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Yoeli-Ullman R, Maayan-Metzger A, Zemet R, Dori Dayan N, Mazaki-Tovi S, Cohen O, Weiss L, Cukierman-Yaffe T. The association between novel glucose indices in parturients with type 1 diabetes mellitus and clinically significant neonatal hypoglycemia. Gynecol Endocrinol 2020; 36:615-619. [PMID: 31825267 DOI: 10.1080/09513590.2019.1698027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The aim of this study was to determine the association between glucose control indices of parturient with type 1 diabetes (T1DM), treated with an insulin pump and utilizing continuous glucose monitoring (CGM), and clinically significant neonatal hypoglycemia. This was a retrospective cohort study which included 37 pregnant women with T1DM. All women were followed at a single tertiary center and had available CGM data. The association between maternal glucose indices before delivery and the risk for neonatal hypoglycemia requiring IV glucose (clinically significant hypoglycemia) was assessed using logistic regression. Mothers to neonates that experienced clinically significant hypoglycemia had a higher glucose standard deviation (SD) before delivery than did mothers to neonates who did not (25.5 ± 13 mg/dL vs. 14.7 ± 6.7 mg/dl respectively; p = .008). This association persisted after adjustment for maternal age, maternal pregestational body mass index (BMI), gestational age at delivery, neonatal birth weight, large for gestational age (LGA) and gender. This study demonstrates an association between high maternal glucose standard deviation before delivery and the risk for clinically significant neonatal hypoglycemia. Larger studies are needed to confirm these results and further explore the role of intrapartum glucose variability in the prediction and prevention of significant neonatal hypoglycemia.
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Affiliation(s)
- Rakefet Yoeli-Ullman
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayala Maayan-Metzger
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neonatology, The Edmond and Lili Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Roni Zemet
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Dori Dayan
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - Lotem Weiss
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics, Ruth Rapport Children Hospital, Rambam Medical Center, Haifa, Israel
| | - Tali Cukierman-Yaffe
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
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Ji H, Godsland I, Oliver NS, Hill NE. Loss of association between HbA1c and vascular disease in older adults with type 1 diabetes. PLoS One 2020; 15:e0234319. [PMID: 32542057 PMCID: PMC7295188 DOI: 10.1371/journal.pone.0234319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/22/2020] [Indexed: 11/21/2022] Open
Abstract
Aims Robust evidence supports intensive glucose control in those with recently diagnosed type 1 diabetes to reduce the risk of developing micro- and macrovascular complications. Data to support longitudinal glycaemic targets is lacking. We aimed to explore if longer duration of diabetes and greater age might reduce the impact of glycaemia on the risk of vascular complications. Research and design methods Data for adults age 20 years or more, was extracted from a clinical database of people with type 1 diabetes cared for at a London teaching hospital. The presence or absence of micro- and macro-vascular complications was recorded. Multivariable logistic regression analysis was performed using HbA1c as independent variable, diabetes duration and age as continuous variable and obesity, hypertension, hypercholesterolaemia, low HDL cholesterol and hypertriglyceridaemia as categorical variables. Results Data from 495 patients was used. HbA1c above 60 mmol/mol (7.6%) was associated with increased microvascular complications in patients aged 20–44 years, independent of age and duration of diabetes. In older people with T1DM duration of diabetes was the major risk factor. Conclusions Our study suggests that increased age and greater duration of diabetes reduce the impact of glycaemia on the risk of vascular complications. Intensive blood glucose management in patients aged ≥45 years may have limited benefits in terms of reducing the risk of complications although this does not dismiss the benefits of good glycaemic control in older people with T1DM.
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Affiliation(s)
- HaEun Ji
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ian Godsland
- Division of Diabetes, Department of Metabolism, Endocrinology and Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Nick S. Oliver
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Division of Diabetes, Department of Metabolism, Endocrinology and Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Neil E. Hill
- Imperial College Healthcare NHS Trust, London, United Kingdom
- * E-mail:
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Khaire SS, Gada JV, Utpat KV, Shah N, Varthakavi PK, Bhagwat NM. A study of glycemic variability in patients with type 2 diabetes mellitus with obstructive sleep apnea syndrome using a continuous glucose monitoring system. Clin Diabetes Endocrinol 2020; 6:10. [PMID: 32518676 PMCID: PMC7275595 DOI: 10.1186/s40842-020-00098-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022] Open
Abstract
Background Obstructive sleep apnea syndrome (OSAS) in association with Type 2 Diabetes Mellitus (DM) may result in increased glycemic variability affecting the glycemic control and hence increasing the risk of complications associated with diabetes. We decided to assess the Glycemic Variability (GV) in patients with type 2 diabetes with OSAS and in controls. We also correlated the respiratory disturbance indices with glycemic variability indices. Methods After fulfilling the inclusion and exclusion criteria patients from the Endocrinology and Pulmonology clinics underwent modified Sleep Apnea Clinical Score (SACS) followed by polysomnography (PSG). Patients were then divided into 4 groups: Group A (DM with OSAS, n = 20), Group B (DM without OSAS, n = 20), Group C (Non DM with OSAS, n = 10) and Group D (Non DM without OSAS, n = 10). Patients in these groups were subjected to continuous glucose monitoring using the Medtronic iPro2 and repeat PSG. Parameters of GV: i.e. mean glucose, SD (standard Deviation), CV (Coefficient of Variation), Night SD, Night CV, MAGE and NMAGE were calculated using the Easy GV software. GV parameters and the respiratory indices were correlated statistically. Quantitative data was expressed as mean, standard deviation and median. The comparison of GV indices between different groups was performed by one-way analysis of variance (ANOVA) or Kruskal Wallis (for data that failed normality). Correlation analysis of AHI with GV parameters was done by Pearson correlation. Results All the four groups were adequately matched for age, sex, Body Mass Index (BMI), waist circumference (WC) and blood pressure (BP). We found that the GV parameters Night CV, MAGE and NMAGE were significantly higher in Group A as compared to Group B (p values < 0.05). Similarly Night CV, MAGE and NMAGE were also significantly higher in Group C as compared to Group D (p value < 0.05). Apnea-hypopnea index (AHI) correlated positively with Glucose SD, MAGE and NMAGE in both diabetes (Group A plus Group B) and non- diabetes groups (Group C plus Group D). Conclusions OSAS has a significant impact on the glycemic variability irrespective of glycemic status. AHI has moderate positive correlation with the glycemic variability.
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Affiliation(s)
- Suhas S Khaire
- Department of Endocrinology, Room no. 419, 4th floor, College building, Topiwala National Medical College and Bai Yamunabai Laxman (B.Y.L.) Nair Charitable Hospital, A.L. Nair Road, Mumbai Central, Mumbai, Maharashtra 400008 India
| | - Jugal V Gada
- Department of Endocrinology, Room no. 419, 4th floor, College building, Topiwala National Medical College and Bai Yamunabai Laxman (B.Y.L.) Nair Charitable Hospital, A.L. Nair Road, Mumbai Central, Mumbai, Maharashtra 400008 India
| | - Ketaki V Utpat
- Department of Endocrinology, Room no. 419, 4th floor, College building, Topiwala National Medical College and Bai Yamunabai Laxman (B.Y.L.) Nair Charitable Hospital, A.L. Nair Road, Mumbai Central, Mumbai, Maharashtra 400008 India.,Department of Chest Medicine, Topiwala National Medical College and Bai Yamunabai Laxman (B.Y.L.) Nair Charitable Hospital, Mumbai, India
| | - Nikita Shah
- Department of Endocrinology, Room no. 419, 4th floor, College building, Topiwala National Medical College and Bai Yamunabai Laxman (B.Y.L.) Nair Charitable Hospital, A.L. Nair Road, Mumbai Central, Mumbai, Maharashtra 400008 India
| | - Premlata K Varthakavi
- Department of Endocrinology, Room no. 419, 4th floor, College building, Topiwala National Medical College and Bai Yamunabai Laxman (B.Y.L.) Nair Charitable Hospital, A.L. Nair Road, Mumbai Central, Mumbai, Maharashtra 400008 India
| | - Nikhil M Bhagwat
- Department of Endocrinology, Room no. 419, 4th floor, College building, Topiwala National Medical College and Bai Yamunabai Laxman (B.Y.L.) Nair Charitable Hospital, A.L. Nair Road, Mumbai Central, Mumbai, Maharashtra 400008 India
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Shi C, Liu S, Yu HF, Han B. Glycemic variability and all-cause mortality in patients with diabetes receiving hemodialysis: A prospective cohort study. J Diabetes Complications 2020; 34:107549. [PMID: 32033851 DOI: 10.1016/j.jdiacomp.2020.107549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/26/2022]
Abstract
AIM We aimed to examine the possible association between glycemic variability (GV) and all-cause mortality in patients with diabetes receiving hemodialysis. METHODS We conducted a prospective longitudinal cohort study of patients with diabetes mellitus undergoing hemodialysis at the Jiaxing Hemodialysis Center between December 2012 and December 2018. GV quantified with coefficient of variation (CV). The endpoint in the current study was defined as all-cause mortality. RESULTS Of 1240 patients included in the analyses, there were 340 (27.4%) patients with death from all causes during a median follow-up time of 2.4 years (range 0-3.0). In a Kaplan-Meier analysis, cumulative survival was significantly dependent on CV quartiles with an apparent dose-response (log-rank P < 0.001). In a multiple Cox regression model, the highest CV quartile was independently associated with increased risk of all-cause mortality (HR 1.887, 95% CI 1.407-2.531, P < 0.001). CONCLUSIONS Higher GV is associated with increased mortality risk among patients with diabetes receiving hemodialysis. Future studies are needed to explore whether decreasing GV would be associated with reduced risk of mortality.
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Affiliation(s)
- Chao Shi
- Department of Nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang, China.
| | - Si Liu
- Department of Nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang, China
| | - Hai-Feng Yu
- Jiaxing Hemodialysis Center, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang, China
| | - Bin Han
- Department of Nephrology, First Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang, China
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Vianna AGD, Lacerda CS, Pechmann LM, Polesel MG, Marino EC, Scharf M, Detsch JM, Marques K, Sanches CP. Improved glycaemic variability and time in range with dapagliflozin versus gliclazide modified release among adults with type 2 diabetes, evaluated by continuous glucose monitoring: A 12-week randomized controlled trial. Diabetes Obes Metab 2020; 22:501-511. [PMID: 31709738 DOI: 10.1111/dom.13913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 12/15/2022]
Abstract
AIMS To evaluate whether there is a difference between the effects of dapagliflozin and gliclazide modified release (MR) on glycaemic variability (GV) and glycaemic control, as assessed by continuous glucose monitoring (CGM), in individuals with uncontrolled type 2 diabetes. MATERIALS AND METHODS This randomized, open-label, active-controlled study was conducted in individuals with uncontrolled type 2 diabetes who were drug-naïve or on steady-dose metformin monotherapy. Participants were treated once daily with 10 mg dapagliflozin or 120 mg gliclazide MR. CGM and GV index calculations were performed at baseline and after 12 weeks. RESULTS In total, 97 participants (age 57.9 ± 8.7 years, 50.5% men, baseline glycated haemoglobin 63 ± 9.8 mmol/mol [7.9 ± 0.9%]) were randomized, and 94 completed the 12-week protocol. Intention-to-treat (ITT) and per-protocol (PP) analyses showed that the reduction in GV, as measured by the mean amplitude of glycaemic excursions, was superior in the dapagliflozin group versus the gliclazide MR group (-0.9 mmol/L [95% CI -1.5, -0.4] vs -0.2 mmol/L [95% CI -0.6, 0.3]; P = 0.030 [ITT]). The reductions in GV estimated by the coefficient of variation and SD were greater in the dapagliflozin group. Moreover, dapagliflozin increased the glucose time in range (TIR; 3.9-10 mmol/L) by 24.9% (95% CI 18.6, 31.2) vs. 17.4% (95% CI 11.6, 23.3) in the gliclazide MR group (P = 0.089 [ITT]; P = 0.041 [PP]). CONCLUSIONS Dapagliflozin improved GV and increased TIR more efficiently than gliclazide MR in individuals with type 2 diabetes over 12 weeks, as demonstrated by CGM.
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Affiliation(s)
- Andre G D Vianna
- Curitiba Diabetes Centre, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Claudio S Lacerda
- Curitiba Diabetes Centre, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Luciana M Pechmann
- Curitiba Diabetes Centre, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Michelle G Polesel
- Curitiba Diabetes Centre, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Emerson C Marino
- Curitiba Diabetes Centre, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Mauro Scharf
- Curitiba Diabetes Centre, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Josiane M Detsch
- Curitiba Diabetes Centre, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Kleber Marques
- Curitiba Diabetes Centre, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Claudia P Sanches
- Curitiba Diabetes Centre, Department of Endocrine Diseases, Hospital Nossa Senhora das Graças, Curitiba, Brazil
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Liu YP, Shao SJ, Guo HD. Schwann cells apoptosis is induced by high glucose in diabetic peripheral neuropathy. Life Sci 2020; 248:117459. [PMID: 32092332 DOI: 10.1016/j.lfs.2020.117459] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 02/06/2023]
Abstract
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus that affects approximately half of patients with diabetes. Current treatment regimens cannot treat DPN effectively. Schwann cells (SCs) are very sensitive to glucose concentration and insulin, and closely associated with the occurrence and development of type 1 diabetic mellitus (T1DM) and DPN. Apoptosis of SCs is induced by hyperglycemia and is involved in the pathogenesis of DPN. This review considers the pathological processes of SCs apoptosis under high glucose, which include the following: oxidative stress, inflammatory reactions, endoplasmic reticulum stress, autophagy, nitrification and signaling pathways (PI3K/AKT, ERK, PERK/Nrf2, and Wnt/β-catenin). The clarification of mechanisms underlying SCs apoptosis induced by high glucose will help us to understand and identify more effective strategies for the treatment of T1DM DPN.
