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Wang Y, Li S, Lu J, Feng K, Huang X, Hu F, Sun M, Zou Y, Li Y, Huang W, Zhou J. The complexity of glucose time series is associated with short- and long-term mortality in critically ill adults: a multi-center, prospective, observational study. J Endocrinol Invest 2024:10.1007/s40618-024-02393-4. [PMID: 38762634 DOI: 10.1007/s40618-024-02393-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The wealth of data taken from continuous glucose monitoring (CGM) remains to be fully used. We aimed to evaluate the relationship between a promising new CGM metric, complexity of glucose time series index (CGI), and mortality in critically ill patients. METHODS A total of 293 patients admitted to mixed medical/surgical intensive care units from 5 medical centers in Shanghai were prospectively included between May 2020 and November 2021. CGI was assessed using intermittently scanned CGM, with a median monitoring period of 12.0 days. Outcome measures included short- and long-term mortality. RESULTS During a median follow-up period of 1.7 years, a total of 139 (47.4%) deaths were identified, of which 73 (24.9%) occurred within the first 30 days after ICU admission, and 103 (35.2%) within 90 days. The multivariable-adjusted HRs for 30-day mortality across ascending tertiles of CGI were 1.00 (reference), 0.68 (95% CI 0.38-1.22) and 0.36 (95% CI 0.19-0.70), respectively. For per 1-SD increase in CGI, the risk of 30-day mortality was decreased by 51% (HR 0.49, 95% CI 0.35-0.69). Further adjustment for HbA1c, mean glucose during hospitalization and glucose variability partially attenuated these associations, although the link between CGI and 30-day mortality remained significant (per 1-SD increase: HR 0.57, 95% CI 0.40-0.83). Similar results were observed when 90-day mortality was considered as the outcome. Furthermore, CGI was also significantly and independently associated with long-term mortality (per 1-SD increase: HR 0.77, 95% CI 0.61-0.97). CONCLUSIONS In critically ill patients, CGI is significantly associated with short- and long-term mortality.
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Affiliation(s)
- Y Wang
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - S Li
- Department of Anesthesiology, Tongji University Affiliated Shanghai Tenth People's Hospital, Shanghai, China
- Department of Critical Care Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - J Lu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China
| | - K Feng
- Department of Critical Care Medicine, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - X Huang
- Department of Critical Care Medicine, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
| | - F Hu
- Department of Critical Care Medicine, Shanghai Fengxian District Central Hospital, Shanghai, China
| | - M Sun
- Department of Critical Care Medicine, Shanghai Eighth People's Hospital, Shanghai, China
| | - Y Zou
- Department of Critical Care Medicine, Shanghai Sixth People's Hospital East Campus, Shanghai, China
| | - Y Li
- Department of Critical Care Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.
- Department of Critical Care Medicine, Tongji University Affiliated Shanghai Tenth People's Hospital, 301 Yanan Middle Road, Shanghai, 200040, China.
| | - W Huang
- Department of Critical Care Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.
- Department of Critical Care Medicine, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, 966 Huaihai Middle Road, Shanghai, 200031, China.
| | - J Zhou
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Clinical Center for Diabetes; Shanghai Diabetes Institute; Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Shanghai, 200233, China.
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2
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Cai J, Yang Q, Lu J, Shen Y, Wang C, Chen L, Zhang L, Lu W, Zhu W, Xia T, Zhou J. Impact of the complexity of glucose time series on all-cause mortality in patients with type 2 diabetes. J Clin Endocrinol Metab 2022; 108:1093-1100. [PMID: 36458883 PMCID: PMC10099164 DOI: 10.1210/clinem/dgac692] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/09/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022]
Abstract
CONTEXT Previous studies suggest that the complexity of glucose time series may serve as a novel marker of glucose homeostasis. OBJECTIVE We aimed to investigate the relationship between the complexity of glucose time series and all-cause mortality in patients with type 2 diabetes. METHODS Prospective data of 6000 adult inpatients with type 2 diabetes from a single center was analyzed. The complexity of glucose time series index (CGI) based on continuous glucose monitoring (CGM) was measured at baseline with refined composite multi-scale entropy. Participants were stratified by the tertiles of CGI: < 2.15, 2.15-2.99, and ≥ 3.00. Cox proportional hazards regression models were used to assess the relationship between CGI and all-cause mortality. RESULTS During a median follow-up of 9.4 years, 1217 deaths were identified. A significant interaction between glycated hemoglobin A1c (HbA1c) and CGI in relation to all-cause mortality was noted (P for interaction = 0.016). The multivariable-adjusted hazard ratios for all-cause mortality at different CGI levels [≥ 3.00 (reference group), 2.15-2.99, and < 2.15] were 1.00, 0.76 (95% CI 0.52-1.12), and 1.47 (95% CI 1.03-2.09) in patients with HbA1c < 7.0%, while the association was nonsignificant in those with HbA1c ≥ 7.0%. The restricted cubic spline regression revealed a non-linear (P for non-linearity = 0.041) relationship between CGI and all-cause mortality in subjects with HbA1c < 7.0% only. CONCLUSIONS Lower CGI is associated with an increased risk of all-cause mortality among patients with type 2 diabetes achieving the HbA1c target. CGI may be a new indicator for the identification of residual risk of death in well-controlled type 2 diabetes.
