Background Whilst skeletal muscles’ primary role is in allowing movement it has important metabolic roles, including in glycaemic control. Indeed, evidence indicates that low muscle mass and function are associated with increased risk of type 2 diabetes, highlighting its’ importance in the development of metabolic disease. Methods In this mini-review, we detail the evidence highlighting the importance of muscle in type 2 diabetes, the efficacy of resistance exercise in improving glycaemic control alongside our approach to increase uptake of such exercise in people with type 2 diabetes. This summary is based in the authors’ knowledge of the filed supplemented by a Pubmed search using the terms “muscle”, “glycaemic control”, “HbA1c”, “type 2 diabetes” and “resistance exercise”. Results The main strategy to increases muscle mass is to perform resistance exercise and, although the quality of evidence is low, such exercise appears effective in reducing HbA1c in people with type 2 diabetes. However, to increase participation we need to improve our understanding of barriers and facilitators to such exercise. Current data indicate that barriers are similar to those reported for aerobic exercise, with additional resistance exercise specific barriers of looking to muscular, increase risk of cardiovascular event, having access to specialised equipment and knowledge of how to use it. Conclusions The development of simple resistance exercises that can be performed anywhere, that use little or no equipment and are effective in reducing HbA1c will be, in our opinion, key to increasing the number of people with type 2 diabetes performing resistance exercise.

ObjectiveThis study evaluated whether adding sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) and/or glucagon‐like peptide‐1 receptor agonists (GLP1‐RA) to insulin reduced weight and glycemia in people with type 1 diabetes.MethodsThis retrospective analysis of electronic health records evaluated 296 people with type 1 diabetes over 12 months after medications were first prescribed. Four groups were defined: control n = 80, SGLT2i n = 94, GLP1‐RA n = 82, and combination of drugs (Combo) n = 40. We measured changes at 1 year in weight and glycated hemoglobin (HbA1c).ResultsThe control group did not have changes in weight or glycemic control. The mean (SD) percentage weight loss after 12 months was 4.4% (6.0%), 8.2%  (8.5%), and 9.0% (8.4%) in the SGLT2i, GLP1‐RA, and Combo groups, respectively (p < 0.001). The Combo group lost the most weight (p < 0.001). The HbA1c reduction was 0.4%  (0.7%), 0.3% (0.7%), and 0.6% (0.8%) in the SGLT2i, GLP1‐RA, and Combo groups, respectively (p < 0.001). The Combo group had the biggest improvements in glycemic control and total and low‐density lipoprotein cholesterol compared with baseline (all p < 0.01). Severe adverse events were similar between all the groups, with no increased risk of diabetic ketoacidosis.ConclusionsThe SGLT2i and GLP1‐RA agents on their own improved body weight and glycemia, but combining the medications resulted in more weight loss. Treatment intensification appears to result in benefits with no difference in severe adverse events.

Diabetes is known to compromise patients' health-related quality of life (HRQoL). It is important to understand the HRQoL of Kuwaiti nationals living with diabetes and identify factors that negatively affect it. This study included 1,182 Kuwaiti nationals with diabetes, aged 18–80 years. Patients' demographic and HRQoL information was collected using the EuroQol EQ-5D-5L instrument. Mean values for each EQ-5D subscale were worst for mobility (1.9) and pain/discomfort (1.8). Most patients reported having no problems in self-care (84.4%). Older adults were most likely to report severe problems with mobility (p &lt; 0.001). Females were more likely to report severe problems with anxiety and depression than males (p &lt; 0.006). The EQ visual analog scale (EQ VAS), which reports perceived overall health on a 0–100 scale, showed a mean of 74.7 (±19.6). Patients with comorbidities and/or complications perceived their health to be worse, with VAS scores significantly lower (p &lt; 0.001). Other factors that negatively affected VAS scores were being female, obesity, insulin usage, and lower levels of education. In conclusion, patients with diabetes who have comorbidities and/or complications perceived their health to be worse. Further research is required to evaluate if current diabetes management interventions help improve patients' HRQoL.

Background Diabetes imposes a large burden on countries’ healthcare expenditures. In Kuwait, diabetes prevalence in adults is estimated at 22.0%%—double the worldwide prevalence (9.3%). There is little current data on pharmaceutical costs in Kuwait of managing diabetes and diabetes-related complications and comorbidities. Objectives Estimate the utilization and cost of drugs for diabetes and diabetes-related complications and comorbidities in Kuwait for year 2018, as well determinants of costs. Methods This cross-sectional study used a multi-stage stratified sampling method. Patients were Kuwaiti citizens with diabetes, aged 18–80, recruited from all six governorates. Physicians collected demographic data, clinical data, and current drug prescription for each patient which was extrapolated for the full year of 2018. A prevalence-based approach and bottom-up costing were used. Data were described according to facility type (primary care vs. hospital). A generalized linear model with log function and normal distribution compared drug costs for patients with and without comorbidities/complications after adjustments for demographic and health confounders (gender, age group, disease duration, and obesity). Results Of 1182 diabetes patients, 64.0% had dyslipidemia and 57.7% had hypertension. Additionally, 40.7% had diabetes-related complications, most commonly neuropathy (19.7%). Of all diabetes patients, 85.9% used oral antidiabetics (alone or in combinations), 49.5% used insulin alone or in combinations, and 29.3% used both oral antidiabetics and insulin. The most frequently used oral drug was metformin (75.7%), followed by DPP4 inhibitors (40.2%) and SGLT2 inhibitors (23.8%). The most frequently used injectables were insulin glargine (36.6%), followed by GLP-1 receptor agonists (15.4%). Total annual drug cost for Kuwait’s diabetic population for year 2018 was US$201 million (US$1,236.30 per patient for antidiabetics plus drugs for comorbidities/complications). Conclusions Drug costs for treating diabetes and comorbidities/complications accounted for an estimated 22.8% of Kuwait’s 2018 drug expenditures. Comorbidities and complications add 44.7% to the average drug cost per diabetes patient.