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Affiliation(s)
- Yu-Pu Liu
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Shui-Jin Shao
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
| | - Hai-Dong Guo
- Department of Anatomy, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China.
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Effect of High Versus Low Carbohydrate Intake in the Morning on Glycemic Variability and Glycemic Control Measured by Continuous Blood Glucose Monitoring in Women with Gestational Diabetes Mellitus-A Randomized Crossover Study. Nutrients 2020; 12:nu12020475. [PMID: 32069857 PMCID: PMC7071236 DOI: 10.3390/nu12020475] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 01/09/2023] Open
Abstract
Carbohydrate is the macronutrient that has the greatest impact on blood glucose response. Limited data are available on how carbohydrate distribution throughout the day affects blood glucose in women with gestational diabetes mellitus (GDM). We aimed to assess how a high-carbohydrate morning-intake (HCM) versus a low-carbohydrate-morning-intake (LCM), affect glycemic variability and glucose control. In this randomized crossover study continuous glucose monitoring (CGM) was performed in 12 women with diet treated GDM (75 g, 2-h OGTT ≥ 8.5 mmol/L), who went through 2 × 3 days of HCM and LCM. A within-subject-analysis showed a significantly higher mean amplitude of glucose excursions (MAGE) (0.7 mmol/L, p = 0.004) and coefficient of variation (CV) (5.1%, p = 0.01) when comparing HCM with LCM, whereas a significantly lower mean glucose (MG) (-0.3 mmol/L, p = 0.002) and fasting blood glucose (FBG) were found (-0.4 mmol/L, p = 0.01) on the HCM diet compared to the LCM diet. In addition, insulin resistance, expressed as Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), decreased significantly during HCM. Results indicate that a carbohydrate distribution of 50% in the morning favors lower blood glucose and improvement in insulin sensitivity in women with GDM, but in contrary gives a higher glycemic variability.
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Abstract
Background Organisms can be primed by metabolic exposures to continue expressing response genes even once the metabolite is no longer available, and can affect the speed and magnitude of responsive gene expression during subsequent exposures. This “metabolic transcriptional memory” can have a profound impact on the survivability of organisms in fluctuating environments. Scope of review Here I present several examples of metabolic transcriptional memory in the microbial world and discuss what is known so far regarding the underlying mechanisms, which mainly focus on chromatin modifications, protein inheritance, and broad changes in metabolic network. From these lessons learned in microbes, some insights into the yet understudied human metabolic memory can be gained. I thus discuss the implications of metabolic memory in disease progression in humans – i.e., the memory of high blood sugar exposure and the resulting effects on diabetic complications. Major conclusions Carbon source shifts from glucose to other less preferred sugars such as lactose, galactose, and maltose for energy metabolism as well as starvation of a signal transduction precursor sugar inositol are well-studied examples of metabolic transcriptional memory in Escherichia coli and Saccharomyces cerevisiae. Although the specific factors guiding metabolic transcriptional memory are not necessarily conserved from microbes to humans, the same basic mechanisms are in play, as is observed in hyperglycemic memory. Exploration of new metabolic transcriptional memory systems as well as further detailed mechanistic analyses of known memory contexts in microbes is therefore central to understanding metabolic memory in humans, and may be of relevance for the successful treatment of the ever-growing epidemic of diabetes. Metabolic exposures can prime genes to have memory. Memory of carbon source shifts occurs in all kingdoms of life. Memory is maintained through multiple mechanisms including chromatin modifications, proteins, and metabolic network. Metabolic transcriptional memory in unicellular organisms is a part of “bet-hedging” strategies to ensure survival. Hyperglycemic memory in humans contributes to diabetes and aging.
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Affiliation(s)
- Poonam Bheda
- Institute of Functional Epigenetics, Helmholtz Zentrum München, Neuherberg, Germany.
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59
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Rezende PC, Hlatky MA, Hueb W, Garcia RMR, da Silva Selistre L, Lima EG, Garzillo CL, Scudeler TL, Boros GAB, Ribas FF, Serrano CV, Ramires JAF, Kalil Filho R. Association of Longitudinal Values of Glycated Hemoglobin With Cardiovascular Events in Patients With Type 2 Diabetes and Multivessel Coronary Artery Disease. JAMA Netw Open 2020; 3:e1919666. [PMID: 31968117 PMCID: PMC6991270 DOI: 10.1001/jamanetworkopen.2019.19666] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Glycated hemoglobin (HbA1c) values are used to guide glycemic control, but in patients with type 2 diabetes and multivessel coronary artery disease (CAD), the association of the longitudinal values of HbA1c with cardiovascular outcomes is unclear. OBJECTIVE To assess whether longitudinal variation of HbA1c is associated with cardiovascular events in long-term follow-up among patients with diabetes and multivessel CAD. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 888 patients with type 2 diabetes and multivessel CAD in the Medicine, Angioplasty, or Surgery Study (MASS) Registry of the Heart Institute of the University of São Paulo from January 2003 to December 2007. Data were analyzed from January 15, 2018, to October 15, 2019. EXPOSURE Longitudinal HbA1c values. MAIN OUTCOMES AND MEASURES The combined outcome of all-cause mortality, myocardial infarction, and ischemic stroke. RESULTS Of 888 patients with type 2 diabetes and multivessel CAD, 725 (81.6%; median [range] age, 62.4 [55.7-68.0] years; 467 [64.4%] men) had complete clinical and HbA1c information during a median (interquartile range) follow-up period of 10.0 (8.0-12.3) years, with a mean (SD) of 9.5 (3.8) HbA1c values for each patient. The composite end point of death, myocardial infarction, or ischemic stroke occurred in 262 patients (36.1%). A 1-point increase in the longitudinal value of HbA1c was significantly associated with a 14% higher risk of the combined end point of all-cause mortality, myocardial infarction, and ischemic stroke (hazard ratio, 1.14; 95% CI, 1.04-1.24; P = .002) in the unadjusted analysis. After adjusting for baseline factors (ie, age, sex, 2-vessel or 3-vessel CAD, initial CAD treatments, ejection fraction, and creatinine and low-density lipoprotein cholesterol levels), a 1-point increase in the longitudinal value of HbA1c was associated with a 22% higher risk of the combined end point (hazard ratio, 1.22; 95% CI, 1.12-1.35; P < .001). CONCLUSIONS AND RELEVANCE Longitudinal increase of HbA1c was independently associated with higher rates of cardiovascular events in patients with type 2 diabetes and multivessel CAD.
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Affiliation(s)
- Paulo Cury Rezende
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Whady Hueb
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rosa Maria Rahmi Garcia
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Eduardo Gomes Lima
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Cibele Larrosa Garzillo
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thiago Luis Scudeler
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gustavo Andre Boeing Boros
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Faglioni Ribas
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Vicente Serrano
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jose Antonio Franchini Ramires
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Instituto do Coração (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Papachristoforou E, Lambadiari V, Maratou E, Makrilakis K. Association of Glycemic Indices (Hyperglycemia, Glucose Variability, and Hypoglycemia) with Oxidative Stress and Diabetic Complications. J Diabetes Res 2020; 2020:7489795. [PMID: 33123598 PMCID: PMC7585656 DOI: 10.1155/2020/7489795] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 02/07/2023] Open
Abstract
Oxidative stress (OS) is defined as a disturbance in the prooxidant-antioxidant balance of the cell, in favor of the former, which results in the antioxidant capacity of the cell to be overpowered. Excess reactive oxygen species (ROS) production is very harmful to cell constituents, especially proteins, lipids, and DNA, thus causing damage to the cell. Oxidative stress has been associated with a variety of pathologic conditions, including diabetes mellitus (DM), cancer, atherosclerosis, neurodegenerative diseases, rheumatoid arthritis, ischemia/reperfusion injury, obstructive sleep apnea, and accelerated aging. Regarding DM specifically, previous experimental and clinical studies have pointed to the fact that oxidative stress probably plays a major role in the pathogenesis and development of diabetic complications. It is postulated that hyperglycemia induces free radicals and impairs endogenous antioxidant defense systems through several different mechanisms. In particular, hyperglycemia promotes the creation of advanced glycation end-products (AGEs), the activation of protein kinase C (PKC), and the hyperactivity of hexosamine and sorbitol pathways, leading to the development of insulin resistance, impaired insulin secretion, and endothelial dysfunction, by inducing excessive ROS production and OS. Furthermore, glucose variability has been associated with OS as well, and recent evidence suggests that also hypoglycemia may be playing an important role in favoring diabetic vascular complications through OS, inflammation, prothrombotic events, and endothelial dysfunction. The association of these diabetic parameters (i.e., hyperglycemia, glucose variability, and hypoglycemia) with oxidative stress will be reviewed here.
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Affiliation(s)
- Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine, Research Unit and Diabetes Centre, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Eirini Maratou
- Second Department of Internal Medicine, Research Unit and Diabetes Centre, National and Kapodistrian University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece
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Yu W, Wu N, Li L, OuYang H, Qian M, Shen H. A Review of Research Progress on Glycemic Variability and Gestational Diabetes. Diabetes Metab Syndr Obes 2020; 13:2729-2741. [PMID: 32801819 PMCID: PMC7414929 DOI: 10.2147/dmso.s261486] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/11/2020] [Indexed: 01/27/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is associated with many adverse obstetric outcomes and neonatal outcomes, including preeclampsia, Cesarean section, and macrosomia. Active screening and early diabetes control can reduce the occurrence of adverse outcomes. Glycosylated hemoglobin (HbA1c) only reflects average blood glucose levels, but not glycemic variability (GV). Studies have shown that GV can cause a series of adverse reactions, and good control of GV can reduce the incidence of adverse pregnancy outcomes in patients with GDM. In order to provide clinicians with a better basis for diagnosis and treatment, this study reviewed the measurement, evaluation, and control of GV, the importance of GV for patients with GDM, and correlations between GV and maternal and neonatal outcomes.
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Affiliation(s)
- Wenshu Yu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’ s Republic of China
| | - Na Wu
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’ s Republic of China
- Correspondence: Na Wu Department of Endocrinology, Shengjing Hospital of China Medical University, 36 Sanhao Road, Heping District, Shenyang, Liaoning Province110004, People’ s Republic of ChinaTel +86 18940258445 Email
| | - Ling Li
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’ s Republic of China
| | - Hong OuYang
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’ s Republic of China
| | - Meichen Qian
- Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, People’ s Republic of China
| | - Haitao Shen
- Department of Emergency Medicine, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China
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Souto DL, Lima ÉDS, Dantas JR, Zajdenverg L, Rodacki M, Rosado EL. Postprandial metabolic effects of fructose and glucose in type 1 diabetes patients: a pilot randomized crossover clinical trial. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:376-384. [PMID: 31365624 PMCID: PMC10528643 DOI: 10.20945/2359-3997000000148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To test the influence of oral fructose and glucose dose-response solutions in blood glucose (BG), glucagon, triglycerides, uricaemia, and malondialdehyde in postprandial states in type 1 diabetes mellitus (T1DM) patients. SUBJECTS AND METHODS The study had a simple-blind, randomized, two-way crossover design in which T1DM patients were selected to receive fructose and glucose solutions (75g of sugars dissolved in 200 mL of mineral-water) in two separate study days, with 2-7 weeks washout period. In each day, blood samples were drawn after 8h fasting and at 180 min postprandial to obtain glucose, glucagon, triglycerides, uric acid, lactate, and malondialdehyde levels. RESULTS Sixteen T1DM patients (seven men) were evaluated, with a mean age of 25.19 ± 8.8 years, a mean duration of disease of 14.88 ± 4.73 years, and glycated hemoglobin of 8.13 ± 1.84%. Fructose resulted in lower postprandial BG levels than glucose (4.4 ± 5.5 mmol/L; and 12.9 ± 4.1 mmol/L, respectively; p < 0.01). Uric acid levels increased after fructose (26.1 ± 49.9 µmol/L; p < 0.01) and reduced after glucose (-13.6 ± 9.5 µmol/L; p < 0.01). The malondialdehyde increased after fructose (1.4 ± 1.6 µmol/L; p < 0.01) and did not change after glucose solution (-0.2 ± 1.6 µmol/L; p = 0.40). Other variables did not change. CONCLUSIONS Fructose and glucose had similar sweetness, flavor and aftertaste characteristics and did not change triglycerides, lactate or glucagon levels. Although fructose resulted in lower postprandial BG than glucose, it increased uric acid and malondialdehyde levels in T1DM patients. Therefore it should be used with caution. ClinicalTrials.gov registration: NCT01713023.
