Evaluation of glycated albumin (GA) and GA/HbA1c ratio for diagnosis of diabetes and glycemic control: A comprehensive review

Proteomic Analysis of Exudates from Chronic Ulcer of Diabetic Foot Treated with Scorpion Antimicrobial Peptide

Scorpion peptides have good therapeutic effect on chronic ulcer of diabetic foot, but the related pharmacological mechanism has remained unclear. The different proteins and bacteria present in ulcer exudates from chronic diabetic foot patients, treated with scorpion antimicrobial peptide at different stages, were analyzed using isobaric tags for quantification-labeled proteomics and bacteriological methods. According to the mass spectrometry data, a total of 1865 proteins were identified qualitatively, and the number of the different proteins was 130 (mid/early), 401 (late/early), and 310 (mid, late/early). In addition, functional annotation, cluster analysis of effects and the analysis of signal pathway, transcription regulation, and protein-protein interaction network were carried out. The results showed that the biochemical changes of wound microenvironment during the treatment involved activated biological functions such as protein synthesis, cell proliferation, differentiation, migration, movement, and survival. Inhibited biological functions such as cell death, inflammatory response, immune diseases, and bacterial growth were also involved. Bacteriological analysis showed that Burkholderia cepacia was the main bacteria in the early and middle stage of ulcer exudate and Staphylococcus epidermidis in the late stage. This study provides basic data for further elucidation of the molecular mechanism of diabetic foot.

Evaluation of the Antihyperglycemic and Antihyperlipidemic Activity of Saussurea hypoleuca Root in Alloxan-Induced Diabetes in Rat Model and Correlation to Its Major Secondary Metabolites

Saussurea hypoleuca belongs to the family Asteraceae, which has previously shown hepatoprotective, anticancer, and antioxidant activity. This study aimed to evaluate the antihyperglycemic and antihyperlipidemic activity of its root methanol extract and various fractions for the first time. This was performed using alloxan-induced diabetes in the rat model for both short, and long-term periods using different administration doses. Different biochemical parameters were studied and further consolidated by histopathological examination and in silico molecular modeling. The results showed that in the long-term study, at a dose of 400 mg/kg b.wt, the ethyl acetate fraction caused a pronounced reduction in fasting blood glucose level (FBG) and glycated hemoglobin (HbA_1c) by 77.2% and 36.8%, respectively, compared to the diabetic group. This was confirmed by the histopathological examination of the animals’ pancreatic sections. The ethyl acetate fraction also showed a reduction in total cholesterol (TC), total glycerides (TG), and low-density lipoprotein cholesterol (LDL-C) levels. It improved kidney and liver functions, causing a reduction in aspartate aminotransferase (AST), alkaline phosphatase (ALP), alanine transaminase (ALT), urea, and creatinine levels. This is mainly attributed to its richness in secondary metabolites. Molecular docking showed that all the tested compounds showed certain inhibitory potential towards human α-glucosidase (HAG) and ATP citrate lyase (ACL). Thus, Saussurea hypoleuca roots can help in the management of hyperglycemia, hyperlipidemia, and hepatic and kidney dysfunction.

The Complexity and Multiplicity of the Specific cAMP Phosphodiesterase Family: PDE4, Open New Adapted Therapeutic Approaches

Cyclic nucleotides (cAMP, cGMP) play a major role in normal and pathologic signaling. Beyond receptors, cyclic nucleotide phosphodiesterases; (PDEs) rapidly convert the cyclic nucleotide in its respective 5'-nucleotide to control intracellular cAMP and/or cGMP levels to maintain a normal physiological state. However, in many pathologies, dysregulations of various PDEs (PDE1-PDE11) contribute mainly to organs and tissue failures related to uncontrolled phosphorylation cascade. Among these, PDE4 represents the greatest family, since it is constituted by 4 genes with multiple variants differently distributed at tissue, cellular and subcellular levels, allowing different fine-tuned regulations. Since the 1980s, pharmaceutical companies have developed PDE4 inhibitors (PDE4-I) to overcome cardiovascular diseases. Since, they have encountered many undesired problems, (emesis), they focused their research on other PDEs. Today, increases in the knowledge of complex PDE4 regulations in various tissues and pathologies, and the evolution in drug design, resulted in a renewal of PDE4-I development. The present review describes the recent PDE4-I development targeting cardiovascular diseases, obesity, diabetes, ulcerative colitis, and Crohn's disease, malignancies, fatty liver disease, osteoporosis, depression, as well as COVID-19. Today, the direct therapeutic approach of PDE4 is extended by developing allosteric inhibitors and protein/protein interactions allowing to act on the PDE interactome.

Analytical Challenges in Diabetes Management: Towards Glycated Albumin Point-of-Care Detection

Diabetes mellitus is a worldwide-spread chronic metabolic disease that occurs when the pancreas fails to produce enough insulin levels or when the body fails to effectively use the secreted pancreatic insulin, eventually resulting in hyperglycemia. Systematic glycemic control is the only procedure at our disposal to prevent diabetes long-term complications such as cardiovascular disorders, kidney diseases, nephropathy, neuropathy, and retinopathy. Glycated albumin (GA) has recently gained more and more attention as a control biomarker thanks to its shorter lifespan and wider reliability compared to glycated hemoglobin (HbA1c), currently the “gold standard” for diabetes screening and monitoring in clinics. Various techniques such as ion exchange, liquid or affinity-based chromatography and immunoassay can be employed to accurately measure GA levels in serum samples; nevertheless, due to the cost of the lab equipment and complexity of the procedures, these methods are not commonly available at clinical sites and are not suitable to home monitoring. The present review describes the most up-to-date advances in the field of glycemic control biomarkers, exploring in particular the GA with a special focus on the recent experimental analysis techniques, using enzymatic and affinity methods. Finally, analysis steps and fundamental reading technologies are integrated into a processing pipeline, paving the way for future point-of-care testing (POCT). In this view, we highlight how this setup might be employed outside a laboratory environment to reduce the time from measurement to clinical decision, and to provide diabetic patients with a brand-new set of tools for glycemic self-monitoring.

Blood hemoglobin A1c might predict adverse differences in heart rate variability in a diabetic population: Evidence from the Midlife in the United States (MIDUS) study

Background

Cardiac autonomic neuropathy in population with diabetes mellitus (DM) is frequent and linked with high risk of cardiovascular mortality. However, studies on whether blood hemoglobin A1c (HbA1c) levels are related to adverse differences in heart rate variability (HRV) in individuals with DM are scarce.

Aim

We aimed to investigate the association of blood HbA1c levels with adverse differences in HRV, which is an indicator of cardiac autonomic control, in adult individuals with and without DM.

Methods

Data were collected from the Midlife in the United States (MIDUS) study, and 928 individuals were analyzed for the relationship between blood HbA1c levels and HRV through a cross-sectional analysis.

Results

Participants with DM had significantly higher HRV than those without DM. The smooth curve suggested inverse relationships between blood HbA1c levels and HF- and LF-HRV seen in participants with DM but not in those without DM after controlling for all covariates (age, sex, BMI, smoking, number of drinking years and exercise). Furthermore, linear regression analysis demonstrated that elevated blood HbA1c levels did contribute to adverse differences in HF-HRV (Sβ= -0.118; 95% CI -0.208, -0.027; P=0.012) and LF-HRV (Sβ= -0.097; 95% CI -0.177, -0.017; P=0.019) after controlling for these covariates in participants with DM, while in participants without DM, blood HbA1c was not significantly related to adverse differences in HF-HRV (Sβ=0.095; 95% CI -0.059, 0.248; P=0.228) or LF-HRV (Sβ=0.043; 95% CI -0.103, 0.189; P=0.565). DM has a significant modifying effect on associations between blood HbA1c and adverse differences in HF-HRV (P for interaction=0.019) and LF-HRV (P for interaction=0.029).

Conclusions

We reported strong evidence that elevated blood levels of HbA1c were associated with adverse differences in HRV in the diabetic population but not in the nondiabetic population. This finding supported that long-term hyperglycemia is related to autonomic nerve injury in the diabetic population. Blood HbA1c might be a good indicator of cardiac autonomic neuropathy.

Serum glycated albumin as a predictive biomarker for renal involvement of antineutrophil cytoplasmic antibody-associated vasculitis in non-diabetic patients

Background

Glycated albumin (GA) is known to reflect the current inflammatory burden in non-diabetes mellitus (DM) patients. In this study, we investigated whether GA at diagnosis could reflect the cross-sectional activity and predict poor outcomes during follow-up in non-DM patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).

Methods

The medical records of 118 immunosuppressive drug-naïve AAV patients were retrospectively reviewed, and 76 patients who had both GA and glycated haemoglobin (HbA1c) results but not DM were included in this study. Demographic, clinical, and laboratory data at diagnosis were assessed.

Results

The median age of AAV patients was 61 years, and 31 patients were male. GA was positively correlated with five-factor score (r = 0.282), Birmingham vasculitis activity score (BVAS) assigned to renal manifestation (r = 0.315), and blood urea nitrogen (r = 0.382), whereas negatively correlated with haemoglobin (r = -0.345). AAV patients with end-stage renal disease (ESRD) exhibited significantly higher GA than those without ESRD (15.8% vs. 13.6%). When the cut-off of GA at diagnosis for ESRD was set at GA ≥ 14.25%, AAV patients with GA ≥ 14.25% had a significantly higher risk for ESRD development than those without (relative risk 12.040). In addition, AAV patients with GA ≥ 14.25% exhibited significantly lower cumulative ESRD-free survival rates than those without (P = 0.020).

Conclusion

In conclusion, GA at diagnosis can reflect the cross-sectional BVAS assigned to renal manifestation of AAV and predict ESRD development during follow-up better than HbA1c or GA/HbA1c in AAV patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-022-02913-5.

