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Karakuş KE, Yeşiltepe Mutlu G, Gökçe T, Eviz E, Can E, Muradoğlu S, Hatun Ş. Insulin Requirements for Basal and Auto-Correction Insulin Delivery in Advanced Hybrid Closed-Loop System: 4193 Days' Real-World Data of Children in Two Different Age Groups. J Diabetes Sci Technol 2024; 18:445-453. [PMID: 35771030 PMCID: PMC10973851 DOI: 10.1177/19322968221106194] [Citation(s) in RCA: 1] [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: 11/16/2022]
Abstract
BACKGROUND The insulin requirements of people with type 1 diabetes (T1D) can vary throughout the day due to factors such as biorhythm, exercise, and food intake. The MiniMed 780G system delivers micro boluses to adjust basal insulin and delivers auto-correction boluses to meet insulin needs when micro bolus increases are insufficient. Through analysis of MiniMed 780G data, this study investigates the variations in insulin requirements throughout the day. METHODS 4193 days' pump and continuous glucose monitoring (CGM) data of 34 children using MiniMed 780G were collected from Medtronic CareLink. Micro and auto-correction boluses were analyzed on an hourly basis for two age groups: below nine years old and above nine years old. Glycemic metrics were analyzed based on International CGM consensus. RESULTS The mean age was 12.3 years and mean duration of diabetes was 6.1 years. The mean time in range (TIR) and glucose management indicator (GMI) were 80.5% and 6.6%, respectively. The micro bolus (basal) ratio between 05.00 and 07.00 was significantly higher than the ratio between 10.00 and 03.00 (P < .01), whereas micro bolus was significantly lower between 19.00 and 21.00 than those between 00.00 and 10.00 (P < .001). The auto-correction ratio between 21.00 and 00.00 was significantly higher than those between 03.00-17.00 (P < .001) and 19.00-21.00 (P = .008), whereas auto-correction was significantly lower between 07.00 and 10.00 than those between 10.00 and 03.00 (P < .001). The micro bolus ratio was significantly higher in children below nine years old than in children above nine years old between 21.00-00.00 (P = .026) and 00.00-03.00 (P = .003). CONCLUSION The basal insulin need follows a diurnal pattern with two significantly different periods-high between 00.00 and 10.00 and low between 10.00 and 00.00. The auto-correction rates are low between 05.00 and 10.00 and show an increasing pattern peaking between 21.00 and 00.00. These findings are compatible with the dawn and reverse dawn phenomena.
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Affiliation(s)
| | - Gül Yeşiltepe Mutlu
- Koc University School of Medicine, Istanbul, Turkey
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
| | - Tuğba Gökçe
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
| | - Elif Eviz
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
| | - Ecem Can
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
| | - Serra Muradoğlu
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
| | - Şükrü Hatun
- Koc University School of Medicine, Istanbul, Turkey
- Division of Pediatric Endocrinology and Diabetes, Koc University Hospital, Istanbul, Turkey
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Gao X, Li H, Yu Y, Huai X, Feng B, Song J. Relationship Between Time in Range and Dusk Phenomenon in Outpatients with Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2023; 16:1637-1646. [PMID: 37304668 PMCID: PMC10257429 DOI: 10.2147/dmso.s410761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose The dusk phenomenon refers to a spontaneous and transient pre-dinner hyperglycemia that affects glucose fluctuation and glycemic control, and the increasing use of continuous glucose monitoring (CGM) has facilitated its diagnosis. We investigated the frequency of the dusk phenomenon and its relationship with the time in range (TIR) in patients with type 2 diabetes mellitus (T2DM). Patients and Methods This study involved 102 patients with T2DM who underwent CGM for 14 days. CGM-derived metrics and clinical characteristics were evaluated. A consecutive dusk blood glucose difference (pre-dinner glucose minus 2-hour post-lunch glucose) of ≥ 0 or once-only dusk blood glucose difference of < 0 was diagnosed as the clinical dusk phenomenon (CLDP). Results We found that the percentage of CLDP was 11.76% (10.34% in men, 13.64% in women). Compared with the non-CLDP group, the CLDP group tended to be younger and have a lower percentage of TIR (%TIR3.9-10) and higher percentage of time above range (%TAR>10 and %TAR>13.9) (P ≤ 0.05). Adjusted for confounding factors, the binary logistic regression analysis showed a negative association of CLDP with %TIR (odds ratio < 1, P < 0.05). We repeated the correlation analysis based on 70%TIR and found significant differences in hemoglobin A1c, fasting blood glucose, mean blood glucose, standard deviation of the sensor glucose values, glucose coefficient of variation, largest amplitude of glycemic excursions, mean amplitude of glycemic excursions, glucose management indicator, and percentage of CLDP between the two subgroups of TIR ≤ 70% and TIR > 70% (P < 0.05). The negative association between TIR and CLDP still remained after adjustment by the binary logistic regression analysis. Conclusion The CLDP was frequently present in patients with T2DM. The TIR was significantly correlated with the CLDP and could serve as an independent negative predictor.
