24-hour glucose control was effective in the group treated with insulin, with good long-term effects when applied consistently. But in the control group only good short-term effect was seen. Therefore, long-term treatment is recommended, even though the majority of patients with poorly controlled diabetes are unaware of the need for it.
The circadian rhythm of blood glucose has been demonstrated through numerous studies. Although the mechanism of glucose regulation is not well understood, it appears that the circadian rhythm of insulin release affects glucose metabolism.
Diabetes remains an emerging health problem that affects many adults and has a profound influence on their quality of life. Current treatments require 24-hour glucose control achieved by intensive insulin infusion or intensive insulin supplementation or combination with oral anti-diabetic treatments. The importance must be given to the necessity of long-term adherence and cost containment of this treatment.
Many patients in the United States do not have 24-hour glucose control. We can only know if individuals have achieved 24-hour glucose control or not if we have complete information about their medical record.
Gestational diabetes is associated with a decrease in beta cell mass of the pancreas. Abnormalities of beta cell cell response to glucose are seen in early pregnancy. Pregnancy may increase the risk of GDM as fetal hyperalergia to glucose and insulin in pregnancy may lead to increased blood glucose levels. 24-hour glucose is significantly lower than conventional glucose in pregnancy. 24-hour glucose may facilitate the diagnosis of gestational diabetes in pregnancy.
For the majority of people with [type 1 diabetes](https://www.withpower.com/clinical-trials/type-1-diabetes) the primary treatment is continuous subcutaneous insulin infusion (CSII) and is prescribed according to an algorithm and in a program that is set up by health professionals. With respect to 24-hour glucose control, the only common medication is glucagon-like peptide 1 receptor agonist (GLP-1RA). Some patients with type 1 diabetes have other treatments as well, such as an oral anti-diabetic drug, a low-calorie food meal that is high in fiber (fiber supplements), or a combination of medication that regulates blood glucose. For more advanced diabetes mellitus, more aggressive approaches should always be taken in close cooperation with endocrinologic-diabetologists.
Upf controlled diet has proven to be more effective than usual diet because it does not only affect a glycemia profile but also a lipid profile towards an LDL-reduction. This effect is independent from the diet regimen itself and seems to be related to a better tolerance of food.
More than half of first-degree relatives showed glucose values in the abnormal range; 1.4% of them had impaired glucose tolerance, and 0.75% diabetes. Findings from a recent study suggest the need for screening of glucose values in people related to known diabetes.
Both HbA1c and FBG have their acceptable limits of accuracy and need further improvement. To achieve similar levels of A1C or FBG, patients should follow their daily pattern of eating, drinking and exercise so as to minimize the risks of hypoglycemia or hyperglycemia.
There is an increasing body of literature reporting on treating 24-hour glucose control with many new approaches. The key issue for many patients and health care insurance providers is to find the most cost-efficient approach because managing high blood glucose levels affects most patients and is the leading cause of hospitalization and death in the United States. There is an urgent need to reduce unnecessary hospitalizations and improve quality of care for the growing number of people with diabetes.
High upf diet increases the need of long-acting insulin and the likelihood to use high upf insulin. It also increases the number of hypoglycemic events. We recommend high upf diet in those with fasting glucose more than 110 mg/dl in the first hours after breakfast.
The data from the HEART study demonstrated that a very low carbohydrate diet can provide effective treatment for patients with type 2 diabetes. The diet tested in this study was developed from the results of a previous small study. It may be that in the future there will be a trial assessing this effect of a high carbohydrate controlled diet.