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Affiliation(s)
- Débora Lopes Souto
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroInstituto de Nutrição Josué de CastroDepartamento de Nutrição e DietéticaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Nutrição Josué de Castro, Departamento de Nutrição e Dietética, Rio de Janeiro, RJ, Brasil
| | - Érika dos Santos Lima
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroInstituto de Nutrição Josué de CastroDepartamento de Nutrição e DietéticaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Nutrição Josué de Castro, Departamento de Nutrição e Dietética, Rio de Janeiro, RJ, Brasil
| | - Joana Rodrigues Dantas
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroDepartamento de Medicina InternaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Departamento de Medicina Interna, Seção de Diabetes e Nutrologia, Rio de Janeiro, RJ, Brasil
| | - Lenita Zajdenverg
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroDepartamento de Medicina InternaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Departamento de Medicina Interna, Seção de Diabetes e Nutrologia, Rio de Janeiro, RJ, Brasil
| | - Melanie Rodacki
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroDepartamento de Medicina InternaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Departamento de Medicina Interna, Seção de Diabetes e Nutrologia, Rio de Janeiro, RJ, Brasil
| | - Eliane Lopes Rosado
- Universidade Federal do Rio de JaneiroUniversidade Federal do Rio de JaneiroInstituto de Nutrição Josué de CastroDepartamento de Nutrição e DietéticaRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro (UFRJ), Instituto de Nutrição Josué de Castro, Departamento de Nutrição e Dietética, Rio de Janeiro, RJ, Brasil
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Yu JH, Han K, Park S, Lee DY, Nam GE, Seo JA, Kim SG, Baik SH, Park YG, Kim SM, Kim NH, Choi KM. Effects of long-term glycemic variability on incident cardiovascular disease and mortality in subjects without diabetes: A nationwide population-based study. Medicine (Baltimore) 2019; 98:e16317. [PMID: 31335679 PMCID: PMC6709246 DOI: 10.1097/md.0000000000016317] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Increased glycemic variability (GV) is an independent risk factor for cardiovascular complications in patients with diabetes. We evaluated the risk of future development of cardiovascular disease (CVD) and death according to GV in a general population without diabetes.We used the National Health Insurance Service, providing a population-based, nationwide database of Koreans. We included individuals without diabetes who underwent glucose measurement at least 3 times during 2002 to 2006. GV was calculated as standard deviation (SD) of fasting plasma glucose (FPG) levels. We observed development of CVD or all-cause death from 2007 to 2015, and also evaluated the mortality within 1 year after CVD.Among 3,211,319 people, we found 23,374 incident cases of myocardial infarction (MI), 27,705 cases of stroke, and 63,275 deaths during 8.3 years of follow-up. After multivariate adjustment, GV was found to be a significant predictor of MI, stroke and all-cause death for their highest quartile, with corresponding hazard ratios (HR) of 1.08 (95% confidence interval, CI 1.04-1.11), 1.09 (95% CI 1.06-1.13), and 1.12 (95% CI 1.10-1.15), respectively. The risk of death increased more in those who had both impaired fasting glucose and the highest quartile of GV (HR 1.24 [95% CI 1.21-1.28]). Moreover, early death rate after 1 year of CVD was higher in the highest quartile of GV compared to the lowest quartile (HR 1.21 [95% CI 1.03-1.41]).Long-term FPG variation was independently associated with CVD and mortality in a general population without diabetes.
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Affiliation(s)
- Ji Hee Yu
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Korea University
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea
| | - Sanghyun Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea
| | - Da Young Lee
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Korea University
| | - Ga Eun Nam
- Department of Family Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Ji A Seo
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Korea University
| | - Sin Gon Kim
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Korea University
| | - Sei Hyun Baik
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Korea University
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea
| | - Seon Mee Kim
- Department of Family Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Nan Hee Kim
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Korea University
| | - Kyung Mook Choi
- Department of Internal Medicine, Division of Endocrinology and Metabolism, College of Medicine, Korea University
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Coco C, Sgarra L, Potenza MA, Nacci C, Pasculli B, Barbano R, Parrella P, Montagnani M. Can Epigenetics of Endothelial Dysfunction Represent the Key to Precision Medicine in Type 2 Diabetes Mellitus? Int J Mol Sci 2019; 20:ijms20122949. [PMID: 31212911 PMCID: PMC6628049 DOI: 10.3390/ijms20122949] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 02/06/2023] Open
Abstract
In both developing and industrialized Countries, the growing prevalence of Type 2 Diabetes Mellitus (T2DM) and the severity of its related complications make T2DM one of the most challenging metabolic diseases worldwide. The close relationship between genetic and environmental factors suggests that eating habits and unhealthy lifestyles may significantly affect metabolic pathways, resulting in dynamic modifications of chromatin-associated proteins and homeostatic transcriptional responses involved in the progression of T2DM. Epigenetic mechanisms may be implicated in the complex processes linking environmental factors to genetic predisposition to metabolic disturbances, leading to obesity and type 2 diabetes mellitus (T2DM). Endothelial dysfunction represents an earlier marker and an important player in the development of this disease. Dysregulation of the endothelial ability to produce and release vasoactive mediators is recognized as the initial feature of impaired vascular activity under obesity and other insulin resistance conditions and undoubtedly concurs to the accelerated progression of atherosclerotic lesions and overall cardiovascular risk in T2DM patients. This review aims to summarize the most current knowledge regarding the involvement of epigenetic changes associated with endothelial dysfunction in T2DM, in order to identify potential targets that might contribute to pursuing “precision medicine” in the context of diabetic illness.
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Affiliation(s)
- Celeste Coco
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy.
| | - Luca Sgarra
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy.
| | - Maria Assunta Potenza
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy.
| | - Carmela Nacci
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy.
| | - Barbara Pasculli
- Laboratory of Oncology, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo (Foggia), Italy.
| | - Raffaela Barbano
- Laboratory of Oncology, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo (Foggia), Italy.
| | - Paola Parrella
- Laboratory of Oncology, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo (Foggia), Italy.
| | - Monica Montagnani
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy.
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Sun B, He F, Gao Y, Zhou J, Sun L, Liu R, Xu H, Chen X, Zhou H, Liu Z, Zhang W. Prognostic impact of visit-to-visit glycemic variability on the risks of major adverse cardiovascular outcomes and hypoglycemia in patients with different glycemic control and type 2 diabetes. Endocrine 2019; 64:536-543. [PMID: 30868413 DOI: 10.1007/s12020-019-01893-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/05/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE The prognostic impact of visit-to-visit glycemic variability on clinical outcomes in patients with different glycemic control and type 2 diabetes remains obscure. We investigated glucose variability and clinical outcomes for patients in the groups of Good glycemic control (GC), Insufficient glycemic control (IC), and Poor glycemic control (PC) in a prospective cohort study. METHODS By using data from Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation (ADVANCE), 930 patients were enrolled from 61 centers in China and grouped into GC, IC, and PC according to their glycated hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG). Visit-to-visit glycemic variability was defined using the coefficient of variation (CV) of five measurements of HbA1c and FPG taken 3-24 months after treatment. Multivariable Cox proportional hazards models were employed to estimate adjusted hazard ratio (aHR). RESULTS Among 930 patients in the intensive glucose control, 82, 538, and 310 patients were assigned to GC, IC, and PC, respectively. During the median of 4.8 years of follow-up, 322 patients were observed hypoglycemia and 244 patients experienced major adverse cardiovascular events (MACE). The CV of HbA1c and FPG was significantly lower for GC (6.0 ± 3.8, 11.2 ± 6.2) than IC (8.3 ± 5.6, 17.9 ± 10.6) and PC (9.5 ± 6.3, 19.3 ± 10.8). High glycemic variability was associated with a greater risk of MACE (aHR: 2.21; 95% confidence interval (CI): 1.61-3.03; p < 0.001) and hypoglycemia (aHR: 1.36; 95% CI: 1.04-1.79; p = 0.025) than low glycemic variability in total patients. The consistent trend was also found in subgroups of GC, IC, and PC. CONCLUSIONS This prospective cohort study showed that glycemic variability was significantly lower for GC than IC and PC. Furthermore, glycemic variability was associated with the risk of MACE and hypoglycemia in total patients and subgroups of different glycemic control.
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Affiliation(s)
- Bao Sun
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078, Changsha, People's Republic of China
- Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078, Changsha, People's Republic of China
| | - Fazhong He
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078, Changsha, People's Republic of China
- Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078, Changsha, People's Republic of China
| | - Yongchao Gao
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078, Changsha, People's Republic of China
- Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078, Changsha, People's Republic of China
| | - Jiecan Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078, Changsha, People's Republic of China
- Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078, Changsha, People's Republic of China
| | - Lei Sun
- Data Analysis Technology Lab, School of Mathematics and Statistics, Henan University, 475004, Kaifeng, People's Republic of China
| | - Rong Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078, Changsha, People's Republic of China
- Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078, Changsha, People's Republic of China
| | - Heng Xu
- Department of Laboratory Medicine, National Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xiaoping Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078, Changsha, People's Republic of China
- Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078, Changsha, People's Republic of China
| | - Honghao Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078, Changsha, People's Republic of China
- Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078, Changsha, People's Republic of China
| | - Zhaoqian Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078, Changsha, People's Republic of China
- Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078, Changsha, People's Republic of China
| | - Wei Zhang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, 410078, Changsha, People's Republic of China.
- Hunan Key Laboratory of Pharmacogenetics, Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Central South University, 410078, Changsha, People's Republic of China.
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Liu M, Ao L, Hu X, Ma J, Bao K, Gu Y, Zhao J, Huang W. Influence of blood glucose fluctuation, C-peptide level and conventional risk factors on carotid artery intima-media thickness in Chinese Han patients with type 2 diabetes mellitus. Eur J Med Res 2019; 24:13. [PMID: 30782217 PMCID: PMC6381641 DOI: 10.1186/s40001-019-0370-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/02/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Some studies have suggested that blood glucose fluctuation and C-peptide level were considered as predictive factors for carotid artery intima-media thickness (CIMT). However, the relationships of these variables are unclear. This research was aimed to identify the potential effects of blood glucose fluctuation, C-peptide level and conventional risk factors on CIMT. METHODS A total of 280 type 2 diabetes mellitus (T2DM) patients were enrolled into this study. Population characteristics were obtained through medical history and clinical parameters. The patients were divided into two groups according to the critical value of CIMT (0.9). Research data were analyzed to identify risk factors of CIMT between the two groups. RESULTS The comparison results of basic information showed that differences in age and illness years between the two groups were statistically significant (p = 0.0002 and p = 0.0063). Logistic regression analysis results indicated that smoking, uric acid (UA) levels, 2 h C-peptide and standard deviation of blood glucose (SDBG) were the influence factors for CIMT thickening (p = 0.032, p = 0.047, p = 0.049 and p = 0.042, respectively). Blood glucose fluctuation could affect the risk of some complications. In largest amplitude of glycemic excursions (LAGE) > 4.4 group, the CIMT abnormal rate was 27.10%, which was significantly higher than 12.12% in the LAGE ≤ 4.4 group (p = 0.012). The CIMT abnormal rate of SDBG > 2.0 group was 27.81%, which was significantly higher than that of the SDBG ≤ 2.0 group (p = 0.018). CONCLUSIONS Blood glucose fluctuation is an independent risk factor associated with CIMT in T2DM patients, in addition to conventional risk factors, such as smoking, high UA level and 2 h C-peptide. Therefore, more attention should be given to the change of CIMT and the complications.
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Affiliation(s)
- Min Liu
- Department of Scientific Research, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Li Ao
- Department of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Cheng Bei Road, Jiading District, Shanghai, 201800, China
| | - Xinyu Hu
- The Former Dalian Sanatorium of Shenyang Military Region, Dalian, Liaoning, China
| | - Jianning Ma
- Department of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Cheng Bei Road, Jiading District, Shanghai, 201800, China.
| | - Kena Bao
- Department of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Cheng Bei Road, Jiading District, Shanghai, 201800, China
| | - Ye Gu
- Department of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Cheng Bei Road, Jiading District, Shanghai, 201800, China
| | - Jing Zhao
- Department of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Cheng Bei Road, Jiading District, Shanghai, 201800, China
| | - Weiping Huang
- Department of Nursing, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Cheng Bei Road, Jiading District, Shanghai, 201800, China.
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Luo Y, Ni WJ, Ding BO, Xu XH, Ye L, Ma JH, Zhu J. Efficacy Comparison of Preprandial and Postprandial Prandilin 25 Administration in Patients with Newly Diagnosed Type 2 Diabetes Using a Continuous Glucose Monitoring System. Diabetes Ther 2019; 10:205-213. [PMID: 30610472 PMCID: PMC6349270 DOI: 10.1007/s13300-018-0545-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine the clinical efficacy of preprandial and postprandial Prandilin 25 (premixed insulin lispro 25) administration in patients with newly diagnosed type 2 diabetes mellitus (T2DM) using a continuous glucose monitoring (CGM) system. METHODS This was a single-center, self-controlled comparative clinical trial. Newly diagnosed T2DM patients with hemoglobin A1c > 8.0% were hospitalized and received Prandilin 25 plus metformin treatment. Glycemic control was reached after a 7-to-8-day run-in period. Patients underwent 2 days of treatment consisting of preprandial Prandilin 25 on day 1 and postprandial Prandilin 25 on day 2 at the same dosage. The primary outcome was the 24-h mean amplitude of glycemic excursion (24 hMAGE); secondary outcomes were other daily glycemic variability parameters, including 24-h mean blood glucose (24hMBG), 24-h standard deviation of blood glucose (24hSDBG), large amplitude of glycemic excursion (LAGE), incremental area under the curve (AUC) values for different glucose levels, postprandial glucose excursion, and incidence of hypoglycemia, which were assessed using a CGM system. RESULTS Eighty-five patients completed this study. There was no statistically significant difference in 24hMAGE, 24hMBG, 24hSDBG, or LAGE between the preprandial injection group and the postprandial injection group. Similarly, there was no between-treatment difference in the AUC for a blood glucose level below 3.9 mmol/L, in the AUC for a blood glucose level above 10.0 mmol/L, or in the percentages of time that the blood glucose level was below 3.9 mmol/L or above 10.0 mmol/L. Further analysis showed that the pre-meal glucose, peak height, and time to peak after each meal, the relative areas under the CGM curve at 1-4 h after each meal, as well as the incidence of hypoglycemia, were similar for the preprandial and postprandial Prandilin 25 groups. CONCLUSION In patients with T2DM managed with premixed insulin lispro 25, postprandial injection (within 30 min of meal onset) may be an acceptable alternative to preprandial injection when the regular preprandial insulin dose is omitted. TRIAL REGISTRATION Chinese Clinical Trial Register identifier: ChiCTR1800015828.