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Affiliation(s)
- Xiangyu Gao
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Hongmei Li
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Yuan Yu
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Xiaoyuan Huai
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Bo Feng
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
| | - Jun Song
- Department of Endocrinology, East Hospital, Tongji University School of Medicine, Shanghai, 200120, People’s Republic of China
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Lindmeyer AM, Meier JJ, Nauck MA. Patients with Type 1 Diabetes Treated with Insulin Pumps Need Widely Heterogeneous Basal Rate Profiles Ranging from Negligible to Pronounced Diurnal Variability. J Diabetes Sci Technol 2021; 15:1262-1272. [PMID: 32806947 PMCID: PMC8655281 DOI: 10.1177/1932296820949939] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pump-treated patients with type 1 diabetes have widely differing basal insulin infusion profiles. We analyzed consequences of such heterogeneity for glycemic control under fasting conditions. METHODS Data from 339 adult patients with type 1 diabetes on insulin pump therapy undergoing a 24-hour fast (basal rate test) were retrospectively analyzed. Hourly programmed basal insulin infusion rates and plasma glucose concentrations as well as their proportions within, below, or above arbitrarily defined target ranges were assessed for specific periods of the day (eg, 1-7 hours, "dawn" period, 16-19 hours, "dusk" period, reference period 20-1 hours/10-14 hours), by tertiles of a predefined "dawn" index (mean basal insulin infusion rate during the "dawn" divided by the reference periods). RESULTS The "dawn" index varied interindividually from 0.7 to 4.4. Basal insulin infusion profiles exhibited substantial differences (P = .011), especially overnight. Despite higher insulin infusion rates at 4 and 6.45 hours, patients with the most pronounced "dawn" phenomenon exhibited higher plasma glucose concentrations at those time points (P < .012). Patients with a marked "dawn" phenomenon exhibited a lower probability for low (<4.4 mmol/L) and a higher probability of high values (>7.2 mmol/L) during the dawn period (all P values <.01). CONCLUSIONS We observe substantial interindividual heterogeneity in the "dawn" phenomenon. However, widely different empirically derived basal insulin infusion profiles appear appropriate for individual patients, as indicated by similar plasma glucose concentrations, mainly in the target range, during a 24-hour fasting period.
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Affiliation(s)
- Anna M. Lindmeyer
- Diabetes Division, Katholisches Klinikum
Bochum, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Germany
- Anna M. Lindmeyer, MD, Department of
Medicine I, Diabetes Division, St. Josef-Hospital (Ruhr University Bochum),
Gudrunstr. 56, Bochum, NRW 44791, Germany.