Association of hemoglobin glycation index and glycation gap with cardiovascular disease among US adults

AIMS

To investigate the association of hemoglobin glycation index (HGI) and glycation gap (GGap), reflecting mismatches between HbA1c and other measures of glycemia, with cardiovascular disease (CVD) in the general population.

METHODS

5966 US adult (age ≥ 20 years) participants were included from the National Health and Nutrition Examination Survey (NHANES) (1999-2004). In this cross-sectional study, predicted HbA1c was calculated based on fasting plasma glucose (FPG) and glycated albumin (GA), respectively. Multivariable binary logistic regression analysis was performed to explore the association of HGI and GGap with CVD prevalence.

RESULTS

Compared to the lowest tertile, the ORs with 95% CIs for CVD across the tertiles were 1.41 (1.01, 1.96) and 0.87 (0.58, 1.31) for HGI (P for trend = 0.535) and 1.06 (0.77, 1.47) and 1.60 (1.18, 2.17) for GGap (P for trend = 0.002) in the fully-adjusted model. Besides, the discordantly high GGap/low HbA1c group was associated with higher CVD prevalence compared with the low GGap/high HbA1c group (OR = 1.50, 95% CI, 1.04-2.16, P = 0.030).

CONCLUSIONS

GGap derived from GA is associated with CVD independent of traditional risk factors, even HbA1c, in US general adults. Considering the potential limitations of HbA1c, the introduction of GGap is warranted.

Vitamin D, Vitamin D-Binding Proteins, and VDR Polymorphisms in Individuals with Hyperglycaemia

Vitamin D reportedly plays an important role in the pathogenesis of diabetes mellitus; however, this role is unclear and debated. This study investigated the association between 25(OH) vitamin D, vitamin D-binding proteins, and vitamin D receptor (VDR) polymorphisms in healthy individuals and those with prediabetes and type 2 diabetes mellitus (T2D) from South Africa. A cross-sectional study was conducted involving subjects of mixed ancestry aged ≥20 years. Males presented with higher mean 25(OH) vitamin D levels than females, while females exhibited significantly higher serum vitamin D-binding protein levels. Significant differences in mean 25(OH) vitamin D levels were observed in normo-glycaemic, prediabetes, screen-detected DM, and known DM individuals. Vitamin D receptor SNPs Fok1 and Taq1 were not associated with glycaemic status. Fok1 was not associated with 25(OH) vitamin D deficiency, while Taq1 was associated with vitamin D insufficiency. This study showed a high prevalence of vitamin D deficiency/insufficiency in this South African population, with decreased vitamin D levels observed in hyperglycaemic individuals, which was not linked to either vitamin D-binding protein or polymorphisms in Fok1 of the VDR gene. These results may be used as a platform for further research into diagnosis and treatment of hyperglycaemia.

Acacia jacquemontii ethyl acetate extract reduces hyperglycemia and pro-inflammatory markers while increasing endogenous antioxidant potential in alloxan-induced diabetic rats

Acacia jacquemontii possess has numerous traditional therapeutic uses. The rationale of this study was to investigate the role of Acacia jacquemontii ethyl acetate extract (AJEAE) in the downregulation of hyperglycemia. The current study was performed in two parts, in vitro, through characterization (high-performance liquid chromatography), estimation of total phenolic content, total flavonoid content, antioxidant (2,2-diphenyl-1-picrylhydrazylassay), and α-amylase inhibitory activities of the studied extract, and in vivo using Wistar rats in which animals were divided into five groups NC, DC, GL, AJEAE 250 mg/kg, and AJEAE 500 mg/kg. The effects of AJEAE on fasting plasma glucose, plasma insulin, HOMA-IR, oral glucose tolerance test, glycated hemoglobin (HBA1c), lipid profile, inflammatory cytokines (Interleukin-6, tumor necrosis factor-alpha), and oxidative stress markers (lipid peroxidation, nitic oxide, superoxide dismutase, catalase, glutathione peroxidase) were evaluated. Our findings confirmed the presence of quercetin, kaempferol, gallic acid, vanillic acid, syringic acid, M-coumaric acid, sinapic acid, chlorogenic acid, cinnamic acid, and ferulic acid in AJEAE. Total flavonoid and phenolic contents in AJEAE were 83.83 mg GAE/g and 77.06 mg QE/g, respectively. Significant inhibition of DPPH (69.470%/1 mg/ml) and α-amylase (71.8%/1 mg/ml) activities were exhibited by AJEAE. Alloxan-injected rats showed marked hyperglycemia and hypoinsulinemia, and increased inflammatory marker levels as compared to normal control (p < 0.001). Additionally, raised levels of triglyceride (139.7 ± 2.771), total cholesterol (198.7 ± 1.856), very low-density lipoprotein (33.43 ± 0.2728), low-density lipoprotein (155.5 ± 2.754), lipid peroxidation, and nitric oxide (p < 0.001) and decreased levels of high-density lipoprotein (17.20 ± 0.1732), superoxide dismutase, catalase, and glutathione peroxidase were observed in diabetic rats (p < 0.001). AJEAE significantly (p < 0.05) improved the aforementioned parameters and the protective efficacy was comparable to glibenclamide. Histopathological findings also evidenced the anti-hyperglycemic properties of AJEAE through regeneration of pancreatic β cells. Conclusively, our findings demonstrated the antihyperglycemic, antihyperlipidemic, antioxidant, anti-inflammatory, and pancreatic beta β cell regenerative properties of AJEAE against alloxan-induced diabetes.

Analgesic and neuroprotective effects of Baimai Ointment on diabetic peripheral neuropathy

ETHNOPHARMACOLOGY RELEVANCE

Baimai (BM) ointment, a traditional Tibetan medicine, has been widely used to treat "white vein" disease, paralysis, hemiplegia and claudication caused by trauma, because of its great effects on muscle stretching and collateral activation. As one of the most terrible complications in diabetes patients, diabetes peripheral neuropathy (DPN) is mainly manifested as abnormal pain or numbness in extremities. However, whether BM ointment is a potential drug for DPN treatment is unclear.

AIMS OF THE STUDY

The aim of this study was to investigate the therapeutic effects of BM on DPN in a high-fat diet/low-dose of streptozotocin induced type 2 diabetes rat model and explore underlying mechanisms.

METHODS

The chemical components of BM were determined by high performance liquid chromatography (HPLC), and the possible targets and related pathways candidates involved in the effects of BM on DPN were predicted using network pharmacology methods. Next, the effects of different doses (1.5, 3.0 and 6.0 g/kg) of BM on physiological changes, pain behaviors, motor nerve conduction velocity (MNCV) in DPN rats were assessed and compared with placebo- and mecobalamine (Meco)-treated DPN controls. Then, the effects of BM on the expression of pain associated genes as well as the phosphorylation of PI3K/AKT and MAPKs pathways in DRG of DPN rats were examined.

RESULTS

Through HPLC analysis, curcumin was identified as one of the primary contents of BM. The information from network pharmacology indicated a series of target candidates for BM including IL6, IL10, TNF, CCL2, CXCL12, EGF, VEGFA, BDNF, TGFβ1 and TNF, as well as PI3K-AKT and MAPK signaling pathways. Topical treatment of BM significantly improved the hypersensitivity of mechanical and thermal pain, MNCV and the morphological changes and demyelination of sciatic nerve fibers, without affecting the body weight, serum metabolism or blood glucose. The up-regulated levels of neuropeptides Cgrp, Sst, Sp and chemokines Ccl2 and Ccl3 along with the abnormal expression of p-P38, p-ERK and p-AKT in the DRG of DPN rats were alleviated by BM application.

CONCLUSION

BM ointment has great activities in relieving pain hypersensitivity, neuroprotecting peripheral nerves damage caused by DPN, which may be related to the inhibition of related neuropeptide (Cgrp, Sst, Sp) and chemokine (Ccl2, Ccl3) expression and the regulation of PI3K/AKT and MAPKs signaling pathways in DRG.

Assessment of arteriosclerosis based on multiscale cross approximate entropy of human finger pulse wave

BACKGROUND: Arteriosclerosis is one of the diseases that endanger human health. There is a large amount of information in pulse wave signals to reflect the degree of arteriosclerosis. OBJECTIVE: The degree of arteriosclerosis is assessed by analyzing pulse wave signal and calculating multi-scale entropy values. METHODS: A method based on the multiscale cross-approximate entropy of the pulse wave of the human finger is proposed to assess the degree of arteriosclerosis. A total of 86 subjects were divided into three groups. The data of 1000 pulse cycles were selected in the experiment, and the multiscale cross-approximate entropy was calculated for the climb time and pulse wave peak interval. Independent sample t-test analysis gives the small-scale cross-approximate entropy of the two time series of climb time and pulse wave peak interval as p< 0.001 in Groups 1 and 2. The large-scale cross-approximate entropy of the two time series of climb time and pulse wave peak interval is p< 0.017 in Groups 2 and 3. RESULTS: Using the proposed algorithm, the results showed that the small-scale cross-approximate entropy of climb time and pulse wave peak interval could reflect the degree of arteriosclerosis in the human body from the perspective of autonomic nerve function. The large-scale cross-approximate entropy of climb time and pulse wave peak interval confirmed the effect of diabetes on the degree of arteriosclerosis. CONCLUSIONS: The results demonstrate the multiscale cross-approximate entropy is a comprehensive index to evaluate the degree of human arteriosclerosis.

The association between glycosylated haemoglobin and newly diagnosed hypertension in a non-diabetic Sudanese population: a cross-sectional study

BACKGROUND

Glycosylated haemoglobin (HbA1c) is considered reliable for diagnosing and monitoring diabetes mellitus (DM). It also indicates cardiovascular complications related to DM. However, only a few studies have been conducted on this topic.

METHODS

We conducted a cross-sectional study to investigate the association between newly diagnosed hypertension and HbA1c among non-diabetic Sudanese adults. The sociodemographic characteristics of the participants in the sample were gathered using a questionnaire, and HbA1c was measured using an Ichroma machine.

