Adel B. Mazanderani

Effect of Internet Therapeutic Intervention on A1C Levels in Patients With Type 2 Diabetes Treated With Insulin

OBJECTIVE To assess the effect of an Internet-based glucose monitoring system (IBGMS) on A1C levels in patients with type 2 diabetes treated with insulin. RESEARCH DESIGN AND METHODS This trial involved 50 patients randomly assigned to receive either conventional treatment alone or with additional follow-up through an IBGMS for 6 months. Patients randomized to the intervention group uploaded blood glucose readings every 2 weeks to a secure Web site for review and receipt of feedback from their endocrinologist. A1C and laboratory test results were collected at 0, 3, and 6 months. RESULTS The baseline parameters were not significantly different. Over a 6-month follow-up, A1C dropped from 8.8 to 7.6% (P < 0.001) in the intervention group compared with 8.5 to 8.4% (P = 0.51) in the control group. CONCLUSIONS The use of IBGMS significantly improved A1C levels in patients with type 2 diabetes treated with insulin.

Efficacy of A1C Reduction Using Internet Intervention in Patients with Type 2 Diabetes Treated with Insulin

ABSTRACT OBJECTIVE: To assess the effect of an Internet-based glucose monitoring system (IBGMS) on glycated hemoglobin (A1C) levels in patients with type 2 diabetes mellitus treated with insulin. METHODS: Fifty patients were randomly assigned to receive conventional care alone (control) or additional follow-up via IBGMS for 6 months. Patients randomized to the IBGMS group uploaded blood glucose readings to a secure website every 2 weeks to receive feedback from their endocrinolo- gist. After 6 months, all patients returned to conventional care. A1C and laboratory test results were collected at 0, 3, 6 and 12 months. RESULTS: Baseline parameters were not significantly different. After a 6-month follow-up, A1C dropped from 8.8% to 7.6% (p CONCLUSION: IBGMS significantly improved A1C levels in patients with type 2 diabetes treated with insulin, but this effect was lost with cessation of the intervention.

Review of the effect of internet therapeutic intervention in patients with type 1 and type 2 diabetes.

The use of the Internet has changed the way health care professionals manage diabetes, with platforms now available allowing patients to upload self-monitoring of blood glucose data and share with their health care provider (1). Previous studies have established the efficacy of Internet blood glucose monitoring systems (1–3). It is now our standard of care to offer an Internet blood glucose monitoring system to patients. We currently have 1,100 patients enrolled and have outcome data on the first 409 patients. Of the 409 patients, 388 had HbA1c at baseline and at least one subsequent HbA1c determination within 9 months. HbA1c values from 3–9 months were averaged to generate follow-up data. The relationship of reporting frequency and HbA1c change was determined by dividing patients into frequent reporters, who reported more than once per month, and infrequent reporters. Patients were instructed to upload self-monitoring …

A Comparison of Internet Monitoring with Continuous Glucose Monitoring in Insulin-Requiring Type 2 Diabetes Mellitus

OBJECTIVE To compare the effects of real-time continuous glucose monitoring (RT-CGM) and an Internet blood glucose monitoring system (IBGMS) on glycated hemoglobin levels in patients with type 2 diabetes mellitus treated with insulin. METHODS Fifty-seven patients with type 2 diabetes treated with insulin were assigned randomly to 1 of 2 groups. Group 1 had the results of their self-monitoring of blood glucose level monitored biweekly using an IBGMS. Group 2 used RT-CGM and were monitored biweekly. Both groups used a secure website to upload data and to receive feedback from their endocrinologist. A1C and laboratory test results were collected at 0, 3 and 6 months. RESULTS The baseline parameters were not significantly different. After a 6-month follow-up period, both IBGMS and RT-CGM showed significant within-group improvements in A1C level. In the IBGMS group, the A1C level decreased from 8.79%±1.25% to 7.96%±1.30% (p<0.05). The RT-CGM group decreased from 8.80%±1.37% to 7.49%±0.70% (p<0.001). IBGMS and RT-CGM did not show significantly different A1C levels at baseline, 3 and 6 months (p>0.05). CONCLUSIONS The use of both IBGMS and RT-CGM significantly improved A1C levels in patients with type 2 diabetes treated with insulin in a randomized trial over a 6-month period. There were no significant differences in A1C values between groups after 6 months.

Apolipoprotein B levels in adults with type 1 diabetes not receiving lipid-lowering therapy

OBJECTIVES To investigate apolipoprotein B (apoB) levels in adult patients with type 1 diabetes with no history of cardiovascular disease and not receiving lipid-lowering therapy. DESIGN AND METHODS Subjects (n=169) were divided into two groups based on gender. Primary analysis examined lipid parameters and glycosylated hemoglobin. Secondary analysis involved classifying patients according to the Canadian Diabetes Associations (CDA) LDL cholesterol and apoB targets. RESULTS Mean apoB levels were 0.81+/-0.17 g/L in males and 0.78+/-0.18 g/L in females. We also found that among patients who failed to achieve the CDA LDL cholesterol target, 62% of males and 66% of females [corrected]met the apoB target. CONCLUSIONS There is low prevalence of elevated apoB among patients with type 1 diabetes. In addition, there is discordance between the proportions of patients meeting either LDL cholesterol or apoB targets, thus a significant number of patients may be prescribed lipid-lowering medications unnecessarily.

Low Prevalence of Elevated ApoB Levels in Patients with Type 2 Diabetes Not Receiving Lipid-Lowering Therapy

OBJECTIVE Cardiovascular disease (CVD) is the leading cause of death in people with type 2 diabetes. Apolipoprotein B (apoB) is known to be a better marker of CVD risk than low-density lipoprotein cholesterol (LDL-C). This study investigated apoB levels in people with type 2 diabetes. METHODS We obtained blood samples from 507 consenting people with type 2 diabetes who were not receiving lipid-lowering medication and who had no previous history of CVD. Subjects were divided into 3 groups: men (M), women <50 years old (W1) and women ≥50 years old (W2). Primary analysis examined lipid parameters, specifically apoB. Secondary analysis involved classifying patients according to the Canadian Diabetes Associations apoB, LDL-C and triglyceride (TG) targets. RESULTS We found a total mean apoB level of 0.92 g/L. Among patients who failed to achieve the LDL-C target, 28% of M, 39% of W1 and 30% of W2 met the apoB target. The proportions of individuals categorized as being above the LDL-C and apoB targets were significantly different in all 3 groups (p<0.01). When LDL-C was below target and TG was <1.5 mmol/L, 100% of M and W1 and 93% of W2 met the apoB target. CONCLUSIONS The discordance between the proportions of patients meeting LDL-C and apoB targets may lead to patients being erroneously classified. ApoB and LDL-C correlate very well when TG is <1.5 mmol/L, but not when ≥1.5 mmol/L. Approximately one-third of patients met both LDL-C and apoB goals. Thus, not all patients with type 2 diabetes should be considered to be at a high risk of CVD.