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Lin R, Yan W, He M, Liu B, Su X, Yi M, Zhang Y. The benefits of hypoglycemic therapy for patients with obstructive sleep apnea. Sleep Breath 2024:10.1007/s11325-024-03015-2. [PMID: 38489146 DOI: 10.1007/s11325-024-03015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is often associated with glycemic abnormalities. This study is conducted to investigate the effects of hypoglycemic therapy on OSA-related indicators. METHOD We systematically searched Web of Science, PubMed, Embase, and the Cochrane Library for articles on OSA patients receiving any hypoglycemic drugs, published until December 25, 2022. Seven original studies were finally included. The proposal was registered with PROSPERO (CRD42022351206). RESULTS In summary, in addition to reduced glycosylated hemoglobin A1c (HbA1c), we found that hypoglycemic treatment can lower the apnea-hypopnea index (AHI) by 7.07/h (p = 0.0001). Although long-term treatment (> 12 weeks) achieved a more significant reduction in HbA1c (- 1.57% vs. - 0.30%) compared to short-term treatment (≤ 12 weeks), there was no significant difference between the two in terms of AHI (intergroup p-value = 0.27). We also found that patients using sodium glucose cotransporter 2 inhibitors (SGLT2i) experienced a greater reduction in AHI (- 11.00/h, p < 0.00001). Additionally, hypoglycemic treatment also showed certain improvements in related indicators like Epworth Sleepiness Scale, body mass index, and blood pressure. CONCLUSIONS Our results affirm the benefits of hypoglycemic treatment for OSA patients and highlight the notable effect of SGLT2i. Further researches are needed to help doctors gain a comprehensive understanding of the interaction between OSA and glycemic abnormalities.
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Affiliation(s)
- Ruihan Lin
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Medical School, Central South University, Changsha, China
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wenjie Yan
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Medical School, Central South University, Changsha, China
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Meng He
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Liu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoli Su
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Minhan Yi
- School of Life Sciences, Central South University, Changsha, China.
| | - Yuan Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Akhter A, Alouffi S, Shahab U, Akasha R, Fazal-Ur-Rehman M, Ghoniem ME, Ahmad N, Kaur K, Pandey RP, Alshammari A, Akhter F, Ahmad S. Vitamin D supplementation modulates glycated hemoglobin (HBA1c) in diabetes mellitus. Arch Biochem Biophys 2024; 753:109911. [PMID: 38280562 DOI: 10.1016/j.abb.2024.109911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
Diabetes is a metabolic illness that increases protein glycosylation in hyperglycemic conditions, which can have an impact on almost every organ system in the body. The role of vitamin D in the etiology of diabetes under RAGE (receptor for advanced glycation end products) stress has recently received some attention on a global scale. Vitamin D's other skeletal benefits have generated a great deal of research. Vitamin D's function in the development of type 1 and type 2 diabetes is supported by the discovery of 1,25 (OH)2D3 and 1-Alpha-Hydroylase expression in immune cells, pancreatic beta cells, and several other organs besides the bone system. A lower HBA1c level, metabolic syndrome, and diabetes mellitus all seems to be associated with vitamin D insufficiency. Most of the cross-sectional and prospective observational studies that were used to gather human evidence revealed an inverse relationship between vitamin D level and the prevalence or incidence of elevated HBA1c in type 2 diabetes. Several trials have reported on the impact of vitamin D supplementation for glycemia or incidence of type 2 diabetes, with varying degrees of success. The current paper examines the available data for a relationship between vitamin D supplementation and HBA1c level in diabetes and discusses the biological plausibility of such a relationship.
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Affiliation(s)
- Asma Akhter
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11790, United States.
| | - Sultan Alouffi
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, University of Hail, 2440, Saudi Arabia.
| | - Uzma Shahab
- Department of Biochemistry, King George Medical University, Lucknow, U.P., India.
| | - Rihab Akasha
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, University of Hail, 2440, Saudi Arabia.
| | | | - Mohamed E Ghoniem
- Department of Internal Medicine, College of Medicine, University of Hail, 2440, Saudi Arabia; Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
| | - Naved Ahmad
- Department of Computer Science and Information System, College of Applied Sciences, AlMaarefa University, P.O.Box 71666, Riyadh, 13713, Saudi Arabia.
| | - Kirtanjot Kaur
- University Centre for Research and Development, Chandigarh University, Mohali, Punjab, India.
| | - Ramendra Pati Pandey
- School of Health Sciences and Technology (SOHST), UPES, Dehradun, 248007, Uttarakhand, India.
| | - Ahmed Alshammari
- Department of Internal Medicine, College of Medicine, University of Hail, Saudi Arabia.
| | - Firoz Akhter
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11790, United States.
| | - Saheem Ahmad
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, University of Hail, 2440, Saudi Arabia.
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Mukherjee S, Yadav P, Ray SK, Jadhav AA, Wakode SL. Clinical Risk Assessment and Comparison of Bias between Laboratory Methods for Estimation of HbA1c for Glycated Hemoglobin in Hyperglycemic Patients. Curr Diabetes Rev 2024; 20:e261023222764. [PMID: 37921160 DOI: 10.2174/0115733998257140231011102518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/28/2023] [Accepted: 08/25/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Hemoglobin A1c (HbA1c), also known as glycated hemoglobin, is a blood test used to evaluate and track a patient's blood sugar levels over the previous 2-3 months. We have compared the analytical performance of the D10 hemoglobin (HPLC) testing system to that of the immunoturbidimetric technique, which is a light-scattering immunoassay. OBJECTIVES To assess the clinical risk assessment between two methods (Compare the two Immunoturbidometric methods (AU680) vs. HPLC method (D10)) in hyperglycemic patients and assess the acceptability of the respective methods in the Clinical biochemistry laboratory. METHODS The charge of the globins in Hb was used as the basis for the HPLC method used to measure HbA1c. HPLC detects and quantifies even the tiniest Hb fractions and the full spectrum of Hb variants. HbA1c was measured using the immunoturbidimetric (AU 680 Beckmann coulter analyzer) and high-performance liquid chromatography (HPLC) techniques. Experiments also made use of immunoturbidimetric techniques (using an AU 680 Beckmann coulter analyzer equipment). RESULTS There is no statistically significant difference in HbA1c readings between male and female patients, as measured by either the Immunoturbidimetric or HPLC techniques. CONCLUSION The immunoturbidimetric and high-performance liquid chromatography techniques for estimating HbA1c yielded identical results. From the results of this study, we may deduce that both techniques are valid for estimating HbA1c. As a result, it may be suggested that both approaches can be used to estimate HbA1c in diabetic individuals.
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Affiliation(s)
- Sukhes Mukherjee
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Prasant Yadav
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Suman Kumar Ray
- Independent Researcher, Bhopal, Madhya Pradesh, 462020, India
| | - Ashish A Jadhav
- Department of Biochemistry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
| | - Santosh L Wakode
- Department of Physiology. All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, 462020, India
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Celik NB, Canoruc Emet D, Canturk M, Ozon ZA, Gonc EN. Dual-basal-insulin regimen for the management of dawn phenomenon in children with type 1 diabetes: a retrospective cohort study. Ther Adv Endocrinol Metab 2023; 14:20420188231220130. [PMID: 38152658 PMCID: PMC10752105 DOI: 10.1177/20420188231220130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 11/11/2023] [Indexed: 12/29/2023] Open
Abstract
Background Handling of the dawn phenomenon (DP) with multiple daily insulin injection (MDII) regimen is a real challenge. Objective We aimed to demonstrate the effectiveness of a dual-basal-insulin (a long-acting glargine and an intermediate-acting neutral protamine Hagedorn (NPH)) regimen for the management of DP in children with type 1 diabetes mellitus (T1DM). The primary efficacy outcome was to overcome morning hyperglycemia without causing hypoglycemia during the non-DP period of the night. Design Retrospective cohort study. Method Charts of 28 children with T1DM (12 female; 42.8%, mean age 13.7 ± 2.1 years) treated with MDII were retrospectively reviewed. The median duration of diabetes was 4.5 years (range 2-13.5 years). DP was diagnosed using a threshold difference of 20 mg/dL (0.1 mmol/L) between fasting capillary blood glucose at 3 a.m. and prebreakfast. NPH was administered at midnight in addition to daily bedtime (08.00-09.00 p.m.) glargine (dual-basal-insulin regimen). Midnight, 03:00 a.m., prebreakfast and postprandial capillary blood glucose readings, insulin-carbohydrate ratios, and basal-bolus insulin doses were recorded the day before the dual-basal-insulin regimen was started and the day after the titration of the insulin doses was complete. Body mass index standard deviation scores (BMI SDS) at the onset-3rd-12th month of treatment were noted. Results Before using dual basal insulin, prebreakfast capillary blood glucose levels were greater than those at midnight and at 03:00 a.m. (F = 64.985, p < 0.01). After titration of the dual-basal-insulin doses, there were significant improvements such that there were no statistically significant differences in the capillary blood glucose measurements at the three crucial time points (midnight, 03.00 a.m., and prebreakfast; F = 1.827, p = 0.172). No instances of hypoglycemia were reported, and the total daily insulin per kilogram of body weight did not change. The BMI SDS remained steady over the course of the 1-year follow-up. Conclusion In this retrospective cohort study, the dual-basal-insulin regimen, using a long-acting glargine and an intermediate-acting NPH, was effective in overcoming early morning hyperglycemia due to insulin resistance in the DP. However, the effectiveness of the dual-basal-insulin regimen needs to be verified by prospective controlled studies using continuous glucose monitoring metrics or frequent blood glucose monitoring.