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Affiliation(s)
- Jinghao Cai
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Qing Yang
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jingyi Lu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Yun Shen
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Chunfang Wang
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Lei Chen
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Lei Zhang
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Wei Lu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Wei Zhu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
| | - Tian Xia
- Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
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Discriminating Bacterial Infection from Other Causes of Fever Using Body Temperature Entropy Analysis. ENTROPY 2022; 24:e24040510. [PMID: 35455174 PMCID: PMC9024484 DOI: 10.3390/e24040510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/17/2022]
Abstract
Body temperature is usually employed in clinical practice by strict binary thresholding, aiming to classify patients as having fever or not. In the last years, other approaches based on the continuous analysis of body temperature time series have emerged. These are not only based on absolute thresholds but also on patterns and temporal dynamics of these time series, thus providing promising tools for early diagnosis. The present study applies three time series entropy calculation methods (Slope Entropy, Approximate Entropy, and Sample Entropy) to body temperature records of patients with bacterial infections and other causes of fever in search of possible differences that could be exploited for automatic classification. In the comparative analysis, Slope Entropy proved to be a stable and robust method that could bring higher sensitivity to the realm of entropy tools applied in this context of clinical thermometry. This method was able to find statistically significant differences between the two classes analyzed in all experiments, with sensitivity and specificity above 70% in most cases.
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Zhang L, Tian Q, Guo K, Wu J, Ye J, Ding Z, Zhou Q, Huang G, Li X, Zhou Z, Yang L. Analysis of detrended fluctuation function derived from continuous glucose monitoring may assist in distinguishing latent autoimmune diabetes in adults from T2DM. Front Endocrinol (Lausanne) 2022; 13:948157. [PMID: 36204110 PMCID: PMC9530584 DOI: 10.3389/fendo.2022.948157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/06/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We aimed to explore the performance of detrended fluctuation function (DFF) in distinguishing patients with latent autoimmune diabetes in adults (LADA) from type 2 diabetes mellitus (T2DM) with glucose data derived from continuous glucose monitoring. METHODS In total, 71 LADA and 152 T2DM patients were enrolled. Correlations between glucose parameters including time in range (TIR), mean glucose, standard deviation (SD), mean amplitude of glucose excursions (MAGE), coefficient of variation (CV), DFF and fasting and 2-hour postprandial C-peptide (FCP, 2hCP) were analyzed and compared. Receiver operating characteristics curve (ROC) analysis and 10-fold cross-validation were employed to explore and validate the performance of DFF in diabetes classification respectively. RESULTS Patients with LADA had a higher mean glucose, lower TIR, greater SD, MAGE and CV than those of T2DM (P<0.001). DFF achieved the strongest correlation with FCP (r = -0.705, P<0.001) as compared with TIR (r = 0.485, P<0.001), mean glucose (r = -0.337, P<0.001), SD (r = -0.645, P<0.001), MAGE (r = -0.663, P<0.001) and CV (r = -0.639, P<0.001). ROC analysis showed that DFF yielded the greatest area under the curve (AUC) of 0.862 (sensitivity: 71.2%, specificity: 84.9%) in differentiating LADA from T2DM as compared with TIR, mean glucose, SD, MAGE and CV (AUC: 0.722, 0.650, 0.800, 0.820 and 0.807, sensitivity: 71.8%, 47.9%, 63.6%, 72.7% and 78.8%, specificity: 67.8%, 83.6%, 80.9%, 80.3% and 72.4%, respectively). The kappa test indicated a good consistency between DFF and the actual diagnosis (kappa = 0.551, P<0.001). Ten-fold cross-validation showed a stable performance of DFF with a mean AUC of 0.863 (sensitivity: 78.8%, specificity: 77.8%) in 10 training sets and a mean AUC of 0.866 (sensitivity: 80.9%, specificity: 84.1%) in 10 test sets. CONCLUSIONS A more violent glucose fluctuation pattern was marked in patients with LADA than T2DM. We first proposed the possible role of DFF in distinguishing patients with LADA from T2DM in our study population, which may assist in diabetes classification.
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Tanaka Y, Ogata H, Park I, Ando A, Ishihara A, Kayaba M, Yajima K, Suzuki C, Araki A, Osumi H, Zhang S, Seol J, Takahashi K, Nabekura Y, Satoh M, Tokuyama K. Effect of a single bout of morning or afternoon exercise on glucose fluctuation in young healthy men. Physiol Rep 2021; 9:e14784. [PMID: 33904659 PMCID: PMC8077162 DOI: 10.14814/phy2.14784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 11/24/2022] Open
Abstract
The timing of exercise plays an important role in the effect of the exercise on physiological functions, such as substrate oxidation and circadian rhythm. Exercise exerts different effects on the glycemic response to exercise and meal intake depending on when the exercise performed. Here, we comprehensively investigated the effects of the timing (morning or afternoon) of exercise on glucose fluctuation on the basis of several indices: glycemic variability over 24 h (24-h SD), J-index, mean amplitude of glucose excursions (MAGE), continuous overall net glycemic action (CONGA), and detrended fluctuation analysis (DFA). Eleven young men participated in 3 trials in a repeated measures design in which they performed a single bout of exercise at 60% of their maximal oxygen uptake for 1 h beginning either at 7:00 (morning exercise), 16:00 (afternoon exercise), or no exercise (control). Glucose levels were measured using a continuous glucose monitoring system (CGMs). Glucose fluctuation was slightly less stable when exercise was performed in the afternoon than in the morning, indicated by higher CONGA at 2 h and α2 in DFA in the afternoon exercise trial than in the control trial. Additionally, decreased stability in glucose fluctuation in the afternoon exercise trial was supported by the descending values of the other glucose fluctuation indices in order from the afternoon exercise, morning exercise, and control trials. Meal tolerance following exercise was decreased after both exercise trials. Glucose levels during exercise were decreased only in the afternoon exercise trial, resulting in less stable glucose fluctuations over 24 h.