| | - Juris J. Meier
- Diabetes Division, Katholisches Klinikum
Bochum, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Germany
| | - Michael A. Nauck
- Diabetes Division, Katholisches Klinikum
Bochum, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Germany
- Diabeteszentrum Bad Lauterberg, Bad
Lauterberg im Harz, Germany
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Huang Y, Xu Y, Qiu J, Jiang C, Tan W, Tao X, Gu Q, Sun J. The impact of dusk phenomenon on total glucose exposure in Chinese people with type 2 diabetes. Medicine (Baltimore) 2021; 100:e25298. [PMID: 33787619 PMCID: PMC8021309 DOI: 10.1097/md.0000000000025298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 03/04/2021] [Indexed: 01/04/2023] Open
Abstract
This study was aimed at assessing the impact of the dusk phenomenon on the total glucose exposure in Chinese people with type 2 diabetes.A total of 380 type 2 diabetes who received a retrospective continuous glucose monitoring system (CGMs) for 72 hours were enrolled in our study, 32 of them failed in CGMs. The patients were first divided into 2 groups: dusk phenomenon (n = 95) and non dusk phenomenon group (n = 253). The magnitude of the dusk phenomenon (δDusk) was quantified by pre-dinner glucose minus post-lunch 2 hours glucose. A persistent δDusk ≥ 0 or a once only δDusk < 0 can be diagnosed with the dusk phenomenon. The participants were secondarily matched for the post-lunch 2 hours glucose to assess the impact of the dusk phenomenon on the overall glucose exposure. The impact of the dusk phenomenon was assessed on high-performance liquid chromatography assay (HbA1c) and 24-hour mean glucose.There were 95 of 348 (27.3%) participants with the dusk phenomenon in the overall population, and the median of δDusk level was -0.8 (-1.8, 0.2) mmol/L. The median of glucose differences between the 2 paired groups were 0.4 (-0.4, 1.0)% for HbA1c, 0.9 (0.2, 1.4) mmol/L for 24 hours mean glucose. The correlation analysis showed no relationship between the magnitude of dawn phenomenon and the dusk phenomenon (r = 0.052, P = .472).The incidence of dusk phenomenon is about 27.3% in people with type 2 diabetes. The impacts of dusk phenomenon on HbA1c and 24-hour mean glucose were about 0.4% and 0.9 mmol/L and the dusk phenomenon was not related with the dawn phenomenon.
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5
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Nauck MA, Lindmeyer AM, Mathieu C, Meier JJ. Twenty-Four Hour Fasting (Basal Rate) Tests to Achieve Custom-Tailored, Hour-by-Hour Basal Insulin Infusion Rates in Patients With Type 1 Diabetes Using Insulin Pumps (CSII). J Diabetes Sci Technol 2021; 15:360-370. [PMID: 31633384 PMCID: PMC8256064 DOI: 10.1177/1932296819882752] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Twenty-four hour fasting periods are being used to scrutinize basal insulin infusion rates for pump-treated patients with type 1 diabetes. METHODS Data from 339 consecutive in-patients with adult type 1 diabetes on insulin pump therapy undergoing a 24-hour fast as a basal rate test were retrospectively analyzed. Hourly programmed basal insulin infusion rates and plasma glucose concentrations within, below, or above arbitrarily defined target ranges were assessed for periods of the day of special interest (eg, 01:00-07:00 am, "dawn" period, 04:00-07:00 pm, and "dusk" period). Statistics: χ2-tests, paired t-tests were used. RESULTS Basal rates (mean: 0.90 ± 0.02 IU/h) showed circadian variations with peaks corresponding to "dawn" (1.07 ± 0.02 IU/h from 01:00 to 07:00 am) and, less prominently, "dusk" (0.95 ± 0.02 IU/h from 03:00 to 07:00 pm). Individual mean plasma glucose concentrations averaged 6.6 ± 0.1 mmol/L, with 53.1% in the predefined "strict" (4.4-7.2 mmol/L) target range. Interestingly, during the "dawn" period, plasma glucose was significantly higher (by 0.5 ± 0.1 mmol/L [95% confidence interval: 0.3-0.8 mmol/L; P < .0001]) and the odds ratio for hypoglycemia was significantly lower compared to the reference period. INTERPRETATION Twenty-four hour fasting periods as basal rate tests frequently unravel periods with inappropriate basal insulin infusion rates potentially responsible for fasting hyper- or hypoglycemia. Notably, the higher basal insulin infusion rate found during the "dawn" period seems to be justified and may need to be accentuated.
