XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

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Modern Applied Statistics With S

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.22759

Diagnosis, management, and treatment of hepatitis C: An update

Hepatitis C virus (HCV) is a major cause of liver disease worldwide and a potential cause of substantial morbidity and mortality in the future. The complexity and uncertainty related to the geographic distribution of HCV infection and chronic hepatitis C, determination of its associated risk factors, and evaluation of cofactors that accelerate its progression, underscore the difficulties in global prevention and control of HCV. Because there is no vaccine and no post-exposure prophylaxis for HCV, the focus of primary prevention efforts should be safer blood supply in the developing world, safe injection practices in health care and other settings, and decreasing the number of people who initiate injection drug use.

https://courses.washington.edu/conj504/readings/alter_reading3.pdf

Global epidemiology of hepatitis C virus infection

Regulatory T (T(Reg)) cells are essential for maintaining peripheral tolerance, preventing autoimmune diseases and limiting chronic inflammatory diseases. However, they also limit beneficial responses by suppressing sterilizing immunity and limiting antitumour immunity. Given that T(Reg) cells can have both beneficial and deleterious effects, there is considerable interest in determining their mechanisms of action. In this Review, we describe the basic mechanisms used by T(Reg) cells to mediate suppression and discuss whether one or many of these mechanisms are likely to be crucial for T(Reg)-cell function. In addition, we propose the hypothesis that effector T cells may not be 'innocent' parties in this suppressive process and might in fact potentiate T(Reg)-cell function.

/pdf/how-regulatory-t-cells-work-3kg9ber5qg.pdf

How regulatory T cells work.

https://www.journal-of-hepatology.eu/article/S0168-8278(10)60268-1/pdf

266 clinical markers of the metabolic syndrome are associated with hcv genotype 1 infection and are strong negative predictors of early virological response

each other and may well also be influenced by multiple factors unexplored in the research by Ludvigsson et al, including anxiety and depression symptom severity, other psychological and physiological comorbidities, illness perceptions, self‐efficacy, and coping styles. Further longitudinal research which accounts for the identified limitations is likely to better elucidate the mechanisms underpinning anxiety and depression in coeliac cohorts and how it relates to mucosal healing. Nevertheless, Ludvigsson et al provide important evidence for the interplay between mucosal healing and psychological comorbidity, and the significant psychological costs associated with maintaining a GFD. Given this, along with utilising a GFD as directed by dieticians and gastroenterologists, it seems that the integration of mental health professionals to identify and address psychological comorbidities is not only warranted but also likely to lead to improved physical and psychological health.

Editorial: "real world data" of AIH-time to connect!

Diabetes therapy aims for stable glycemic control and minimal hypoglycemia risk, previously linked to day-to-day variability. In a post-hoc analysis, day-to-day fasting glycemic variability with IDegLira was compared with IGlar U100, in DUAL V (IDegLira vs. IGlar U100) and VII (IDegLira vs. IGlar U100 and bolus insulin aspart) (NCT 01952145 and 02420262). Weekly and overall measures of day-to-day fasting glycemic variability were calculated using subjects’ daily fasting SMPG values, overall measure was used to divide the populations into tertiles, and proportional odds were statistically significant favoring IDegLira (Table). More subjects treated with IDegLira had lower overall day-to-day fasting glucose variability vs. IGlar 100 (Table). Hypoglycemia rates were reduced with lower variability with IDegLira vs. comparators in all tertiles (Table). In DUAL V (IDegLira vs. IGlar U100) and DUAL VII (IDegLira vs. IGlar U100 plus bolus insulin aspart) respectively, statistical analysis of weekly variances showed a 32% (p Disclosure I. Lingvay: Advisory Panel; Self; Novo Nordisk A/S, Eli Lilly and Company, AstraZeneca, Intarcia Therapeutics, Inc., Sanofi-Aventis. Research Support; Self; Novo Nordisk A/S, Merck Sharp & Dohme Corp., Pfizer Inc., GI Dynamics Inc., Novartis AG. Other Relationship; Self; Sanofi, AstraZeneca, Boehringer Ingelheim GmbH, Novo Nordisk A/S. A. Doshi: Advisory Panel; Self; Pfizer Inc. P.A. Garcia-Hernandez: Research Support; Self; Novo Nordisk A/S, PAREXEL International Corporation, Amgen Inc., ICON plc.. Speaker9s Bureau; Self; Eli Lilly and Company, Novo Nordisk A/S, Amgen Inc., AstraZeneca. J. Merino Torres: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk A/S. Speaker9s Bureau; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis, Janssen Pharmaceuticals, Inc. M. Rodacki: Research Support; Self; Faperj. Speaker9s Bureau; Self; Allergan, Novo Nordisk A/S. Speaker9s Bureau; Spouse/Partner; Biogen. S. Eggert: Employee; Self; Novo Nordisk A/S. R. Gron: Employee; Self; Novo Nordisk A/S. E. Jaeckel: Advisory Panel; Self; Novo Nordisk A/S, Lilly, AstraZeneca, Boehringer, Merck Sharp & Dohme Corp., Janssen, Roche, Novartis. Board Member; Self; Novo Nordisk A/S, Lilly. Research Support; Self; Novo Nordisk A/S, Novartis, Gilead Sciences, Inc., Roche, Miltenyi Biotec, Biotest Pharmaceuticals Corporation, Fresenius SE & Co. KGaA, DFG, BMBF, EU, JDRF, VolkswagenStiftung. Speaker9s Bureau; Self; Novo Nordisk A/S, Lilly, AstraZeneca, Boehringer, Merck Sharp & Dohme Corp., Janssen, Roche, Novartis AG.

Lower Day-to-Day Fasting Self-Measured Plasma Glucose (SMPG) Variability with Insulin Degludec/Liraglutide (IDegLira) vs. Insulin Glargine 100 Units/mL (IGlar U100)

SARS-CoV-2-specific immunity in immunosuppressed COVID-19 convalescents with autoimmune hepatitis.

Hepatitis C Virus (HCV) infection is a common cause of chronic liver disease but is rarely diagnosed at the stage of acute hepatitis C. HCV becomes chronic in about 85% of individuals and leads to cirrhosis in 5 to 30 percent of cases [1]. The chronic course of acute infection should be avoided to prevent the potential risk of cirrhosis and hepatocellular carcinoma in patients with chronic hepatitis C. Overall, approximately 3% of the world’s population is thought to be infected with HCV. In the US, the National Health and Nutrition Examination Study III (NHANES III) showed an anti-HCV prevalence of 1.8% corresponding to 3.9 million anti-HCV-positive patients [2]. In Germany, approximately 350,000 individuals (0.4% of the population) are HCV carriers [3].

Elmar Jaeckel

Papers

266 clinical markers of the metabolic syndrome are associated with hcv genotype 1 infection and are strong negative predictors of early virological response

Editorial: "real world data" of AIH-time to connect!

Lower Day-to-Day Fasting Self-Measured Plasma Glucose (SMPG) Variability with Insulin Degludec/Liraglutide (IDegLira) vs. Insulin Glargine 100 Units/mL (IGlar U100)

SARS-CoV-2-specific immunity in immunosuppressed COVID-19 convalescents with autoimmune hepatitis.

Treatment of Acute Hepatitis C