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Affiliation(s)
- Yoshiaki Tanaka
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hitomi Ogata
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
| | - Insung Park
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Ando
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Asuka Ishihara
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Momoko Kayaba
- Department of Somnology, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Katsuhiko Yajima
- Department of Nutritional Physiology, Faculty of Pharmaceutical Sciences, Josai University, Sakado, Saitama, Japan
| | - Chihiro Suzuki
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akihiro Araki
- Faculty of Health Science, Tsukuba International University, Tsuchiura, Ibaraki, Japan
| | - Haruka Osumi
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Simeng Zhang
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Jaehoon Seol
- R&D Center for Tailor-Made QOL, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keigo Takahashi
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiharu Nabekura
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Makoto Satoh
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kumpei Tokuyama
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
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Colás A, Varela M, Mraz M, Novak D, Cuesta-Frau D, Vigil L, Benes M, Pelikanova T, Haluzik M, Burda V, Vargas B. Influence of glucometric 'dynamical' variables on duodenal-jejunal bypass liner (DJBL) anthropometric and metabolic outcomes. Diabetes Metab Res Rev 2020; 36:e3287. [PMID: 31916665 DOI: 10.1002/dmrr.3287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 11/19/2019] [Accepted: 12/30/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND The endoscopically implanted duodenal-jejunal bypass liner (DJBL) is an attractive alternative to bariatric surgery for obese diabetic patients. This article aims to study dynamical aspects of the glycaemic profile that may influence DJBL effects. METHODS Thirty patients underwent DJBL implantation and were followed for 10 months. Continuous glucose monitoring (CGM) was performed before implantation and at month 10. Dynamical variables from CGM were measured: coefficient of variation of glycaemia, mean amplitude of glycaemic excursions (MAGE), detrended fluctuation analysis (DFA), % of time with glycaemia under 6.1 mmol/L (TU6.1), area over 7.8 mmol/L (AO7.8) and time in range. We analysed the correlation between changes in both anthropometric (body mass index, BMI and waist circumference) and metabolic (fasting blood glucose, FBG and HbA1c) variables and dynamical CGM-derived metrics and searched for variables in the basal CGM that could predict successful outcomes. RESULTS There was a poor correlation between anthropometric and metabolic outcomes. There was a strong correlation between anthropometric changes and changes in glycaemic tonic control (∆BMI-∆TU6.1: rho = - 0.67, P < .01) and between metabolic outcomes and glycaemic phasic control (∆FBG-∆AO7.8: r = .60, P < .01). Basal AO7.8 was a powerful predictor of successful metabolic outcome (0.85 in patients with AO7.8 above the median vs 0.31 in patients with AO7.8 below the median: Chi-squared = 5.67, P = .02). CONCLUSIONS In our population, anthropometric outcomes of DJBL correlate with improvement in tonic control of glycaemia, while metabolic outcomes correlate preferentially with improvement in phasic control. Assessment of basal phasic control may help in candidate profiling for DJBL implantation.
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Affiliation(s)
- Ana Colás
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Manuel Varela
- Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
| | - Milos Mraz
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Daniel Novak
- Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - David Cuesta-Frau
- Technological Institute of Informatics, Universitat Politècnica de València, Alcoi, Spain
| | - Luis Vigil
- Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
| | - Marek Benes
- Hepatogastroenterology Department, Transplantation Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Terezie Pelikanova
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Martin Haluzik
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
- Laboratory of Experimental Diabetology, Experimental Medicine Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Vaclav Burda
- Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic
| | - Borja Vargas
- Department of Internal Medicine, Hospital Universitario de Móstoles, Madrid, Spain
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Colás A, Vigil L, Vargas B, Cuesta–Frau D, Varela M. Detrended Fluctuation Analysis in the prediction of type 2 diabetes mellitus in patients at risk: Model optimization and comparison with other metrics. PLoS One 2019; 14:e0225817. [PMID: 31851681 PMCID: PMC6919578 DOI: 10.1371/journal.pone.0225817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 11/13/2019] [Indexed: 11/18/2022] Open
Abstract
Complexity analysis of glucose time series with Detrended Fluctuation Analysis (DFA) has been proved to be useful for the prediction of type 2 diabetes mellitus (T2DM) development. We propose a modified DFA algorithm, review some of its characteristics and compare it with other metrics derived from continuous glucose monitorization in this setting. Several issues of the DFA algorithm were evaluated: (1) Time windowing: the best predictive value was obtained including all time-windows from 15 minutes to 24 hours. (2) Influence of circadian rhythms: for 48-hour glucometries, DFA alpha scaling exponent was calculated on 24-hour sliding segments (1-hour gap, 23-hour overlap), with a median coefficient of variation of 3.2%, which suggests that analysing time series of at least 24-hour length avoids the influence of circadian rhythms. (3) Influence of pretreatment of the time series through integration: DFA without integration was more sensitive to the introduction of white noise and it showed significant predictive power to forecast the development of T2DM, while the pretreated time series did not. (4) Robustness of an interpolation algorithm for missing values: The modified DFA algorithm evaluates the percentage of missing values in a time series. Establishing a 2% error threshold, we estimated the number and length of missing segments that could be admitted to consider a time series as suitable for DFA analysis. For comparison with other metrics, a Principal Component Analysis was performed and the results neatly tease out four different components. The first vector carries information concerned with variability, the second represents mainly DFA alpha exponent, while the third and fourth vectors carry essentially information related to the two “pre-diabetic behaviours” (impaired fasting glucose and impaired glucose tolerance). The scaling exponent obtained with the modified DFA algorithm proposed has significant predictive power for the development of T2DM in a high-risk population compared with other variability metrics or with the standard DFA algorithm.
