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Gu N, Dong A, Gao L, Xie C, Hou P, Wang W, Zhu S, Yao C, Zhang J, Guo X. Effectiveness and safety of pulsatile intravenous insulin therapy for the improvement of respiratory quotient in Chinese patients with diabetes mellitus. Exp Ther Med 2020; 19:3069-3075. [PMID: 32256794 PMCID: PMC7086298 DOI: 10.3892/etm.2020.8563] [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: 05/31/2019] [Accepted: 12/20/2019] [Indexed: 11/18/2022] Open
Abstract
Pulsatile intravenous insulin therapy (PIVIT) is a means of imitating naturally occurring insulin pulses artificially. It is thought to improve carbohydrate metabolism, which can be assessed using the respiratory quotient (RQ). The aim of this present study was to assess the efficacy and safety of PIVIT for the improvement of RQ in Chinese patients with diabetes mellitus (DM). This 12-week, multi-center, prospective, randomized, open-label, parallel-group study involved 110 DM patients (both type 1 and type 2) whose RQ was <0.8. Of these, 53 patients formed the control group, in which standard anti-diabetic therapy was maintained, and 54 patients formed the treatment group, which underwent weekly PIVIT in addition to the administration of standard anti-diabetic therapy. RQ was evaluated monthly in control subjects, and before and after every PIVIT treatment in the treatment group. After weekly PIVIT for 12 weeks, the mean RQ increased from 0.70 to 0.90 in the treatment group, but did not change in the control group. The percentage of subjects reporting adverse events (AEs) was 31.5% (17/54) in the treatment group and 9.43% (5/53) in the control group (P=0.0053). The most frequently reported AE (by 12 subjects) was a gastroenteric reaction when these individuals were receiving 50% glucose during the PIVIT treatment. The majority of AEs were mild and did not interfere with the ongoing treatment. Thus, PIVIT can be viewed as tolerated and effective for the improvement of RQ in Chinese DM patients. This study was retrospectively registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn) on November 13th 2019 (registration no. ChiCTR1900027510).
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Affiliation(s)
- Nan Gu
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Aimei Dong
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Lei Gao
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Chenying Xie
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Peiyi Hou
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Wenbo Wang
- Department of Endocrinology, Peking University Shougang Hospital, Beijing 100144, P.R. China
| | - Sainan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing 100034, P.R. China
| | - Chen Yao
- Department of Biostatistics, Peking University First Hospital, Beijing 100034, P.R. China
| | - Junqing Zhang
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, P.R. China
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Åm MK, Fougner AL, Ellingsen R, Hjelme DR, Bösch PC, Stavdahl Ø, Carlsen SM, Christiansen SC. Why intraperitoneal glucose sensing is sometimes surprisingly rapid and sometimes slow: A hypothesis. Med Hypotheses 2019; 132:109318. [DOI: 10.1016/j.mehy.2019.109318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/19/2019] [Indexed: 01/04/2023]
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Some oscillatory phenomena of blood glucose regulation: An exploratory pilot study in pigs. PLoS One 2018; 13:e0194826. [PMID: 29608585 PMCID: PMC5880381 DOI: 10.1371/journal.pone.0194826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/09/2018] [Indexed: 01/20/2023] Open
Abstract
It is well-known that blood glucose oscillates with a period of approximately 15 min (900 s) and exhibits an overall complex behaviour in intact organisms. This complexity is not thoroughly studied, and thus, we aimed to decipher the frequency bands entailed in blood glucose regulation. We explored high-resolution blood glucose time-series sampled using a novel continuous intravascular sensor in four pigs under general anaesthesia for almost 24 hours. In all time series, we found several interesting oscillatory components, especially in the 5000–10000 s, 500–1000 s, and 50–100 s regions (0.0002–0.0001 Hz, 0.002–0.001 Hz, and 0.02–0.01 Hz). The presence of these oscillations is not permanent, as they come and go. This is the first report of glucose oscillations in the 50–100 s range. The origin of these oscillations and their role in overall blood glucose regulation is unknown. Although the sample size is small, we believe this finding is important for our understanding of glucose regulation and perhaps for our understanding of general homeostatic regulation in intact organisms.