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Affiliation(s)
- Michael A. Nauck
- Diabeteszentrum Bad Lauterberg,
Germany
- Diabetes Division, St. Josef-Hospital,
Klinikum der Ruhr-Universität Bochum, Germany
- Michael A. Nauck, MD, Diabetes Division, St.
Josef-Hospital, Ruhr University Bochum, Gudrunstr. 56, Bochum NRW 44791,
Germany.
| | - Anna M. Lindmeyer
- Diabetes Division, St. Josef-Hospital,
Klinikum der Ruhr-Universität Bochum, Germany
| | | | - Juris J. Meier
- Diabetes Division, St. Josef-Hospital,
Klinikum der Ruhr-Universität Bochum, Germany
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Zickri MB, Sadek EM, Fares AE, Heteba NG, Reda AM. Effect of Stem Cells, Ascorbic Acid and SERCA1a Gene Transfected Stem Cells in Experimentally Induced Type I Diabetic Myopathy. Int J Stem Cells 2020; 13:163-175. [PMID: 32114738 PMCID: PMC7119208 DOI: 10.15283/ijsc18066] [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: 08/13/2018] [Revised: 12/06/2018] [Accepted: 01/15/2019] [Indexed: 11/09/2022] Open
Abstract
Background and Objectives Sarco/endoplasmic reticulum Ca2+-ATPase (SERCA) inhibition was proved in streptozotocin (STZ)-diabetic rats. The present study aimed at investigating and comparing the therapeutic effect of bone marrow mesenchymal stem cells (BMMSCs), BMMSCs combined with ascorbic acid (AA) and SERCA1a gene transfected BMMSCs in induced type I diabetic myopathy of male albino rat. Methods and Results 54 rats were divided into donor group of 6 rats for isolation, propagation and characterization of BMMSCs and SERCA1a transfected BMMSCs, groups I∼V 48 rats. Group I of 8 control rats, group II (Diabetic) of 10 rats given STZ 50 mg/kg intraperitoneal, group III (BMMSCs) of 10 rats given STZ and BMMSCs intravenous (IV), group IV (BMMSCs and AA) of 10 rats given STZ, BMMSCs IV and AA 500 mg/kg and group V (SERCA 1a transfected BMMSCs) of 10 rats given STZ and SERCA1a transfected BMMSCs IV. The rats were sacrificed after 8 weeks. Gastrocnemius specimens were subjected to biochemical, histological, morphometric and statistical studies. Diabetic rats revealed inflammatory and degenerative muscle changes, a significant increase in blood glucose level, mean DNA fragmentation and mean MDA values and a significant decrease in mean GSH and catalase values, area of pale nuclei, area% of CD105 and CD34 +ve cells, SERCA1a protein and gene values. The morphological changes regressed by therapy. In group III significant decrease in DNA fragmentation and MDA, significant increase in GSH and catalase, significant increase in the mean area of pale nuclei, area % of CD105 and CD34 +ve cells versus diabetic group. In group IV, same findings as group III versus diabetic and BMMSCs groups. In group V, same findings as group IV versus diabetic and treated groups. Western blot and PCR proved a mean value of SERCA1a protein and gene comparable to the control group. Mean calcium concentration values revealed a significant increase in the diabetic group, in BMMSCs and AA group versus control and SERCA1a group. Conclusions SERCA1a transfected BMMSCs proved a definite therapeutic effect, more remarkable than BMMSCs combined with AA. This effect was evidenced histologically and confirmed by significant changes in the biochemical tests indicating oxidative stress, muscle calcium concentration, morphometric parameters and PCR values of SERCA1a.