RESULTS

Three hundred and eighty-four healthy participants were enrolled in this study. The median (interquartile range [IQR]) age was 56.0 (14.0) years, and 72.1% of the participants were female. The median (IQR) body mass index (BMI) was 31.2 (8.7) kg/m². One hundred and fifteen (29.9%) participants presented newly diagnosed hypertension. The results of the multivariate analysis showed that age (adjusted odd ratio [AOR] = 1.03; 95% confidence interval [CI] = 1.01‒1.05); BMI (AOR = 1.09; 95% CI = 1.05‒1.14); HbA1c levels (AOR = 2.18; 95% CI = 1.29‒3.67) was positively associated with newly diagnosed hypertension. For an HbA1c level of 5.0% or more, the sensitivity and specificity of newly diagnosed hypertension were 91.3% and 28.2%, respectively (area under the curve = 0.61; 95% CI = 0.55-0.67; P ˂ 0.001). Participants who presented HbA1c levels of 5.0% or more were found to be at higher risk for newly diagnosed hypertension (AOR = 2.53; 95% CI = 1.14‒5.61).

CONCLUSION

The results of this study indicated a high prevalence of newly diagnosed hypertension, and HbA1c levels were positively associated with newly diagnosed hypertension.

Glycated Albumin and Glycated Albumin/HbA1c Predict the Progression of Coronavirus Disease 2019 from Mild to Severe Disease in Korean Patients with Type 2 Diabetes

Hyperglycemia is among the main risk factors for severe COVID-19. We evaluated the association of glycated albumin (GA) and GA/HbA1c ratio with progression of COVID-19 from mild to severe disease in patients with type 2 diabetes mellitus (T2DM). Our retrospective study included 129 patients aged over 18 years with COVID-19 and T2DM who did not have any need of oxygen supplement. Of these, 59 patients whose COVID-19 was aggravated and required oxygen supplementation eventually were classified as having severe disease. Clinical and laboratory data were compared between mild and severe cases. The median of GA (18.4% vs. 20.95%, p = 0.0013) and GA/HbA1c (2.55 vs. 2.68, p = 0.0145) were higher in severe disease than in mild disease and positively correlated with C-reactive protein (Kendal Tau coefficient 0.200 and 0.126, respectively; all p < 0.05). Multiple logistic regression analysis showed that GA (odds ratio (OR), 1.151; 95% confidence interval (CI), 1.024−1.294) and GA/HbA1c (OR, 8.330; 95% CI, 1.786−38.842) increased the risk of severe disease. Patients with GA 20% or higher were 4.03 times more likely to progress from mild to severe disease. GA and GA/HbA1c ratio predicted progression of COVID-19 from mild to severe disease in patients with T2DM.

Diabetes care in the time of COVID ‐19: video consultation as a means of diabetes management

Background: This review specifically focuses on the use of video consultation in diabetes management, in comparison to standard care. The population of chronic condition sufferers in the UK is considerable and teleconsultation use has, in recent years, been explored. COVID‐19 has created an additional pressure on health services to use teleconsultation. Diabetes mellitus affects approximately four million people in the UK. If clinical outcomes are uncompromised, the benefits of using a remote service could encourage the use of video consultation for diabetes management in normal practice.

Aims: A systematic review of the use of video consultation in place of standard consultation in the management of diabetes mellitus. Both clinical and non‐clinical outcomes are reviewed, in addition to patient satisfaction levels after using video consultation.

Methods: A systematic literature search was conducted to select published articles from web‐based health databases. Data extraction and analysis of results followed.

Results: Twelve studies were selected. Overall, the clinical outcomes (HbA_1c, low‐density lipoprotein levels and blood pressure) appeared to be uncompromised with the use of video consultation. Patient satisfaction was high, with few limitations found. The economic and time saving benefits of this approach proved to be additional advantages.

Conclusions: Despite there being a lack of literature identified in this field, the results support the use of video consultation in diabetes management. The evidence suggests that this approach should be utilised in the time of COVID‐19 and beyond. Future research should assess the use of video consultation over a reasonable duration through randomised controlled trials. Copyright © 2022 John Wiley & Sons.

Hypertension and Associated Lipid, Glucose, and Adiposity Parameters in School-Aged Adolescents in the Federal District, Brazil

BACKGROUND

The prevalence of hypertension and other metabolic disorders has increased in young individuals. However, no representative studies have been conducted in the population of the Federal District, Brazil.

OBJECTIVE

To estimate the prevalence of hypertension and its association with lipid, glucose, and adiposity markers in school-aged adolescents living in the Federal District.

METHODS

This cross-sectional study included participants of the Study of Cardiovascular Risks in Adolescents (Portuguese acronym, ERICA). Blood pressure, blood glucose, glycated hemoglobin, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, body mass index (BMI), waist circumference, and economic, demographic, and sexual maturity variables were assessed. The data were analyzed in Stata, and the analysis was divided into different stages: descriptive, crude, and adjusted. Significant results were set at p < 0.05.

RESULTS

In total, 1,200 adolescents were included, and their mean age was 14.8 years. The prevalence of hypertension was 8% (95% confidence interval: 6.3; 9.9). Most parameters were associated with blood pressure in crude analysis. In adjusted analysis, glucose, lipid, and adiposity markers maintained the associations, and the highest magnitudes were those of BMI and HOMA-IR.

CONCLUSION

The study revealed a high prevalence of hypertension in adolescents living in the Federal District, and blood pressure levels were associated with other markers of lipid, glucose, and adiposity profile. The findings indicate the relevance of health surveillance for planning effective actions aimed at reversing this situation and preventing new cases.

Association of HbA1c with carotid artery plaques in patients with coronary heart disease: a retrospective clinical study

BACKGROUND AND AIMS

Haemoglobin A1c (HbA1c) levels have been shown to be related to carotid artery plaques. However, studies on the relationship between HbA1c levels and carotid artery plaques in patients with coronary heart disease (CHD) are limited and inconsistent. Our objective was to examine the correlation between HbA1c levels and carotid artery plaques in patients with CHD.

METHODS

The study comprised 9275 Chinese adults with CHD from January 1, 2014, to September 30, 2020. HbA1c levels were assessed, and colour Doppler ultrasound was used to evaluate the carotid artery, including plaque presence, intima-media thickness, and plaque echo properties, to investigate the association between HbA1c and carotid plaque. A logistic regression model was used to assess the association between carotid artery plaques, carotid plaque echogenicity, and HbA1c.

RESULTS

The HbA1c level of the plaque-present group was higher than that of the plaque-absent group [6.1 (5.6-7.2) vs. 5.8 (5.5-6.5), p < 0.001]. In multiple linear regression analysis, intima-media thickness was associated with HbA1c (p < 0.001). Logistic regression showed that a higher HbA1c level was associated with plaque incidence as well as hyperechoic and heterogeneous plaques (p < 0.001). These associations persist after adjusting for age, sex, blood pressure, lipid profiles, alcohol consumption, and tobacco exposure.

CONCLUSION

HbA1c levels are notably associated with carotid artery plaque incidence, intima-media thickness, and plaque echogenicity in patients with CHD. These findings show that different levels of HbA1c may be an indicator for carotid artery plaques and thus, should be observed in patients with CHD.

Stress hyperglycaemia is associated with poor functional outcomes in patients with acute ischaemic stroke after intravenous thrombolysis

BACKGROUND

Transient hyperglycaemia in the context of illness with or without known diabetes has been termed as 'stress hyperglycaemia'. Stress hyperglycaemia can result in poor functional outcomes in patients with acute ischaemic stroke (AIS) who underwent mechanical thrombectomy. We investigated the association between stress hyperglycaemia and clinical outcomes in AIS patients undergoing intravenous thrombolysis (IVT).

METHODS

We examined 666 consecutive patients with AIS who underwent IVT from 2006 to 2018. All patients had a glycated haemoglobin level (HbA1c) and fasting venous blood glucose measured within 24 h of admission. Stress hyperglycaemia ratio (SHR) was defined as the ratio of the fasting glucose to the HbA1c. Univariate and multivariate analyses were employed to identify predictors of poor functional outcomes (modified Rankin Scale 3-6 at 3 months) after IVT.

RESULTS

Three-hundred and sixty-one patients (54.2%) had good functional outcomes. These patients tended to be younger (60.7 ± 12.7 vs. 70 ± 14.4 years, P < 0.001), male (70.7% vs. 51.5%, P < 0.001), had lower prevalence of atrial fibrillation (13.0% vs. 20.7%, P = 0.008) and lower SHR (0.88 ± 0.20 vs. 0.99 ± 26, P < 0.001). Patients with high SHR (≥0.97) were slightly older than those with low SHR (<0.97) and were more likely to have diabetes mellitus. On multivariate analysis, higher SHR was independently associated with poor functional outcomes (adjusted odds ratio 3.85, 95% confidence interval 1.59-9.09, P = 0.003).

CONCLUSION

SHR appears to be an important predictor of functional outcomes in patients with AIS undergoing IVT. This may have important implications on the role of glycaemic control in the acute management of ischaemic stroke.

Vitamin D and Omega-3 Polyunsaturated Fatty Acids in Type 1 Diabetes modulation

BACKGROUND

Type 1 diabetes (T1D) is a chronic autoimmune disease that affects people globally. Usually developed during childhood, T1D is characterized by the destruction of pancreatic β-cells due to immune cell attack and the establishment of an inflammatory process.

OBJECTIVE

The study aimed to investigate the effects of vitamin D through its nuclear receptor and the ω-3 polyunsaturated fatty acids (PUFAs) through their lipid derivatives in T1D modulation. Both components exert anti-inflammatory activity and act directly on cells of the immune system, attenuating the destruction of insulin-producing cells. Furthermore, they lead to a better glycemic level, reducing the need for insulin and a normal immune state, such as C-peptide maintenance.