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Affiliation(s)
- Nur Berna Celik
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, 06230, Turkey
| | - Dicle Canoruc Emet
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Merve Canturk
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Z. Alev Ozon
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - E. Nazli Gonc
- Division of Pediatric Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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5
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Bwititi P, Wang L, Butkowski E, Nwose EU. Impact of Anaemia on HbA1c Interpretation Among Normogylcaemic Individuals With Diabetes Mellitus: A Clinical Laboratory Observational Study. Cureus 2023; 15:e49901. [PMID: 38174171 PMCID: PMC10763517 DOI: 10.7759/cureus.49901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND AIM Over the past decades, glycosylated haemoglobin (HbA1c) has been a gold standard for monitoring diabetes control over a long period, relative to blood glucose level (BGL) which measures short-term results. It is speculated that anaemia and factors that induce haemolysis may cause falsely elevated HbA1c leading to 'false positive' interpretations. This study aimed to investigate how anaemia impacts HbA1c. METHODS This was a pathology-based observational pilot study using archived data of diabetic subjects monitored with both BGL and HbA1c in regional New South Wales (NSW), Australia. A total of 28,487 cases of blood glucose results were pooled and those with HbA1c and anaemia results were evaluated for correlation with the BGL results. Data collection was limited to de-identified information from the laboratory information system, hence details on the ethnicity and medical history were unavailable. Descriptive frequencies and Pearson correlations were performed. RESULTS In the pooled data, 53.36% of individuals were females, and 50.54% had BGL ≥5.6 mmol/L. In the pilot dataset, the majority (64.86%) were males, 18.92% with BGL ≤5.6 mmol/L and 67.57% had HbA1c (≥6.5%). In the entire dataset, BGL was moderately and positively correlated with HbA1c (r = 0.6), whereas in the subset of individuals with normo-BGL and anaemia, the correlation was negative (r = -0.2). DISCUSSION This pilot investigation observed a pertinent issue, which is a negative correlation between glycaemia and HbA1c in patients with anaemia. HbA1c was falsely increased despite normal blood glucose levels in individuals with anaemia. This advances the speculation that anaemia falsely increases HbA1c. Therefore, caution is necessary while interpreting HbA1c results for patients with anaemia, and new methods for interpretation are required.
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Affiliation(s)
- Phillip Bwititi
- Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, AUS
| | - Lexin Wang
- Cardiology, Wagga Wagga Medical Centre, Wagga Wagga, AUS
- Cardiology, Liaocheng People's Hospital, Shandong First Medical University, Liaocheng, CHN
| | | | - Ezekiel U Nwose
- Public and Community Health, Novena University, Amai Campus, Ndokwa West, NGA
- Health and Medical Sciences, University of Southern Queensland, Toowoomba, AUS
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Michetti C, Ferrante D, Parisi B, Ciano L, Prestigio C, Casagrande S, Martinoia S, Terranova F, Millo E, Valente P, Giovedi' S, Benfenati F, Baldelli P. Low glycemic index diet restrains epileptogenesis in a gender-specific fashion. Cell Mol Life Sci 2023; 80:356. [PMID: 37947886 PMCID: PMC10638170 DOI: 10.1007/s00018-023-04988-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
Dietary restriction, such as low glycemic index diet (LGID), have been successfully used to treat drug-resistant epilepsy. However, if such diet could also counteract antiepileptogenesis is still unclear. Here, we investigated whether the administration of LGID during the latent pre-epileptic period, prevents or delays the appearance of the overt epileptic phenotype. To this aim, we used the Synapsin II knockout (SynIIKO) mouse, a model of temporal lobe epilepsy in which seizures manifest 2-3 months after birth, offering a temporal window in which LGID may affect epileptogenesis. Pregnant SynIIKO mice were fed with either LGID or standard diet during gestation and lactation. Both diets were maintained in weaned mice up to 5 months of age. LGID delayed the seizure onset and induced a reduction of seizures severity only in female SynIIKO mice. In parallel with the epileptic phenotype, high-density multielectrode array recordings revealed a reduction of frequency, amplitude, duration, velocity of propagation and spread of interictal events by LGID in the hippocampus of SynIIKO females, but not mutant males, confirming the gender-specific effect. ELISA-based analysis revealed that LGID increased cortico-hippocampal allopregnanolone (ALLO) levels only in females, while it was unable to affect ALLO plasma concentrations in either sex. The results indicate that the gender-specific interference of LGID with the epileptogenic process can be ascribed to a gender-specific increase in cortical ALLO, a neurosteroid known to strengthen GABAergic transmission. The study highlights the possibility of developing a personalized gender-based therapy for temporal lobe epilepsy.
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Affiliation(s)
- Caterina Michetti
- Department of Experimental Medicine, University of Genova, Genoa, Italy.
- Center for Synaptic Neuroscience and Technology, Italian Institute of Technology, Genoa, Italy.
| | - Daniele Ferrante
- Department of Experimental Medicine, University of Genova, Genoa, Italy
| | - Barbara Parisi
- Department of Experimental Medicine, University of Genova, Genoa, Italy
| | - Lorenzo Ciano
- Department of Experimental Medicine, University of Genova, Genoa, Italy
- Center for Synaptic Neuroscience and Technology, Italian Institute of Technology, Genoa, Italy
| | - Cosimo Prestigio
- Department of Experimental Medicine, University of Genova, Genoa, Italy
| | - Silvia Casagrande
- Department of Experimental Medicine, University of Genova, Genoa, Italy
| | - Sergio Martinoia
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genova, Genoa, Italy
| | - Fabio Terranova
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genova, Genoa, Italy
| | - Enrico Millo
- Department of Experimental Medicine, University of Genova, Genoa, Italy
| | - Pierluigi Valente
- Department of Experimental Medicine, University of Genova, Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Silvia Giovedi'
- Department of Experimental Medicine, University of Genova, Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabio Benfenati
- Center for Synaptic Neuroscience and Technology, Italian Institute of Technology, Genoa, Italy
- IRCCS, Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Baldelli
- Department of Experimental Medicine, University of Genova, Genoa, Italy.
- IRCCS, Ospedale Policlinico San Martino, Genoa, Italy.
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Elsheikh E, Aljohani SS, Alshaikhmubarak MM, Alhawl MA, Alsubaie AW, Alsultan N, Sharif AF, Ibrahim Ali S. Implications of Iron Deficiency Anaemia on Glycemic Dynamics in Diabetes Mellitus: A Critical Risk Factor in Cardiovascular Disease. Cureus 2023; 15:e49414. [PMID: 38149144 PMCID: PMC10750114 DOI: 10.7759/cureus.49414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Iron deficiency anemia (IDA) is a highly prevalent comorbidity in patients with diabetes, with rates estimated between 13% and 47% across studies. Iron deficiency anemia may potentially influence hemoglobin A1c (HbA1c) values, which are routinely measured to monitor long-term glycemic control in diabetes. Some evidence suggests that HbA1c may be lower in diabetics with IDA due to increased red blood cell turnover. However, current evidence elucidating the effects of IDA on HbA1c and diabetes outcomes remains inconsistent and inconclusive. OBJECTIVE This cross-sectional study aimed to evaluate the relationship between IDA, HbA1c levels, and glycemic dynamics in patients with diabetes mellitus. METHODS The study sample included 143 adult patients diagnosed with diabetes, recruited from outpatient clinics in Saudi Arabia. Iron deficiency anemia was identified through serum ferritin <100 ng/mL, transferrin saturation <20%, and hematologic parameters. The HbA1c levels were measured using standardized laboratory methods. Daily glucose profiles were obtained by continuous glucose monitoring (CGM) in a subset of patients to assess glycemic dynamics. RESULTS The prevalence of IDA was 39.9% among the diabetic cohort. Patients with IDA had a numerically higher mean HbA1c of 7.2% compared to 6.8% in non-anemic diabetics, suggesting a potential effect of IDA on HbA1c. Those with IDA also spent more time in hyperglycemic ranges, along with greater glucose variability based on CGM data. Iron deficiency measures, including low ferritin and high red cell distribution width (RDW), showed weak positive correlations with HbA1c levels. CONCLUSION Iron deficiency anemia is highly prevalent among Saudi diabetic patients and is potentially associated with inaccurate HbA1c values and poor short-term glycemic control. However, larger controlled studies are warranted to conclusively investigate mechanisms linking IDA to alterations in HbA1c and glycemic dynamics. Optimized screening and treatment of IDA may lead to more accurate diabetes monitoring and improved outcomes.
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Affiliation(s)
- Eman Elsheikh
- Cardiology, College of Medicine, Tanta University Hospital, Tanta, EGY
- Internal Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Sereen S Aljohani
- Diabetes and Endocrinology, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | | | - Meshari A Alhawl
- Dermatology, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Alhanouf W Alsubaie
- Diabetes and Endocrinology, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Norah Alsultan
- Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
| | - Asmaa F Sharif
- Clinical Medical Sciences, College of Medicine, Dar Al Uloom University, Riyadh, SAU
- Forensic Medicine and Clinical Toxicology, College of Medicine, Tanta University Hospital, Tanta, EGY
| | - Sayed Ibrahim Ali
- Family and Community Medicine, College of Medicine, King Faisal University, Al-Hofuf, SAU
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8
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McLachlan F, Johnstone AM, Myint PK. Glycated Haemoglobin (HbA1c) and Future Physical and Mental Functional Health in the European Prospective Investigation into Cancer (EPIC)-Norfolk Population-Based Study. J Pers Med 2023; 13:1336. [PMID: 37763104 PMCID: PMC10532805 DOI: 10.3390/jpm13091336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Little is understood about the relationship between glycated haemoglobin and future functional health in the general population. In this work, we aimed to assess if glycaemic control is associated with future physical and mental functional health at 18-month follow-up in a UK general population, in those with and without diabetes. This work was a cross-sectional study. Between 1995 and 1997, participants of the European Prospective Investigation into Cancer, Norfolk, attended a health check including blood testing for haemoglobin A1c (HbA1c) and completed a health and lifestyle questionnaire. Eighteen months later, self-reported physical and mental functional health were assessed using short form-36 (SF-36). Outcomes of interest included physical and mental component summary (PCS and MCS, respectively) scores of the SF-36. A total of 7343 participants (56% women, mean (SD) 58.1 ± 9.5 years) were eligible to be included, of whom 167 had prevalent diabetes. In our linear regression analysis, a higher HbA1c (mmol/mol) was found to be associated with a poorer PCS score (coefficient -0.15 (p < 0.0001)) at follow-up. After adjustment for comorbid conditions, including obesity, this association was no longer statistically significant. A higher HbA1c (mmol/mol) was associated with a better MCS score at follow-up; this finding was significant when adjusted for comorbid conditions (coefficient 0.029 (p < 0.05)). Our findings suggest that the association between a higher HbA1c and poorer physical functional health is explained by a higher BMI and comorbidity status in a general population. While higher HbA1c was found to be associated with higher mental functional health at follow-up, the magnitude of this association was small. Healthy responder bias and unmeasured confounding variables may have influenced this result; thus, it should be interpreted with caution.