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Affiliation(s)
- Maha B Zickri
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Cairo University, Giza, Egypt.,Faculty of Oral and Dental Medicine, Future University in Egypt (FUE), New Cairo City, Egypt
| | - Eman M Sadek
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Amal E Fares
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Ahmed M Reda
- Faculty of Pharmacy and Biotechnology, German University in Cairo (GUC), New Cairo City, Egypt.,Faculty of Pharmacy, Near East University, North Cyprus, Cyprus
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7
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Sun ZZ, Xia F, Du SN, Li W. Spontaneous and transient hyperglycemia before sleep in a patient with glaucomatous blindness and diabetes: A case reprt. Medicine (Baltimore) 2019; 98:e14590. [PMID: 30813182 PMCID: PMC6408078 DOI: 10.1097/md.0000000000014590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The peak of blood glucose was during 9 PM to 3 AM. There is a stable, spontaneous and short-term abnormal increase of blood glucose. The pathophysiological mechanism is unknown. It is speculated that the cause might be the imbalance of the glucose-regulating hormone that is caused by the disorder of the biological clock system. PATIENT CONCERNS The case was a 73-year old man with bilateral glaucoma (only mild light perception) and was hospitalized to establish a viable hypoglycemic plan. He received 4 shots of insulin enhancement, oral meditation, pre-mixed insulin treatment during the 22 days. However, his blood glucose had been spontaneously increased from 9 PM to 3 AM which was the highest of the day, and then resumed by itself. Insulin intervention was effective. DIAGNOSIS Glaucomatous blindness and diabetes, spontaneous and transient hyperglycemia before sleep. INTERVENTIONS We used insulin aspart 3u when we found hyperglycemia three times at 9 PM and it was effective. Without intervention, blood sugar will automatically improve in the morning. OUTCOMES During the late night and early morning, there is a stable, spontaneous and short-term transit abnormal increase in blood glucose, which suggests the complexity of blood glucose adjustment. LESSONS Due to the case specialty, we could not do the systematic review of the study. However, it improves the awareness of the abnormal periodically increase of blood glucose during the special periods, and provides with a reference for clinical research of dawn and dusk phenomenon. Multi-point blood glucose monitoring or dynamic blood glucose monitoring throughout the day is of great significance for the detection of special types of hyperglycemia.
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Affiliation(s)
- Zhan-Zhan Sun
- Department of Endocrinology, Affiliated Cixi Hospital,Wenzhou Medical University, Cixi
| | - Fang Xia
- Department of Endocrinology, Ningbo Beilun District People's Hospital, Ningbo
| | - Si-na Du
- Department of Endocrinology, Affiliated Cixi Hospital,Wenzhou Medical University, Cixi
| | - Wei Li
- Department of Endocrinology, Affiliated Cixi Hospital,Wenzhou Medical University, Cixi
- Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China
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Zickri MB, Aboul-Fotouh GI, Omar AI, El-Shafei AA, Reda AM. Effect of Stem Cells and Gene Transfected Stem Cells Therapy on the Pancreas of Experimentally Induced Type 1 Diabetes. Int J Stem Cells 2018; 11:205-215. [PMID: 30021252 PMCID: PMC6285289 DOI: 10.15283/ijsc18002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/11/2018] [Accepted: 05/01/2018] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives Insulin secretion entirely depends on Ca2+ influx and sequestration into endoplasmic reticulum (ER) of β-cells, performed by Sarco-ER Ca2+-ATPase 2b (SERCA2b). In diabetes, SERCA2b is decreased in the β-cells leading to impaired intracellular Ca2+ homeostasis and insulin secretion. Adipose mesenchymal stem cells (AMSCs) play a potential role in transplantation in animal models. The present study aimed at investigating and comparing the therapeutic effect of non-transfected AMSCs and SERCA2b gene transfected AMSCs on the pancreas of induced diabetes type 1 in rat. Methods and Results 58 adult male albino rats were divided into: Donor group: 22 rats, 2 for isolation, propagation and characterization of AMSCs and SERCA2b transfected AMSCs, in addition 20 for isolated islet calcium level assessment. Group I (Control Group): 6 rats, Group II (Diabetic Group): 10 rats, 50 mg streptozotocin (STZ) were injected intraperitoneal (IP), Group III (AMSCs Group): 10 rats, 1×106 AMSCs were injected intravenous and Group IV (SERCA2b transfected AMSCs Group): 10 rats, 1×106SERCA2b transfected AMSCs were injected as in group III. Groups I, II, III and IV were sacrified 3 weeks following confirmation of diabetes. Serological, histological, morphometric studies and quantitative polymerase chain reaction (qPCR) were performed. Nuclear, cytoplasmic degenerative and extensive fibrotic changes were detected in the islets of group II that regressed in groups III and IV. Isolated islet calcium, blood glucose, plasma insulin and qPCR were confirmative. Conclusions AMSCs and SERCA2b gene transfected AMSCs therapy proved definite therapeutic effect, more obvious in response to SERCA2b gene transfected AMSCs.