METHOD

Presently, our review highlights the significant studies that evaluated the supplementation of vitamin D and ω-3 PUFAs in humans and animal models in the modulation of T1D.

CONCLUSION

The data collected suggests that supplementation can provide potential benefits, mainly when done early in the diagnosis, since it reduces the need for insulin and the risk of complications generated by the disease.

A ratiometric electrochemical biosensor for glycated albumin detection based on enhanced nanozyme catalysis of cuprous oxide-modified reduced graphene oxide nanocomposites

Nanozymes have enzyme-like characteristics and nanozyme-based electrochemical sensors have been widely studied for biomarker detection. In this work, cuprous oxide-modified reduced graphene oxide (Cu₂O-rGO) nanozyme was prepared by simultaneous reduction of copper chloride and graphene oxide. This Cu₂O-rGO nanozyme displayed an outstanding electrocatalytic activity to glucose oxidation and was used as the modified material of a glassy carbon electrode to fabricate an electrochemical ratiometric biosensor for glycated albumin (GA) detection. In this ratiometric biosensor, methylene blue-labeled DNA tripods (MB-tDNA) were adsorbed on the Cu₂O-rGO/GCE surface to form a bioinspired electrode (MB-tDNA/Cu₂O-rGO/GCE), in which the catalytic sites of Cu₂O-rGO were covered by MB-tDNA. In the presence of target GA, GA could be identified by the aptamer sequence contained in MB-tDNA, and a MB-tDNA/GA complex was formed and released into the solution, so the reduced current of MB-tDNA was decreased. Simultaneously, the oxidized current of the outer added glucose was increased since more catalytic sites of Cu₂O-rGO nanozyme on the substrate electrode surface were exposed. The ratio of the peak currents of glucose oxidation and methylene blue reduction (I_Glu/I_MB) was used to monitor the GA level and ultimately improve the accuracy of the method. The electrochemical sensor showed a low detection limit of 0.007 μg mL^-1 and a wide linear range from 0.02 to 1500 μg mL^-1. The proposed sensor was also successfully used to measure the GA expression level in the blood serum of a diabetic mouse model.

The Association between Daily Total Dietary Nutrient Intake and Recent Glycemic Control States of Non-Pregnant Adults 20+ Years Old from NHANES 1999-2018 (Except for 2003-2004)

Background: Although daily total dietary nutrient intakes were potentially important factors in maintaining glycemic balance, their overall effect on glycemic control was still unclear among American adults. Objectives: We aimed to examine the association between daily total dietary nutrient intake and recent glycemic control status (RGCS). Methods: This cohort was composed of 41,302 individuals from the National Health and Nutrition Examination Survey (NHANES). The daily total intake of dietary nutrients and RGCS were independent and dependent variables, respectively. To evaluate their association, we carried out binary logistic regression, model fitting, linear discriminant analysis, and the receiver operator characteristic (ROC) analysis. Results: The result of robust check model showed that only the daily total dietary vitamin B6 intake (adjusted OR = 0.848; 95% CI: 0.738, 0.973; p-value = 0.019) was significantly negatively correlated with RGCS. When daily total dietary vitamin B6 intake and glycosylated hemoglobin (HbA1c) were used as independent variables and dependent variables, respectively, to fit the curves and lines, the established robust check model could distinguish American adults with different RGCS well. Moreover, the robust check model results of ROC analysis indicated that daily total dietary vitamin B6 intake might be a potential predictor for RGCS (AUC = 0.977; 95% CI: 0.974, 0.980; p-value < 0.001). Conclusions: This study showed that only daily total dietary vitamin B6 intake was a beneficial factor in RGCS, but it might need further multicenter or prospective studies to verify whether vitamin B6 had biological implications and public health meaning for glycemic control among American adults (specifically referred to non-pregnant participants over 20 years old).

AMPK Activity: A Primary Target for Diabetes Prevention with Therapeutic Phytochemicals

Diabetes is a metabolic syndrome characterized by inadequate blood glucose control and is associated with reduced quality of life and various complications, significantly shortening life expectancy. Natural phytochemicals found in plants have been traditionally used as medicines for the prevention of chronic diseases including diabetes in East Asia since ancient times. Many of these phytochemicals have been characterized as having few side effects, and scientific research into the mechanisms of action responsible has accumulated mounting evidence for their efficacy. These compounds, which may help to prevent metabolic syndrome disorders including diabetes, act through relevant intracellular signaling pathways. In this review, we examine the anti-diabetic efficacy of several compounds and extracts derived from medicinal plants, with a focus on AMP-activated protein kinase (AMPK) activity.

Glycated albumin as a biomarker for diagnosis of diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

Glycated albumin (GA), the non-enzymatic glycation product of albumin in plasma, became a glycemic marker in the beginning of the 21st century. The assay is not affected by hemoglobin levels and reflects the glycemic status over a shorter period as compared to HbA1c measurements. Thus, GA may contributes as an intermediate glucose index in the current diabetes mellitus (DM) diagnostic system.

AIM

To search and summarize the available data on glycated albumin measurements required for the diagnosis of diabetes mellitus.

METHODS

Databases, including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL), among others, were systematically searched. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was applied for the assessment of quality, and the bivariate model was used to pool the sensitivity and specificity. The hierarchical summary receiver operator characteristic curves (HSROC) model was utilized to estimate the summary receiver operating characteristics curve (SROC). Sensitivity analysis was performed to investigate the association of the study design and patient characteristics with the test accuracy and meta-regression to find the source of heterogeneity.

RESULTS

Three studies regarding gestational diabetes mellitus (GDM) and a meta-analysis of 16 non-GDM studies, comprising a total sample size of 12876, were included in the work. Results reveal that the average cut-off values of GA reported for the diagnosis of GDM diagnosis was much lower than those for non-GDM. For non-GDM cases, diagnosing DM with a circulating GA cut-off of 14.0% had a sensitivity of 0.766 (95%CI: 0.539, 0.901), specificity of 0.687 (95%CI: 0.364, 0.894), and area under the curve of 0.80 (95%CI: 0.76, 0.83) for the SROC. The estimated SROC at different GA cut-off values for non-GDM exhibited that the average location parameter lambda of 16 non-GDM studies was 2.354 (95%CI: 2.002, 2.707), and the scale parameter beta was -0.163 (95%CI: -0.614, 0.288). These non-GDM studies with various thresholds had substantial heterogeneity, which may be attributed to the type of DM, age, and body mass index as possible sources.

CONCLUSION

Glycated albumin in non-DM exhibits a moderate diagnostic accuracy. Further research on the diagnostic accuracy of GA for GDM and combinational measurements of GA and other assays is suggested.

Raman spectroscopy on blood serum samples of patients with end-stage liver disease

Raman spectroscopy has shown to be a promising method for the examination of biomedical samples. However, until now, its efficacy has not been established in clinical diagnostics. In this study, Raman spectroscopy’s potential application in medical laboratories is evaluated for a large variety (38) of biomarkers. Given 234 serum samples from a cohort of patients with different stages of liver disease, we performed Raman spectroscopy at 780nm excitation wavelength. The Raman spectra were analyzed in combination with the results of routine diagnostics using specifically developed complex mathematical algorithms, including fluorescence filtering, frequency subset selection and several overfitting circumventing strategies, such as independent validation. With the results of this cohort, which were validated in 328 independent samples, a significant proof-of-concept study was completed. This study highlights the need to prevent overfitting and to use independent data for validation. The results reveal that Raman spectroscopy has high potential for use in medical laboratory diagnostics to simultaneously quantify multiple biomarkers.

Do We Store Packed Red Blood Cells under "Quasi-Diabetic" Conditions?

Red blood cell (RBC) transfusion is one of the most common therapeutic procedures in modern medicine. Although frequently lifesaving, it often has deleterious side effects. RBC quality is one of the critical factors for transfusion efficacy and safety. The role of various factors in the cells’ ability to maintain their functionality during storage is widely discussed in professional literature. Thus, the extra- and intracellular factors inducing an accelerated RBC aging need to be identified and therapeutically modified. Despite the extensively studied in vivo effect of chronic hyperglycemia on RBC hemodynamic and metabolic properties, as well as on their lifespan, only limited attention has been directed at the high sugar concentration in RBCs storage media, a possible cause of damage to red blood cells. This mini-review aims to compare the biophysical and biochemical changes observed in the red blood cells during cold storage and in patients with non-insulin-dependent diabetes mellitus (NIDDM). Given the well-described corresponding RBC alterations in NIDDM and during cold storage, we may regard the stored (especially long-stored) RBCs as “quasi-diabetic”. Keeping in mind that these RBC modifications may be crucial for the initial steps of microvascular pathogenesis, suitable preventive care for the transfused patients should be considered. We hope that our hypothesis will stimulate targeted experimental research to establish a relationship between a high sugar concentration in a storage medium and a deterioration in cells’ functional properties during storage.

Glycation of albumin and its implication in Diabetes: A comprehensive analysis using mass spectrometry

AIM

To understand the mechanism of glycation of albumin and effects on cysteinylation and methionine oxidation.

METHODS

The in vitro glycation of HSA and BSA was studied with varying concentrations of glucose. Clinical blood samples of diabetic subjects with varying HbA1c values, were analyzed to assess in vivo glycation. All samples and their tryptic digests were analyzed using liquid chromatography/mass spectrometry. Glycation sites were mapped on to the three-dimensional structure of the HSA and BSA.

RESULTS

A total thirty-one sites for glycation and eight sites of N^ε-carboxymethyl-lysine (CML) modification were identified on albumin. The site selectivity of glycation was correlated with the environment of the reactive residue in the three-dimensional structure.

CONCLUSIONS

The maximum percentage glycation under extreme conditions was in the range of ~55 to 88% in four weeks. Two major glycation sites K-233 and K-525 were identified, which together accounted for 40-50% of total glycation. A correlation was observed between glycation and oxidation of methionine residues in samples glycated in vitro. The role of spatially proximate residues in facilitating the glycation process is evident. The tri- and tetra-glycated isoforms of albumin can serve as biomarkers for the severe uncontrolled diabetic state.