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Affiliation(s)
- Fiona McLachlan
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Room 4.013, Polwarth Building, Aberdeen AB25 2ZD, UK
| | | | - Phyo Kyaw Myint
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Room 4.013, Polwarth Building, Aberdeen AB25 2ZD, UK
- Aberdeen Cardiovascular & Diabetes Centre, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
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9
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Gojda J, Koudelková K, Ouřadová A, Lang A, Krbcová M, Gvozdeva A, Šebo V, Slagmolen L, Potočková J, Tůma P, Rossmeislová L, Anděl M, Karpe F, Schlesinger S. Severe COVID-19 associated hyperglycemia is caused by beta cell dysfunction: a prospective cohort study. Nutr Diabetes 2023; 13:11. [PMID: 37460458 DOI: 10.1038/s41387-023-00241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/11/2023] [Accepted: 06/29/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND COVID-19, an infectious disease caused by SARS-CoV-2, was shown to be associated with an increased risk of new-onset diabetes. Mechanisms contributing to the development of hyperglycemia are still unclear. We aimed to study whether hyperglycemia is related to insulin resistance and/or beta cell dysfunction. MATERIALS AND METHODS Survivors of severe COVID-19 but without a known history of diabetes were examined at baseline (T0) and after 3 (T3) and 6 (T6) months: corticosteroids use, indirect calorimetry, and OGTT. Insulin response and sensitivity (IS) were expressed as insulinogenic (IGI), disposition (DI), and Matsuda insulin sensitivity index (ISI). Resting energy expenditure (REE) and respiratory quotient (RQ) was calculated from the gas exchange and nitrogen losses. RESULTS 26 patients (out of 37) with complete outcome data were included in the analysis (age ~59.0 years; BMI ~ 30.4, 35% women). Patients were hypermetabolic at T0 (30.3 ± 4.0 kcal/kg lean mass/day, ~120% predicted) but REE declined over 6 months (ΔT6-T0 mean dif. T6-T0 (95% CI): -5.4 (-6.8, -4.1) kcal/kg FFM/day, p < 0.0001). 17 patients at T0 and 13 patients at T6 had hyperglycemia. None of the patients had positive islet autoantibodies. Insulin sensitivity in T0 was similarly low in hyperglycemic (H) and normoglycemic patients (N) (T0 ISIH = 3.12 ± 1.23, ISIN = 3.47 ± 1.78, p = 0.44), whereas insulin response was lower in the H group (DIH = 3.05 ± 1.79 vs DIN = 8.40 ± 5.42, p = 0.003). Over 6 months ISI (ΔT6-T0 mean dif. T6-T0 for ISI (95% CI): 1.84 (0.45, 3.24), p = 0.01)) increased in the H group only. CONCLUSIONS Patients with severe COVID-19 had increased REE and insulin resistance during the acute phase due to the infection and corticosteroid use, but these effects do not persist during the follow-up period. Only patients with insufficient insulin response developed hyperglycemia, indicating that beta cell dysfunction, rather than insulin resistance, was responsible for its occurrence.
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Affiliation(s)
- Jan Gojda
- Department of Internal Medicine, Third Faculty of Medicine, Charles University, and Královské Vinohrady University Hospital, Prague, Czech Republic.
| | - Kateřina Koudelková
- Department of Internal Medicine, Third Faculty of Medicine, Charles University, and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Anna Ouřadová
- Department of Internal Medicine, Third Faculty of Medicine, Charles University, and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Alexander Lang
- Institute for Biometrics and Epidemiology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Magdaléna Krbcová
- Department of Internal Medicine, Third Faculty of Medicine, Charles University, and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Alexandra Gvozdeva
- Department of Internal Medicine, Third Faculty of Medicine, Charles University, and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Viktor Šebo
- Department of Pathophysiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lotte Slagmolen
- Faculty of Movement and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jana Potočková
- Department of Internal Medicine, Third Faculty of Medicine, Charles University, and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Petr Tůma
- Department of Hygiene, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Rossmeislová
- Institute for Biometrics and Epidemiology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michal Anděl
- Department of Internal Medicine, Third Faculty of Medicine, Charles University, and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Fredrik Karpe
- Oxford Center for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, UK
| | - Sabrina Schlesinger
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
- Department of Pathophysiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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10
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Agrawal OD, Kulkarni YA. Treatment with Terminalia chebula Extract Reduces Insulin Resistance, Hyperglycemia and Improves SIRT1 Expression in Type 2 Diabetic Rats. Life (Basel) 2023; 13:life13051168. [PMID: 37240813 DOI: 10.3390/life13051168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Terminalia chebula Retz., Family Combretaceae (T. chebula) is one of the important plants mentioned in Ayurveda, a traditional system of medicine. The present work was designed to study the effect of the aqueous extract of T. chebula fruits in type 2 diabetic rats. METHODS The aqueous extract of the fruits was prepared by the double maceration technique. The extract was subjected to HPTLC analysis, which showed the presence of ellagic acid and gallic acid. Type 2 diabetes was induced in rats with a low dose of Streptozotocin (35 mg/kg) after administering a high-fat diet for fourteen days. Diabetic animals were treated with 500 and 1000 mg/kg of aqueous extract of T. chebula fruits for six weeks. RESULTS Diabetic rats showed a significantly (511.7 ± 17.6) (p < 0.001) high plasma glucose level compared to the normal group (106 ± 3.358). The T. chebula treatment group showed a significant (p < 0.001) reduction in plasma glucose at 500 mg/kg (394.3 ± 10.35) and 1000 mg/kg (368.6 ± 30.08) doses when compared with the diabetic control group. Treatment with aqueous extract significantly reduced lipid parameters in diabetic animals when compared to the animals in the diabetic control group. Treatment with extract at a dose of 500 mg/kg and 1000 mg/kg showed a significant reduction in AST (p < 0.01, p < 0.001) when compared with diabetic control rats. Treatment with extract significantly reduced ALT at 500 mg/kg (p < 0.05) and 1000 mg/kg (p < 0.001) doses when compared with diabetic control rats. The extract treatment improved insulin sensitivity and insulin sensitivity index (ISI) and significantly decreased HOMR-IR. Treatment with T. chebula aqueous extract at 1000 mg/kg significantly increased the level of GSH (p < 0.05) when compared to diabetic control rats. T. chebula treatment at 1000 mg/kg significantly increased levels of CAT (p < 0.01). Histopathology of pancreatic tissue revealed that the extract has a protective effect against the damage caused by hyperglycemia. Immunohistochemistry of pancreatic tissue showed increased expression of SIRT1 in diabetic animals treated with the extract. CONCLUSIONS The results of the present study indicate that the extract of T. chebula has significant effects in the management of type 2 diabetes.
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Affiliation(s)
- Ojaskumar D Agrawal
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai 400056, India
- Vivekanand Education Society's College of Pharmacy, University of Mumbai, Chembur (E), Mumbai 400074, India
| | - Yogesh A Kulkarni
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's NMIMS, V.L. Mehta Road, Vile Parle (W), Mumbai 400056, India
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11
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ARSHAM A, ROSENBERG P, LITTLE M. Effects of stopping criterion on the growth of trees in regression random forests. THE NEW ENGLAND JOURNAL OF STATISTICS IN DATA SCIENCE 2023; 1:46-61. [PMID: 37986713 PMCID: PMC10659741 DOI: 10.51387/22-nejsds5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Random forests are a powerful machine learning tool that capture complex relationships between independent variables and an outcome of interest. Trees built in a random forest are dependent on several hyperparameters, one of the more critical being the node size. The original algorithm of Breiman, controls for node size by limiting the size of the parent node, so that a node cannot be split if it has less than a specified number of observations. We propose that this hyperparameter should instead be defined as the minimum number of observations in each terminal node. The two existing random forest approaches are compared in the regression context based on estimated generalization error, bias-squared, and variance of resulting predictions in a number of simulated datasets. Additionally the two approaches are applied to type 2 diabetes data obtained from the National Health and Nutrition Examination Survey. We have developed a straightforward method for incorporating weights into the random forest analysis of survey data. Our results demonstrate that generalization error under the proposed approach is competitive to that attained from the original random forest approach when data have large random error variability. The R code created from this work is available and includes an illustration.
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Affiliation(s)
- Aryana ARSHAM
- Center for Data, Mathematical & Computational Sciences,
Integrative Data Analytics, Goucher College, USA
| | | | - Mark LITTLE
- Radiation Epidemiology Branch, National Cancer Institute,
USA
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12
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Yadav N, Kumar Mandal A. Interference of hemoglobin variants in HbA 1c quantification. Clin Chim Acta 2023; 539:55-65. [PMID: 36476843 DOI: 10.1016/j.cca.2022.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Fasting blood glucose and glycated hemoglobin (HbA1c) are routine biomarkers to screen and monitor diabetes mellitus. HbA1c results from glycation at the N-terminus of the β globin chain of tetrameric human hemoglobin. Fasting blood glucose level varies with the nature and amount of food intake, physical exercise, etc., and, accordingly, is a short-term measure of glucose control. In contrast, HbA1c provides an average measure of glucose control for the long-term (8-12 weeks). Unfortunately, genetic variants of hemoglobin may interfere with HbA1c quantification using ion exchange chromatography, capillary electrophoresis, immunoassay and boronate affinity chromatography. Mass spectrometry, however, measures total glycation of hemoglobin across both α and β globin chains and correlates well with the ion exchange based method. Additionally, mass spectrometry based quantification is not impacted by the presence of genetic variants of hemoglobin and thus might be a better analytical choice for diabetes mellitus.
