The optimization of metabolic control in Type 1 and Type 2 diabetes mellitus (T1DM and T2DM, respectively) [i.e., the maintenance of near-normal hemoglobin A(1c) (HbA(1c)) without increasing the risk of hypoglycemia] could be enhanced by analysis of self-monitoring blood glucose (SMBG) data assessing complementary processes: exposure to hyperglycemia and hypoglycemia. We present algorithms that simultaneously estimate HbA(1)c and risk for significant hypoglycemia using 45-60 days of SMBG. The algorithms were developed using a primary data for 96 subjects with T1DM (n = 48) and T2DM, and were validated in an external data for 520 subjects with T1DM (n = 231) and T2DM. All subjects were on insulin. In the primary (external) data the estimation of HbA(1c) had absolute error of 0.5 (0.7) units of HbA(1c) and percent error of 6.8% (8.1%); 96% (96%) of all estimates were within 20% from reference HbA(1c). The SMBG-estimated value of HbA(1c) was closer to current reference HbA(1c) than a reference HbA(1c) value taken only 2-3 months ago. The results in T1DM and T2DM were similar. Linear model predicted future significant hypoglycemia (R(2) = 62%, p < 0.0001). The leading predictor was a previously introduced Low Blood Glucose Index, which alone had R(2) = 55%. Probability model assessed accurately the odds for future moderate/severe hypoglycemia (coefficients of determination 92%/94%). Four risk categories were identified; within moderate- and high-risk category, there was no difference between T1DM and T2DM in the occurrence of prospective significant hypoglycemia. SMBG data allow for accurate estimation of the two most important markers of metabolic control in T1DM and T2DM - HbA(1c) and risk for hypoglycemia.

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Objective: Low-level laser therapy (also known as photobiomodulation therapy, PBMT) promotes accelerated healing of diabetic foot ulcers (DFUs), thereby preventing the risk of future complications and amputation. The aim of this study was to determine the effect of PBMT, with structured, graded mobilisation and foot care, on DFU healing dynamics. Method: Patients diagnosed with type 2 diabetes, diabetic peripheral neuropathy and presenting with a chronic neuroischaemic DFU, were treated with PBMT using scanning and non-contact probe methods. The DFU was clinically observed and the area measured every seven days until complete healing. Neuropathic parameters were also measured. The PBMT was administered until complete closure of the DFU and patients also undertook a programme of graded mobilisation. Results: A total of 17 participants were recruited, with a mean age of 69±8 years, and a mean duration of diabetes of 13±5 years. Mean complete closure time was 26±11days. In addition, a mean reduction of the semi-quantitative vibration pressure threshold from 49±2 volts to 20±4 volts was observed in all participants. Conclusion: PBMT can be effectively used as a treatment mode for neuroischaemic DFUs in patients with type 2 diabetes. Graded mobilisation with focused foot care could improve the function of people living with type 2 diabetes with a chronic DFU.

Alstrom's syndrome (AS) is a rare autosomal recessive ciliopathic condition affecting 1:10,00,000 children. It's a single gene disorder of ALMS1 on chromosome 2 with multisystem involvement with cone-rod retinal dystrophy causing juvenile blindness, obesity, insulin resistance, type 2 Diabetes mellitus, hypogonadism and sensorineural hearing loss. Till now only 800 patients with this disorder has been identified so far. In this report, we describe the case of a 9-year old male boy from south India. He had been initially referred for polyphagia, polyuria, polydipsia, generalized weakness from 1 weeks. On examination he was demonstrated features suggestive of AS, including blindness, obesity, type 2 diabetes, altered lipid profile, hypogonadism, acanthosis nigricans, seborrheic dermatitis, right ear discharge and episodes of respiratory tract infections. So, diagnosis of AS is critical as it can easily be overlooked because of the many features associated with metabolic syndrome starting at age 7, a relatively early age.