Blood Levels of Glycated Hemoglobin, D-Dimer, and Fibrinogen in Diabetic Retinopathy

PURPOSE

This study aimed to describe the levels of glycated hemoglobin (HbA1c), D-dimer (D-D), and fibrinogen (FIB) in different types of diabetic retinopathy (DR).

METHODS

A total of 61 patients with diabetes, who were treated in our department between November 2017 and May 2019, were selected. According to their non-mydriatic fundus photography and fundus angiography results, patients were divided into three groups, ie, the non-DR (NDR) group (n=23), the non-proliferative DR (NPDR) group (n=17), and the proliferative DR (PDR) group (n=21). A control group of 20 people who had tested negative for diabetes was also included. The levels of HbA1c, D-D, and FIB were measured and compared, respectively.

RESULTS

The mean values of HbA1c were 6.8% (5.2%, 7.7%), 7.4% (5.8%, 9.0%), and 8.5% (6.3%, 9.7%) in the NDR, NPDR, and PDR groups, respectively. The control group values were 4.9% (4.1%, 5.8%). These results indicated a significant statistical difference between groups. The mean values of D-D were 0.39 ± 0.21 mg/L, 1.06 ± 0.54 mg/L, and 1.39 ± 0.59 mg/L in the NDR, NPDR, and PDR groups, respectively. The control group result was 0.36 ± 0.17 mg/L. The values of the NPDR and PDR groups were significantly higher than those of the NDR and control groups, and the value of the PDR group was significantly higher than that of the NPDR group, indicating a significant difference between the groups (P < 0.001). The mean values of FIB were 3.07 ± 0.42 g/L, 4.38 ± 0.54 g/L, and 4.46 ± 1.09 g/L in the NDR, NPDR, and PDR groups, respectively. The control group result was 2.97 ± 0.67 g/L. The difference between the groups was statistically significant (P < 0.05).

CONCLUSION

Blood levels of HbA1c, D-D, and FIB in the PDR group were significantly higher than in the NPDR group.

Burning sensation in the feet and glycosylated haemoglobin levels in Swedish- and non-Swedish-born primary healthcare patients

BACKGROUND

A painful burning sensation in the feet is a common problem. The most common cause is small fibre neuropathy, a type of peripheral neuropathy that is often a consequence of diabetes and prediabetes.

AIM

To examine the association between a self-reported burning sensation in the feet and HbA1c levels in primary healthcare patients.

METHODS

This study used data from patients in the 4D diabetes project in Swedish primary healthcare. The study population included 824 patients. Logistic regression was performed to study the association between the outcome and explanatory variables.

RESULTS

A total of 24% of patients reported a burning sensation in the feet. This sensation was not associated with HbA1c levels. However, the probability of reporting a burning sensation was two times higher in non-Swedish-born than Swedish-born patients (OR, 2.31; 95% CI, 1.55-3.44) and higher in smokers than those who had never smoked, regardless of region of birth (OR, 1.69; 95% CI, 1.07-2.65).

CONCLUSIONS

Our results do not support the hypothesis that a self-reported burning sensation in the feet is associated with HbA1c levels. Rather, they indicate a strong relationship between a burning sensation and region of birth, as well as between a burning sensation and smoking.

Improved Functional Causal Likelihood-Based Causal Discovery Method for Diabetes Risk Factors

Diabetes mellitus is a disease that has reached epidemic proportions globally in recent years. Consequently, the prevention and treatment of diabetes have become key social challenges. Most of the research on diabetes risk factors has focused on correlation analysis with little investigation into the causality of these risk factors. However, understanding the causality is also essential to preventing the disease. In this study, a causal discovery method for diabetes risk factors was developed based on an improved functional causal likelihood (IFCL) model. Firstly, the issue of excessive redundant and false edges in functional causal likelihood structures was resolved through the construction of an IFCL model using an adjustment threshold value. On this basis, an IFCL-based causal discovery algorithm was designed, and a simulation experiment was performed with the developed algorithm. The experimental results revealed that the causal structure generated using a dataset with a sample size of 2000 provided more information than that produced using a dataset with a sample size of 768. In addition, the causal structures obtained with the developed algorithm had fewer redundant and false edges. The following six causal relationships were identified: insulin→plasma glucose concentration, plasma glucose concentration→body mass index (BMI), triceps skin fold thickness→BMI and age, diastolic blood pressure→BMI, and number of times pregnant→age. Furthermore, the reasonableness of these causal relationships was investigated. The algorithm developed in this study enables the discovery of causal relationships among various diabetes risk factors and can serve as a reference for future causality studies on diabetes risk factors.

Clinical trials with plants in diabetes mellitus therapy: a systematic review

INTRODUCTION

The chronic metabolic disorder diabetes mellitus is a fast-growing global problem with huge social, health, and economic consequences, having one of the highest morbidities and mortality rates. Prolonged use of many available medications can produce undesirable side effects. Thus, plants appear as an important source of bioactive resources for the discovery of new treatments for diabetes.

AREAS COVERED

In this sense, this systematic review focused on clinical trials involving plants of National List of Medicinal Plants of Interest to the Unified Health System (RENISUS) (or compounds) with antidiabetic properties. We analyzed indexed studies in PubMed following the reporting guidelines of PRISMA.

EXPERT OPINION

Of the 51 clinical trials found, Curcuma longa, Glycine max, Zingiber officinale, Punica granatum, Aloe vera, Momordica charantia are the species with the greatest amount of clinical trials and the attenuation of insulin resistance, decreased fasting blood glucose and glycosylated hemoglobin levels are some of the main mechanisms by which these plants exert hypoglycemic effects. Thus, we speculate that the Clinical Pharmacology should explore the field of plant-based compounds that will keep concentrating the attention of researchers, and therefore, we gathered studies in advanced stages that highlight the role of plants in the diabetes therapy.

Analysis of the clinical characteristics of insulin autoimmune syndrome induced by exogenous insulin in diabetic patients

BACKGROUND

The exact incidence, clinical features and uniform diagnostic criteria of exogenous insulin autoimmune syndrome (EIAS) are still unclear. The purpose of this study is to explore the clinical characteristics of EIAS and to provide a structural approach for clinical diagnosis, treatment and prevention.

METHODS

The literature on EIAS in Chinese and English from 1970 to 2020 was collected for retrospective analysis.

RESULTS

A total of 122 patients (33 males and 73 females) were included in the study with a median age of 67 years (range 14-86) and a median HbA1c of 7.7%. EIAS mainly occurred in type 2 diabetes mellitus patients using premixed insulin. Symptoms manifested were hypoglycemia in 86.54%, recurrent episodes of symptomatic hypoglycemia in 35.58%, nocturnal hypoglycemia along with daytime hyperglycemia in 21.15% and recurrent hypoglycemia after discontinued insulin in 64.43%. The onset of symptoms occurred at night, in the early morning or during fasting, ranging from a few days to 78 months after the administration of insulin. The mean blood glucose level during the hypoglycemic phase was 2.21 mmol/L (range 1-3.4), and the serum insulin levels were mainly ≥ 100 U/mL and were associated with low C-peptide levels (≤ 10 ng/ml). Insulin autoantibodies (IAAs) were positive in all EIAS patients. The 75-g extended oral glucose tolerance test (OGTT) mainly showed a diabetic curve. Pancreatic imaging was unremarkable. Withdrawal of insulin alone or combination of oral hypoglycemic agents or replacement of insulin formulations or with corticosteroid treatment eliminated hypoglycemia in a few days to 3 months. IAA turned negative in 6 months (median, range 1-12). No hypoglycemia episodes were observed at a median follow-up of 6 months (range 0.5-60).

CONCLUSIONS

EIAS is an autoimmune disease caused by insulin-binding antibodies in susceptible subjects. Insulin antibodies change glucose dynamics and could increase the incidence of hypoglycemic episodes. Detection of insulin antibodies is the diagnostic test. Changing therapeutic modalities reduced the incidence of hypoglycemic episodes.

Association of Type 2 Diabetes Mellitus and Glycemic Control With Intracranial Plaque Characteristics in Patients With Acute Ischemic Stroke

BACKGROUND

Type 2 diabetes mellitus (T2DM) has shown to be associated with carotid plaque vulnerability. However, the impact of T2DM on intracranial artery atherosclerosis is not well-understood.

PURPOSE

To evaluate the association of diabetes and glycemic control with intracranial atherosclerotic plaque characteristics identified by three-dimensional contrast enhanced MR vessel wall imaging in patients after acute ischemic stroke.

STUDY TYPE

Prospective.

POPULATION

Two hundred and eighty-eight symptomatic patients with acute ischemic stroke due to intracranial atherosclerotic plaque.

FIELD STRENGTH/SEQUENCE

T₁ WI volume isotropic turbo spin-echo acquisition sequence at 3.0 T.

ASSESSMENT

Clinical profiles, blood biomarkers, the number of intracranial plaques, plaque enhanced score, and the features (location, luminal stenotic rate, intraplaque hemorrhage, length, burden, enhancement grade, and ratio) of culprit plaque (defined as the most stenotic lesion ipsilateral to the ischemic event) and nonculprit plaque were analyzed by three radiologists.

STATISTICAL TESTS

Analysis of variance (ANOVA), Shapiro-Wilk normality test, Levene's test, ANOVA with Bonferroni post-hoc test, Kruskal Wallis H test with subsequent pairwise comparisons, chi-square with Bonferroni post-hoc test, generalized linear regression, Pearson correlation test, Kendall's W and intra-class correlation coefficient.