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Affiliation(s)
- Ana Colás
- Department of Internal Medicine, Hospital 12 de Octubre, Madrid, Spain
| | - Luis Vigil
- Department of Internal Medicine, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - Borja Vargas
- Department of Internal Medicine, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
- * E-mail:
| | - David Cuesta–Frau
- Technological Institute of Informatics, Universitat Politècnica de València, Alcoi Campus, Alcoi, Spain
| | - Manuel Varela
- Department of Internal Medicine, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
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8
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Ogata H, Kayaba M, Tanaka Y, Yajima K, Iwayama K, Ando A, Park I, Kiyono K, Omi N, Satoh M, Tokuyama K. Effect of skipping breakfast for 6 days on energy metabolism and diurnal rhythm of blood glucose in young healthy Japanese males. Am J Clin Nutr 2019; 110:41-52. [PMID: 31095288 DOI: 10.1093/ajcn/nqy346] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/06/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Skipping breakfast has become a common trend that may lead to obesity and type 2 diabetes. Previous studies, which imposed a single incidence of breakfast skipping, did not observe any decrease in 24-h energy expenditure. Furthermore, the effects of breakfast skipping on diurnal blood glucose profiles over 24 h are contradictory. OBJECTIVE The aim of this study was to clarify the influence of 6 consecutive days of breakfast skipping and sedentary behavior on energy metabolism and glycemic control. METHODS Ten young men participated in 2 trials (with or without breakfast) that lasted for 6 consecutive days, and the 2 trials were conducted 1 wk apart with a repeated-measures design. During the meal intervention, each subject's blood glucose was measured using the continuous glucose monitoring system. If breakfast was skipped, subjects ate large meals at lunch and dinner such that the 24-h energy intake was identical to that of the 3-meal condition. At 2200 on the fifth day, the subjects entered a room-sized respiratory chamber, where they remained for 33 h, and were instructed to carry out sedentary behavior. RESULTS The glucose levels were similar between the 2 meal conditions during the first 5 d of meal intervention, but the blood glucose at 2300 was higher in the breakfast-skipping condition than in the 3-meal condition. Breakfast skipping elevated postprandial glycemic response after lunch on the first day of meal intervention. On the sixth day, there were no significant differences in 24-h energy expenditure and substrate oxidation. When subjects remained in a metabolic chamber, the level of physical activity significantly decreased, glycemic stability slightly deteriorated, and mean blood glucose over 24 h was higher in the breakfast-skipping trial than in the 3-meal trial. CONCLUSIONS Sedentary lifestyle and repeated breakfast skipping caused abnormal glucose fluctuations, whereas 24-h energy metabolism remained unaffected. Clinical Trial Registry: This trial was registered at http://www.umin.ac.jp/english/ as UMIN000032346.
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Affiliation(s)
- Hitomi Ogata
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan.,Faculty of Health and Sport Science
| | - Momoko Kayaba
- International Institute for Integrative Sleep Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Katsuhiko Yajima
- Faculty of Health and Sport Science.,Faculty of Health and Nutrition, Tokyo Seiei College, Tokyo, Japan
| | | | | | - Insung Park
- International Institute for Integrative Sleep Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka, Japan
| | | | - Makoto Satoh
- International Institute for Integrative Sleep Medicine, University of Tsukuba, Tsukuba, Japan
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9
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Kohnert KD, Heinke P, Vogt L, Augstein P, Salzsieder E. Applications of Variability Analysis Techniques for Continuous Glucose Monitoring Derived Time Series in Diabetic Patients. Front Physiol 2018; 9:1257. [PMID: 30237767 PMCID: PMC6136234 DOI: 10.3389/fphys.2018.01257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/20/2018] [Indexed: 02/05/2023] Open
Abstract
Methods from non-linear dynamics have enhanced understanding of functional dysregulation in various diseases but received less attention in diabetes. This retrospective cross-sectional study evaluates and compares relationships between indices of non-linear dynamics and traditional glycemic variability, and their potential application in diabetes control. Continuous glucose monitoring provided data for 177 subjects with type 1 (n = 22), type 2 diabetes (n = 143), and 12 non-diabetic subjects. Each time series comprised 576 glucose values. We calculated Poincaré plot measures (SD1, SD2), shape (SFE) and area of the fitting ellipse (AFE), multiscale entropy (MSE) index, and detrended fluctuation exponents (α1, α2). The glycemic variability metrics were the coefficient of variation (%CV) and standard deviation. Time of glucose readings in the target range (TIR) defined the quality of glycemic control. The Poincaré plot indices and α exponents were higher (p < 0.05) in type 1 than in the type 2 diabetes; SD1 (mmol/l): 1.64 ± 0.39 vs. 0.94 ± 0.35, SD2 (mmol/l): 4.06 ± 0.99 vs. 2.12 ± 1.04, AFE (mmol2/l2): 21.71 ± 9.82 vs. 7.25 ± 5.92, and α1: 1.94 ± 0.12 vs. 1.75 ± 0.12, α2: 1.38 ± 0.11 vs. 1.30 ± 0.15. The MSE index decreased consistently from the non-diabetic to the type 1 diabetic group (5.31 ± 1.10 vs. 3.29 ± 0.83, p < 0.001); higher indices correlated with lower %CV values (r = -0.313, p < 0.001). In a subgroup of type 1 diabetes patients, insulin pump therapy significantly decreased SD1 (-0.85 mmol/l), SD2 (-1.90 mmol/l), and AFE (-16.59 mmol2/l2), concomitantly with %CV (-15.60). The MSE index declined from 3.09 ± 0.94 to 1.93 ± 0.40 (p = 0.001), whereas the exponents α1 and α2 did not. On multivariate regression analyses, SD1, SD2, SFE, and AFE emerged as dominant predictors of TIR (β = -0.78, -1.00, -0.29, and -0.58) but %CV as a minor one, though α1 and MSE failed. In the regression models, including SFE, AFE, and α2 (β = -0.32), %CV was not a significant predictor. Poincaré plot descriptors provide additional information to conventional variability metrics and may complement assessment of glycemia, but complexity measures produce mixed results.
