucagon needed in response to sensed glucose. When islet cells have been transplanted via the Edmonton protocol , insulin production and glycemic control was restored, but at the expense of continued immunosuppression drugs.

Encapsulation of the islet cells in a protective coating has been developed to block the immune response to transplanted cells, which relieves the burden of immunosuppression and benefits the longevity of the transplant.

Research is being done at several locations in which islet cells are developed from stem cells. Stem cell research has also been suggested as a potential avenue for a cure since it may permit regrowth of Islet cells which are genetically part of the treated individual, thus perhaps eliminating the need for immuno-suppressants.

Julio Voltarelli, Dr. Carlos Eduardo Couri, Dr Richard Burt, and colleagues and it was the first study to use stem cell therapy in human diabetes mellitus This was initially tested in mice and in there was the first publication of stem cell therapy to treat this form of diabetes.

In the trial, severe immunosuppression with high doses of cyclophosphamide and anti-thymocyte globulin is used with the aim of "turning off" the immunologic system", and then autologous hematopoietic stem cells are reinfused to regenerate a new one.

In summary it is a kind of "immunologic reset" that blocks the autoimmune attack against residual pancreatic insulin-producing cells.

Until December , 12 patients remained continuously insulin-free for periods ranging from 14 to 52 months and 8 patients became transiently insulin-free for periods ranging from 6 to 47 months.

Of these last 8 patients, 2 became insulin-free again after the use of sitagliptin, a DPP-4 inhibitor approved only to treat type 2 diabetic patients and this is also the first study to document the use and complete insulin-independendce in humans with type 1 diabetes with this medication.

In parallel with insulin suspension, indirect measures of endogenous insulin secretion revealed that it significantly increased in the whole group of patients, regardless the need of daily exogenous insulin use.

Technology for gene therapy is advancing rapidly such that there are multiple pathways possible to support endocrine function, with potential to practically cure diabetes.

In November the FDA approved Teplizumab a monoclonal antibody drug which aims to delay type 1 diabetes by reprogramming the immune system to stop mistakenly attacking pancreatic cells. Type 2 diabetes is usually first treated by increasing physical activity, and eliminating saturated fat and reducing sugar and carbohydrate intake with a goal of losing weight.

These can restore insulin sensitivity even when the weight loss is modest, for example around 5 kg 10 to 15 lb , most especially when it is in abdominal fat deposits.

Diets that are very low in saturated fats have been claimed to reverse insulin resistance. Cognitive Behavioural Therapy is an effective intervention for improving adherence to medication, depression and glycaemic control, with enduring and clinically meaningful benefits for diabetes self-management and glycaemic control in adults with type 2 diabetes and comorbid depression.

Testosterone replacement therapy may improve glucose tolerance and insulin sensitivity in diabetic hypogonadal men. The mechanisms by which testosterone decreases insulin resistance is under study.

Recently [ when? The precise causal mechanisms are being intensively researched; its results may not simply be attributable to weight loss, as the improvement in blood sugars seems to precede any change in body mass.

This approach may become a treatment for some people with type 2 diabetes, but has not yet been studied in prospective clinical trials.

MODY is a rare genetic form of diabetes, often mistaken for Type 1 or Type 2. The medical management is variable and depends on each individual case. Several immunosuppressive drugs targeting the chronic inflammation in type 2 diabetes have been tested.

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Short-term evaluation of individual and group training". com Diabetes Driving. Journal of Diabetes Science and Technology. See "Glycemic control and vascular complications in type 1 diabetes mellitus" and "Overview of general medical care in nonpregnant adults with diabetes mellitus".

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Language Chinese English. Authors: Silvio E Inzucchi, MD Beatrice Lupsa, MD Section Editor: David M Nathan, MD Deputy Editor: Katya Rubinow, MD Literature review current through: Jan This topic last updated: Jan 02, Although the benefit of glycemic control on microvascular disease in type 2 diabetes was documented in the United Kingdom Prospective Diabetes Study UKPDS , its role in reducing cardiovascular risk has not been similarly established.

Your Glycemic control sugar Olive oil skin is the range you try to Glycemic control as much Glydemic possible. Read about Monitoring Your Blood Glycwmic and All Glycemuc Your A1C. Staying Gylcemic your Glycemic control range can also help improve your energy and mood. Find answers below to common questions about blood sugar for people with diabetes. Use a blood sugar meter also called a glucometer or a continuous glucose monitor CGM to check your blood sugar. A blood sugar meter measures the amount of sugar in a small sample of blood, usually from your fingertip.

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