RESULTS

Two hundred and twenty-five participants (age 60 ± 10 years, 58.7% male) with 958 intracranial plaques were included. More intracranial plaques were found in the T2DM group than the non-T2DM group (4.80 ± 2.22 vs. 3.60 ± 1.78, P < 0.05). Patients with poorly-controlled T2DM exhibited higher culprit plaque enhancement ratio than patients with well-controlled T2DM and non-T2DM (2.32 ± 0.61 vs. 1.60 ± 0.62 and 1.39 ± 0.39; respectively, P < 0.05). After adjusting for other clinical variables, T2DM was independently associated with increased intracranial plaque number (β = 0.269, P < 0.05), and HbA1c level was independently associated with culprit plaque enhancement ratio (β = 0.641, P < 0.05) in multivariate analysis.

DATA CONCLUSION

T2DM is associated with an increased intracranial plaque number. Higher HbA1c is associated with stronger plaque enhancement. 3D contrast enhanced MR vessel wall imaging may help better understand the association of T2DM and glycemic control with intracranial plaque.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY STAGE: 3.

The effect of ambient ozone on glucose-homoeostasis: A prospective study of non-diabetic older adults in Beijing

OBJECTIVE

To investigate potential effects of short- and medium-term exposure to low levels of ozone (O3) on glucose-homeostasis in non-diabetic older adults.

METHODS

166 non-diabetic, older participants in Beijing were deemed eligible to partake in this longitudinal population-based study. Observations were recorded on three separate occasions from November 2016 up until January 2018. Concentrations of outdoor O3 were monitored throughout the study period. Biomarkers indicative of glucose-homeostasis, including fasting blood glucose, insulin, HbAlc, glycated albumin percentage (glycated albumin/albumin), HOMA-IR and HOMA-B were measured at 3 sessions. A linear mixed effects model with random effects was adopted to quantify the effect of O3 across a comprehensive set of glucose-homeostasis markers.

RESULTS

Short-term O3 exposure positively associated with increased fasting blood glucose, insulin, HOMA-IR and HOMA-B. The effect on glucose occurred at 3-, 5-, 6- and 7-days, although the largest effect manifested on 6-days (5.6%, 95% CI: 1.4, 9.9). Significant associations with both insulin and HOMA-IR were observed on the 3- and 4-days. For HOMA-B, positive associations were identified from 3- to 7-days with estimates ranging from 40.0% (95% CI: 2.3, 91.5) to 83.1% (95% CI: 25.3, 167.5). Stratification suggests that women may be more susceptible to short-term O3 exposure. There does not appear to be a significant association between O3 and glucose-homeostasis in medium-term exposures.

CONCLUSIONS

In this study, we found that O3 exposure is at least partially associated with type II diabetes in older adults with no prior history of this condition. O3 therefore appears to be a potential risk factor, which is a particular concern when we consider the rise in global concentrations. Evidence also suggests that women may be more susceptible to short-term O3 exposure although we are not quite sure why. Future research may look to investigate this phenomenon further.

HbA1c Performance in African Descent Populations in the United States With Normal Glucose Tolerance, Prediabetes, or Diabetes: A Scoping Review

Introduction

African descent populations in the United States have high rates of type 2 diabetes and are incorrectly represented as a single group. Current glycated hemoglobin A_1c (HbA_1c) cutoffs (5.7% to <6.5% for prediabetes; ≥6.5% for type 2 diabetes) may perform suboptimally in evaluating glycemic status among African descent groups. We conducted a scoping review of US-based evidence documenting HbA_1c performance to assess glycemic status among African American, Afro-Caribbean, and African people.

Methods

A PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) search (January 2020) yielded 3,238 articles published from January 2000 through January 2020. After review of titles, abstracts, and full texts, 12 met our criteria. HbA_1c results were compared with other ethnic groups or validated against the oral glucose tolerance test (OGTT), fasting plasma glucose (FPG), or previous diagnosis. We classified study results by the risk of false positives and risk of false negatives in assessing glycemic status.

Results

In 5 studies of African American people, the HbA_1c test increased risk of false positives compared with White populations, regardless of glycemic status. Three studies of African Americans found that HbA_1c of 5.7% to less than 6.5% or HbA_1c of 6.5% or higher generally increased risk of overdiagnosis compared with OGTT or previous diagnosis. In one study of Afro-Caribbean people, HbA_1c of 6.5% or higher detected fewer type 2 diabetes cases because of a greater risk of false negatives. Compared with OGTT, HbA_1c tests in 4 studies of Africans found that HbA_1c of 5.7% to less than 6.5% or HbA_1c of 6.5% or higher leads to underdiagnosis.

Conclusion

HbA_1c criteria inadequately characterizes glycemic status among heterogeneous African descent populations. Research is needed to determine optimal HbA_1c cutoffs or other test strategies that account for risk profiles unique to African American, Afro-Caribbean, and African people living in the United States.

Influence of dialysis duration on outcomes of simultaneous pancreas-kidney transplant

OBJECTIVE

The objective of this study was to assess how pre-transplant dialysis duration affects transplant outcomes after simultaneous pancreas-kidney transplant (SPK) in patients with type 1 diabetes mellitus (T1DM).

METHODS

Data of 6887 T1DM patients who underwent SPK transplantation between 2008 and 2018 were obtained from the Scientific Registry of Transplant Recipients database. According to pre-transplant dialysis duration, the patients were divided into the preemptive SPK, 0-2 years, 2-5 years, and >5 years dialysis groups. Kaplan-Meier survival analysis was performed to compare patient and graft survival among the groups. Univariate and multivariate Cox regression analyses were used to identify predictors of transplant outcomes.

RESULTS

The mean follow-up period was 56.7 ± 34.7 months. Compared with no dialysis or preemptive SPK, dialysis for 0-2 years was not significantly associated with patient or kidney graft survival, while long-term dialysis of 2-5 years and >5 years was significantly associated with increased risk of death and kidney graft failure. However, the duration of dialysis was not associated with pancreas graft survival.

CONCLUSION

Long-term dialysis duration before SPK transplant is an independent predictor of patient death and kidney graft failure in T1DM patients.

Increased Levels of Serum Glycosylated Hemoglobin are Associated with Depressive Symptoms in a Population with Cancer (≥49 Years): An Antidepressant-Stratified Analysis

Purpose

Patients with cancer tend to have a high prevalence of depressive symptoms. The direct relationship between serum glycosylated hemoglobin (GHb) levels and depressive symptoms in cancer patients is still uncertain. We aimed to evaluate the association with serum GHb levels with depressive symptoms in the population (aged ≥49 years) with cancer.

Patients and Methods

Longitudinal data in 204 participants with cancer obtained from The Irish LongituDinal Study on Ageing (TILDA) were used to investigate the association of serum GHb levels with depressive symptoms.

Results

Our results suggested a positive and significant association between serum GHb levels and depression score, independent of age, gender, body mass index (BMI), currently married, education, smoking status, drink alcohol, systolic and diastolic blood pressure (BP), physical activity, self-reported cardiovascular diseases and laboratory measurement in participants with cancer (coefficient =0.141, P<0.001; Model 2) at baseline (wave 1). Higher GHb levels did associate with higher prevalence of depressive symptoms in participants with cancer (OR=2.100, 95% CI 1.105–5.036, P=0.004; Model 2) after adjustment for these same confounding factors in wave 1 was made. Stratified analysis further showed that these significant associations were interfered by antidepressants. Sensitivity analysis showed that higher serum GHb levels in subjects with cancer were linked to higher prevalence of depression events during a follow-up of 4 years.

Conclusion

Our results found a significant association between elevated serum GHb levels and increased risk of depressive symptoms in the population aged ≥49 years with cancer after confounding factors were adjusted.

Silver-Coated Disordered Silicon Nanowires Provide Highly Sensitive Label-Free Glycated Albumin Detection through Molecular Trapping and Plasmonic Hotspot Formation

Glycated albumin (GA) is rapidly emerging as a robust biomarker for screening and monitoring of diabetes. To facilitate its rapid, point-of-care measurements, a label-free surface-enhanced Raman spectroscopy (SERS) sensing platform is reported that leverages the specificity of molecular vibrations and signal amplification on silver-coated silicon nanowires (Ag/SiNWs) for highly sensitive and reproducible quantification of GA. The simulations and experimental measurements demonstrate that the disordered orientation of the nanowires coupled with the wicking of the analyte molecules during the process of solvent evaporation facilitates molecular trapping at the generated plasmonic hotspots. Highly sensitive detection of glycated albumin is shown with the ability to visually detect spectral features at as low as 500 × 10^-9 m, significantly below the physiological range of GA in body fluids. Combined with chemometric regression models, the spectral data recorded on the Ag/SiNWs also allow accurate prediction of glycated concentration in mixtures of glycated and non-glycated albumin in proportions that reflect those in the bloodstream.

Correlation between glycosylated serum albumin and glycosylated haemoglobin in the southwest Chinese population: Establishment of a regression model

AIMS

To correlate glycated albumin (GA) and glycosylated haemoglobin (HbA1c) and establish a novel formula for estimating HbA1c from GA.

METHODS

We retrospectively enrolled 20,381 cases and excluded HbA1c and GA outliers by residual analysis. HbA1c ranged from 4.0-12.0% and GA from 7.5-45%. The HbA1c range of 4.0-8.0% in both sexes was stratified into eight groups with an increase of 0.5%, and the means of GA and HbA1c were compared. HbA1c was divided into 38 groups with increments of 0.1% (range, 4.3-8.0%), and the correlation between HbA1c and GA was investigated.

RESULTS

There was no significant sex-based difference between HbA1c and GA. The analysis showed that when HbA1c was 6.2% or GA was 12.28%, the linear relationship between the two parameters was not continuous. When HbA1c was <6.2% or GA < 12.28%, we devised the formula: HbA1c = 1.136 × GA - 7.289 (R² = 0.824). For HbA1c ≥ 6.2% or GA ≥ 12.28%, the equation was: HbA1c = 0.252 × GA + 3.163 (R² = 0.948).