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Affiliation(s)
| | - Peter Heinke
- Institute of Diabetes "Gerhardt Katsch", Karlsburg, Germany
| | - Lutz Vogt
- Diabetes Service Center, Karlsburg, Germany
| | - Petra Augstein
- Institute of Diabetes "Gerhardt Katsch", Karlsburg, Germany.,Heart and Diabetes Medical Center, Karlsburg, Germany
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10
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Kohnert KD, Heinke P, Vogt L, Augstein P, Thomas A, Salzsieder E. Associations of blood glucose dynamics with antihyperglycemic treatment and glycemic variability in type 1 and type 2 diabetes. J Endocrinol Invest 2017; 40:1201-1207. [PMID: 28484994 DOI: 10.1007/s40618-017-0682-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/26/2017] [Indexed: 12/20/2022]
Abstract
AIMS The dynamical structure of glucose fluctuation has largely been disregarded in the contemporary management of diabetes. METHODS In a retrospective study of patients with diabetes, we evaluated the relationship between glucose dynamics, antihyperglycemic therapy, glucose variability, and glucose exposure, while taking into account potential determinants of the complexity index. We used multiscale entropy (MSE) analysis of continuous glucose monitoring data from 131 subjects with type 1 (n = 18), type 2 diabetes (n = 102), and 11 nondiabetic control subjects. We compared the MSE complexity index derived from the glucose time series among the treatment groups, after adjusting for sex, age, diabetes duration, body mass index, and carbohydrate intake. RESULTS In type 2 diabetic patients who were on a diet or insulin regimen with/without oral agents, the MSE index was significantly lower than in nondiabetic subjects but was lowest in the type 1 diabetes group (p < 0.001). The decline in the MSE complexity across the treatment groups correlated with increasing glucose variability and glucose exposure. Statistically, significant correlations existed between higher MSE complexity indices and better glycemic control. In multivariate regression analysis, the antidiabetic therapy was the most powerful predictor of the MSE (β = -0.940 ± 0.242, R 2 = 0.306, p < 0.001), whereas the potential confounders failed to contribute. CONCLUSIONS The loss of dynamical complexity in glucose homeostasis correlates more closely with therapy modalities and glucose variability than with clinical measures of glycemia. Thus, targeting the glucoregulatory system by adequate therapeutic interventions may protect against progressive worsening of diabetes control.
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Affiliation(s)
- K-D Kohnert
- Institute of Diabetes "Gerhardt Katsch" Karlsburg, Karlsburg, Germany.
| | - P Heinke
- Institute of Diabetes "Gerhardt Katsch" Karlsburg, Karlsburg, Germany
| | - L Vogt
- Diabetes Service Center, Karlsburg, Germany
| | - P Augstein
- Institute of Diabetes "Gerhardt Katsch" Karlsburg, Karlsburg, Germany
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - A Thomas
- Medtronic GmbH, Meerbusch, Germany
| | - E Salzsieder
- Institute of Diabetes "Gerhardt Katsch" Karlsburg, Karlsburg, Germany
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11
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Rodríguez de Castro C, Vigil L, Vargas B, García Delgado E, García Carretero R, Ruiz‐Galiana J, Varela M. Glucose time series complexity as a predictor of type 2 diabetes. Diabetes Metab Res Rev 2017; 33:e2831. [PMID: 27253149 PMCID: PMC5333459 DOI: 10.1002/dmrr.2831] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/02/2016] [Accepted: 05/20/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Complexity analysis of glucose profile may provide valuable information about the gluco-regulatory system. We hypothesized that a complexity metric (detrended fluctuation analysis, DFA) may have a prognostic value for the development of type 2 diabetes in patients at risk. METHODS A total of 206 patients with any of the following risk factors (1) essential hypertension, (2) obesity or (3) a first-degree relative with a diagnosis of diabetes were included in a survival analysis study for a diagnosis of new onset type 2 diabetes. At inclusion, a glucometry by means of a Continuous Glucose Monitoring System was performed, and DFA was calculated for a 24-h glucose time series. Patients were then followed up every 6 months, controlling for the development of diabetes. RESULTS In a median follow-up of 18 months, there were 18 new cases of diabetes (58.5 cases/1000 patient-years). DFA was a significant predictor for the development of diabetes, with ten events in the highest quartile versus one in the lowest (log-rank test chi2 = 9, df = 1, p = 0.003), even after adjusting for other relevant clinical and biochemical variables. In a Cox model, the risk of diabetes development increased 2.8 times for every 0.1 DFA units. In a multivariate analysis, only fasting glucose, HbA1c and DFA emerged as significant factors. CONCLUSIONS Detrended fluctuation analysis significantly performed as a harbinger of type 2 diabetes development in a high-risk population. Complexity analysis may help in targeting patients who could be candidates for intensified treatment. Copyright © 2016 The Authors. Diabetes/Metabolism Research and Reviews Published by John Wiley & Sons Ltd.
