Background Insulin injection technique re-education and diabetes knowledge empowerment has led to improved glycemic control. Objectives To evaluate the impact of pharmacist’s monthly re-education on insulin injection technique (IT), lipohypertrophy, patients’ perception on insulin therapy and its effect on glycaemic control. Methods This randomized controlled, multi-centered study was conducted among type 2 diabetics from 15 government health clinics. 160 diabetics with baseline HbA1 C ≥ 8% and unsatisfactory IT technique were randomized into control or intervention group. Control group received standard pharmacist counselling during initiation and at 4th month. Intervention group received monthly counselling and IT re-education for 4 months. Assessment of diabetes, IT knowledge, adherence and perception towards diabetes were conducted using validated study tools Insulin Treatment Appraisal Scale (ITAS) and Medication Compliance Questionnaire (MCQ)). Results 139 patients completed the study; control group (69), intervention group (70). In control group, all outcomes shown improvement except for patient’s perception. Mean HbA1 C decreased 0.79% ± 0.24 (p = 0.001). In intervention group, all outcomes improved significantly. HbA1c reduces significantly by 1.19% ± 0.10 (p < 0.001). Monthly re-education improved patient’s perception towards insulin therapy (ITAS score reduced 1.44 ± 2.36; p = 0.021). Between groups, interventional arm shown significantly better improvement in all outcomes. Improvement was shown in IT technique (+2.02 score; p < 0.001), medication adherence (+1.48 score; p < 0.001) and ITAS (−1.99 score; p = 0.037). Mean HbA1 C reduced an additional of 0.63% (p = 0.008) compared to control arm. Conclusion Re-education is more effective in increasing adherence, reducing lipohypertrophy, improving injection technique and patient’s perception on insulin therapy, thereby providing better glycaemic control.
Background: Vitamin C is an essential element required for normal metabolic function. We investigated the effect of vitamin C supplementation on circulating miRNA (miR) expression in subjects with poorly controlled type 2 diabetes mellitus (T2DM). Changes in miR expression were also correlated with clinical measures of disease. Methods: Pre-and post-vitamin C supplementation samples from five participants who had increased vitamin C levels, improved oxidative status and polymorphonuclear (PMN) function after receiving 1,000 mg of vitamin C daily for six weeks were screened for miRNA expression using the NanoString miRNA assay. Differences in miRNA expression identified from the miRNA screen were validated by qRT-PCR. Results: Four miRNAs showed significantly different expression post-vitamin C supplementation relative to baseline, including the downregulation of miR-451a (-1.72 fold change (FC), p=0.036) and up-regulation of miR-1253 (0.62 FC, p=0.027), miR-1290 (0.53 FC, p=0.036) and miR-644a (0.5 FC, p=0.042). The validation study showed only miR-451a expression was significantly different from baseline with vitamin C supplementation. MiR-451a expression was negatively correlated with vitamin C levels (r=-0.497, p=0.049) but positively correlated with levels of malondialdehyde (MDA) (r=0.584, p=0.017), cholesterol (r=0.564, p=0.022) and lowdensity lipoproteins (LDL) (r=0.522, p=0.037). Bioinformatics analysis of the putative target genes of miR-451a indicated gene functions related to signaling pathways involved in cellular processes, such as the mammalian target of rapamycin (mTOR) signaling
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