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Affiliation(s)
- Yong Luo
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wen-Ji Ni
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - B O Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiang-Hong Xu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lei Ye
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | - Jian-Hua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Jian Zhu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Zhao Q, Zhou F, Zhang Y, Zhou X, Ying C. Fasting plasma glucose variability levels and risk of adverse outcomes among patients with type 2 diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 148:23-31. [PMID: 30583033 DOI: 10.1016/j.diabres.2018.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/11/2018] [Accepted: 12/17/2018] [Indexed: 01/06/2023]
Abstract
AIM This systematic review and meta-analysis assessed the association between fasting plasma glucose (FPG) variability levels and the risk of retinopathy and all-cause mortality in patients with type 2 diabetes. METHODS PubMed and EMBASE were searched to identify studies that evaluated the association between FPG variability and retinopathy and all-cause mortality in patients with type 2 diabetes mellitus. The hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled with the random-effects model. RESULTS Eight studies were included in our meta-analysis. Five studies evaluated the impact of FPG variability on all-cause mortality and showed that high FPG variability was associated with the risk of all-cause mortality (HR 1.28, 95% CI 1.12-1.46; three studies). For median or mean FPG variability levels under 20%, the relationship between all-cause mortality and FPG variability was not significant. Three studies evaluated FPG variability and the risk of diabetic retinopathy and showed that high FPG variability was strongly associated with the risk of retinopathy (odds ratio (OR) = 3.68; 95% CI 1.01-13.4). CONCLUSION High FPG variability levels were positively associated with the risk of retinopathy and all-cause mortality in patients with type 2 diabetes.
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Affiliation(s)
- Qian Zhao
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Fan Zhou
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Yusheng Zhang
- The Graduate School, Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China
| | - Xiaoyan Zhou
- Laboratory of Morphology, Xuzhou Medical University, Xuzhou, Jiangsu 221004, PR China
| | - Changjiang Ying
- Department of Endocrinology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, PR China.
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Kuhlman P, Isom S, Pardee TS, Burns C, Tawfik B, Lamar ZS, Powell BL, Klepin HD. Association between glycemic control, age, and outcomes among intensively treated patients with acute myeloid leukemia. Support Care Cancer 2018; 27:2877-2884. [PMID: 30554278 DOI: 10.1007/s00520-018-4582-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/27/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE To investigate the impact of hyperglycemia and glycemic variability during intensive acute myeloid leukemia therapy (AML) on outcomes by age. METHODS Retrospective study of 262 consecutive patients with newly diagnosed AML hospitalized for intensive induction. Hyperglycemia was assessed by mean blood glucose (BG) (mg/dL) during hospitalization and glycemic variability was determined by the standard deviation (SD) of mean BG. Outcomes were complete remission ± incomplete count recovery (CR + CRi), and overall survival (OS). We used logistic regression to evaluate CR + CRi, and Cox proportional hazard models for OS, stratified by age (< 60 vs ≥ 60 years). RESULTS Older patients (N = 138, median age 70) had higher baseline comorbidity (CCI > 1 60.1% vs 25.8%) and prevalence of diabetes (20.3% vs 7.3%) compared to younger (N = 124, median age 47). The mean ± SD number of BG values obtained per patient during hospitalization was 61 ± 71. The mean (± SD) glucose (mg/dL) during hospitalization was 121.7 (25.9) in older patients (≥ 60 years) versus 111.6 (16.4) in younger. In older patients, higher mean glucose and greater glycemic variability were associated with lower odds of remission (OR 0.80, 95% CI 0.69-0.93 and OR 0.73, 95% CI 0.61-0.88 respectively, per 10-unit increase) and higher mortality rates (HR 1.13, 95% CI 1.05-1.21 and HR 1.17, 95% CI 1.09-1.26, respectively, per 10-unit increase) in multivariate analyses. CONCLUSIONS Our observations that hyperglycemia and increased glycemic variability were associated with lower remission rates and increased mortality in older patients suggest glycemic control may be a potentially modifiable factor to improve AML outcomes.
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Affiliation(s)
- Patrick Kuhlman
- Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Scott Isom
- Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Timothy S Pardee
- Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Cynthia Burns
- Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Bernard Tawfik
- University of Texas Southwestern Medical Center, Harry Hines Blvd, Dallas, TX, USA
| | - Zanetta S Lamar
- Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Bayard L Powell
- Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Heidi D Klepin
- Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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Kim MK, Han K, Park YM, Kwon HS, Kang G, Yoon KH, Lee SH. Associations of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Mass Index With Mortality and Cardiovascular Outcomes in the General Population. Circulation 2018; 138:2627-2637. [DOI: 10.1161/circulationaha.118.034978] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Mee Kyoung Kim
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Yeouido St Mary’s Hospital (M.K.K., H.-S.K.), College of Medicine, The Catholic University of Korea, Seoul
| | - Kyungdo Han
- Department of Medical Statistics (K.H.), College of Medicine, The Catholic University of Korea, Seoul
| | - Yong-Moon Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC (Y.-M.P.)
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Yeouido St Mary’s Hospital (M.K.K., H.-S.K.), College of Medicine, The Catholic University of Korea, Seoul
| | - Gunseog Kang
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea (G.K.)
| | - Kun-Ho Yoon
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Seoul St Mary’s Hospital (K.-H.Y., S.-H.L.), College of Medicine, The Catholic University of Korea, Seoul
- Department of Medical Informatics (K.-H.Y.), College of Medicine, The Catholic University of Korea, Seoul
| | - Seung-Hwan Lee
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Seoul St Mary’s Hospital (K.-H.Y., S.-H.L.), College of Medicine, The Catholic University of Korea, Seoul
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Luo Y, Wang XQ, Ni WJ, Ding B, Xu XH, Ye L, Ma JH, Zhu J. Comparison of Efficacy and Economic Value of Prandilin 25 and Humalog Mix 25 in Patients with Newly Diagnosed Type 2 Diabetes by a Continuous Glucose Monitoring System. Diabetes Ther 2018; 9:2219-2228. [PMID: 30244319 PMCID: PMC6250620 DOI: 10.1007/s13300-018-0502-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION To determine the clinical efficacy and economic value of insulin lispro 25-Prandilin 25 vs. insulin lispro 25-Humalog mix 25 in treatment of newly diagnosed type 2 diabetes mellitus (T2DM) by a continuous glucose monitoring system (CGMS). METHODS This was a single-center, randomized, case-crossover clinical trial. Participants were randomly allocated to two groups and underwent two kinds of insulin lispro 25 treatment separated by a 1-day washout period. In total, 81 patients with newly diagnosed T2DM with hemoglobin A1c (HbA1c) above 9% were hospitalized and randomly divided to receive Prandilin 25/Humalog mix 25 or Humalog mix 25/Prandilin 25 treatment. All participants were subjected to metformin therapy simultaneously. Glycemic control was reached after 7-8 days Prandilin 25 or Humalog mix 25 treatment; each patient received continuous glucose monitoring (CGM) for 5 consecutive days (from day 1 to day 5). On day 3 of CGM performance, Prandilin 25 treatment was switched to Humalog mix 25 treatment at the same dosage or vice versa. Parameters representing glycemic variability (GV) and postprandial glucose excursions, including 24-h mean blood glucose (24hMBG), 24-h standard deviation of blood glucose (24hSDBG), 24-h mean amplitude of glycemic excursion (24hMAGE), large amplitude of glycemic excursion (LAGE), incremental area under the curve (AUC) for different glucose levels, and postmeal relative areas under the CGM curve (AUCpp) for 1-4 h of each meal, were calculated for each patient. RESULTS No significant differences were found in the 24hMAGE, 24hMBG, 24hSDBG, LAGE, mean 1-h preprandial blood glucose and the incidence of hypoglycemia between the Prandilin 25 treatment group and Humalog mix 25 treatment group. Similarly, there were no between-treatment differences for AUC and time when blood glucose was below 3.9 mmol/l, between 3.9 mmol/l and 10.0 mmol/l, or above 10.0 mmol/l. Further analysis showed the AUCpp for 1-4 h of each meal for two kinds of treatments were similar. However, the mean estimated cost of Prandilin 25 was only 85% of Humalog mix 25 in one treatment course. CONCLUSION Prandilin 25 is non-inferior in clinical efficacy compared with Humalog mix 25. In view of the significant difference in the cost of the two kinds of insulin lispro 25, Prandilin 25 is a much more cost-effective anti-diabetes drug for management of T2DM. TRIAL REGISTRATION Chinese Clinical Trial Register identifier, ChiCTR1800015829.
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Affiliation(s)
- Yong Luo
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xue-Qin Wang
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, First People's Hospital of Nantong City, Nantong, China
| | - Wen-Ji Ni
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Bo Ding
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiang-Hong Xu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lei Ye
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Jian-Hua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Jian Zhu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Nusca A, Tuccinardi D, Albano M, Cavallaro C, Ricottini E, Manfrini S, Pozzilli P, Di Sciascio G. Glycemic variability in the development of cardiovascular complications in diabetes. Diabetes Metab Res Rev 2018; 34:e3047. [PMID: 30028067 DOI: 10.1002/dmrr.3047] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/28/2018] [Accepted: 07/12/2018] [Indexed: 01/08/2023]
Abstract
Diabetes mellitus represents a major risk factor for the development of coronary artery disease and other vascular complications. Glycated haemoglobin, fructosamine, and fasting blood glucose levels are partial parameters to exhaustively describe patient dysglycemic status. Thus, recently the new concept of glycemic variability has emerged, including information about two major aspects: the magnitude of blood glucose excursions (from nadir to peak, thus lower and higher spikes) and the time intervals in which these fluctuations occur. Despite the lack of consensus regarding the most appropriate definition and tools for its assessment, glycemic variability seems to have more deleterious effects than sustained hyperglycemia in the pathogenesis of diabetic cardiovascular complications. This manuscript aimed to review the most recent evidence on glycemic variability and its potential use in everyday clinical practice to identify diabetic patients at higher risk of cardiovascular complications and thus needing stricter monitoring and treatment.
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Affiliation(s)
- Annunziata Nusca
- Unit of Cardiac Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Dario Tuccinardi
- Unit of Endocrinology and Diabetes Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marzia Albano
- Unit of Cardiac Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Camilla Cavallaro
- Unit of Cardiac Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Silvia Manfrini
- Unit of Endocrinology and Diabetes Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
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Zhou JJ, Schwenke DC, Bahn G, Reaven P. Glycemic Variation and Cardiovascular Risk in the Veterans Affairs Diabetes Trial. Diabetes Care 2018; 41:2187-2194. [PMID: 30082325 PMCID: PMC6150432 DOI: 10.2337/dc18-0548] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/20/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There is uncertainty about the importance of glycemic variability in cardiovascular complications in patients with type 2 diabetes. Using the Veterans Affairs Diabetes Trial (VADT), we investigated the association between variation in fasting glucose and glycated hemoglobin (HbA1c) over time and the incidence of cardiovascular disease (CVD) and assessed whether this is influenced by intensive or standard glycemic control. RESEARCH DESIGN AND METHODS During the VADT, fasting glucose and HbA1c were measured every 3 months for up to 84 months in 1,791 individuals. Variability measures included coefficient of variation (CV) and average real variability (ARV) for fasting glucose and HbA1c. Overall mean glucose and HbA1c measures as well as their maximum and the most recent measurement were also examined. RESULTS Variability measures (CV and ARV) of fasting glucose were significantly associated with CVD even after adjusting for other risk factors, including mean fasting glucose. When considering separately groups receiving intensive and standard glycemic control, this relationship was evident in the intensive treatment group but not in the standard group. Additional adjustment for severe hypoglycemic episodes did not alter the relationship between fasting glucose variability and CVD. Interestingly, no HbA1c measures were associated with CVD after adjusting for multiple baseline risk factors. CONCLUSIONS Our analysis indicates that in the VADT, variability of fasting glucose plays a role in the development of CVD complications beyond the influence of standard fasting glucose measures. The adverse consequences of fasting glucose variability on CVD appear greatest in those receiving intensive glucose control.
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Affiliation(s)
- Jin J Zhou
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | | | - Gideon Bahn
- Hines VA Cooperative Studies Program Coordinating Center, Edward Hines, Jr. VA Hospital, Hines, IL
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Shohat N, Foltz C, Restrepo C, Goswami K, Tan T, Parvizi J. Increased postoperative glucose variability is associated with adverse outcomes following orthopaedic surgery. Bone Joint J 2018; 100-B:1125-1132. [DOI: 10.1302/0301-620x.100b8.bjj-2017-1283.r1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Aims The aim of this study was to examine the association between postoperative glycaemic variability and adverse outcomes following orthopaedic surgery. Patients and Methods This retrospective study analyzed data on 12 978 patients (1361 with two operations) who underwent orthopaedic surgery at a single institution between 2001 and 2017. Patients with a minimum of either two postoperative measurements of blood glucose levels per day, or more than three measurements overall, were included in the study. Glycaemic variability was assessed using a coefficient of variation (CV). The length of stay (LOS), in-hospital complications, and 90-day readmission and mortality rates were examined. Data were analyzed with linear and generalized linear mixed models for linear and binary outcomes, adjusting for various covariates. Results The cohort included 14 339 admissions, of which 3302 (23.0%) involved diabetic patients. Patients with CV values in the upper tertile were twice as likely to have an in-hospital complication compared with patients in the lowest tertile (19.4% versus 9.0%, p < 0.001), and almost five times more likely to die compared with those in the lowest tertile (2.8% versus 0.6%, p < 0.001). Results of the adjusted analyses indicated that the mean LOS was 1.28 days longer in the highest versus the lowest CV tertile (p < 0.001), and the odds of an in-hospital complication and 90-day mortality in the highest CV tertile were respectively 1.91 (p < 0.001) and 2.10 (p = 0.001) times larger than the odds of these events in the lowest CV tertile. These associations were significant even for non-diabetic patients. After adjusting for hypoglycaemia, the relationships remained significant, except that the CV tertile no longer predicted mortality in diabetics. Conclusion These results indicate that higher glycaemic variability is associated with longer LOS and in-hospital complications. Glycaemic variability also predicted death, although that primarily held for non-diabetic patients in the highest CV tertile following orthopaedic surgery. Prospective studies should examine whether ensuring low postoperative glycaemic variability may reduce complication rates and mortality. Cite this article: Bone Joint J 2018;100-B:1125–32.