CONCLUSION

A discontinuous linear relationship exists between HbA1c and GA when HbA1c is 6.2% or GA is 12.28%, although with a significant turning point. The GA value can be used to estimate the HbA1c value with the two regression equations to accurately estimate the long-term average blood glucose level of patients.

Surrogate markers and predictors of endogenous insulin secretion in children and adolescents with type 1 diabetes

BACKGROUND

No studies have examined endogenous insulin secretion in pediatric patients with type 1 diabetes in China using the gold-standard mixed-meal tolerance test. Because the latter is labor-intensive, we examined simpler surrogate markers of endogenous insulin secretion in Chinese youth, as previously reported for a European population.

METHODS

Participants were 57 children and adolescents with type 1 diabetes aged 4.4-16.8 years (56% females). We performed 120-minute mixed-meal tolerance tests with serum C-peptide (CP) measurements every 30 minutes. Severe insulin deficiency (SID) was defined as CP peak < 0.2 nmol/L. Urine CP and creatinine levels were measured at 0 and 120 minutes.

RESULTS

Twenty-five (44%) patients had SID. Fasting CP levels missed one case (96% sensitivity) with no false positives (100% specificity). While the 120-minute urine CP/creatinine had 100% sensitivity, it yielded markedly lower specificity (63%). Every 1-year increase in diabetes duration and 1-year decrease in age at diagnosis were associated with 37% (P < 0.001) and 20% (P = 0.005) reductions in serum CP area-under-the-curve, respectively. Thus, 86% of children aged < 5 years had SID compared to none among patients aged ≥ 11 years.

CONCLUSIONS

Simple fasting CP measurements could be used to detect most SID cases in Chinese youth with type 1 diabetes. Fasting CP is a far more reliable measure of endogenous insulin secretion than the more commonly used insulin dose. Therefore, it could more precisely determine insulin secretory capacity to target those who could benefit, if treatments to preserve residual insulin secretion are developed.

Cost-Effectiveness of Point-of-Care A1C Tests in a Primary Care Setting

Objective: We evaluated the cost-effectiveness of the point-of-care A1c (POC-A1c) test device vs. the traditional laboratory dosage in a primary care setting for people living with type 2 diabetes. Materials and Methods: The Markov model with a 10-year time horizon was based on data from the HealthRise project, in which a group of interventions was implemented to improve diabetes and hypertension control in the primary care network of the urban area of a Brazilian municipality. A POC-A1c device was provided to be used directly in a primary care unit, and for a period of 18 months, 288 patients were included in the point-of-care group, and 1,102 were included in the comparison group. Sensitivity analysis was performed via Monte Carlo simulation and tornado diagram. Results: The results indicated that the POC-A1c device used in the primary care unit was a cost-effective alternative, which improved access to A1c tests and resulted in an increased rate of early control of blood glucose. In the 10-year period, POC-A1c group presented a mean cost of US$10,503.48 per patient and an effectiveness of 0.35 vs. US$9,992.35 and 0.09 for the traditional laboratory test, respectively. The incremental cost was US$511.13 and the incremental effectiveness was 0.26, resulting in an incremental cost-effectiveness ratio of 1,947.10. In Monte Carlo simulation, costs and effectiveness ranged between $9,663.20-$10,683.53 and 0.33-0.37 for POC-A1c test group, and $9,288.28-$10,413.99 and 0.08-0.10 for traditional laboratory test group, at 2.5 and 97.5 percentiles. The costs for nephropathy, retinopathy, and cardiovascular disease and the probability of being hospitalized due to diabetes presented the greatest impact on the model's result. Conclusion: This study showed that using POC-A1c devices in primary care settings is a cost-effective alternative for monitoring glycated hemoglobin A1c as a marker of blood glucose control in people living with type 2 diabetes. According to our model, the use of POC-A1c device in a healthcare unit increased the early control of type 2 diabetes and, consequently, reduced the costs of diabetes-related outcomes, in comparison with a centralized laboratory test.

Derivation and Validation of a Prediction Model for Predicting the 5-Year Incidence of Type 2 Diabetes in Non-Obese Adults: A Population-Based Cohort Study

PURPOSE

The aim of this study was to derivate and validate a nomogram based on independent predictors to better evaluate the 5-year risk of T2D in non-obese adults.

PATIENTS AND METHODS

This is a historical cohort study from a collection of databases that included 12,940 non-obese participants without diabetes at baseline. All participants were randomised to a derivation cohort (n = 9651) and a validation cohort (n = 3289). In the derivation cohort, the least absolute shrinkage and selection operator (LASSO) regression model was used to determine the optimal risk factors for T2D. Multivariate Cox regression analysis was used to establish the nomogram of T2D prediction. The receiver operating characteristic (ROC) curve, C-index, calibration curve, and decision curve analysis were performed by 1000 bootstrap resamplings to evaluate the discrimination ability, calibration, and clinical practicability of the nomogram.

RESULTS

After LASSO regression analysis of the derivation cohort, it was found that age, fatty liver, γ-glutamyltranspeptidase, triglycerides, glycosylated hemoglobin A1c and fasting plasma glucose were risk predictors, which were integrated into the nomogram. The C-index of derivation cohort and validation cohort were 0.906 [95% confidence interval (CI), 0.878-0.934] and 0.837 (95% CI, 0.760-0.914), respectively. The AUC of 5-year T2D risk in the derivation cohort and validation cohort was 0.916 (95% CI, 0.889-0.943) and 0.829 (95% CI, 0.753-0.905), respectively. The calibration curve indicated that the predicted probability of nomogram is in good agreement with the actual probability. The decision curve analysis demonstrated that the predicted nomogram was clinically useful.

CONCLUSION

Our nomogram can be used as a reasonable, affordable, simple, and widely implemented tool to predict the 5-year risk of T2D in non-obese adults. With this model, early identification of high-risk individuals is helpful to timely intervene and reduce the risk of T2D in non-obese adults.

Risk factors for in-hospital mortality among acute ischemic stroke patients in China: a nationwide prospective study

Objective: We aimed to investigate factors related to in-hospital mortality (IHM) in acute ischemic stroke (AIS) patients.Methods: We prospectively investigated 827,314 patients who were admitted within 7 days of AIS between August 2015 and July 2019. Demographic characteristics, risk factors, and clinical and laboratory characteristics of patients were assessed. Univariate and multivariate logistic regression analyses were performed to identify predictors associated with IHM.Results: The IHM rate in this study was 0.5% in women and 0.3% in men. Factors associated with IHM in AIS included diabetes (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.03-1.43), female (OR 0.84, 95%CI 0.74-0.96), hypertension (OR 1.16, 95%CI 1.01-1.34), atrial fib/flutter (OR 1.51, 95%CI 1.29-1.77), other heart disease (OR1.43, 95%CI 1.23-1.67), prior myocardial infarction (OR 2.00, 95%CI 1.54-2.60), antiplatelet therapies (OR 0.71, 95%CI 0.60-0.84), gastrointestinal bleeding (OR 3.54, 95%CI 2.83-4.44), pulmonary embolism (OR 2.53, 95%CI1.41-4.53), dysphagia(OR7.32, 95%CI6.23-8.61), glycosylated hemoglobin (OR1.05, 95%CI 1.02-1.09), serum creatinine (OR 1.001, 95%CI 1.001-1.002), urea nitrogen (OR 1.10, 95%CI 1.08-1.12), National Institutes of Health Stroke Scale (NIHSS) score (4-5 vs. 0-4: OR 3.58; ≥15 vs. 0-4: OR 8.78), stroke rehabilitation (OR 0.27, 95%CI 0.23-0.30), age (third IQR vs. first IQR: OR 1.57; fourth IQR vs. first IQR: OR 2.23), and in-hospital stroke/TIArecurrence (OR 2.38, 95%CI 2.03-2.78).Conclusions: The findings from this study may help clinicians control the risk of IHM better for patients with AIS.

The ratio of estimated average glucose to fasting plasma glucose level as an indicator of insulin resistance in young adult diabetes: An observational study

At present, glycated hemoglobin (HbA1c) and glycated albumin (GA) are used to evaluate glycemic control in diabetic patients, but they cannot reflect insulin deficiency and/or insulin resistance.We investigated the feasibility of using estimated average glucose to fasting plasma glucose ratio (eAG/fPG ratio) to estimate insulin resistance in young adult diabetes. A total of 387 patients with type 2 diabetes were included and were stratified into 2 groups based on median values of the glycemic index ratio: the GA/A1c ratio <2.09 (n = 91) and ≥2.09 (n = 296); the eAG/fPG ratio <1.69 (n = 155) and ≥1.69 (n = 232). HbA1c, GA, fructosamine, insulin, and C-peptide levels were measured. The ratio of GA to HbA1c was calculated, and the homeostasis model assessment of β-cell function and insulin resistance were determined. The homeostasis model assessment of insulin resistance level was significantly associated with the eAG/fPG ratio, but not with the ratio of GA to HbA1c, GA, HbA1c, and fructosamine levels. The ratio of estimated average glucose to fasting plasma glucose level correlates with insulin resistance in young adult diabetes.

Recombinant ling zhi-8 enhances Tregs function to restore glycemic control in streptozocin-induced diabetic rats

OBJECTIVES

To explore the effect of recombinant LZ-8 (rLZ-8) on streptozocin (STZ)-induced diabetic rats and further illustrate its underlying mechanism.

METHODS

Rats were intraperitoneally injected with single-dose STZ 50 mg/kg for induction of type 1 diabetes (T1D), and then, the diabetic rats were treated with rLZ-8 for 3 months. The clinical symptoms, fasting blood glucose, insulin, cytokines, histopathology, flow cytometry and immunofluorescence were used to evaluate the therapeutic effect and underlying mechanism of rLZ-8 on alleviating diabetes mellitus (DM).