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Kovács L. A robust fixed point transformation-based approach for type 1 diabetes control. NONLINEAR DYNAMICS 2017; 89:2481-2493. [PMID: 32025098 PMCID: PMC6979507 DOI: 10.1007/s11071-017-3598-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 06/03/2017] [Indexed: 06/10/2023]
Abstract
Modeling and control of diabetes mellitus (DM) are difficult due to the highly nonlinear attitude, time-delay effects, the impulse kind input signals and the lack of continuously available blood glucose (BG) level to be regulated. Regarding the mentioned problems, identification of DM model is crucial. Furthermore, due to the lack of information about the internal states (which cannot be measured in everyday life) and because the BG level is not available in every moment over time, adaptive robust control design method regardless exact model dependency would successfully handle these unfavorable effects without simplifications. The recently developed nonlinear robust fixed point transformation (RFPT)-based controller design method requires only a roughly approximate model in order to realize the controller structure. Moreover, parallel simulated approximate models-in order to provide additional internal information-can be used with the method. In this paper, the usability of the novel RFPT-based technique is demonstrated on the physiological problem of diabetes.
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Affiliation(s)
- Levente Kovács
- Physiological Controls Research Center, Research and Innovation Center of the Óbuda University, Kiscelli Street 82., Budapest, 1032 Hungary
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Joseph JI, Torjman MC, Strasma PJ. Vascular Glucose Sensor Symposium: Continuous Glucose Monitoring Systems (CGMS) for Hospitalized and Ambulatory Patients at Risk for Hyperglycemia, Hypoglycemia, and Glycemic Variability. J Diabetes Sci Technol 2015; 9:725-38. [PMID: 26078254 PMCID: PMC4525658 DOI: 10.1177/1932296815587938] [Citation(s) in RCA: 9] [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: 01/08/2023]
Abstract
Hyperglycemia, hypoglycemia, and glycemic variability have been associated with increased morbidity, mortality, length of stay, and cost in a variety of critical care and non-critical care patient populations in the hospital. The results from prospective randomized clinical trials designed to determine the risks and benefits of intensive insulin therapy and tight glycemic control have been confusing; and at times conflicting. The limitations of point-of-care blood glucose (BG) monitoring in the hospital highlight the great clinical need for an automated real-time continuous glucose monitoring system (CGMS) that can accurately measure the concentration of glucose every few minutes. Automation and standardization of the glucose measurement process have the potential to significantly improve BG control, clinical outcome, safety and cost.
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Affiliation(s)
- Jeffrey I Joseph
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Marc C Torjman
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Pulsatile insulin secretion, impaired glucose tolerance and type 2 diabetes. Mol Aspects Med 2015; 42:61-77. [PMID: 25637831 DOI: 10.1016/j.mam.2015.01.003] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/09/2015] [Accepted: 01/10/2015] [Indexed: 12/28/2022]
Abstract
Type 2 diabetes (T2DM) results when increases in beta cell function and/or mass cannot compensate for rising insulin resistance. Numerous studies have documented the longitudinal changes in metabolism that occur during the development of glucose intolerance and lead to T2DM. However, the role of changes in insulin secretion, both amount and temporal pattern, has been understudied. Most of the insulin secreted from pancreatic beta cells of the pancreas is released in a pulsatile pattern, which is disrupted in T2DM. Here we review the evidence that changes in beta cell pulsatility occur during the progression from glucose intolerance to T2DM in humans, and contribute significantly to the etiology of the disease. We review the evidence that insulin pulsatility improves the efficacy of secreted insulin on its targets, particularly hepatic glucose production, but also examine evidence that pulsatility alters or is altered by changes in peripheral glucose uptake. Finally, we summarize our current understanding of the biophysical mechanisms responsible for oscillatory insulin secretion. Understanding how insulin pulsatility contributes to normal glucose homeostasis and is altered in metabolic disease states may help improve the treatment of T2DM.
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