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Affiliation(s)
- Neha Yadav
- Department of Biological Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, Nadia, West Bengal 741246, India
| | - Amit Kumar Mandal
- Department of Biological Sciences, Indian Institute of Science Education and Research Kolkata, Mohanpur, Nadia, West Bengal 741246, India.
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Martínez-Ramírez OC, Salazar-Piña A, Cerón-Ramírez X, Rubio-Lightbourn J, Torres-Romero F, Casas-Avila L, Castro-Hernández C. Effect of Inulin Intervention on Metabolic Control and Methylation of INS and IRS1 Genes in Patients with Type 2 Diabetes Mellitus. Nutrients 2022; 14:nu14235195. [PMID: 36501225 PMCID: PMC9737482 DOI: 10.3390/nu14235195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Currently, treatments are being sought to improve the control of type II diabetes mellitus (T2DM), and inulin has been shown to be effective in reducing glucose levels and other metabolic control parameters. These effects on metabolic control may be associated with changes in the epigenetic modulation of genes of the insulin pathway. Therefore, our objective is to determine the effect of agave inulin in metabolic control parameters and in INS and IRS1 genes' methylation in T2DM patients. METHODS This was a longitudinal experimental study with 67 Mexican participants who received an intervention of inulin agave (10 g daily) for 2 months. The methylation of the INS and IRS1 genes was determined by MSP. RESULTS For the INS gene, we found a significant decrease in the proportions of T2DM patients with methylated DNA after inulin intervention (p = 0.0001). In contrast, the difference in the proportions of the unmethylated IRS1 gene before and after the inulin intervention was not significant (p = 0.79). On the other hand, we observed changes in the number of T2DM patients' recommended categories for metabolic control depending on the methylation of INS and IRS1 genes before and after treatment with inulin. CONCLUSION For the first time, we report the modification in the methylation of two genes, INS and IRS1, of the insulin pathway and provide information on the possible relevant role of epigenetics as a key factor in positive changes in metabolic control parameters by inulin intake in T2DM patients.
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Affiliation(s)
- Ollin Celeste Martínez-Ramírez
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Cuernavaca C.P. 62350, Morelos, Mexico
- Correspondence:
| | - Azucena Salazar-Piña
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Cuernavaca C.P. 62350, Morelos, Mexico
| | - Ximena Cerón-Ramírez
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Cuernavaca C.P. 62350, Morelos, Mexico
| | - Julieta Rubio-Lightbourn
- Departamento de Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México C.P. 04510, Mexico
| | - Fernando Torres-Romero
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Cuernavaca C.P. 62350, Morelos, Mexico
| | - Leonora Casas-Avila
- Laboratorio de Medicina Genómica, Instituto Nacional de Rehabilitación, Ciudad de Mexico C.P. 14389, Mexico
| | - Clementina Castro-Hernández
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México C.P. 14080, Mexico
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14
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Caixeta DC, Pennisi PRC, Moura DV, Nunes MAC, Espindola FS, Blumenberg C, Paranhos LR, Sabino-Silva R. Association of salivary alpha-2-macroglobulin with glycemia and glycated hemoglobin in type 2 diabetes mellitus: a systematic review and meta-analysis study. SAO PAULO MED J 2022; 140:818-828. [PMID: 36102452 PMCID: PMC9671562 DOI: 10.1590/1516-3180.2021.0816.r2.19052022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 05/19/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronically elevated alpha-2-macroglobulin (A2MG) in the blood has been correlated with diabetes and the HbA1c profile; however, no systematic review has been conducted to evaluate the association of A2MG salivary levels and glycemia or HbA1c levels in diabetes mellitus type 2 (DM2) patients. OBJECTIVE To evaluate whether A2MG salivary levels are related to the glycemia or HbA1c levels in DM2 patients. DESIGN AND SETTING Systematic review developed at Universidade Federal de Uberlândia (UFU), Brazil. METHODS Eight databases were used as research sources. The eligibility criteria included studies that reported data regarding mean salivary A2MG and the correlation between glycemia and/or HbA1c levels of DM2 subjects (uncontrolled and well-controlled) and non-diabetic subjects. The risk of bias of the studies selected was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools for use in JBI systematic reviews. Pooled correlation coefficients were estimated using the Hunter-Schmidt method. Study estimates were weighted according to their sample size, and heterogeneity was calculated using the chi-square statistic. RESULTS Four studies on DM2 patients were included in this systematic review after careful analysis of 1482 studies. Three studies compared A2MG with HbA1c and glycemia. Overall, the correlation between A2MG and HbA1c was strong (r = 0.838). In contrast, the correlation between A2MG and glycemia was low (r = 0.354). CONCLUSION The strong association between HbA1C and salivary A2MG suggests that this salivary protein has the potential to be a surrogate for HbA1C, if corroboratory further evidence is obtained through large-scale studies.
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Affiliation(s)
- Douglas Carvalho Caixeta
- PhD. Collaborative Researcher, Innovation Center in Salivary Diagnostics and Nanotheranostics, Department of Physiology, Institute of Biomedical Sciences, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil
| | | | - Douglas Vieira Moura
- Master’s Student, Innovation Center in Salivary Diagnostics and Nanotheranostics, Department of Physiology, Institute of Biomedical Sciences, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil
| | | | - Foued Salmen Espindola
- PhD. Professor, Institute of Biotechnology, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil
| | - Cauane Blumenberg
- PhD. Collaborative Researcher, Postgraduate Program on Epidemiology, Universidade Federal University de Pelotas (UFPel), Pelotas (RS), Brazil
| | - Luiz Renato Paranhos
- PhD. Professor, Division of Preventive and Social Dentistry, School of Dentistry, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil
| | - Robinson Sabino-Silva
- PhD. Professor, Innovation Center in Salivary Diagnostics and Nanotheranostics, Department of Physiology, Institute of Biomedical Sciences, Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil
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15
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Schmitz T, Harmel E, Heier M, Peters A, Linseisen J, Meisinger C. Undiagnosed Impaired Glucose Tolerance and Type-2 Diabetes in Acute Myocardial Infarction Patients: Fequency, Characteristics and Long-Term Mortality. Front Cardiovasc Med 2022; 9:869395. [PMID: 35548418 PMCID: PMC9081974 DOI: 10.3389/fcvm.2022.869395] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background In this study we investigated the prevalence of undiagnosed impaired glucose tolerance and type-2-diabetes (T2D) among patients with acute myocardial infarction (AMI) and prospectively analyzed whether these patients have a higher long-term mortality. Methods The analysis was based on 2,317 AMI patients aged 25–84 years from the population-based Myocardial Infarction Registry Augsburg, recruited between 2009 and 2014 and followed-up until 2019 (median follow-up time 6.5 years [IQR: 4.9–8.1]). AMI patients with a diagnosis of diabetes were divided into a high (>7.0%) and a low HbA1c group (≤7.0%) according to HbA1c values at admission. The remaining patients (without known diabetes) were grouped into normal (<5.7%), elevated (5.7–6.4%), and high (≥6.5%) HbA1c groups. In a multivariable-adjusted COX regression analysis, the association between HbA1c groups and long-term mortality was investigated. Linear regression models were used to identify AMI patients with elevated HbA1c values by means of personal characteristics. Results At admission, 29.5% of all patients reported a diagnosis of diabetes. Of all patients without known diabetes, 5.4% had HbA1c values of ≥ 6.5 and 37.9% had HbA1c values between 5.7 and 6.4%. The fully adjusted Cox regression model showed a non-significant trend toward higher long-term mortality for AMI patients with increased HbA1c values (HbA1c 5.7–6.4% HR: 1.05 [0.79–1.38], HbA1c > 6.5% HR: 1.34 [0.77–2.31]). A linear regression model including the variables admission serum glucose, BMI, age, sex and type of infarction (STEMI, NSTEMI) showed only poor prediction of HbA1c values (R2: 11.08%). Conclusion A fairly high number of AMI patients without known diabetes have elevated HbA1c values. Though we could not prove a higher risk of premature mortality in these patients, early detection and adequate therapy might lead to reduced diabetes-associated complications and improve long-term outcomes.
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Affiliation(s)
- Timo Schmitz
- Chair of Epidemiology, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
- *Correspondence: Timo Schmitz,
| | - Eva Harmel
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Margit Heier
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
- Helmholtz Zentrum München, Institute for Epidemiology, Neuherberg, Germany
| | - Annette Peters
- Helmholtz Zentrum München, Institute for Epidemiology, Neuherberg, Germany
- Chair of Epidemiology, Medical Faculty, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Jakob Linseisen
- Chair of Epidemiology, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
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16
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Samuel SM, Varghese E, Triggle CR, Büsselberg D. COVID-19 Vaccines and Hyperglycemia—Is There a Need for Postvaccination Surveillance? Vaccines (Basel) 2022; 10:vaccines10030454. [PMID: 35335086 PMCID: PMC8952286 DOI: 10.3390/vaccines10030454] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 vaccines currently in use have undoubtedly played the most significant role in combating the SARS-CoV-2 virus and reducing disease severity and the risk of death among those affected, especially among those with pre-existing conditions, such as diabetes. The management of blood glucose levels has become critical in the context of the COVID-19 pandemic, where data show two- to threefold higher intensive care hospital admissions and more than twice the mortality rate among diabetic COVID-19 patients when compared with their nondiabetic counterparts. Furthermore, new-onset diabetes and severe hyperglycemia-related complications, such as hyperosmolar hyperglycemic syndrome (HHS) and diabetic ketoacidosis (DKA), were reported in COVID-19 patients. However, irrespective of the kind of vaccine and dosage number, possible vaccination-induced hyperglycemia and associated complications were reported among vaccinated individuals. The current article summarizes the available case reports on COVID-19 vaccination-induced hyperglycemia, the possible molecular mechanism responsible for this phenomenon, and the outstanding questions that need to be addressed and discusses the need to identify at-risk individuals and promote postvaccination monitoring/surveillance among at-risk individuals.