KEY FINDINGS

Treatment with rLZ-8 obviously alleviated the clinical symptoms of T1D and dose-dependently reduced the levels of blood glucose, blood lipid and haemoglobin A1c (HbA1c) in diabetic rat model. Meanwhile, rLZ-8 markedly increased insulin secretion and protected against STZ-induced pancreatic tissue injury. Additionally, rLZ-8 dramatically inhibited the levels of TNF-α and IL-1β, and obviously increased the level of IL-10 in serum and pancreas. Further investigation indicated that rLZ-8 treatment significantly increased the number of regulatory T cells (Tregs) and up-regulated the expression of Foxp3 to restore balance between anti-inflammatory and inflammatory cytokines.

CONCLUSIONS

These data suggest that rLZ-8 can antagonize STZ-induced T1D, and its mechanism may be related to inhibit inflammation and enhance Tregs generation.

1,5-Anhydroglucitol × glycated hemoglobin A1c/100 as a potential biomarker for islet β-cell function among patients with type 2 diabetes

AIMS

This study aimed to explore the level of and changes in the 1,5-anhydroglucitol × glycated hemoglobin A_1c/100 (AH index, AHI) associated with different glucose metabolism statuses and to evaluate the islet function and insulin sensitivity of patients with type 2 diabetes (T2DM) with different AHI levels.

METHODS

Of the 3562 subjects enrolled in this study, 1697 had T2DM. The disposition index (DI) was the product of islet secretion function and insulin sensitivity-related indexes.

RESULTS

The mean AHI level was 1.0 (0.7-1.3) in the general population, while the mean AHI level in the T2DM group was 0.8 (0.5-1.2), which was significantly lower than that in the impaired glucose regulation and normal glucose tolerance group (both 1.2 (0.9-1.5), both P < 0.01). We further divided patients with T2DM into four subgroups according to the quartile of AHI. The results showed that with the increase in AHI level, the homeostasis model assessment of insulin resistance (HOMA-IR) decreased, while HOMA-β, insulin generation index, insulin sensitivity index, and DI increased (all P_{for trend} < 0.01). Multivariate logistic regression showed that the odds ratios for a low DI for increasing levels of AHI were 1.00, 0.22 (0.16-0.29), 0.16 (0.11-0.22), and 0.09 (0.06-0.13), showing a decreasing trend (P_{for trend} < 0.05).

CONCLUSION

The AHI could reflect the variation in glycemic disorder and the function of islet β cells. The lower the AHI, the worse the glycemic disorder, as well as the islet β-cell function.

Serum 1,5-Anhydroglucitol to Glycated Albumin Ratio Can Help Early Distinguish Fulminant Type 1 Diabetes Mellitus from Newly Onset Type 1A Diabetes Mellitus

BACKGROUND

Fulminant type 1 diabetes mellitus (FT1DM) onsets abruptly and usually occurs within 1 week after the onset of hyperglycemic symptoms. Glycated albumin (GA) and 1,5-anhydroglucitol (1,5-AG) are indicators that reflect short-term glucose levels. This study was aimed at investigating whether the 1,5-AG/GA index (AGI) is a suitable indicator for early FT1DM identification.

METHODS

A total of 226 subjects were enrolled, all with glycated hemoglobin A1c (HbA1c) < 8.7%. FT1DM was diagnosed based on the 2012 Japan Diabetes Society criteria.

RESULTS

The AGI level was 0.54 (0.17-1.36) in the whole group. It was lower in FT1DM patients (0.16 [0.10-0.25]). Among the participants whose HbA1c did not exceed 7.0%, the AGI of FT1DM decreased significantly compared to type 1A diabetes (T1ADM) and latent autoimmune diabetes in adults (LADA) patients (0.16 [0.12-0.26] vs. 0.46 [0.24-0.72] vs. 0.46 [0.24-0.72] P < 0.05). The receiver operating characteristic (ROC) curve showed that AGI can be used to distinguish FT1DM and T1ADM patients with HbA1c < 8.7%. Diagnosing FT1DM based on AGI ≤ 0.3 only can help narrow down suspected FT1DM by up to 26.87%. If we diagnosed FT1DM when AGI was ≤0.3 and HbA1c was ≤7.0%, the success rate further increased to 86.57%, among which 85.00% of FT1DM and 87.23% of T1ADM patients were successfully identified. Therefore, using the combination criteria of AGI and HbA1c would improve the differential diagnosis efficacy by 61.11% compared with the AGI criterion only.

CONCLUSION

AGI can help facilitate the early differential diagnosis of FT1DM and T1ADM when HbA1c < 8.7%, with an optimal cut-off point of 0.3.

Influence of Sex Hormones on the Relationship Between Body Fat and Glycated Albumin Levels

BACKGROUND

Previous studies have reported that glycated albumin (GA) is affected by body fat distribution. Sex hormones are reported to play an important role in fat metabolism.

AIM

This study aimed to explore the influence of sex hormones on the relationship between body fat and GA in a community population.

METHODS

We recruited 763 middle-aged and elderly subjects with normal glucose tolerance from communities. GA was determined using the enzyme method, and serum estradiol (E₂), total testosterone, and sex hormone-binding globulin (SHBG) were detected using chemiluminescent microparticle immunoassays.

OUTCOME

There was a statistically significant association between SHBG and GA remained after adjusting for body fat in both men and women.

RESULTS

The average serum GA levels were 13.40 ± 1.10% in the 298 men and 465 postmenopausal women included in this study. GA presented a significant downward trend with increasing quartiles of total fat mass (FM), limb FM, and trunk FM in both men and women (all P for trend < .01). In men, total testosterone, free testosterone, and SHBG were positively correlated with GA (both P < .01), and the correlation between SHBG and GA remained after adjusting for body fat (P < .01). In women, E2, free testosterone, bioactive testosterone, and SHBG were correlated with GA (all P < .01); furthermore, the positive correlation between SHBG and GA and the inverse correlation between E2 and GA remained after adjusting for body fat (both P < .05). Multivariate linear regression analyses showed that in addition to trunk FM, SHBG was positively correlated with GA in both men and women (standardized β = 0.136, P = .035; standardized β = 0.101, P = .033); however, E2 was not independently correlated with GA in women.

CLINICAL IMPLICATIONS

SHBG may contribute to the influence of body fat, especially trunk fat on GA levels.

STRENGTHS & IMPLICATIONS

This study used an automated bioelectrical impedance analyzer to measure segmental body composition including limb FM and trunk FM and further investigated the role of segmental body fat in the correlation between SHBG and GA. Sex hormones may explain in part why body fat content and distribution can alter GA levels.

CONCLUSION

SHBG is positively correlated with serum GA levels, and this correlation is independent of total or segmental body fat. Xu Y, Ma X, Shen Y, et al. Influence of Sex Hormones on the Relationship Between Body Fat and Glycated Albumin Levels. J Sex Med 2020;17:903-910.

Pioglitazone Attenuates Reoxygenation Injury in Renal Tubular NRK-52E Cells Exposed to High Glucose via Inhibiting Oxidative Stress and Endoplasmic Reticulum Stress

Renal ischemia-reperfusion injury is a major cause of acute kidney injury. In the present study, we investigated the effects of pioglitazone on hypoxia/reoxygenation (H/R) injury in rat renal tubular epithelial cells (RTECs) under normal- (NG) or high-glucose (HG) culture conditions via evaluating oxidative stress and endoplasmic reticulum stress (ERS). The RTECs (NRK-52E cells) were divided into six groups as follows: NG group, HG group, NG + H/R group, HG + H/R group, NG + Pio + H/R group, and HG + Pio + H/R group, among which cells in H/R groups were subjected to 4 h of hypoxia followed by 12 h of reoxygenation. After that, the cells were evaluated using the Cell Counting Kit-8 assay for the determination of their viability and flow cytometry assay for the detection of apoptosis. The levels of superoxide dismutase (SOD), glutathione reductase (GSH), catalase (CAT), and malondialdehyde (MDA) were determined via colorimetric chemical assays. In addition, the expression of ERS-associated proteins, i.e. ATF4, ATF6, GRP78, and CHOP, was determined via western blotting. A HG environment could reduce the viability and increase the apoptotic rate of NRK-52E cells with increased MDA levels and decreased SOD, CAT, and GSH levels, and upregulate the expression of ERS-associated proteins, i.e. ATF4, ATF6, and GRP78. H/R injury could further aggravate changes in the above indicators, but pioglitazone could significantly reverse such changes and alleviate cell injury. Thus, Pioglitazone exhibits a cytoprotective effect on RTECs against H/R injury under NG or HG culture conditions by inhibiting oxidative stress and ERS.

Glycated Plasma Proteins as More Sensitive Markers for Glycemic Control in Type 1 Diabetes

PURPOSE

Glycated hemoglobin (HbA1c) is used clinically for diagnosis and therapeutic management of diabetes. However, HbA1c reflects average blood glucose level over a long period. The aim of this study is to look for short period, more sensitive protein markers that correlate better with glycemic level.

EXPERIMENTAL DESIGN

The glycated proteome of human plasma from type 1 diabetic individuals with good and poor (n = 20 each) glycemic control are analyzed using an online two-dimensional proteomics approach. Selected glycated peptides are further validated for their potential as candidate biomarkers using parallel reaction monitoring.

RESULTS

305 glycated peptides are quantified and 290 are significantly increased in samples with poor glycemic control. 76 of the 88 selected glycated peptides have receiver operating characteristic area under curve (AUC) values greater than 0.8. Six validated glycated peptides with high AUC show high correlation with HbA1c and have higher fold changes between poor and good glycemic control than HbA1c. The parent proteins have half-lives shorter than HbA1c.

CONCLUSIONS AND CLINICAL RELEVANCE

Using an advanced proteomics platform for protein glycation analysis, glycated peptides and proteins are identified that are promising as more sensitive, shorter term indicators of glycemic control in diabetic patients than the commonly used HbA1c.