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Affiliation(s)
- N. Shohat
- Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel
and Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - C. Foltz
- Rothman Institute at Thomas Jefferson
University, Philadelphia, Pennsylvania, USA
| | - C. Restrepo
- Rothman Institute at Thomas Jefferson
University, Philadelphia, Pennsylvania, USA
| | - K. Goswami
- Rothman Institute at Thomas Jefferson
University, Philadelphia, Pennsylvania, USA
| | - T. Tan
- Rothman Institute at Thomas Jefferson
University, Philadelphia, Pennsylvania, USA
| | - J. Parvizi
- Rothman Institute at Thomas Jefferson
University, Philadelphia, Pennsylvania, USA
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Kazkayasi I, Burul-Bozkurt N, Ismail MAM, Merino-Serrais P, Pekiner C, Cedazo-Minguez A, Uma S. Insulin deprivation decreases insulin degrading enzyme levels in primary cultured cortical neurons and in the cerebral cortex of rats with streptozotocin-induced diabetes. Pharmacol Rep 2018; 70:677-683. [PMID: 29940507 DOI: 10.1016/j.pharep.2018.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/21/2017] [Accepted: 01/30/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Inci Kazkayasi
- Hacettepe University, Faculty of Pharmacy, Department of Pharmacology, Ankara, Turkey.
| | - Nihan Burul-Bozkurt
- Hacettepe University, Faculty of Pharmacy, Department of Pharmacology, Ankara, Turkey
| | - Muhammad-Al-Mustafa Ismail
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Paula Merino-Serrais
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Can Pekiner
- Hacettepe University, Faculty of Pharmacy, Department of Pharmacology, Ankara, Turkey
| | - Angel Cedazo-Minguez
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Serdar Uma
- Hacettepe University, Faculty of Pharmacy, Department of Pharmacology, Ankara, Turkey
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Metformin add-on continuous subcutaneous insulin infusion on precise insulin doses in patients with type 2 diabetes. Sci Rep 2018; 8:9713. [PMID: 29946148 PMCID: PMC6018811 DOI: 10.1038/s41598-018-27950-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/11/2018] [Indexed: 01/24/2023] Open
Abstract
To investigate whether metformin add-on to the continuous subcutaneous insulin infusion (Met + CSII) therapy leads to a significant reduction in insulin doses required by type 2 diabetes (T2D) patients to maintain glycemic control, and an improvement in glycemic variation (GV) compared to CSII only therapy. We analyzed data from our two randomized, controlled open-label trials. Newly diagnoses T2D patients were randomized assigned to receive either CSII therapy or Met + CSII therapy for 4 weeks. Subjects were subjected to a 4-day continuous glucose monitoring (CGM) at the endpoint. Insulin doses and GV profiles were analyzed. The primary endpoint was differences in insulin doses and GV between the two groups. A total of 188 subjects were admitted as inpatients. Subjects in metformin add-on therapy required significantly lower total, basal and bolus insulin doses than those of control group. CGM data showed that patients in Met + CSII group exhibited significant reduction in the 24-hr mean amplitude of glycemic excursions (MAGE), the standard deviation, and the coefficient of variation compared to those of control group. Our data suggest that metformin add-on to CSII therapy leads to a significant reduction in insulin doses required by T2D patients to control glycemic variations.
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The initial glycemic variability is associated with early neurological deterioration in diabetic patients with acute ischemic stroke. Neurol Sci 2018; 39:1571-1577. [PMID: 29869743 DOI: 10.1007/s10072-018-3463-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022]
Abstract
The association between glycemic variability and early neurological deterioration (END) in acute ischemic stroke remains unclear. This study attempted to explore whether initial glycemic variability increases END in diabetic patients with acute ischemic stroke. We enrolled type 2 diabetic patients undergoing acute ischemic stroke from November 2015 to November 2016. A total of 336 patients within 72 h from stroke onset were included. The serum glucose levels were checked four times per day during the initial 3 hospital days. The standard deviation of blood glucose (SDBG) values and the mean amplitude of glycemic excursions (MAGE) were calculated for glycemic variability. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ≥ 2 points between hospital days 0 and 5. The frequencies of END and HbA1c were significantly different in subjects grouped according to tertiles of MAGE (9.09, 12.07 and 50.00%, p < 0.001 for END; 7.36 ± 1.91, 7.83 ± 1.93 and 8.56 ± 1.79, p < 0.001 for HbA1c). Compared to patients without END, patients with END had significantly higher HbA1c levels (8.30 ± 1.92 vs 7.80 ± 1.93, p = 0.043), increased SDBG (3.42 ± 1.14 vs 2.60 ± 0.96, p < 0.001), and increased MAGE (6.46 ± 2.09 vs 4.59 ± 1.91, p < 0.001). In a multivariable logistic regression, stroke etiology (OR 0.675; 95% CI 0.485-0.940, p = 0.020), baseline NIHSS (OR 1.086; 95% CI 1.004-1.175, p = 0.040), and MAGE (OR 1.479; 95% CI 1.162-1.882, p = 0.001) were significantly associated with END. Initial glycemic variability is associated with END in diabetic patients with acute ischemic stroke.
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Su G, Zhang T, Yang H, Dai W, Tian L, Tao H, Wang T, Mi S. Admission glycemic variability correlates with in-hospital outcomes in diabetic patients with non-ST segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. Anatol J Cardiol 2018; 19:368-373. [PMID: 29848920 PMCID: PMC5998864 DOI: 10.14744/anatoljcardiol.2018.47487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the effects of admission glycemic variability (AGV) on in-hospital outcomes in diabetic patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). METHODS We studied 759 diabetic patients with NSTE-ACS undergoing PCI. AGV was accessed based on the mean amplitude of glycemic excursions (MAGEs) in the first 24 hours after admission. Primary outcome was a composite of in-hospital events, all-cause mortality, new-onset myocardial infarction, acute heart failure, and stroke. Secondary outcomes were each of these considered separately. Predictive effects of AGV on the in-hospital outcomes in patients were analyzed. RESULTS Patients with high MAGE levels had significantly higher incidence of total outcomes (9.9% vs. 4.8%, p=0.009) and all-cause mortality (2.3% vs. 0.4%, p=0.023) than those with low MAGE levels during hospitalization. Multivariable analysis revealed that AGV was significantly associated with incidence of in-hospital outcomes (Odds ratio=2.024, 95% CI 1.105-3.704, p=0.022) but hemoglobin A1c (HbA1c) was not. In the receiver-operating characteristic curve analysis for MAGE and HbA1c in predicting in-hospital outcomes, the area under the curve for MAGE (0.608, p=0.012) was superior to that for HbA1c (0.556, p=0.193). CONCLUSION High AGV levels may be closely correlated with increased in-hospital poor outcomes in diabetic patients with NSTE-ACS following PCI.
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Affiliation(s)
- Gong Su
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University; Beijing-China.
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Vianna AGD, Lacerda CS, Pechmann LM, Polesel MG, Marino EC, Faria-Neto JR. A randomized controlled trial to compare the effects of sulphonylurea gliclazide MR (modified release) and the DPP-4 inhibitor vildagliptin on glycemic variability and control measured by continuous glucose monitoring (CGM) in Brazilian women with type 2 diabetes. Diabetes Res Clin Pract 2018; 139:357-365. [PMID: 29596951 DOI: 10.1016/j.diabres.2018.03.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/05/2018] [Accepted: 03/20/2018] [Indexed: 12/24/2022]
Abstract
AIMS This study aims to evaluate whether there is a difference between the effects of vildagliptin and gliclazide MR (modified release) on glycemic variability (GV) in women with type 2 diabetes (T2DM) as evaluated by continuous glucose monitoring (CGM). METHODS An open-label, randomized study was conducted in T2DM women on steady-dose metformin monotherapy which were treated with 50 mg vildagliptin twice daily or 60-120 mg of gliclazide MR once daily. CGM and GV indices calculation were performed at baseline and after 24 weeks. RESULTS In total, 42 patients (age: 61.9 ± 5.9 years, baseline glycated hemoglobin (HbA1c): 7.3 ± 0.56) were selected and 37 completed the 24-week protocol. Vildagliptin and gliclazide MR reduced GV, as measured by the mean amplitude of glycemic excursions (MAGE, p = 0.007 and 0.034, respectively). The difference between the groups did not reach statistical significance. Vildagliptin also significantly decreased the standard deviation of the mean glucose (SD) and the mean of the daily differences (MODD) (p = 0.007 and 0.030). CONCLUSIONS Vildagliptin and gliclazide MR similarly reduced the MAGE in women with T2DM after 24 weeks of treatment. Further studies are required to attest differences between vildagliptin and gliclazide MR regarding glycemic variability.
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Affiliation(s)
- Andre Gustavo Daher Vianna
- Pontifical Catholic University of Parana, Curitiba, Brazil; Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Curitiba, Brazil.
| | - Claudio Silva Lacerda
- Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Curitiba, Brazil.
| | - Luciana Muniz Pechmann
- Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Curitiba, Brazil.
| | - Michelle Garcia Polesel
- Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Curitiba, Brazil.
| | - Emerson Cestari Marino
- Curitiba Diabetes Center, Division of Endocrinology, Hospital Nossa Senhora das Graças, Curitiba, Brazil.
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Hu YM, Zhao LH, Zhang XL, Cai HL, Huang HY, Xu F, Chen T, Wang XQ, Guo AS, Li JA, Su JB. Association of glycaemic variability evaluated by continuous glucose monitoring with diabetic peripheral neuropathy in type 2 diabetic patients. Endocrine 2018; 60:292-300. [PMID: 29411305 DOI: 10.1007/s12020-018-1546-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/23/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE Diabetic peripheral neuropathy (DPN), a common microvascular complication of diabetes, is linked to glycaemic derangements. Glycaemic variability, as a pattern of glycaemic derangements, is a key risk factor for diabetic complications. We investigated the association of glycaemic variability with DPN in a large-scale sample of type 2 diabetic patients. METHODS In this cross-sectional study, we enrolled 982 type 2 diabetic patients who were screened for DPN and monitored by a continuous glucose monitoring (CGM) system between February 2011 and January 2017. Multiple glycaemic variability parameters, including the mean amplitude of glycaemic excursions (MAGE), mean of daily differences (MODD), standard deviation of glucose (SD), and 24-h mean glucose (24-h MG), were calculated from glucose profiles obtained from CGM. Other possible risks for DPN were also examined. RESULTS Of the recruited type 2 diabetic patients, 20.1% (n = 197) presented with DPN, and these patients also had a higher MAGE, MODD, SD, and 24-h MG than patients without DPN (p < 0.001). Using univariate and multiple logistic regression analyses, MAGE and conventional risks including diabetic duration, HOMA-IR, and hemoglobin A1c (HbA1c) were found to be independent contributors to DPN, and the corresponding odds ratios (95% confidence interval) were 4.57 (3.48-6.01), 1.10 (1.03-1.17), 1.24 (1.09-1.41), and 1.33 (1.15-1.53), respectively. Receiver operating characteristic analysis indicated that the optimal MAGE cutoff value for predicting DPN was 4.60 mmol/L; the corresponding sensitivity was 64.47%, and the specificity was 75.54%. CONCLUSIONS In addition to conventional risks including diabetic duration, HOMA-IR and HbA1c, increased glycaemic variability assessed by MAGE is a significant independent contributor to DPN in type 2 diabetic patients.
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Affiliation(s)
- Yu-Ming Hu
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, 210029, Nanjing, China
- Department of Rehabilitation, The Affiliated Hospital of Nantong University, No. 20 Xishi Road, 226001, Nantong, China
| | - Li-Hua Zhao
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, No. 6 North Hai-er-xiang Road, 226001, Nantong, China
| | - Xiu-Lin Zhang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nantong University, No. 6 North Hai-er-xiang Road, 226001, Nantong, China
| | - Hong-Li Cai
- Department of Geriatrics, The Second Affiliated Hospital of Nantong University, No. 6 North Hai-er-xiang Road, 226001, Nantong, China
| | - Hai-Yan Huang
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, No. 6 North Hai-er-xiang Road, 226001, Nantong, China
| | - Feng Xu
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, No. 6 North Hai-er-xiang Road, 226001, Nantong, China
| | - Tong Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nantong University, No. 6 North Hai-er-xiang Road, 226001, Nantong, China
| | - Xue-Qin Wang
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, No. 6 North Hai-er-xiang Road, 226001, Nantong, China
| | - Ai-Song Guo
- Department of Rehabilitation, The Affiliated Hospital of Nantong University, No. 20 Xishi Road, 226001, Nantong, China
| | - Jian-An Li
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, 210029, Nanjing, China.
| | - Jian-Bin Su
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, No. 6 North Hai-er-xiang Road, 226001, Nantong, China.