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Affiliation(s)
- Samson Mathews Samuel
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha P.O. Box 24144, Qatar;
- Correspondence: (S.M.S.); (D.B.); Tel.: +974-4492-8269 (S.M.S.); +974-4492-8334 (D.B.); Fax: +974-4492-8333 (S.M.S. & D.B.)
| | - Elizabeth Varghese
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha P.O. Box 24144, Qatar;
| | - Chris R. Triggle
- Department of Pharmacology, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha P.O. Box 24144, Qatar;
| | - Dietrich Büsselberg
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Education City, Qatar Foundation, Doha P.O. Box 24144, Qatar;
- Correspondence: (S.M.S.); (D.B.); Tel.: +974-4492-8269 (S.M.S.); +974-4492-8334 (D.B.); Fax: +974-4492-8333 (S.M.S. & D.B.)
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17
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Piona C, Marigliano M, Mozzillo E, Di Candia F, Zanfardino A, Iafusco D, Maltoni G, Zucchini S, Piccinno E, Maffeis C. Evaluation of HbA1c and glucose management indicator discordance in a population of children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:84-89. [PMID: 34888998 DOI: 10.1111/pedi.13299] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Glucose management indicator (GMI) is a useful metric for the clinical management of diabetic patients using continuous glucose monitoring (CGM). In adults, a marked discordance between HbA1c and GMI has been reported. To date, no studies have evaluated this discordance in children/adolescents with type 1 diabetes (T1D). METHODS HbA1c and real-life CGM data of the 12 weeks preceding HbA1c measurement were collected from 805 children/adolescents. The absolute difference between HbA1c and GMI was calculated for both the 12-week and 4-week periods preceding HbA1c measurement and the proportion of discordant patients was defined according to specific thresholds in the entire study population and in subjects stratified by type of CGM, insulin therapy, gender, age and puberty. Regression analyses were performed with HbA1c-GMI discordance as dependent variable and patients' characteristics as independent ones. A new GMI equation for children and adolescent was derived from the linear regression analysis between mean glucose and HbA1c. RESULTS HbA1c-GMI discordance calculated on the 12-week period was <0.1, ≥0.5 and ≥1.0 in 24.8, 33.9 and 9.2% of the subjects, respectively. No significant differences in the proportion of discordant patients were found comparing patients stratified by type of CGM, insulin therapy, gender, age and puberty. GMI-HbA1c discordance was not significantly explained by age, gender, BMI, type of CGM, insulin therapy, hemoglobin, anemia and autoimmune diseases (R2 = 0.012, p = 0.409). HbA1c-GMI discordance calculated on the 4-week period was comparable. GMI (%) equation derived for this cohort was: 3.74 + 0.022x (mean glucose in mg/dl). CONCLUSIONS GMI could be meaningfully discordant respect to HbA1c in more than a third of children/adolescents with T1D. This discrepancy should be taken into careful consideration when the two indices are directly compared in daily clinical practice.
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Affiliation(s)
- Claudia Piona
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Marco Marigliano
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enza Mozzillo
- Regional Center of Pediatric Diabetes, Department of Translational and Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Francesca Di Candia
- Regional Center of Pediatric Diabetes, Department of Translational and Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Angela Zanfardino
- Regional Center of Pediatric Diabetology "G.Stoppoloni" - University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Dario Iafusco
- Regional Center of Pediatric Diabetology "G.Stoppoloni" - University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Zucchini
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elvira Piccinno
- Metabolic Disorder and Diabetes Unit, "Giovanni XXIII" Children Hospital, Bari, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Glycemic Variability Impacted by SGLT2 Inhibitors and GLP 1 Agonists in Patients with Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10184078. [PMID: 34575189 PMCID: PMC8470178 DOI: 10.3390/jcm10184078] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
To investigate the effect of sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) agonists on glycemic variability (GV), the mean amplitude of glucose excursion (MAGE), mean blood glucose (MBG) levels, and percentage of time maintaining euglycemia were evaluated. Randomized controlled trials evaluating the efficacy of SGLT-2 inhibitors and GLP-1 agonists for treating people with diabetes were selected through searches of PubMed, EMBASE, and other databases. Sixteen studies were finally analyzed. There were no differences in the reductions in MAGE after treatment with SGLT-2 inhibitors or GLP-1 agonists (standardized mean difference (SMD) = −0.59, 95% CI = −0.82 to −0.36 vs. SMD = −0.43, 95% CI = −0.51 to −0.35, respectively), and treatment with SGLT-2 inhibitors was associated with an increased reduction in MBG levels (SMD = −0.56, 95% CI = −0.65 to −0.48, p < 0.00001). Monotherapy and add-on therapy with medications were correlated with MAGE and MBG level reductions. In conclusion, SGLT-2 inhibitors and GLP-1 agonists were associated with a reduction in GV and could be alternatives for treating people with diabetes.
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Relación entre hemoglobina glucosilada, tiempo en rango y variabilidad glucémica en una cohorte de pacientes pediátricos y adultos con diabetes tipo 1 con monitorización flash de glucosa. ENDOCRINOL DIAB NUTR 2021. [DOI: 10.1016/j.endinu.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Díaz-Soto G, Bahíllo-Curieses MP, Jimenez R, Nieto MDLO, Gomez E, Torres B, López Gomez JJ, de Luis D. The relationship between glycosylated hemoglobin, time-in-range and glycemic variability in type 1 diabetes patients under flash glucose monitoring. ENDOCRINOL DIAB NUTR 2021; 68:465-471. [PMID: 34863411 DOI: 10.1016/j.endien.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/23/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Flash glucose monitoring in patients with type 1 diabetes provides new glucometric data that allow for the assessment of glycemic control beyond HbA1c. The objective of the study was to evaluate the relationship between HbA1c, time-in-range (TIR) and glycemic variability in a cohort of paediatric and adult patients with type 1 diabetes and treatment with flash glucose monitoring. MATERIAL AND METHODS This was a cross-sectional study in 195 patients with type 1 diabetes (42.6% females, 70 paediatric, 26.2% continuous subcutaneous insulin infusion, 28.7% coefficient of variation [CV]≤36%) in intensive treatment and flash glucose monitoring. Clinical, analytical and glucometric data were evaluated. RESULTS The relationship between the TIR and HbA1c showed a strong negative linear correlation (R=-0.746; R2=0.557; P<.001), modified in those patients with CV≤36% (R=-0.852; R2=0.836) compared to CV>36% (R=-0.703; R2=0.551). A similar correlation was found when evaluating the TIR and the Glucose Management Indicator (R=-0.846; R2=0.715; P<.001); in patients with CV≤36% (R=-0.980; R2=0.960) versus CV>36% (R=-0.837; R2=0.701); P<.001. Both correlations remained stable in the paediatric population (R=-0.724; R2=0.525; P<.001) and adults (R=-0.706; R2=0.498; P<.001) and by type of treatment: multiple doses of insulin (R=-0.747; R2=0.558; P<.001) and continuous subcutaneous insulin infusion (R=-0.711; R2=0.506; P<.001). In a multiple regression analysis evaluating HbA1c as dependent variable, the only parameters that maintained statistical significance were the TIR (β=-0,031; P<.001), CV (β=0.843; P<.05) and TIR-CV interaction (β=-0.017; P<.01). CONCLUSIONS The glycemic variability defined by the CV modifies the relationship between the TIR and HbA1c/Glucose Management Indicator and should be taken into account when individualising TIR targets, regardless of age or the type of treatment used.
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Affiliation(s)
- Gonzalo Díaz-Soto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain.
| | | | - Rebeca Jimenez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
| | - Maria de la O Nieto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
| | - Emilia Gomez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
| | - Beatriz Torres
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
| | - Juan Jose López Gomez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
| | - Daniel de Luis
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición Clínica (IENVa), Universidad de Valladolid, Valladolid, Spain
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Piona C, Marigliano M, Mozzillo E, Rosanio F, Zanfardino A, Iafusco D, Maltoni G, Zucchini S, Piccinno E, Delvecchio M, Maffeis C. Relationships between HbA1c and continuous glucose monitoring metrics of glycaemic control and glucose variability in a large cohort of children and adolescents with type 1 diabetes. Diabetes Res Clin Pract 2021; 177:108933. [PMID: 34216681 DOI: 10.1016/j.diabres.2021.108933] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/31/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
AIMS To evaluate the relationships between HbA1c and Continuous Glucose Monitoring (CGM) metrics in children/adolescents with Type 1 Diabetes (T1D). METHODS HbA1c and real-life CGM data of the 12 weeks preceding its measurement were retrospectively collected from 654 children/adolescents with T1D. The relationships between HbA1c and CGM metrics were assessed by Spearman correlation coefficient. Participants were categorized into groups based on HbA1c and CGM metrics values. ANOVA was run across HbA1c and CGM metrics groups in the entire study population and in subjects stratified by CGM type, insulin therapy, age and puberty. RESULTS HbA1c was positively correlated with mean glucose, SD, %TAR > 180 mg/dL, %TAR > 250 mg/dL, HBGI and negatively with %TIR, %TBR and %time < 54 mg/dL. HbA1c-based groups were significantly associated with these metrics, but for each group their value widely ranged with a substantial overlap between them. HbA1c and HbA1c-based groups were not associated with %CV and LBGI, as well as %CV and LBGI-based groups had not significantly different HbA1c. Comparable results were found analysing subjects according to age, type of CGM, insulin therapy and puberty. CONCLUSIONS The relationships between HbA1c and CGM metrics described in this cohort of paediatric subjects with T1D support the importance of the evaluation of these metrics, in particular %CV and LBGI, independently of HbA1c value.