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Affiliation(s)
| | - Luis Vigil
- Internal MedicineHospital Universitario de MostolesMostolesSpain
| | - Borja Vargas
- Internal MedicineUniversidad Europea de MadridMadridSpain
| | | | | | | | - Manuel Varela
- Internal MedicineHospital Universitario de MostolesMostolesSpain
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12
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Varela M, Vigil L, Rodriguez C, Vargas B, García-Carretero R. Delay in the Detrended Fluctuation Analysis Crossover Point as a Risk Factor for Type 2 Diabetes Mellitus. J Diabetes Res 2016; 2016:9361958. [PMID: 27294154 PMCID: PMC4884848 DOI: 10.1155/2016/9361958] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/11/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022] Open
Abstract
Detrended Fluctuation Analysis (DFA) measures the complexity of a glucose time series obtained by means of a Continuous Glucose Monitoring System (CGMS) and has proven to be a sensitive marker of glucoregulatory dysfunction. Furthermore, some authors have observed a crossover point in the DFA, signalling a change of dynamics, arguably dependent on the beta-insular function. We investigate whether the characteristics of this crossover point have any influence on the risk of developing type 2 diabetes mellitus (T2DM). To this end we recruited 206 patients at increased risk of T2DM (because of obesity, essential hypertension, or a first-degree relative with T2DM). A CGMS time series was obtained, from which the DFA and the crossover point were calculated. Patients were then followed up every 6 months for a mean of 17.5 months, controlling for the appearance of T2DM diagnostic criteria. The time to crossover point was a significant predictor risk of developing T2DM, even after adjusting for other variables. The angle of the crossover was not predictive by itself but became significantly protective when the model also considered the crossover point. In summary, both a delay and a blunting of the crossover point predict the development of T2DM.
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Affiliation(s)
- Manuel Varela
- Servicio de Medicina Interna, Hospital Universitario de Mostoles, Rio Jucar s/n, Mostoles, 28935 Madrid, Spain
- *Manuel Varela:
| | - Luis Vigil
- Servicio de Medicina Interna, Hospital Universitario de Mostoles, Rio Jucar s/n, Mostoles, 28935 Madrid, Spain
| | - Carmen Rodriguez
- Servicio de Medicina Interna, Hospital Universitario de Mostoles, Rio Jucar s/n, Mostoles, 28935 Madrid, Spain
| | - Borja Vargas
- European University of Madrid, Villaviciosa de Odón, Spain
| | - Rafael García-Carretero
- Servicio de Medicina Interna, Hospital Universitario de Mostoles, Rio Jucar s/n, Mostoles, 28935 Madrid, Spain
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Ikezaki H, Furusyo N, Ihara T, Hayashi T, Ura K, Hiramine S, Mitsumoto F, Takayama K, Murata M, Kohzuma T, Ai M, Schaefer EJ, Hayashi J. Glycated albumin as a diagnostic tool for diabetes in a general Japanese population. Metabolism 2015; 64:698-705. [PMID: 25817605 DOI: 10.1016/j.metabol.2015.03.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/19/2015] [Accepted: 03/07/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Diabetes mellitus is a major cause of cardiovascular, kidney, neurologic, and eye diseases, and may be preventable in some cases by lifestyle modification. Screening tests for diabetes mellitus include fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c). Our objective was to evaluate the utility of plasma glycated albumin (GA) in the diagnosis of diabetes mellitus. DESIGN AND METHODS A cross-sectional, community-based population study of 908 non-diabetic Japanese residents was conducted. Of these subjects, 176 with FPG value between 5.5 and 6.9mmol/l, and an HbA1c level of <6.5% received an oral glucose tolerance test (OGTT). RESULTS The OGTT results were used for the diagnosis of diabetes mellitus using World Health Organization criteria. Receiver operating characteristic (ROC) analyses demonstrated that optimal threshold values for the diagnosis of diabetes in this population were 15.2% for GA and 5.9% for HbA1c, respectively. Using these cutoff levels, the sensitivity of GA at 62.1% for detecting diabetes was the same as that of HbA1c. However the specificity for GA for detecting diabetes was 61.9%, while for HbA1c it was higher at 66.7%. CONCLUSIONS Our results indicate that the measurement of glycated albumin may serve as a useful screening test for diabetes in a general Japanese population.
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Affiliation(s)
- Hiroaki Ikezaki
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan; Cardiovascular Nutrition Laboratory, Jean Mayor USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA
| | - Norihiro Furusyo
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan.
| | - Takeshi Ihara
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan
| | - Takeo Hayashi
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan
| | - Kazuya Ura
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan
| | - Satoshi Hiramine
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan
| | - Fujiko Mitsumoto
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan
| | - Koji Takayama
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan
| | - Masayuki Murata
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan
| | - Takuji Kohzuma
- Diagnostic Department, Asahi-Kasei Pharma, Tokyo 1018101, Japan
| | - Masumi Ai
- Department of Insured Medical Care Management, Tokyo Medical and Dental University Hospital, Tokyo 1138510, Japan
| | - Ernst J Schaefer
- Cardiovascular Nutrition Laboratory, Jean Mayor USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111, USA
| | - Jun Hayashi
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka 8128582, Japan; Kyushu General Internal Medicine Center, Hara-Doi Hospital, Fukuoka 8138588, Japan
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14
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Costa MD, Goldberger AL. Response to "Comment on 'Dynamical glucometry: Use of multiscale entropy analysis in diabetes'" [Chaos 25, 058101 (2015)]. CHAOS (WOODBURY, N.Y.) 2015; 25:058102. [PMID: 26026329 PMCID: PMC5848688 DOI: 10.1063/1.4920983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/29/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Madalena D Costa
- The Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts 02115, USA
| | - Ary L Goldberger
- The Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts 02115, USA
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15
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Declining ß-cell function is associated with the lack of long-range negative correlation in glucose dynamics and increased glycemic variability: A retrospective analysis in patients with type 2 diabetes. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2014; 1:192-199. [PMID: 29159101 PMCID: PMC5685022 DOI: 10.1016/j.jcte.2014.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/01/2014] [Accepted: 09/12/2014] [Indexed: 11/24/2022]
Abstract
Objective To determine whether characteristics of glucose dynamics are reflections of β-cell function or rather of inadequate diabetes control. Materials/methods We analyzed historical liquid meal tolerance test (LMTT) and continuous glucose monitoring (CGM) data, which had been obtained from 56 non-insulin treated type 2 diabetic outpatients during withdrawal of antidiabetic drugs. Computed CGM parameters included detrended fluctuation analysis (DFA)-based indices, autocorrelation function exponent, mean amplitude of glycemic excursions (MAGE), glucose SD, and measures of glycemic exposure. The LMTT-based disposition index (LMTT-DI) calculated from the ratio of the area-under-the-insulin-curve to the area-under-the-glucose-curve and Matsuda index was used to assess relationships among β-cell function, glucose profile complexity, autocorrelation function, and glycemic variability. Results The LMTT-DI was inverse linearly correlated with the short-range α1 and long-range scaling exponent α2 (r = −0.275 and −0.441, respectively, p < 0.01) such that lower glucose complexity was associated with better preserved insulin reserve, but it did not correlate with the autocorrelation decay exponent γ. By contrast, the LMTT-DI was strongly correlated with MAGE and SD (r = 0.625 and 0.646, both p < 0.001), demonstrating a curvilinear relationship between β-cell function and glycemic variability. On stepwise regression analyses, the LMTT-DI emerged as an independent contributor, explaining 20, 38, and 47% (all p < 0.001) of the variance in the long-range DFA scaling exponent, MAGE, and hemoglobin A1C, respectively, whereas insulin sensitivity failed to contribute independently. Conclusions Loss of complexity and increased variability in glucose profiles are associated with declining β-cell reserve and worsening glycemic control.