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81
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Gondhalekar R, Dassau E, Doyle FJ. Velocity-weighting & velocity-penalty MPC of an artificial pancreas: Improved safety & performance. AUTOMATICA : THE JOURNAL OF IFAC, THE INTERNATIONAL FEDERATION OF AUTOMATIC CONTROL 2018; 91:105-117. [PMID: 30034017 PMCID: PMC6051553 DOI: 10.1016/j.automatica.2018.01.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A novel Model Predictive Control (MPC) law for the closed-loop operation of an Artificial Pancreas (AP) to treat type 1 diabetes is proposed. The contribution of this paper is to simultaneously enhance both the safety and performance of an AP, by reducing the incidence of controller-induced hypoglycemia, and by promoting assertive hyperglycemia correction. This is achieved by integrating two MPC features separately introduced by the authors previously to independently improve the control performance with respect to these two coupled issues. Velocity-weighting MPC reduces the occurrence of controller-induced hypoglycemia. Velocity-penalty MPC yields more effective hyperglycemia correction. Benefits of the proposed MPC law over the MPC strategy deployed in the authors' previous clinical trial campaign are demonstrated via a comprehensive in-silico analysis. The proposed MPC law was deployed in four distinct US Food & Drug Administration approved clinical trial campaigns, the most extensive of which involved 29 subjects each spending three months in closed-loop. The paper includes implementation details, an explanation of the state-dependent cost functions required for velocity-weighting and penalties, a discussion of the resulting nonlinear optimization problem, a description of the four clinical trial campaigns, and control-related trial highlights.
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Affiliation(s)
- Ravi Gondhalekar
- Harvard John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA, USA
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82
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Stone JA, Houlden RL, Lin P, Udell JA, Verma S. Cardiovascular Protection in People With Diabetes. Can J Diabetes 2018; 42 Suppl 1:S162-S169. [DOI: 10.1016/j.jcjd.2017.10.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 10/17/2022]
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83
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Li HQ, Lu CF, Wang J, Yin GP, Sun R, Xu XH, Liu BL, Li FF, Jing T, Lee KO, Ye L, Ma JH, Su XF. A comparison of clinical efficacy and economic value in Basalin- and Lantus-treated patients with type 2 diabetes using continuous glucose monitoring system. J Endocrinol Invest 2018. [PMID: 28643298 DOI: 10.1007/s40618-017-0712-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To determine the clinical non-inferiority of recombinant glargine-Basalin vs glargine-Lantus, in treatment of type 2 diabetes mellitus (T2DM) using continuous glucose monitoring system (CGMS). METHODS One hundred patients with T2DM were recruited. They were either regularly taking Basalin (Basalin group) or Lantus (Lantus group) (n = 50 each). CGMS was employed to real-time monitor blood glucose profile for 4 days (from day 1 to day 5). To exclude the effect of patient background, the study design was to have a blinded crossover from glargine-Basalin to glargine-Lantus on day 3, and vice versa. 24-hour mean blood glucose (24hMBG), 24-hour standard deviation of blood glucose (24hSDBG), 24-hour mean amplitude of glycemic excursion (24hMAGE), and number of glycemic excursion (NGE) every 24 h (24hNGE) were calculated for each glargine from 100 patients. RESULTS No significant difference of 24hMBG, 24hSDBG, 24hMAGE, and 24hNGE (p > 0.05 for all) was found between Basalin and Lantus treatments. The glucose area under the curve and time when blood glucose was below 3.9 mmol/L, between 3.9 and 10.0 mmol/L, or above 10.0 mmol/L were similar between Basalin and Lantus treatment. The frequency of hypoglycemic episodes was also similar. However, the mean cost of Basalin was only 72% of Lantus's in one treatment course. CONCLUSION Glargine-Basalin is non-inferior in clinical efficacy compared to glargine-Lantus. In view of the large difference in the cost of glargine-Basalin, it would be much more cost-effective for our patients.
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Affiliation(s)
- H Q Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - C F Lu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - J Wang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - G P Yin
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - R Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - X H Xu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - B L Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - F F Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - T Jing
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - K O Lee
- Division of Endocrinology, Department of Medicine, National University of Singapore, Singapore, Singapore
| | - L Ye
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - J H Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China.
| | - X F Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China.
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84
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Carreiro MP, Nogueira AI, Ribeiro-Oliveira A. Controversies and Advances in Gestational Diabetes-An Update in the Era of Continuous Glucose Monitoring. J Clin Med 2018; 7:E11. [PMID: 29370080 PMCID: PMC5852427 DOI: 10.3390/jcm7020011] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 12/17/2022] Open
Abstract
Diabetes in pregnancy, both preexisting type 1 or type 2 and gestational diabetes, is a highly prevalent condition, which has a great impact on maternal and fetal health, with short and long-term implications. Gestational Diabetes Mellitus (GDM) is a condition triggered by metabolic adaptation, which occurs during the second half of pregnancy. There is still a lot of controversy about GDM, from classification and diagnosis to treatment. Recently, there have been some advances in the field as well as recommendations from international societies, such as how to distinguish previous diabetes, even if first recognized during pregnancy, and newer diagnostic criteria, based on pregnancy outcomes, instead of maternal risk of future diabetes. These new recommendations will lead to a higher prevalence of GDM, and important issues are yet to be resolved, such as the cost-utility of this increase in diagnoses as well as the determinants for poor outcomes. The aim of this review is to discuss the advances in diagnosis and classification of GDM, as well as their implications in the field, the issue of hyperglycemia in early pregnancy and the role of hemoglobin A1c (HbA1c) during pregnancy. We have looked into the determinants of the poor outcomes predicted by the diagnosis by way of oral glucose tolerance tests, highlighting the relevance of continuous glucose monitoring tools, as well as other possible pathogenetic factors related to poor pregnancy outcomes.
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Affiliation(s)
- Marina P Carreiro
- Laboratory of Endocrinology, Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil.
| | - Anelise I Nogueira
- Laboratory of Endocrinology, Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil.
| | - Antonio Ribeiro-Oliveira
- Laboratory of Endocrinology, Federal University of Minas Gerais, Belo Horizonte 30130-100, Brazil.
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85
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Glucose Profiles in Pregnant Women After a Gastric Bypass : Findings from Continuous Glucose Monitoring. Obes Surg 2017; 26:2150-2155. [PMID: 26757924 DOI: 10.1007/s11695-016-2061-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The diagnosis of gestational diabetes mellitus (GDM) usually requires an oral glucose tolerance test, but this procedure seems inappropriate after gastric bypass surgery (Roux-en-Y gastric bypass (RYGB)) due to specific altered glycemic responses. We aimed here at describing continuous glucose monitoring (CGM) profile of pregnant women after RYGB. METHODS CGM was performed in 35 consecutive pregnant women after RYGB at 26.2 ± 5 weeks of gestation. RESULTS After RYGB, pregnant women display high postprandial interstitial glucose (IG) peaks and low IG before and 2 h after meals. The postprandial IG peak is reached early, within 54 ± 9 min. The maximum IG values reach 205 mg/dl, and the percentage of time above 140 mg/dl (6.6 ± 7 %) is similar to what is described in GDM women. CONCLUSIONS This study is the first to describe CGM profile in pregnant women after RYGB. CGM features are similar to those of non-pregnant post-RYGB patients, characterized by wide and rapid changes in postprandial IG, and high exposure to hyperglycemia. The exposure to hyperglycemia is similar to what is reported in GDM although the time to postprandial peak is shorter. CGM could be an additional useful approach to screen for glucose intolerance during pregnancy after RYGB.
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86
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Rottenstreich A, Elazary R, Ezra Y, Kleinstern G, Beglaibter N, Elchalal U. Hypoglycemia during oral glucose tolerance test among post-bariatric surgery pregnant patients: incidence and perinatal significance. Surg Obes Relat Dis 2017; 14:347-353. [PMID: 29306610 DOI: 10.1016/j.soard.2017.11.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/31/2017] [Accepted: 11/28/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND While hypoglycemia during an oral glucose tolerance test (OGTT) has been shown to occur in a considerable portion of nonpregnant post-bariatric surgery (BS) patients, its incidence among pregnant post-BS patients evaluated for gestational diabetes has only been sparsely studied. OBJECTIVES We investigated OGTT results and pregnancy outcomes in pregnant women who underwent 3 types of bariatric procedures before pregnancy. SETTING A university hospital. METHODS From medical records, data were collected on glucose measurements during a 100-g, 3-hour OGTT, as well as maternal and fetal outcomes. RESULTS Of 119 post-BS pregnant patients included in the study, 55 underwent laparoscopic sleeve gastrectomy, 34 laparoscopic adjustable gastric banding, and 30 laparoscopic Roux-en-Y gastric bypass surgery. Hypoglycemia (<55 mg/dL) was encountered in 59 (49.6%) patients during the OGTT. Among them, the nadir plasma glucose levels occurred 2 hours after glucose ingestion in 25 (42.4%) and after 3 hours in 34 (57.6%), with a median value of 47 (44-52) mg/dL. The risk of hypoglycemia was higher among women with prior laparoscopic Roux-en-Y gastric bypass surgery (83.3%) than among those with prior laparoscopic sleeve gastrectomy (54.5%; P = .009) or laparoscopic adjustable gastric banding (11.8%; P<.0001). Time from surgery to conception was significantly shorter among women with evidence of hypoglycemia during OGTT (median 711 versus 1246 days, P = .002). Compared with patients without evidence of hypoglycemia, patients who experienced hypoglycemia had lower rates of gestational diabetes (P = .03) but higher proportions of low birth weight (P = .01) and small for gestational age infants (P = .03). CONCLUSIONS Because hypoglycemia is common during OGTT among post-BS parturients, other diagnostic methods should be considered in this setting. The association found between hypoglycemia and poor fetal growth warrants investigation as to whether interventions to prevent hypoglycemia will improve fetal outcome.
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Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Ram Elazary
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein-Kerem Campus, Jerusalem, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Geffen Kleinstern
- Braun School of Public Health and Community Medicine, Faculty of Medicine of the Hebrew University and Hadassah, Jerusalem, Israel; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Nahum Beglaibter
- Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus Campus, Jerusalem, Israel
| | - Uriel Elchalal
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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87
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de Candia P, Spinetti G, Specchia C, Sangalli E, La Sala L, Uccellatore A, Lupini S, Genovese S, Matarese G, Ceriello A. A unique plasma microRNA profile defines type 2 diabetes progression. PLoS One 2017; 12:e0188980. [PMID: 29200427 PMCID: PMC5714331 DOI: 10.1371/journal.pone.0188980] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/16/2017] [Indexed: 01/21/2023] Open
Abstract
A major unmet medical need to better manage Type 2 Diabetes (T2D) is the accurate disease prediction in subjects who show glucose dysmetabolism, but are not yet diagnosed as diabetic. We investigated the possibility to predict/monitor the progression to T2D in these subjects by retrospectively quantifying blood circulating microRNAs in plasma of subjects with i) normal glucose tolerance (NGT, n = 9); ii) impaired glucose tolerance (IGT, n = 9), divided into non-progressors (NP, n = 5) and progressors (P, n = 4) based on subsequent diabetes occurrence, and iii) newly diagnosed T2D (n = 9). We found that impaired glucose tolerance associated with a global increase of plasma circulating microRNAs. While miR-148 and miR-222 were specifically modulated in diabetic subjects and correlated with parameters of glucose tolerance, the most accentuated microRNA dysregulation was found in NP IGT subjects, with increased level of miR-122, miR-99 and decreased level of let-7d, miR-18a, miR-18b, miR-23a, miR-27a, miR-28 and miR-30d in comparison with either NGT or T2D. Interestingly, several of these microRNAs significantly correlated with parameters of cholesterol metabolism. In conclusion, we observed the major perturbation of plasma circulating microRNA in NP pre-diabetic subjects and identified a unique microRNA profile that may become helpful in predicting diabetic development.
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Affiliation(s)
- Paola de Candia
- Department of Diabetology and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
- * E-mail:
| | - Gaia Spinetti
- Department of Diabetology and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Claudia Specchia
- Department of Diabetology and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia Italy
| | - Elena Sangalli
- Department of Diabetology and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Lucia La Sala
- Department of Diabetology and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | | | - Silvia Lupini
- Department of Diabetology and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Stefano Genovese
- Department of Diabetology and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Giuseppe Matarese
- Laboratory of Immunology, Institute of Endocrinology and Experimental Oncology, National Research Council (IEOS-CNR), Naples, Italy
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, Naples, Italy
| | - Antonio Ceriello
- Department of Diabetology and Dysmetabolic Diseases, IRCCS MultiMedica, Milan, Italy
- Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/Rosselló, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
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88
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Sundberg F, Barnard K, Cato A, de Beaufort C, DiMeglio LA, Dooley G, Hershey T, Hitchcock J, Jain V, Weissberg-Benchell J, Rami-Merhar B, Smart CE, Hanas R. ISPAD Guidelines. Managing diabetes in preschool children. Pediatr Diabetes 2017; 18:499-517. [PMID: 28726299 DOI: 10.1111/pedi.12554] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 05/14/2017] [Accepted: 05/31/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Frida Sundberg
- The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Katharine Barnard
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Allison Cato
- Neurology Division, Nemours Children's Health System, Jacksonville, Florida
| | - Carine de Beaufort
- Clinique Pediatrique, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg.,Department of Pediatrics, UZ Brussels, Jette, Belgium
| | - Linda A DiMeglio
- Department of Pediatrics, Section of Pediatric Endocrinology/Diabetology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Tamara Hershey
- Psychiatry Department, Washington University School of Medicine, St. Louis, Missouri.,Radiology Department, Washington University School of Medicine, St. Louis, Missouri
| | | | - Vandana Jain
- Pediatric Endocrinology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jill Weissberg-Benchell
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Carmel E Smart
- Department of Endocrinology, John Hunter Children's Hospital and University of Newcastle, Newcastle, Australia
| | - Ragnar Hanas
- Institute of Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden
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89
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Lee CL, Sheu WHH, Lee IT, Lin SY, Liang WM, Wang JS, Li YF. Trajectories of fasting plasma glucose variability and mortality in type 2 diabetes. DIABETES & METABOLISM 2017; 44:121-128. [PMID: 29032950 DOI: 10.1016/j.diabet.2017.09.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/24/2017] [Accepted: 09/04/2017] [Indexed: 11/24/2022]
Abstract
AIM To investigate the effect of changes in fasting plasma glucose (FPG) variability, as assessed by 2-year trajectories of FPG variability, on mortality risk in patients with type 2 diabetes (T2D). METHODS From 2009 to 2012, outpatients with T2D, aged>18 years, were enrolled from a medical centre. FPG was measured every 3 months for 2 years in 3569 people. For each of the eight 3-month intervals, FPG variability and means were calculated, with variability defined as the coefficient of variation of FPG. Also, trajectories of FPG variability and means were determined separately, using group-based trajectory analysis with latent class growth models. These models were fitted using the SAS Proc Traj procedure. The primary outcome was all-cause mortality, which was followed-up to the end of 2014. RESULTS Five distinct trajectories of FPG variability (low, increasing, fluctuating, decreasing and high) and means (well controlled, stable control, worsening control, improving control and poor control) were established. The five trajectories of mean FPG were all associated with the same mortality risk. In contrast, in comparison to the low FPG variability trajectory, the fluctuating, decreasing and high variability trajectories all had significantly higher risks of mortality, with respective hazards ratios of 2.63 (95% CI: 1.40-4.93; P=0.003), 2.78 (95% CI: 1.33-5.80; P=0.007) and 4.44 (95% CI: 1.78-11.06; P=0.001) after multivariable adjustment. CONCLUSION Changes in FPG variability were independently associated with increased mortality risk in patients with T2D.
