Coronavirus disease 2019 (COVID-19) is continuing to spread around the world despite the introduction of vaccines. Individuals with diabetes have been reported to have more severe clinical outcomes of COVID-19 infection. As there is potential that glucose-lowering agents can influence the clinical outcomes in diabetic patients with COVID-19, a number of studies are ongoing to explore the differences in clinical outcomes related to glucose-lowering agents. In this article, I summarize the published research on the relationship between glucose-lowering agents and clinical outcomes of diabetic patients with COVID-19 and suggest clinical consideration for usage of glucose-lowering agents.

The prevalence of metabolic diseases such as obesity, type 2 diabetes, and insulin resistance continues to rise. These conditions are associated with multiple social, genetic, and environmental risk factors, including the human gut microbiota, which has emerged as a critical mediator linked to metabolic disease. Recent evidence suggests that the gut microbiota has personalized effects on the gut-brain axis, which controls metabolic function. Gut microbiota can be a great source of prognostic biomarkers and therapies for metabolic diseases. The microbiome also influences immune system development and homeostasis. In this review, I summarize recent findings regarding the association between the gut microbiome and type 2 diabetes. These findings will inform future diabetes mellitus prevention, diagnosis, and treatment strategies.

Not only mean blood glucose, but also 'glycemic variability,' the degree of fluctuation in blood glucose, has been suggested to contribute to diabetic complications. Glycemic variability can be expressed with various indices, such as standard deviation, coefficient of variation (CV), mean amplitude of glycemic excursion, etc.; however, standard indicators have not been established. Recently, CV was designated in cases of application of continuous glucose monitoring system according to international consensus. In this review, clinical implications of glycemic variability are dealt with respect to micro- and macrovascular complications of diabetes, and clinical evidence of new anti-diabetics are summarized about efficacy on the glycemic variability.

Increased blood pressure variability (BPV) has been found to significantly increase the risk of cardiovascular morbidity and mortality in the non-diabetic population. The prognostic importance of increased BPV for the development of micro- and macrovascular complications in type 2 diabetes has been investigated. Type 2 diabetes can increase BPV through different mechanisms, including increased arterial stiffness and autonomic dysfunction. Several studies in type 2 diabetic patients showed inconclusive results regarding all-cause mortality, microvascular complication, and extended major adverse cardiovascular events (MACE). However, some trials showed that BPV might be regarded as a potentially important therapeutic target in the management of type 2 diabetes regarding MACE. For now, the primary goal of antihypertensive treatment in patients with type 2 diabetes shall remain to controll mean blood pressure levels. However, when future studies show consistent results, BPV might be regarded as a therapeutic target in type 2 diabetic patients.

Diabetic dyslipidemia is characterized by hypertriglyceridemia, low HDL (high-density lipoprotein)- cholesterol, elevated LDL (low-density lipoprotein)-cholesterol, and predominance of small dense LDL particles caused by insulin resistance in type 2 diabetes or insulin deficiency in type 1 diabetes. Dyslipidemia is a major risk factor for atherosclerotic cardiovascular disease in diabetes, and lowering lipid levels can reduce its morbidity and mortality. Current guidelines for dyslipidemia management recommend that the LDL-C goal be lower than 55~100 mg/dL depending on the underlying risk factors. However, higher visit-to-visit variability in cholesterol levels might be an independent predictor of major adverse cardiovascular events and poor renal outcomes in diabetes. In this review, we focused on clinical implications of lipid variability in diabetes.

Dieting has multiple meanings including 'intentional weight loss' or 'a specific eating pattern.' Although obesity is considered a deleterious health problem worldwide, there are many problems caused by 'too strict' weight control and distorted body image ideals. Many people want to lose weight and repeat weight loss and gain multiple times throughout their lives. This is called 'weight cycling.' Recent studies report the negative impact of obesity and the danger of weight cycling for cardiometabolic health. Many experimental studies show that weight cycling can cause fluctuations in cardiovascular risk factors, such as blood pressure, heart rate, sympathetic activity, and circulating levels of glucose, lipids, and insulin. These repeated fluctuations during periods of weight regain put additional stress on the cardiovascular system. This study reviews current evidence for the effects of weight cycling on diabetes mellitus.

The use of continuous glucose monitoring (CGM) for blood glucose control is increasing and is effective in changing treatment methods and improving lifestyle by identifying problems in blood sugar patterns. However, adverse skin events are increasing due to the insertion of invasive tools or attachment of sensors to the skin for 14 days for intermittent CGM. These adverse events can be the reason for the discontinuation of CGM. Therefore, this paper aims to determine methods to identify and manage skin irritation and side effects caused by CGM accessories.

Medical nutrition therapy (MNT) plays an important role in diabetes management. For effective MNT, not only an individualized meal plan considering daily eating habits and preferences, but also overall management strategies and adjustments on drug therapy and physical activity are required. In particular, an individualized meal plan is needed based on an understanding of the medicine's mechanism and side effects, because glucose is controlled well only when prescription medicines and diet are in harmony.

The purpose of this study was to examine the effects of motivational interviewing (MI) training on diabetes educators' counseling skills and self-efficacy. Diabetes educators were randomly allocated to the MI training group or control group. The experimental group was provided with a one-day course on MI. Pre-, post-, and follow-up (F/U) measurements were compared. Twenty-four diabetes educators participated in this study. Scores on the counseling skills post-test and F/U-test increased significantly compared to pre-test in the MI training group, as did scores on the helping skill self-efficacy post-test and F/U-test. Session management self-efficacy post-test scores also increased significantly compared to pre-test in the MI training group. There were no significant differences in pre-post and pre-F/U scores in the control group. Diabetes educator-patient communication is an important factor affecting the management of diabetes. MI training increases the counseling skills & self-efficacy of diabetes educators. Diabetes educators should use MI to facilitate patient health behavior changes in diabetes education.

Background: This study aimed to explore the long-term management of diabetes patients in domestic general hospitals by reviewing 2013 and 2018 data on diabetes management status.
Methods: Of 1,802 type 2 diabetes patients who received outpatient treatment at nine general hospitals in Korea and who participated in the 2013 study, 1,124 were enrolled in this study. General characteristics, comorbidities, complications, and management were investigated through medical records.
Results: The average age of the subjects was 65.4 ± 10.6 years, the average duration of diabetes mellitus was 15.6 ± 8.0 years, and 58.2% of the subjects had a family history of diabetes. Concomitant diseases were hypertension in 63.0% and dyslipidemia in 78.8%. Diabetic retinopathy was observed in 31.5%, nephropathy in 24.6%, and neuropathy in 24.5%. The mean glycosylated hemoglobin (HbA1c) level was 7.4 ± 2.2% and according to Korean Diabetes Association guidelines, 20.4% of patients with diabetes achieved a HbA1c level of < 6.5%, 70.1% achieved a blood pressure of < 140/85 mm Hg, and 77.1% achieved a low density lipoprotein cholesterol level of < 100 mg/dL. The target achievement rate was 12.5% for blood sugar, blood pressure, and lipid parameters.
Conclusion: In diabetes management, blood sugar control was poor compared to blood pressure and lipid control. A systematic management plan is needed to ensure proper blood sugar control.