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Key Words
- ACF, autocorrelation function
- AUC, area under the curve
- CGM, continuous glucose monitoring
- Cp, C-peptide
- DFA, detrended fluctuation analysis
- Disposition index
- Glucose profile dynamics
- LMTT, liquid meal tolerance test
- LMTT-DI, LMTT-based disposition index
- MAGE, mean amplitude of glycemic excursions
- OHA, oral hypoglycemic agent
- SD, standard deviation
- TZDs, thiazolidinediones
- Type 2 diabetes
- β-Cell reserve
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Costa MD, Henriques T, Munshi MN, Segal AR, Goldberger AL. Dynamical glucometry: use of multiscale entropy analysis in diabetes. CHAOS (WOODBURY, N.Y.) 2014; 24:033139. [PMID: 25273219 PMCID: PMC5848691 DOI: 10.1063/1.4894537] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/22/2014] [Indexed: 06/03/2023]
Abstract
Diabetes mellitus (DM) is one of the world's most prevalent medical conditions. Contemporary management focuses on lowering mean blood glucose values toward a normal range, but largely ignores the dynamics of glucose fluctuations. We probed analyte time series obtained from continuous glucose monitor (CGM) sensors. We show that the fluctuations in CGM values sampled every 5 min are not uncorrelated noise. Next, using multiscale entropy analysis, we quantified the complexity of the temporal structure of the CGM time series from a group of elderly subjects with type 2 DM and age-matched controls. We further probed the structure of these CGM time series using detrended fluctuation analysis. Our findings indicate that the dynamics of glucose fluctuations from control subjects are more complex than those of subjects with type 2 DM over time scales ranging from about 5 min to 5 h. These findings support consideration of a new framework, dynamical glucometry, to guide mechanistic research and to help assess and compare therapeutic interventions, which should enhance complexity of glucose fluctuations and not just lower mean and variance of blood glucose levels.
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Affiliation(s)
- Madalena D Costa
- The Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts 02115, USA
| | - Teresa Henriques
- The Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts 02115, USA
| | - Medha N Munshi
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA
| | - Alissa R Segal
- Joslin Diabetes Center, Boston, Massachusetts 02215, USA
| | - Ary L Goldberger
- The Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, Massachusetts 02115, USA
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17
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Weissman A, Binah O. The fractal nature of blood glucose fluctuations. J Diabetes Complications 2014; 28:646-51. [PMID: 24996977 DOI: 10.1016/j.jdiacomp.2014.05.009] [Citation(s) in RCA: 8] [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] [Received: 03/17/2014] [Revised: 05/24/2014] [Accepted: 05/27/2014] [Indexed: 11/26/2022]
Abstract
AIMS Fluctuations of blood glucose are generated by multiple external and internal factors continuously modifying glucose concentrations through complex feedback loops. This equilibrium may be perturbed during physiological or pathological conditions. The traditional theory suggests that physiological systems achieve homeostasis when disturbed and restore equilibrium through linear feedback loops. Complex systems on the other hand, may function nonlinearly with feedback loops that operate at different time scales, exhibiting chaotic or fractal behavior. We hypothesized that blood glucose fluctuations recorded for prolonged time periods show chaotic, fractal-like behavior that may be altered in diabetes. METHODS We applied nonlinear analytical methods such as detrended fluctuation analysis to glucose data derived from continuous glucose monitoring devices for prolonged time periods in healthy volunteers, diabetes type 1 and pregnant diabetes type 1 patients. RESULTS Glucose fluctuations extracted for prolonged time periods show fractal-like behavior and power law behavior of the system. CONCLUSIONS Hidden features underlying glucose fluctuations in health and in disease were revealed by using dynamic nonlinear analyses methods to discrete glucose readings extracted from continuous glucose monitoring devices. By using such methods we can enhance our understanding of the dynamics of blood glucose fluctuations in health and disease.