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Affiliation(s)
- Claudia Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, P.le Stefani, 1, Verona, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, P.le Stefani, 1, Verona, Italy.
| | - Enza Mozzillo
- Regional Center of Pediatric Diabetes, Department of Traslational and Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Francesco Rosanio
- Regional Center of Pediatric Diabetes, Department of Traslational and Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Angela Zanfardino
- Regional Center of Pediatric Diabetology "G.Stoppoloni" - University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Dario Iafusco
- Regional Center of Pediatric Diabetology "G.Stoppoloni" - University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulio Maltoni
- University Hospital of Bologna Sant'Orsola-Malpighi, Paediatric Endocrine Unit, Bologna, Italy
| | - Stefano Zucchini
- University Hospital of Bologna Sant'Orsola-Malpighi, Paediatric Endocrine Unit, Bologna, Italy
| | - Elvira Piccinno
- Metabolic Disorder and Diabetes Unit, "Giovanni XXIII" Children Hospital, Bari, Italy
| | - Maurizio Delvecchio
- Metabolic Disorder and Diabetes Unit, "Giovanni XXIII" Children Hospital, Bari, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, P.le Stefani, 1, Verona, Italy
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Zeugswetter FK, Beer R, Schwendenwein I. Evaluation of fructosamine concentration as an index marker for glycaemic control in diabetic dogs. Vet Rec 2021; 190:e244. [PMID: 33870504 DOI: 10.1002/vetr.244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 02/12/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although fructosamine is a commonly used surrogate marker to assess glycaemic control in diabetic dogs, its diagnostic accuracy has been questioned. The main objective of this study was to evaluate the reliability of fructosamine measurements to diagnose well and poorly controlled diabetes mellitus (DM), using continuous glucose monitoring as a gold standard. METHODS Twenty-four dogs with treated DM and continuous glucose monitoring for mean (±SD) 13.1 (±1.7) days were retrospectively analysed. Two assessment strategies were applied to categorize glycaemic control, and fructosamine concentrations were determined shortly after sensor cessation using a colorimetric assay. RESULTS Correlations of individual fructosamine concentrations with mean glucose as well as percentage of measurements > 15 mmol/L were not significant (p = 0.372, p = 0.129). Fructosamine did not differ between dogs with and without hypoglycaemic episodes (p = 0.64). Receiver operating characteristic analysis for fructosamine to diagnose either good or poor glycaemic control revealed AUC values of 0.71 (p = 0.025) indicating moderate accuracy, and 0.7 (p = 0.135) indicating AUC is non-discriminatory, respectively. The respective positive likelihood ratios for the optimal cutoffs to identify good (<396 μmol/L) and poor control (>449 μmol/L) were three. CONCLUSIONS Fructosamine measurement is an imperfect surrogate marker for classifying glycaemic control in diabetic dogs and can only complement serial glucose measurements.
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Affiliation(s)
- Florian K Zeugswetter
- Clinical Department for Small Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Raphael Beer
- Clinical Department for Small Animals and Horses, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Ilse Schwendenwein
- Department of Pathobiology, Central Laboratory, University of Veterinary Medicine Vienna, Vienna, Austria
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23
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Herane-Vives A, Espinoza S, Sandoval R, Ortega L, Alameda L, Young AH, Arnone D, Hayes A, Benöhr J. A Novel Earwax Method to Measure Acute and Chronic Glucose Levels. Diagnostics (Basel) 2020; 10:E1069. [PMID: 33321856 PMCID: PMC7764152 DOI: 10.3390/diagnostics10121069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 11/16/2022] Open
Abstract
Diabetes is the fourth cause of death globally. To date, there is not a practical, as well as an accurate sample for reflecting chronic glucose levels. We measured earwax glucose in 37 controls. Participants provided standard serum, glycated hemoglobin (HbA1c) and earwax samples at two time-points, one month apart. The specimens measured baseline fasting glucose, a follow-up postprandial glucose level and a between sample chronic glucose, calculated using the average level on the two occasions. The baseline earwax sample was obtained using a clinical method and the follow-up using a novel self-sampling earwax device. The earwax analytic time was significantly faster using the novel device, in comparison to the clinical use of the syringe. Earwax accurately reflected glucose at both assessments with stronger correlations than HbA1c. Follow-up postprandial concentrations were more significant than their respective fasting baseline concentrations, reflecting differences in fasting and postprandial glycemia and more efficient standardization at follow up. Earwax demonstrated to be more predictable than HbA1c in reflecting systemic fasting, postprandial and long-term glucose levels, and to be less influenced by confounders. Earwax glucose measurements were approximately 60% more predictable than HbA1c in reflecting glycemia over a month. The self-sampling device provided a sample that might accurately reflect chronic glycemia.
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Affiliation(s)
- Andrés Herane-Vives
- Institute of Cognitive Neuroscience, Clinical, Educational & Health Psychology Department, Faculty of Brain Disease, University College London, Alexandra House, 17-19 Queen Square, Bloomsbury, London WC1N 3AZ, UK
- Centre for Affective Disorders, Affective Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (A.H.Y.); (D.A.); (A.H.)
| | - Susana Espinoza
- Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Larrondo 1281, 1781421 Coquimbo, Chile; (S.E.); (R.S.); (L.O.)
| | - Rodrigo Sandoval
- Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Larrondo 1281, 1781421 Coquimbo, Chile; (S.E.); (R.S.); (L.O.)
| | - Lorena Ortega
- Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Larrondo 1281, 1781421 Coquimbo, Chile; (S.E.); (R.S.); (L.O.)
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK;
- Instituto de Investigación Sanitaria de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, Departamento de Psiquiatría, Universidad de Sevilla, 41013 Sevilla, Spain
- Service of General Psychiatry, Lausanne University Hospital (CHUV), 1008 Lausanne, Switzerland
| | - Allan H. Young
- Centre for Affective Disorders, Affective Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (A.H.Y.); (D.A.); (A.H.)
| | - Danilo Arnone
- Centre for Affective Disorders, Affective Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (A.H.Y.); (D.A.); (A.H.)
- Department of Psychiatry and Behavioural Science, College of Medicine and Health Sciences, United Arab Emirates University, 5MW2+PW Al Ain, Abu Dhabi, UAE
| | - Alexander Hayes
- Centre for Affective Disorders, Affective Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (A.H.Y.); (D.A.); (A.H.)
| | - Jan Benöhr
- Benöhr Design Creatives, Jollystrasse 5, 81545 München, Germany;
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Schexnayder CD, Agbahiwe S, Emelogu O. Burnt Out? The Phenomenon of Type 2 Diabetes Mellitus in End-Stage Renal Disease. Fed Pract 2020; 37:580-585. [PMID: 33424218 PMCID: PMC7789851 DOI: 10.12788/fp.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In patients with T2DM and ESRD, insulin is the antidiabetic medication of choice with a hemoglobin A1c target of 6 to 8%, using fructosamine levels or other measures for better assessment of glycemic control.
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Affiliation(s)
- Chandler D Schexnayder
- is a Home-Based Primary Care Clinical Pharmacy Specialist, and is a Primary Care Clinical Pharmacy Specialist, both at the Michael E. DeBakey Veteran Affairs Medical Center in Houston, Texas. is a Primary Care Clinical Pharmacy Specialist at the Audie L. Murphy Memorial Veterans' Hospital in San Antonio, Texas
| | - Sylvester Agbahiwe
- is a Home-Based Primary Care Clinical Pharmacy Specialist, and is a Primary Care Clinical Pharmacy Specialist, both at the Michael E. DeBakey Veteran Affairs Medical Center in Houston, Texas. is a Primary Care Clinical Pharmacy Specialist at the Audie L. Murphy Memorial Veterans' Hospital in San Antonio, Texas
| | - Oluchi Emelogu
- is a Home-Based Primary Care Clinical Pharmacy Specialist, and is a Primary Care Clinical Pharmacy Specialist, both at the Michael E. DeBakey Veteran Affairs Medical Center in Houston, Texas. is a Primary Care Clinical Pharmacy Specialist at the Audie L. Murphy Memorial Veterans' Hospital in San Antonio, Texas
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25
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Biphasic human insulin 30 thrice daily, is it reasonable? BMC Res Notes 2020; 13:250. [PMID: 32448382 PMCID: PMC7247174 DOI: 10.1186/s13104-020-05090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/16/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the efficacy and safety of thrice daily Biphasic Human Insulin 30 (BHI 30) versus the traditional twice-daily regimen in type 2 diabetes mellitus (T2DM) patients. It’s a cross over single clinical study. Twenty-two diabetic patients who were already using BHI 30 in twice or thrice daily regimens with or without metformin were included. At the 1st interval; patients continued on their usual insulin regimen as twice or thrice daily injections with adjustment of insulin doses guided by their glucose readings. On the 2nd interval; patients were switched to the other regimen with the same total daily insulin dose redistributed. Results There was a significant decrease in HbA1c level (p < 0.05) at the end of the first 3 months of trial regardless on which regimen the patient started, but there was no significant difference in the mean HbA1c reduction in patients when they were on twice daily insulin injections (1.1 ± 1.3) versus the time they were on thrice daily insulin injections (0.8 ± 1.71), p > 0.05. On the other hand, patients had lower average blood glucose readings (mg/dl) when they were on thrice daily insulin injections (161.4 ± 62.7) compared to twice daily regimen (166.0 ± 69.5), p < 0.05.