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Affiliation(s)
- Chia-Lin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung 407, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Public Health, College of Public Health, China Medical University, No. 91, Hsueh-Shih Road, Taichung 404, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung 407, Taiwan; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Medical Technology, College of Life Science, National Chung-Hsing University, Taichung, Taiwan; School of Medicine, National Defence Medical Centre, Taipei, Taiwan
| | - I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung 407, Taiwan; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shih-Yi Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung 407, Taiwan; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Miin Liang
- Department of Public Health, College of Public Health, China Medical University, No. 91, Hsueh-Shih Road, Taichung 404, Taiwan
| | - Jun-Sing Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung 407, Taiwan; Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yu-Fen Li
- Department of Public Health, College of Public Health, China Medical University, No. 91, Hsueh-Shih Road, Taichung 404, Taiwan.
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90
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Li H, Lu C, Xu L, Tian N, Gao X, Fan Z, Ye L, Chen S, Ma J, Su X. The relationship between GRACE risk score and glucose fluctuation in patients with acute coronary syndrome and abnormal glucose metabolism. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0576-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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91
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Uncoupling Protein 2 Inhibition Exacerbates Glucose Fluctuation-Mediated Neuronal Effects. Neurotox Res 2017; 33:388-401. [PMID: 28875237 DOI: 10.1007/s12640-017-9805-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/04/2017] [Accepted: 08/23/2017] [Indexed: 01/10/2023]
Abstract
Though glucose fluctuations have been considered as an adverse factor for the development of several diabetes-related complications, their impact in the central nervous system is still not fully elucidated. This study was conducted to evaluate the responses of neuronal cells to different glycemic exposures alongside to elucidate the role of uncoupling protein 2 (UCP2) in regulating such responses. To achieve our goals, primary cortical neurons were submitted to constant high (HG)/low (LG) or glucose level variations (GVs), and the pharmacological inhibition of UCP2 activity was performed using genipin. Results obtained show that GV decreased neuronal cells' viability, mitochondrial membrane potential, and manganese superoxide dismutase activity and increased reactive oxygen species (ROS) production. GV also caused an increase in the glutathione/glutathione disulfide ratio and in the protein expression levels of nuclear factor E2-related factor 2 (NRF2), UCP2, NADH-ubiquinone oxidoreductase chain 1 (ND1), and mitochondrially encoded cytochrome c oxidase I (MTCO1), both mitochondrial DNA encoded subunits of the electron transport chain. Contrariwise, genipin abrogated all those compensations and increased the levels of caspase 3-like activity, potentiated mitochondrial ROS levels, and the loss of neuronal synaptic integrity, decreased the protein expression levels of NRF1, and increased the protein expression levels of UCP5. Further, in the control and LG conditions, genipin increased mitochondrial ROS and the protein expression levels of UCP4, postsynaptic density protein 95 (PSD95), ND1, and MTCO1. Overall, these observations suggest that UCP2 is in the core of neuronal cell protection and/or adaptation against GV-mediated effects and that other isoforms of neuronal UCPs can be upregulated to compensate the inhibition of UCP2 activity.
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92
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Su JB, Yang XH, Zhang XL, Cai HL, Huang HY, Zhao LH, Xu F, Chen T, Cheng XB, Wang XQ, Lu Y. The association of long-term glycaemic variability versus sustained chronic hyperglycaemia with heart rate-corrected QT interval in patients with type 2 diabetes. PLoS One 2017; 12:e0183055. [PMID: 28846720 PMCID: PMC5573287 DOI: 10.1371/journal.pone.0183055] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/30/2017] [Indexed: 01/24/2023] Open
Abstract
Objectives Prolonged heart rate-corrected QT(QTc) interval is related to ventricular arrhythmia and cardiovascular mortality, with considerably high prevalence of type 2 diabetes. Additionally, long-term glycaemic variability could be a significant risk factor for diabetic complications in addition to chronic hyperglycaemia. We compared the associations of long-term glycaemic variability versus sustained chronic hyperglycaemia with the QTc interval among type 2 diabetes patients. Methods In this cross-sectional study, 2904 type 2 diabetes patients were recruited who had undergone at least four fasting plasma glucose (FPG) and 2-hour postprandial plasma glucose (PPG) measurements (at least once for every 3 months, respectively) during the preceding year. Long-term glycaemic variabilities of FPG and 2-hour PPG were assessed by their standard deviations (SD-FPG and SD-PPG, respectively), and chronic fasting and postprandial hyperglycaemia were assessed by their means (M-FPG and M-PPG, respectively). HbA1c was also determined upon enrolment to assess current overall glycaemic control. QTc interval was estimated from resting 12-lead electrocardiograms, and more than 440 ms was considered abnormally prolonged. Results Patients with prolonged QTc interval (≥440 ms) had greater M-FPG, M-PPG, SD-PPG and HbA1c than those with normal QTc interval but comparable SD-FPG. QTc interval was correlated with M-FPG, M-PPG, SD-PPG and HbA1c (r = 0.133, 0.153, 0.245 and 0.207, respectively, p = 0.000) but not with SD-FPG (r = 0.024, p = 0.189). After adjusting for metabolic risk factors via multiple linear regression analysis, SD-PPG, M-PPG and HbA1c (t = 12.16, 2.69 and 10.16, respectively, p = 0.000) were the major independent contributors to the increased QTc interval. The proportion of prolonged QTc interval increased significantly from 10.9% to 14.2% to 26.6% for the first (T1) to second (T2) to third (T3) tertiles of SD-PPG. After adjusting via multiple logistic regression analysis, the odd ratios of prolonged QTc interval of the T2 and T3 versus the T1 of SD-PPG were 1.15 (95% CI, 0.82–1.60) and 2.62 (1.92–3.57), respectively. Conclusions Increased long-term variability of PPG is a strong independent risk factor for prolonged QTc interval in type 2 diabetes patients, in addition to long-term postprandial hyperglycaemia and current HbA1c.
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Affiliation(s)
- Jian-Bin Su
- Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Endocrinology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Xiao-Hua Yang
- Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Endocrinology, The Affiliated Haian Hospital of Nantong University, Haian, China
| | - Xiu-Lin Zhang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Hong-Li Cai
- Department of Geriatrics, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Hai-Yan Huang
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Li-Hua Zhao
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Feng Xu
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Tong Chen
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Xing-Bo Cheng
- Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xue-Qin Wang
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Yan Lu
- Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, China
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93
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Chiu HT, Li TC, Li CI, Liu CS, Lin WY, Lin CC. Visit-to-visit glycemic variability is a strong predictor of chronic obstructive pulmonary disease in patients with type 2 diabetes mellitus: Competing risk analysis using a national cohort from the Taiwan diabetes study. PLoS One 2017; 12:e0177184. [PMID: 28489885 PMCID: PMC5425194 DOI: 10.1371/journal.pone.0177184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 04/23/2017] [Indexed: 01/08/2023] Open
Abstract
Background This study aims to examine the association between visit-to-visit glucose variability, which was measured by coefficient of variation (CV) of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c), and risk of chronic obstructive pulmonary disease (COPD) in a large number of patients with type 2 diabetes with an average follow-up of 7.58 years. Methods We conducted a retrospective cohort study on 27,257 patients with type 2 diabetes who participated in the National Diabetes Case Management Program in Taiwan. Visit-to-visit variability in HbA1c and FPG at baseline and the incidence of COPD were analyzed using a modified Cox proportional hazards model considering competing risks. Results A total of 2,346 incident cases of COPD. Patients were grouped into tertiles of FPG-CV and HbA1c-CV. The incidence rates in the first, second, and third tertiles were 9.87, 11.06, and 13.19, respectively, for FPG-CV and 10.2, 11.81, and 12.07, for HbA1c-CV per 1000 person-years. After adjusting for age, gender, diabetes duration, treatment type, smoking, hypertension, hyperlipidemia, baseline FPG and HbA1c levels, and complications, both FPG-CV and HbA1c-CV were independently associated with COPD. The hazard ratios of COPD for the third terile compared with the first tertile of FPG-CV were 1.26 (95% confidence interval [CI]: 1.13–1.40). Moreover, the hazard ratios of COPD for the third and second tertiles compared with the first tertile of HbA1c-CV were 1.13 (1.02–1.25) and 1.13 (1.02–1.26), respectively. Conclusions Patients with FPG-CV higher than 34.6% or HbA1c-CV higher than 8.4% exhibited an increased risk of COPD. This finding confirmed the linear relationship of FPG-CV and HbA1c-CV to COPD. Visit-to-visit variability in FPG and HbA1c levels are strong predictors of COPD in patients with type 2 diabetes. Future studies should focus on lung dysfunction in diabetes, and adequate glucose control strategy in regular clinical practices must be established for COPD prevention.
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Affiliation(s)
- Hsien-Tsai Chiu
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Clinical Research Outcome and Training Center, Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Yuan Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Testa R, Bonfigli AR, Prattichizzo F, La Sala L, De Nigris V, Ceriello A. The "Metabolic Memory" Theory and the Early Treatment of Hyperglycemia in Prevention of Diabetic Complications. Nutrients 2017; 9:nu9050437. [PMID: 28452927 PMCID: PMC5452167 DOI: 10.3390/nu9050437] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/20/2017] [Accepted: 04/24/2017] [Indexed: 12/12/2022] Open
Abstract
Several epidemiological and prospective studies suggest that an early intensive control of hyperglycaemia is able to decrease the risk of diabetic micro- and macro-vascular complications. A growing body of experimental evidence supports the concept that the risk for diabetes complications may be linked to oxidative stress, non-enzymatic glycation of proteins, epigenetic changes, and chronic inflammation, laying the foundation for the “metabolic memory” theory. From a clinical point of view, this theory supports the need for a very early aggressive treatment, with the goal of normalizing metabolic control as soon as possible. It may also prove beneficial to introduce therapeutic agents that are able to reduce reactive species and glycation, in addition to presenting better control of glucose levels in patients with diabetes, in order to minimize long-term diabetes complications. In this review, we evaluate the effect of glucose intake and metabolism in the light of this theory.
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Affiliation(s)
- Roberto Testa
- Experimental Models in Clinical Pathology, INRCA-IRCCS National Institute, Ancona I-60127, Italy.
| | - Anna Rita Bonfigli
- Scientific Direction, INRCA-IRCCS National Institute, Ancona I-60127, Italy.
| | - Francesco Prattichizzo
- Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Sesto San Giovanni I-20099, Italy.
| | - Lucia La Sala
- Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Sesto San Giovanni I-20099, Italy.
| | - Valeria De Nigris
- Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/Rosselló, 149-153, Barcelona 08036, Spain.
| | - Antonio Ceriello
- Department of Cardiovascular and Metabolic Diseases, IRCCS Multimedica, Sesto San Giovanni I-20099, Italy.
- Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/Rosselló, 149-153, Barcelona 08036, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona 08036, Spain.
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Xue B, Wang L, Zhang Z, Wang R, Xia XX, Han PP, Cao LJ, Liu YH, Sun LQ. Puerarin may protect against Schwann cell damage induced by glucose fluctuation. J Nat Med 2017; 71:472-481. [PMID: 28181078 DOI: 10.1007/s11418-016-1067-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/16/2016] [Indexed: 12/21/2022]
Abstract
Puerarin is one of the major active ingredients in Gegen, a traditional Chinese herb that has been reported to have a wide variety of beneficial pharmacology functions. Previous studies have implicated that the damaging effects of hyperglycemia resulting from oxidative stress and glucose fluctuation may be more dangerous than constant high glucose in the development of diabetes-related complications. The present study focuses on the effects of puerarin on glucose fluctuation-induced oxidative stress-induced Schwann cell (SC) apoptosis in vitro. Primarily cultured SCs were exposed to different conditions and the effect of puerarin on cell viability was determined by MTT assays. Intracellular reactive oxygen species (ROS) generation and mitochondrial transmembrane potential were detected by flow cytometry analysis. Apoptosis was confirmed by the Annexin V-FITC/PI and TUNEL method. Quantitative real-time reverse transcriptase polymerase chain reaction was performed to analyze the expression levels of bax and bcl-2. Western blot was performed to analyze the expression levels of some important transcription factors and proteins. The results showed that incubating SCs with intermittent high glucose for 48 h decreased cell viability and increased the number of apoptotic cells whereas treating with puerarin protected SCs against glucose fluctuation-induced cell damage. Further study demonstrated that puerarin suppressed activation of apoptosis-related proteins including PARP and caspase-3, downregulation of bcl-2, and upregulation of intracellular distribution of bax from cytosol to mitochondria, which was induced by glucose fluctuation. Moreover, puerarin inhibited the elevation of intracellular ROS and mitochondrial depolarization induced by glucose fluctuation. These results suggest that puerarin may protect SCs against glucose fluctuation-induced cell injury through inhibiting apoptosis as well as oxidative stress.