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Affiliation(s)
- Amir Weissman
- Department of Obstetrics & Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Department of Physiology, Haifa, Israel.
| | - Ofer Binah
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Department of Physiology, Haifa, Israel; The Sohnis Family Stem Cells Center, Haifa, Israel; The Rappaport Family Institute for Research in the Medical Sciences, Haifa, Israel
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18
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Vigil L, Condés E, Varela M, Rodriguez C, Colas A, Vargas B, Lopez M, Cirugeda E. Glucose series complexity in hypertensive patients. ACTA ACUST UNITED AC 2014; 8:630-6. [PMID: 25065679 DOI: 10.1016/j.jash.2014.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 10/25/2022]
Abstract
Nonlinear methods have been applied to the analysis of biological signals. Complexity analysis of glucose time series may be a useful tool for the study of the initial phases of glucoregulatory dysfunction. This observational, cross-sectional study was performed in patients with essential hypertension. Glucose complexity was measured with detrended fluctuation analysis (DFA), and glucose variability was measured by the mean amplitudes of glycemic excursion (MAGE). We included 91 patients with a mean age of 59 ± 10 years. We found significant correlations for the number of metabolic syndrome (MS)-defining criteria with DFA (r = 0.233, P = .026) and MAGE (r = 0.396, P < .0001). DFA differed significantly between patients who complied with MS and those who did not (1.44 vs. 1.39, P = .018). The MAGE (f = 5.3, P = .006), diastolic blood pressures (f = 4.1, P = .018), and homeostasis model assessment indices (f = 4.2, P = .018) differed between the DFA tertiles. Multivariate analysis revealed that the only independent determinants of the DFA values were MAGE (β coefficient = 0.002, 95% confidence interval: 0.001-0.004, P = .001) and abdominal circumference (β coefficient = 0.002, 95% confidence interval: 0.000015-0.004, P = .048). In our population, DFA was associated with MS and a number of MS criteria. Complexity analysis seemed to be capable of detecting differences in variables that are arguably related to the risk of the development of type 2 diabetes.
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Affiliation(s)
- Luis Vigil
- Department of Internal Medicine, University Hospital of Mostoles, Madrid, Spain.
| | - Emilia Condés
- Universidad Europea de Madrid (Campus Villaviciosa de Odón), Madrid, Spain
| | - Manuel Varela
- Department of Internal Medicine, University Hospital of Mostoles, Madrid, Spain
| | - Carmen Rodriguez
- Department of Internal Medicine, University Hospital of Mostoles, Madrid, Spain
| | - Ana Colas
- Department of Internal Medicine, University Hospital of Mostoles, Madrid, Spain
| | - Borja Vargas
- Department of Internal Medicine, University Hospital of Mostoles, Madrid, Spain
| | - Manuel Lopez
- Department of Internal Medicine, University Hospital of Mostoles, Madrid, Spain
| | - Eva Cirugeda
- Computer Science Department (DISCA), Polytechnic University of Valencia, Alcoi, Spain
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Abstract
Hyperglycemia, hypoglycemia, preexisting diabetes, and glycemic variability each may affect hospital outcomes. Observational findings derived from randomized trials or retrospective studies suggest that independent of hypoglycemia and hyperglycemia, a relationship exists between variability and hospital outcomes. A review of studies conducted in diverse hospital populations is reported here, showing a relationship between measures of variability and nonglycemic outcomes, including ICU and hospital mortality and length of stay. "Glycemic variability" has an intuitive meaning, understood as a propensity of a single patient to develop repeated episodes of excursions of BG over a relatively short period of time that exceed the amplitude expected in normal physiology. It is proposed that each of 3 dimensions of variability should be separately studied: (1) magnitude of glycemic excursions during intervals of relative stability of the moving average of BG, (2) frequency with which a critical magnitude of excursion is exceeded, and (3) presence or absence of fine tuning. Multiple hospital studies have found that the standard deviation (SD) of the data set of blood glucose values (BG) of individual patients predicts outcomes. An appropriate refinement would be to report the "Reverse-transformed group mean of the SD of the logarithmically transformed BG data set of each patient," with confidence intervals. In logarithmic space, group means of the SD of BGs of each patient may be compared, using an appropriate parametric test. Upon reverse transformation, the upper and lower bounds of the confidence intervals become asymmetric about the reverse-transformed group mean of the SD. There is a need to understand what patterns of dispersion of BG over time are captured by SD as a predictor of outcomes. Among the causes of high SD, a subgroup may consist of patients having frequent oscillations of BG. Another subgroup may consist of patients experiencing a major change of overall glycemia during the timeframe of data collection. Appropriate metrics should be developed to recognize both variability in the sense of recurrent large oscillations of BG, and separately to recognize any time-dependent change of overall glycemia during hospitalization. Especially in relation to uncontrolled diabetes, there is a need to know whether rapid correction of chronic hyperglycemia adversely affects hospital outcomes. We have some understanding of how to control or prevent change of overall glycemia, and less understanding of how to control variability. Each may be associated with outcomes, and each may be detected by a high SD, but it remains uncertain whether intervention to prevent either pattern of changing glycemia would affect outcomes.
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Affiliation(s)
- Susan S Braithwaite
- Section of Endocrinology, Diabetes and Metabolism, Visiting Clinical Professor of Medicine, University of Illinois at Chicago, 1819 W. Polk Street, M/C 640, Chicago, IL 60612, USA,
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van Hooijdonk RTM, Abu-Hanna A, Schultz MJ. Glycemic variability is complex--is glucose complexity variable? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:178. [PMID: 23171831 PMCID: PMC3672583 DOI: 10.1186/cc11834] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Observational studies show an independent association between increased glycemic variability and higher mortality in critically ill patients. Minimization of glycemic variability is therefore suggested as a new target of glycemic control, which may require very frequent or almost continuous monitoring of glucose levels. Brunner and colleagues show the use of real-time subcutaneous continuous glucose monitoring does not decrease glycemic variability. Continuous glucose monitoring, however, may reveal changes in glucose complexity, which may be of interest since both increased and decreased glucose complexity is associated with higher mortality in the critically ill.
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