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Mechanisms of Antidiabetic Activity of Methanolic Extract of Punica granatum Leaves in Nicotinamide/Streptozotocin-Induced Type 2 Diabetes in Rats. PLANTS 2020; 9:plants9111609. [PMID: 33228177 PMCID: PMC7699557 DOI: 10.3390/plants9111609] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 12/23/2022]
Abstract
The current study aimed to establish the mechanisms of antidiabetic activity of methanolic extract of Punica granatum leaves (MEPGL) in nicotinamide/streptozotocin-induced type 2 diabetes in rats. Phytochemical screening, HPLC analysis, and acute toxicity study of MEPGL were carried out. Various concentrations of MEPGL (100, 200, 400, and 600 mg/kg) were administered orally to diabetic rats for 45 days on a daily basis. The antidiabetic effect of MEPGL was examined by measuring blood glucose, plasma insulin, and glycated hemoglobin (HbA1c) levels, as well as with an oral glucose tolerance test. The antioxidant effect of MEPGL was determined by analyzing hepatic and renal antioxidant markers, namely superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), reduced glutathione (GSH), and lipid peroxidation. The other biochemical markers alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), urea, and creatinine, as well as total cholesterol, triglycerides, and high-density lipoprotein (HDL) were also studied. Type 2 diabetes significantly altered these parameters, while oral administration of the MEPGL significantly ameliorated them. Moreover, the pancreatic histopathological changes were attenuated with MEPGL treatment. In a nutshell, oral MEPGL administration in diabetic rats showed antidiabetic activity due to its antioxidant activity, most probably due to the gallic acid, ellagic acid, and apigenin found in MEPGL.
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Kundury KK, Hathur B. Intervention through Short Messaging System (SMS) and phone call alerts reduced HbA1C levels in ~47% type-2 diabetics-results of a pilot study. PLoS One 2020; 15:e0241830. [PMID: 33201926 PMCID: PMC7671489 DOI: 10.1371/journal.pone.0241830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite extensive research and newer methods of interventions, the incidence and prevalence of diabetes is increasing at an alarming rate. Currently, according to world health organization (WHO) statistics, 422 million individuals are suffering from diabetes worldwide. In India, recent estimates have reported a significant increase in the number of diabetics in the last decade. Poor dietary habits, minimal adherence to treatment regimens, lack of timely education are some of the contributing factors for increasing incidence and huge economic burden; which can be handled by life style behavior modifications backed up by hand holding through continuous education. Prior studies have demonstrated the efficacy of various self-management tools and educational programs in better disease management behaviors among individuals with diabetes. Among various self-management tools, educating the individuals and alerting them using mobile phone calls and short messaging system (SMS) are widely accepted due to (a) the increasing mobile phone users and (b) availability of short messaging systems in local languages in the recent years. Therefore, a pilot study was conducted to determine the benefit of educating patients through phone calls and SMS in the self-management of diabetes. OBJECTIVES The objective of the study is to determine the feasibility and utility of SMS and phone call-based interventions in the management of diabetes by comparing the HbA1c values. METHODOLOGY The study was conducted for a period of 14 months from December 2017 till Feb 2019. Out of 380 individuals initially enrolled into the study, 120 had completed the 14-months period. Diabetes education through SMS and phone calls was provided on regular basis, and HbA1C levels at baseline, 8-months and 14-months quantified. In addition, feedback on patients' satisfaction and utility of the SMS / Phone calls was collected using questionnaires. RESULTS Data from our study demonstrated that after 8-months of intervention through phone calls, a significant increase in the number of individuals with HbA1c in the range of 5.1 to 7.0 was observed (from 27 individuals at base line to 37 individuals after 8-months intervention). Much more significant improvement in the number of individuals with lower HbA1c was observed at 14-months of intervention, indicating the benefit of regular phone call-based system in managing diabetes. A Chi square (χ2) test was performed to examine if the frequencies in the cells varied at baseline and at 8 and 14 months. CONCLUSION Chronic diseases like diabetes needs awareness and education to patients in adopting disease self-management practices. As mobile phone users are increasing in number, providing diabetes management education through mobile phone intervention could be a viable strategy for controlling diabetes.
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Affiliation(s)
- Kanakavalli K. Kundury
- Department of Health System Management Studies, JSS Academy of Higher Education & Research (JSS AHER), Mysore, Karnataka, India
- Special Interest Group in Patient Care Management (SIG-PCM), Mysore, Karnataka, India
| | - Basavanagowdappa Hathur
- Department of Medicine, JSS Medical College & Hospital, Mysore, Karnataka, India
- JSS Medical College, Mysore, Karnataka, India
- Special Interest Group in Patient Care Management (SIG-PCM), JSS AHER, Mysore, Karnataka, India
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Biohorology and biomarkers of aging: Current state-of-the-art, challenges and opportunities. Ageing Res Rev 2020; 60:101050. [PMID: 32272169 DOI: 10.1016/j.arr.2020.101050] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 02/06/2020] [Accepted: 03/22/2020] [Indexed: 02/08/2023]
Abstract
The aging process results in multiple traceable footprints, which can be quantified and used to estimate an organism's age. Examples of such aging biomarkers include epigenetic changes, telomere attrition, and alterations in gene expression and metabolite concentrations. More than a dozen aging clocks use molecular features to predict an organism's age, each of them utilizing different data types and training procedures. Here, we offer a detailed comparison of existing mouse and human aging clocks, discuss their technological limitations and the underlying machine learning algorithms. We also discuss promising future directions of research in biohorology - the science of measuring the passage of time in living systems. Overall, we expect deep learning, deep neural networks and generative approaches to be the next power tools in this timely and actively developing field.
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Use of Glycated Hemoglobin (A1c) as a Biomarker for Vascular Risk in Type 2 Diabetes: Its Relationship with Matrix Metalloproteinases-2, -9 and the Metabolism of Collagen IV and Elastin. ACTA ACUST UNITED AC 2020; 56:medicina56050231. [PMID: 32403389 PMCID: PMC7279148 DOI: 10.3390/medicina56050231] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/03/2020] [Accepted: 05/05/2020] [Indexed: 01/05/2023]
Abstract
Background and objectives: HbA1c measurements may be useful not only in optimizing glycemic control but also as a tool for managing overall vascular risk in patients with diabetes. In the present study, we investigate the clinical significance of HbA1c as a biomarker for hyperglycemia-induced vascular damages in type 2 diabetes (T2D) based on the levels of matrix metalloproteinases-2, -9 (MMP-2, MMP-9), anti-collagen IV (ACIV), and anti-elastin (AE) antibodies (Abs) IgM, IgG, and IgA, and CIV-derived peptides (CIV-DP) reflecting collagen and elastin turnover in the vascular wall. The aim is to show the relationship of hyperglycemia with changes in the levels of vascular markers and the dynamics of this relationship at different degrees of glycemic control reported by HbA1c levels. Materials and Methods: To monitor elastin and collagen IV metabolism, we measured serum levels of these immunological markers in 59 patients with T2D and 20 healthy control subjects with an ELISA. Results: MMP-2, MMP-9, and the AEAbs IgA levels were significantly higher in diabetic patients than in control subjects, whereas those of the AEAbs IgM, ACIVAbs IgM, and CIV-DP were significantly lower. MMP-9 levels were significantly lower at HbA1c values >7.5%. Conclusions: A set of three tested markers (MMP-2, MMP-9, and AEAbs IgA) showed that vascular damages from preceding long-term hyperglycemia begin to dominate at HbA1c values ≥7.5%, which is the likely cut-point to predict increased vascular risk.
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Wasana KGP, Attanayake AP, Weerarathna TP, Ayoma Perera Wijewardana Jayatilaka K. Demographic Associations of Diabetes Status by Both Fasting Plasma Glucose Concentration and Glycated Hemoglobin in a Community Survey in Galle District, Sri Lanka. J Nutr Metab 2020; 2020:6127432. [PMID: 32322415 PMCID: PMC7166292 DOI: 10.1155/2020/6127432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/10/2020] [Indexed: 11/29/2022] Open
Abstract
Diagnostic tools used in detecting individuals with diabetes mellitus (DM) include fasting plasma glucose (FPG), glycated hemoglobin (HbA1C), and oral glucose tolerance test (OGTT). The present study was aimed to determine the demographic associations of diabetes status by both tests (FPG and HbA1C) in Galle district, Sri Lanka. 147 adults (30-60 years) who are having FPG ≥ 126 mg/dL underwent demographic evaluations and testing for HbA1C. Group 01 (diabetes status diagnosed by both tests) and group 2 (diabetes status diagnosed only by FPG) were compared using independant sample t-test and chi-square test. Logistic regression was used to study the association between the demographic factors and the diabetes status by both tests. Of the 147 study subjects, 38.1% were males, 61.9% were females, and 63.3% had a family history of diabetes among first-degree relatives (FDR). Mean age, body mass index (BMI), waist circumference (WC), FPG, and HbA1C of the participants were 48.4 ± 7.2 years, 25.1 ± 4.0 kg/m2, 88.8 ± 9.0 cm, 139.4 ± 30.1 mg/dL, and 6.4 ± 0.7%, respectively. The prevalence of diabetes based on both tests was 55.1%. There is a significant difference in mean BMI and WC while no significant differences in mean age between groups 01 and 02. No association was seen between gender and diabetes status (X 2(1) = 0.086, p=0.770), while a significant difference was observed between DM among FDR and diabetes status (X 2(1) = 33.215, p < 0.001). Significance of odds of having diabetes by both tests with rising BMI (OR = 1.97, CI 1.15-3.36, p=0.013) and DM among FDR (OR = 7.95, CI 3.54-17.88, p=0.000) was seen. We conclude rising BMI and having DM among FDR are strongly associated with diabetes status diagnosed by both tests of FPG and HbA1C in community screening.
