The present review, basal insulin is a highly effective treatment in reducing fasting blood glucose, but it is associated with considerable risk of hypoglycemia and weight gain. Glucagon like peptide 1 receptor agonists (GLP-1 RAs) is also effective in terms of glycemic control and associated with weight loss and low risk of hypoglycemia. The potential benefits of combining GLP-1RAs with basal insulin are contemplated in the current position statement of both the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE). The add-on of short acting insulin to an existing basal insulin therapy enabled similar HbA_1c reductions to the add-on of a GLP-1 RA, but simultaneously increased the number of episodes of hypoglycaemia and might lead to more unfavourable body weight developments. A fixed combination of basal and GLP1 agonist showed an effective and rather steady blood glucose reduction in a 24-hour interval vs. basal insulin or GLP-1 RA alone.

With ease to use devcies and wearable technologies of today, it is possible to monitor and collect the health paramaters reliably and regularly and draw conclusions regarding the state the state of the health and can get faster interventions of medical experts when conditions are not right. The health data collected can be processed for  additional information of the vital parameter trends, instinctive abnormalities, repeatation frequency patterns of the abnormalities and variations to the medical experts for correct diagnostic decisions and care planning. Advanced and intelligent signal processing,analytical and statistical algorithms offer great assistance to doctors to diagnose and plan the care offering. This user friendly information makes the anxious patients aware of the situation and manage their health and needed assistance. Sensesemi’s health eco system shown in figure 1 consisting of easy to use handheld integrated device which monitors vitals blood pressure, blood glucose,heart rate, Body temperature and  ECG in the first release which will soon be expanded with other parameters. The the lifestyle information is collected by the eco system as the user input and machine learnt as the user uses the device for determining the overall health of the person.

FDA confirms increased risk of leg and foot amputations with the anti-diabetic agent canagliflozin (Invokana, Invokamet, Invokamet XR). Based on new data from two large clinical trials, the U.S. FDA has concluded that the T2D medicine canagliflozin causes an increased risk of leg and foot amputations. Doctors before starting canagliflozin, should consider factors that may predispose the need for amputations. Factors include a history of prior amputation, peripheral vascular disease, neuropathy, & diabetic foot ulcers. Untreated, T2D can lead to serious problems, including blindness, nerve and kidney damage, and heart disease. Final results from two clinical trials – the CANVAS (Canagliflozin CV Assessment Study) and CANVAS-R (A Study of the Effects of Canagliflozin on Renal Endpoints in Adult Participants With T2D) – showed that leg & foot amputations occurred about twice as often in patients treated with canagliflozin compared to patients treated with placebo.  Amputations of the toe and middle of the foot were the most common; however, amputations involving the leg, below and above the knee, also occurred. Some patients had more than one amputation, some involving both limbs. Other side effects include low BP, ketoacidosis; kidney problems; a high amount of potassium in the blood; serious UTI; low blood sugar when combined with other diabetes medicines; yeast infections; bone breaks; & increased cholesterol. Although it is not yet clear why and how it increases amputation risks, the European Medicines Agency EMA advises: “For canagliflozin, lower limb amputation should be listed as an uncommon side effect (occurring in between 1 & 10 patients in 1,000). Doctors should consider stopping treatment if patients develop significant foot complications such as infection or skin ulcers.” The EMA investigation into the connection between canagliflozin and lower limb amputation began in April of 2016. Meanwhile, here at home, the FDA continues to sit on its hands. Last year, the US regulatory agency said that it “has not determined whether canagliflozin increases the risk of leg and foot amputations,” but that it was “currently investigating this new safety issue” and would “update the public” when more information was available. So far, there has been no further word or action on the FDA’s part beyond the release of a few safety notices.

Objective:  The primary objective of the study was to establish the effectiveness of an exercise and dietary intervention program on the changes in baseline HbA1C and Lipid profiles between and among exercise and control groups over time. 

Methods:  The study was undertaken in Guateng, S.A, in Mamelodi, a suburb in the city of Tshwane.  A community hall in the Mamelodi area was used to perform the interventional exercise and educational sessions.  The study spanned for duration of 5 months (20 weeks), Study participants comprised of both black male and female participants between the ages 40-65 years with type 2 DM. Subjects had to comply with the Inclusion and Exclusion Criteria. 

Results:  In comparing the difference in glucose control in both the exercise and control groups over time having adjusted for baseline there was a significant difference in the exercise group over time (p<0.04), however the was no significant difference (p=0.72) in the control group over time.  In viewing the Lipid profiles there has been no significant difference among the exercise group (p>0.5).  There also was no significant difference over time between both groups (p>0.05).  The above is indicative that exercise did not positively influence their lipid profiles.  Conclusion: The primacy outcome of the study was to determine whether a supervised exercise and dietary intervention to decrease HbA1c over a 20-week period in type 2 subjects was more effective than a dietary education.  However, the HbA1c did improve in the exercise group over time as compare to the control group but had no significant difference among between groups over time.  This 20-week intervention program involving the lifestyle change of dietary education and dietary education and exercise intervention resulted in better glycemic control in the exercise group.  Significant reductions were achieved in the HbA1c percentages in the exercise group (p=0.04) over time whilst no-significant difference was observed in the control group over time.  There has been no significant change in the lipid values over time. 

Aim: To evaluate the effectiveness of serum interleukin-18 (IL-18) levels as a predictive marker for cardiovascular complications in patients with diabetic nephropathy

Method: We included 40 patients with diabetic nephropathy and exclude patients with previous history of cardiovascular disease, cerebrovascular disease, any sign of infection, and pulmonary disease. We measured IL-18 2 times, one at baseline and one time after 2 years of follow-up. We also run a transthoracic echocardiography 2 times at baseline and after 2 years of follow-up.

Results: The mean baseline interleukin 18 level was 162 pg/ml with SD 12.45 pg/ml which was significantly above the normal level. The mean of baseline ejection fraction was 52% with SD

During the 2 years follow-up, 8 cases of acute coronary syndrome were reported. The mean IL-18 level in the patients that developed ACS was 192 pg/ml while in non-ACS patients, the secondary interleukin 18 mean was 171 pg/ml (P<00.1). After a 2 year follow-up, we performed echocardiography in all patients and we found that there is a reverse relationship between ejection fraction and interleukin 18 levels (EF>50% and mean IL-18 of 165, EF 40-50% and mean IL-18 of 171, EF<40% and mean IL-18>180, P<0.05).

Conclusion: There is a strong association between diabetic nephropathy and death from cardiovascular disease. Both diabetes and nephropathy predispose patients for cardiovascular disease. Studies have shown that patients with diabetic nephropathy should be managed more rigorously for cardiovascular risk factor modification. Finding a reliable marker that can predict the risk of cardiovascular disease in patients can help with better management and early angiography if needed. Interleukin 18 levels may be considered as a predictor of heart failure and acute coronary syndrome in diabetics.