OBJECTIVEDiabetes self-management is universally regarded as a foundation of diabetes care. We determined whether comparable glycemic control could be achieved by self-titration versus physician titration of a once-daily bolus insulin dose in patients with type 2 diabetes who are unable to achieve optimal glycemia control with a basal insulin. RESEARCH DESIGN AND METHODSPatients with type 2 diabetes, an HbA 1c level >7% (53 mmol/mol), and either nocturnal hypoglycemia episodes or an insufficient basal insulin glargine level (with or without oral agents) to achieve a fasting plasma glucose level £6 mmol/L (108 mg/dL) were studied. Participants all had bolus insulin glulisine added at breakfast and were allocated to either algorithm-guided patient self-titration or physician titration. The primary outcome was an HbA 1c level £7% (53 mmol/mol) without severe hypoglycemia. RESULTSAfter a mean (SD) follow-up of 159.4 days (36.2 days), 28.4% of participants in the self-titration arm vs. 21.2% in the physician titration arm achieved an HbA 1c level of £7% (53 mmol/mol) without severe hypoglycemia (between-group absolute difference 7.2%; 95% CI 23.2 to 17.7). The lower end of this 95% confidence interval was within the predetermined noninferiority boundary of 25% (P noninferiority = 0.011). CONCLUSIONSIn stable patients with type 2 diabetes who are receiving doses of basal insulin glargine who require bolus insulin, a simple bolus insulin patient-managed titration algorithm is as effective as a physician-managed algorithm.

Background/Aim:Helicobacter pylori (H pylori) plays an important role in the pathogenesis of chronic gastritis, peptic ulcer disease, and gastric neoplasms. Therefore, it is necessary to select an effective regimen for H pylori eradication. The aim of this study was to compare the efficacy of two quadruple-therapy regimens—one with azithromycin and the other with metronidazole—for H pylori eradication in patients with dyspepsia.Materials and Methods:In this double-blind randomized clinical trial conducted in Rasoule-Akram Hospital in 2006, we included 60 patients (aged 15–70 years) who had dyspepsia and H pylori infection as diagnosed by upper gastrointestinal endoscopy and rapid urease test. Patients were randomly assigned to receive a quadruple-therapy regimen for 2 weeks: 1) the MAO-B group (n= 30) received metronidazole 500 mg b.i.d, amoxicillin 1g b.i.d, omeprazole 20 mg b.i.d, and bismuth 240 mg b.i.d and 2) the AAO-B group (n = 30) received azithromycin 500 mg once daily for 1 week and amoxicillin 1g b.i.d, omeprazole 20 mg b.i.d, and bismuth 240 mg b.i.d for 2 weeks). H pylori eradication was assessed by the rapid urease test (RUT) 2 months after the cessation of treatment.Results:H pylori was eradicated in 68% and 69% of patients in the MAO-B and AAO-B groups, respectively. There was no significant difference in H pylori eradication rates between the two groups (P = 0.939).Conclusion:No significant difference exists between the two quadruple-therapy regimens that were tested.

To our knowledge, Diabetes FORWARD is the first diabetes-focused, practice-based research network in the United States and Canada. The current study will provide robust data that should reflect typical management of T2DM in clinical practice in North America.

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This chapter addresses the challenges and opportunities for financial stability and bank supervision in the twenty-first century. It is argued that one of the major challenges to the vision of achieving a world where the financial systems are stable, reliable, and accessible was the 2008 global financial crisis. The G20 took up an agenda to improve regulation and supervision regimes globally through initiatives such as higher capital requirements and new liquidity regulations. However, challenges have emerged due to advances in technology, financial innovations, climate change, legislative or regulatory barriers and money laundering, organized crime, corruption, and the financing of terrorism. In particular, supervisors in developing economies face the challenge of how to ensure financial stability while at the same time promoting the development of the financial system to sustainable economic growth for poverty reduction and greater equality.