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Affiliation(s)
- Bing Xue
- Department of Endocrinology, General Hospital of Shenyang Military Region, 83 Wenhua Rd, Shenyang, 110016, Liaoning, China
| | - Lin Wang
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yantaxi Rd, Xi'an, 710061, Shanxi, China
| | - Zhe Zhang
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yantaxi Rd, Xi'an, 710061, Shanxi, China
| | - Rui Wang
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yantaxi Rd, Xi'an, 710061, Shanxi, China
| | - Xin-Xin Xia
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yantaxi Rd, Xi'an, 710061, Shanxi, China
| | - Ping-Ping Han
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yantaxi Rd, Xi'an, 710061, Shanxi, China
| | - Li-Jun Cao
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yantaxi Rd, Xi'an, 710061, Shanxi, China
| | - Yong-Hui Liu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yantaxi Rd, Xi'an, 710061, Shanxi, China
| | - Lian-Qing Sun
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yantaxi Rd, Xi'an, 710061, Shanxi, China.
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Yang CP, Li CI, Liu CS, Lin WY, Hwang KL, Yang SY, Li TC, Lin CC. Variability of fasting plasma glucose increased risks of diabetic polyneuropathy in T2DM. Neurology 2017; 88:944-951. [PMID: 28179465 DOI: 10.1212/wnl.0000000000003682] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/12/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine whether variations in fasting plasma glucose (FPG), as measured by the coefficient of variation (CV), is a predictor of diabetic polyneuropathy (DPN) risk, considering glycated hemoglobin (HbA1c) and other traditional risk factors. METHODS Type 2 diabetic patients enrolled in the National Diabetes Care Management Program were ≥30 years of age and free of DPN (n = 36,152). They were enrolled in 2002-2004 and were monitored until 2011. The related factors were analyzed using Cox proportional hazards regression models. RESULTS During an average 7.23 years of follow-up, a total of 7,219 incident cases of DPN were identified, with a crude incidence rate of 27.62/1,000 person-years (25.83 for men and 29.31 for women). After multivariate adjustment, both FPG-CV and HbA1c were significant predictors of DPN, with corresponding hazard ratios of 1.14 (95% confidence interval [CI] 1.05-1.23) and 1.15 (95% CI 1.06-1.24) for FPG-CV in the fourth to fifth quintiles and 1.13 (95% CI 1.07-1.20) for HbA1c ≥7%. This finding maintained consistency after excluding potential confounders in the sensitivity analysis, further validating the results. CONCLUSIONS FPG-CV and HbA1c ≥7% were potent predictors of DPN in type 2 diabetic patients. The associations among HbA1c, glycemic variability, and DPN suggest a linked pathophysiologic mechanism, which may play a crucial role in clinical risk assessments.
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Affiliation(s)
- Chun-Pai Yang
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chia-Ing Li
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Chiu-Shong Liu
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Wen-Yuan Lin
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Kai-Lin Hwang
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Sing-Yu Yang
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Tsai-Chung Li
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Cheng-Chieh Lin
- From the Department of Neurology (C.-P.Y.), Kuang Tien General Hospital; Department of Nutrition (C.-P.Y.), Huang-Kuang University; Department of Medical Research (C.-I.L., C.-S.L., C.-C.L.), China Medical University Hospital; School of Medicine, College of Medicine (C.-I.L., C.-S.L., W.-Y.L., C.-C.L.), Department of Family Medicine (C.-S.L., W.-Y.L., C.-C.L.), and Department of Public Health, College of Public Health (S.-Y.Y., T.-C.L.), China Medical University; Department of Public Health (K.-L.H.), Chung Shan Medical University; and Department of Healthcare Administration (T.-C.L.), College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Clergeau A, Parienti JJ, Reznik Y, Clergeau D, Seguin A, Valette X, du Cheyron D, Joubert M. Impact of a Paper-Based Dynamic Insulin Infusion Protocol on Glycemic Variability, Time in Target, and Hypoglycemic Risk: A Stepped Wedge Trial in Medical Intensive Care Unit Patients. Diabetes Technol Ther 2017; 19:115-123. [PMID: 28118045 DOI: 10.1089/dia.2016.0314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Stress-induced hyperglycemia is a common feature of intensive care unit (ICU) patients. Besides mean blood glucose (BG) level, glucose variability and hypoglycemia have been highlighted as independent predictors of ICU and hospital mortality. Recent ICU recommendations suggest using insulin infusion protocols that can minimize glucose variability and hypoglycemic risk. Our aim was to assess the efficacy, safety, and acceptance by nurses of a paper-based simple dynamic insulin protocol compared with those by nurses of a paper-based static protocol. METHODS This is a 1 year stepped-wedge study that compared a static sliding scale protocol (SP - static protocol) with a validated dynamic paper-based intravenous insulin infusion protocol (DP - dynamic protocol) in medical ICU patients of a single university hospital. Patients with stress-induced hyperglycemia >9.9 mmol/L and ≥48 h intravenous insulin infusion were included in this trial. RESULTS One hundred thirty-one patients were included and received continuous intravenous insulin infusion managed with SP (n = 65) or DP (n = 66). Glucose variability was significantly higher in the SP group than in the DP group (mean average glucose excursion index: 0.90 [0.00-1.91] mmol/L vs. 0.00 [0.00-0.90] mmol/L, respectively; P = 0.001). The percentage of time spent in the target range (7.7-9.9 mmol/L) was lower in the SP group than in the DP group (42.5% [28.8%-54.2%] vs. 47.5% [36.6%-57.1%]; P = 0.037). Low BG (<4.4 mmol/L) and hypoglycemia (<3.3 mmol/L) were more frequent in the SP group than in the DP group. According to a satisfaction survey, this protocol was well accepted by nurses. CONCLUSIONS Our simple and feasible paper-based, dynamic insulin infusion protocol reduced glycemic variability and hypoglycemic risk in a medical ICU.
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Affiliation(s)
- Antoine Clergeau
- 1 Diabetes Care Unit, University Hospital of Caen , Caen, France
| | | | - Yves Reznik
- 1 Diabetes Care Unit, University Hospital of Caen , Caen, France
| | - Deborah Clergeau
- 3 Intensive Care Unit, University Hospital of Caen , Caen, France
| | - Amelie Seguin
- 3 Intensive Care Unit, University Hospital of Caen , Caen, France
| | - Xavier Valette
- 3 Intensive Care Unit, University Hospital of Caen , Caen, France
| | | | - Michael Joubert
- 1 Diabetes Care Unit, University Hospital of Caen , Caen, France
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98
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Choi HS, Kim S, Kim MJ, Kim MS, Kim J, Park CW, Seo D, Shin SS, Oh SW. Efficacy and safety of Panax ginseng berry extract on glycemic control: A 12-wk randomized, double-blind, and placebo-controlled clinical trial. J Ginseng Res 2017; 42:90-97. [PMID: 29348727 PMCID: PMC5766700 DOI: 10.1016/j.jgr.2017.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 12/18/2016] [Accepted: 01/04/2017] [Indexed: 12/12/2022] Open
Abstract
Background Antihyperglycemic effects of Panax ginseng berry have never been explored in humans. The aims of this study were to assess the efficacy and safety of a 12-wk treatment with ginseng berry extract in participants with a fasting glucose level between 100 mg/dL and 140 mg/dL. Methods This study was a 12-wk, randomized, double-blind, placebo-controlled clinical trial. A total of 72 participants were randomly allocated to two groups of either ginseng berry extract or placebo, and 63 participants completed the study. The parameters related to glucose metabolism were assessed. Results Although the present study failed to show significant antihyperglycemic effects of ginseng berry extract on the parameters related to blood glucose and lipid metabolism in the total study population, it demonstrated that ginseng berry extract could significantly decrease serum concentration of fasting glucose by 3.7% (p = 0.035), postprandial glucose at 60 min during 75 g oral glucose tolerance test by 10.7% (p = 0.006), and the area under the curve for glucose by 7.7% (p = 0.024) in those with fasting glucose level of 110 mg/dL or higher, while the placebo group did not exhibit a statistically significant decrease. Safety profiles were not different between the two groups. Conclusion The present study suggests that ginseng berry extract has the potential to improve glucose metabolism in human, especially in those with fasting glucose level of 110 mg/dL or higher. For a more meaningful benefit, further research in people with higher blood glucose levels is required.
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Affiliation(s)
- Han Seok Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Gyeonggi, Republic of Korea
| | - Sunmi Kim
- Research and Development Center, Amorepacific Corporation, Yongin, Gyeonggi, Republic of Korea
| | - Min Jung Kim
- Nutrition and Metabolism Research Group, Korea Food Research Institute, Seongnam, Gyeonggi-do, Republic of Korea
| | - Myung-Sunny Kim
- Nutrition and Metabolism Research Group, Korea Food Research Institute, Seongnam, Gyeonggi-do, Republic of Korea
| | - Juewon Kim
- Research and Development Center, Amorepacific Corporation, Yongin, Gyeonggi, Republic of Korea
| | - Chan-Woong Park
- Research and Development Center, Amorepacific Corporation, Yongin, Gyeonggi, Republic of Korea
| | - Daebang Seo
- Research and Development Center, Amorepacific Corporation, Yongin, Gyeonggi, Republic of Korea
| | - Song Seok Shin
- Research and Development Center, Amorepacific Corporation, Yongin, Gyeonggi, Republic of Korea
| | - Sang Woo Oh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Gyeonggi, Republic of Korea
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Laiteerapong N, Karter AJ, Moffet HH, Cooper JM, Gibbons RD, Liu JY, Gao Y, Huang ES. Ten-year hemoglobin A1c trajectories and outcomes in type 2 diabetes mellitus: The Diabetes & Aging Study. J Diabetes Complications 2017; 31:94-100. [PMID: 27503405 PMCID: PMC5209280 DOI: 10.1016/j.jdiacomp.2016.07.023] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/20/2016] [Accepted: 07/22/2016] [Indexed: 11/29/2022]
Abstract
AIMS To classify trajectories of long term HbA1c values in patients after diagnosis of type 2 diabetes and examine each trajectory's associations with subsequent microvascular and macrovascular events and mortality. METHODS A longitudinal follow-up of 28,016 patients newly diagnosed with type 2 diabetes was conducted. Latent growth mixture modeling was used to identify ten-year HbA1c trajectories. Cox proportional hazards models were used to assess how HbA1c trajectories were associated with events (microvascular and macrovascular) and mortality. RESULTS We identified 5 HbA1c trajectories: "low stable" (82.5%), "moderate increasing late" (5.1%), "high decreasing early" (4.9%), "moderate peaking late" (4.1%) and "moderate peaking early" (3.3%). After adjusting for average HbA1c, compared to the low stable trajectory, all non-stable trajectories were associated with higher incidences of microvascular events (hazard ratio (HR) range, 1.28 (95% CI, 1.08-1.53) (high decreasing early) to 1.45 (95% CI, 1.20-1.75) (moderate peaking early)). The high decreasing early trajectory was associated with an increased mortality risk (HR, 1.27 (95% CI, 1.03-1.58)). Trajectories were not associated with macrovascular events. CONCLUSIONS Non-stable HbA1c trajectories were associated with greater risk of microvascular events and mortality. These findings suggest a potential benefit of early diabetes detection, prioritizing good glycemic control, and maintaining control over time.
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Affiliation(s)
- Neda Laiteerapong
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 2007, Chicago, IL 60637, USA.
| | - Andrew J Karter
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA
| | - Howard H Moffet
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA
| | - Jennifer M Cooper
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 2007, Chicago, IL 60637, USA
| | - Robert D Gibbons
- Departments of Medicine and Public Health Sciences, University of Chicago, 5841 S Maryland Avenue, MC 2000, Chicago, IL 60637, USA
| | - Jennifer Y Liu
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA
| | - Yue Gao
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 2007, Chicago, IL 60637, USA
| | - Elbert S Huang
- Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 2007, Chicago, IL 60637, USA
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Fasting plasma glucose variability and all-cause mortality among type 2 diabetes patients: a dynamic cohort study in Shanghai, China. Sci Rep 2016; 6:39633. [PMID: 28004765 PMCID: PMC5177938 DOI: 10.1038/srep39633] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/25/2016] [Indexed: 02/07/2023] Open
Abstract
The study aims to examine whether the variation of fasting plasma glucose (FPG), represented by coefficient of variation (CV), independently predicts all-cause mortality among Chinese type 2 diabetes patients. This retrospective cohort study was designed based on a standardized electronic management system of diabetes patients in Shanghai, China. 8871 type 2 diabetes patients were enrolled between 1 January 2007 and 31 December 2007 and were followed-up for all-cause mortality until 31 December 2014. All patients were grouped by the quartiles of CV of FPG. 1136 patients deceased during following-up. After adjusting for other risk factors, CV of FPG was not independently associated with all-cause mortality. Stratified analysis by mean FPG levels (<7 mmol/L and ≥7 mmol/L) observed a significant modifying effect of CV of FPG (P for interact test <0.01). CV of FPG was independently associated with all-cause mortality in patients whose glucose control was poor, with the HRs (95% CI) for the second, third, fourth vs first quartiles of CV of FPG being 1.23(0.94–1.61), 1.23(0.94–1.61), and 1.63(1.25–2.13), respectively. Our results suggest that variability of FPG may be an important predictor of mortality among type 2 diabetes in China, particularly for those with their glycemic status uncontrolled.
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