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Affiliation(s)
- Maha Baligh Zickri
- Department of Medical Histology & Cell Biology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Faculty of Oral and Dental Medicine, Future University, Cairo, Egypt (FUE)
| | | | - Abeer Ibraheem Omar
- Department of Medical Histology & Cell Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Asmaa Ahmed El-Shafei
- Department of Medical Histology & Cell Biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Mahmoud Reda
- Clinical Pharmacy, Near East University North Cyprus, German University in Cairo, Cairo, Egypt
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Du S, Shi MJ, Sun ZZ, Li W. Clinical diagnosis for dusk phenomenon of diabetes. Medicine (Baltimore) 2018; 97:e11873. [PMID: 30142783 PMCID: PMC6112941 DOI: 10.1097/md.0000000000011873] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022] Open
Abstract
The diabetes dusk phenomenon (spontaneous and transient pre-dinner hyperglycemia) anecdotally exists but has not been investigated.A total of 80 diabetic patients that received continuous subcutaneous insulin infusions were retrospectively studied. They were grouped into a routine group (R) (consecutive δDG [dusk blood glucose difference] <0 mmol/L) and a classic dusk phenomenon group (CDP, consecutive δDG≥0 mmol/L). δDG represents differences in blood glucose measurements between pre-dinner and post-lunch (δDG: dusk blood glucose difference). Other patients were placed in a suspicious group (S). The suspicious group was further divided into 3 groups based on the frequency at which the δDG occurred: suspicious 1 group (S1), δDG≥0 mmol/L occurred once only; suspicious 3 group (S3), δDG < 0 mmol/L occurred once only, and the remaining patients were grouped in the suspicious 2 group (S2).We identified the CDP and S3 groups as the "clinical dusk phenomenon" group (CLDP). We confirmed that the S1 and R groups to be in the "clinical routine" group. The S2 group was significantly different from the CDP group. In addition, the S2 group had significant differences in δDG measurements and post-lunch blood glucose values compared with the R group, but no differences in other parameters were seen. Multiple comparisons with the other suspicious groups also showed no statistical difference in many parameters. Thus, we placed these patients into the "suspicious clinical dusk phenomenon" group (SDP). The δDG cut-off for the CLDP group was 1.0167 mmol/L. The pre-dinner-pre-lunch blood glucose cut-off for this group was 2.72 mmol/L. The δDG cut-off for the SDP group was -0.95 mmol/L. The pre-dinner-pre-lunch blood glucose cut-off for this group was 0.87 mmol/L. The cut-off points for the post-dinner-post-lunch blood glucose measurements in the CLDP and SDP groups were both 1.2667 mmol/L.A consecutive δDG≥0 or a once only δDG < 0 could be diagnosed as falling into the CLDP group. The CLDP could be excluded when a consecutive δDG < 0 or a once only δDG≥0 was found. Patients falling into other categories were placed into the SDP group.
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Affiliation(s)
- Sina Du
- Department of Endocrinology, Affiliated Cixi Hospital, Wenzhou Medical University, Cixi
| | - Min-jia Shi
- Department of Endocrinology, Affiliated Cixi Hospital, Wenzhou Medical University, Cixi
| | - Zhan-zhan Sun
- Department of Endocrinology, Affiliated Cixi Hospital, Wenzhou Medical University, Cixi
| | - Wei Li
- Department of Endocrinology, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China
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