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Oriot P, Hermans MP. "Mind the gap please…": estimated vs. measured A 1c from continuous measurement of interstitial glucose over a 3-month period in patients with type 1 diabetes. Acta Clin Belg 2020; 75:109-115. [PMID: 30596337 DOI: 10.1080/17843286.2018.1561780] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Glycated hemoglobin (A1c) is the measurement of choice to estimate the glycemic exposure over the last 3 months prior to sampling. The Free Style Libre® is a continuous glucose monitoring device which provides an estimated A1c (eA1c) from average interstitial glucose using Nathan's ADAG equation. The objective of this study was to compare eA1c and A1c in type 1 diabetes patients (T1D) over a period of 3 months.Materials and methods: Data were collected from patient charts between July 2016 and October 2017. 3-months recordings with >70% of data available were analyzed. eA1c was recorded at each visit and the corresponding A1c value measured by high performance liquid chromatography in a single reference lab.Results: A total of 344 reports from 170 T1D were studied, 3 categories were identified: eA1c = A1c: 13% of reports. eA1c > A1c: 57% of reports, positive difference (eA1c - A1c) of +0.74 ± 0.5% (P < 0.0001). eA1c < A1c: 30% of reports, negative difference (eA1c - A1c) of -0.5 ± 0.3% (P < 0.0001).Conclusion: eA1c value was generally overestimated compared to measured A1c in this T1D cohort. This lesser concordance may result from differences in measured glucose source and/or frequency to calculate eA1c compared to ADAG, but also from using the reverse equation which is a source of potential bias. Another explanation could be a different rate of hypoglycemia between groups, or an asymmetric distribution of A1c patients' phenotypes with differential hyper- or hypoglycation intrinsic propensity.
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Affiliation(s)
- Philippe Oriot
- Centre Hospitalier de Mouscron, Service de diabétologie et endocrinologie, Mouscron, Belgium
| | - Michel P Hermans
- Cliniques universitaires Saint-Luc, Service d’Endocrinologie et Nutrition, Brussels, Belgium
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Holmbäck U, Forslund A, Grudén S, Alderborn G, Söderhäll A, Hellström PM, Lennernäs H. Effects of a novel combination of orlistat and acarbose on tolerability, appetite, and glucose metabolism in persons with obesity. Obes Sci Pract 2020; 6:313-323. [PMID: 32523721 PMCID: PMC7278902 DOI: 10.1002/osp4.405] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 01/16/2023] Open
Abstract
Objective There is an unmet medical need for a safe and effective weight loss product with minimal systemic side‐effects. In this study, the effect of a novel modified‐release fixed‐dose combination of orlistat and acarbose (MR‐OA) was compared with conventional orlistat (CO) regarding tolerability, appetite and glucose metabolism. Methods Sixty‐seven men with obesity, aged 24 to 60 years with body mass indexes (BMIs) 33 to 40 kg m−2 or BMIs 30 to 32 kg m−2 and waist circumference above 102 cm were included. They were randomized to either three different doses of the test formulation MR‐OA (60 mg orlistat/20 mg acarbose, 90/30 and 120/40) or CO (Xenical, 120 mg orlistat) for a 2‐week study of daily treatment. The participants spent days 1 and 14 at the clinical research centre where they received standardized meals, had blood sampling and filled in questionnaires regarding tolerability and appetite after meals. In days 2 to 13, the participants were at home and continued to fill in the questionnaires daily. Results In the MR‐OA groups, reports of liquid and oily stools as well as faecal incontinence were fewer, whereas reports of gastric distension and flatulence were higher, compared with the CO group. More participants reported decreased hunger in the 90/30 and 120/40 MR‐OA, and postprandial plasma glucose concentration was reduced in all MR‐OA groups compared with CO. Conclusions This study shows that by using a modified‐release dosage form, orlistat and acarbose can be combined without compromising tolerability. Furthermore, MR‐OA shows promising effects regarding reduction of appetite and reduces postprandial glucose. Tolerability is coupled to compliance and thereby efficacy of a treatment; therefore, this novel combination MR‐OA could be an effective approach for weight loss treatment. A follow‐up study in a more diverse population and for a longer duration with weight loss as primary outcome variable is planned.
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Affiliation(s)
- Ulf Holmbäck
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism Uppsala University Uppsala Sweden
| | - Anders Forslund
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | | | | | | | - Per M Hellström
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | - Hans Lennernäs
- Department of Pharmacy Uppsala University Uppsala Sweden
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Li CI, Liu CS, Lin CH, Lin WY, Lee YD, Yang SY, Li TC, Lin CC. Competing risk analysis on visit-to-visit glucose variations and risk of depression: The Taiwan Diabetes Study. DIABETES & METABOLISM 2019; 46:223-229. [PMID: 31472230 DOI: 10.1016/j.diabet.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/09/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
AIM Patients with diabetes have higher rates of depression than does the general population, but diabetes management mainly aims to maintain glucose stability. For this reason, our study assessed the relationship between 1-year variations in fasting plasma glucose (FPG) and risk of depression in Chinese patients with type 2 diabetes (T2D). METHODS This retrospective cohort study was conducted on 32,829 patients aged ≥30 years who were diagnosed with T2D and who participated in the National Diabetes Case Management Program in Taiwan. Their 1-year FPG variation as a predictor was determined by coefficient of variation (CV), whereas depressive events were analyzed by Cox's proportional hazards models. RESULTS During a mean 8.23 years of follow-up, 1041 new cases of depression were diagnosed. When patients were grouped based on quartiles of FPG-CV, incidence rates were 3.23, 3.49, 3.96 and 4.80 per 1000 person-years in the first, second, third and fourth quartile subgroups, respectively. After adjusting for traditional risk factors, baseline fasting glucose and HbA1c levels, and diabetes complications, FPG-CV was independently linked with incident depression. Hazard ratios of depression for FPG-CV in the fourth vs first quartile subgroups was 1.33 (95% CI: 1.11-1.59), respectively. CONCLUSION Patients whose 1-year FPG variations were>42.6% had an increased risk of depression, thus suggesting that FPG variations may be a predictor of depression in patients with T2D. Also, glucose variation during outpatient visits may be an indicator for individualized diabetes management in clinical practice.
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Affiliation(s)
- C-I Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - C-S Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - C-H Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - W-Y Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Y-D Lee
- Department of Psychiatry, Medical College, National Cheng-Kung University, Tainan, Taiwan
| | - S-Y Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - T-C Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - C-C Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
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Petersson J, Åkesson K, Sundberg F, Särnblad S. Translating glycated hemoglobin A1c into time spent in glucose target range: A multicenter study. Pediatr Diabetes 2019; 20:339-344. [PMID: 30652407 DOI: 10.1111/pedi.12817] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/21/2018] [Accepted: 12/17/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Approximately 90% of children and adolescents with type 1 diabetes in Sweden use continuous glucose monitoring (CGM), either as real-time CGM or intermittently scanned CGM to monitor their glucose levels. Time in target range (TIT) is an easily understandable metric for assessing glycemic control. OBJECTIVE The aim of this study was to examine the relation between TIT and hemoglobin A1c (HbA1c). SUBJECTS AND METHODS Subjects were recruited from three diabetes care centers in Sweden. Glucose data were collected for 133 children and adolescents with type 1 diabetes through CGM using Diasend. Subjects with registration time over 80% were included in the analysis. HbA1c was collected from SWEDIABKIDS, the Swedish pediatric diabetes quality registry. TIT was defined as 3.9 to 7.8 mmol/L (70-140 mg/dL) and time in range (TIR) as 3.9 to 10 mmol/L (70-180 mg/dL). RESULTS During the period of 60 days, 105 subjects provided complete data for analysis. Mean age was 12.2 (±3.3) years, mean HbA1c was 53.9 (±8.2) mmol/mol or 7.1% (±0.7%). Mean sensor glucose value was 8.6 (±1.3) mmol/L, mean coefficient of variation was 42.2% (±7.2%), mean TIT was 40.9% (±SD 12.2%), and mean TIR was 60.8% (±13.1%). There was a significant nonlinear relation between TIT during 60 days and HbA1c, R2 = 0.69. CONCLUSION This study suggests a nonlinear relation between time spent in glucose target range and HbA1c. The finding implies that time spent in TIT could be a useful metric in addition to HbA1c to assess glycemic control.
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Affiliation(s)
| | - Karin Åkesson
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Frida Sundberg
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Särnblad
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Pediatrics, University Hospital Örebro, Örebro, Sweden
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TEO SHAUNYM, KANALEY JILLA, GUELFI KYMJ, COOK SUMMERB, HEBERT JEFFREYJ, FORREST MITCHELLRL, FAIRCHILD TIMOTHYJ. Exercise Timing in Type 2 Diabetes Mellitus: A Systematic Review. Med Sci Sports Exerc 2018; 50:2387-2397. [DOI: 10.1249/mss.0000000000001732] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Polyphenol-rich ethyl acetate fraction isolated from Molineria latifolia ameliorates insulin resistance in experimental diabetic rats via IRS1/AKT activation. Biomed Pharmacother 2018; 98:125-133. [DOI: 10.1016/j.biopha.2017.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 11/21/2022] Open
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37
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Curcumin or combined curcuminoids are effective in lowering the fasting blood glucose concentrations of individuals with dysglycemia: Systematic review and meta-analysis of randomized controlled trials. Pharmacol Res 2018; 128:137-144. [DOI: 10.1016/j.phrs.2017.09.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 02/05/2023]
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McMillan KA, Kirk A, Hewitt A, MacRury S, Lennon M. Methods for combining continuously measured glucose and activity data in people with Type 2 diabetes: Challenges and solutions. J Rehabil Assist Technol Eng 2018; 5:2055668318782805. [PMID: 31191946 PMCID: PMC6453028 DOI: 10.1177/2055668318782805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/22/2018] [Indexed: 01/30/2023] Open
Abstract
AIMS To present the novel application of combining continuously measured glucose with continuous accelerometer measured physical activity and sedentary behaviour data and discusses the principles used and challenges faced in combining and analysing these two sets of data in the context of diabetes management. METHODS The background and rationale for exploring glucose, physical activity and sedentary behaviour in people with Type 2 diabetes is presented, the paper outlines the technologies used, the individual data extraction and finally the combined data analysis. A case study approach is used to illustrate the application of the combined data processing and analysis. RESULTS The data analytic principles used could be transferred to different conditions where continuous data sets are being combined to help individuals or health professionals better manage and care for people with long term conditions. CONCLUSIONS Future work should focus on generating validated techniques to visualise combined data sets and explore ways to present data back to the individual in an effective way to support health care management and rehabilitation.
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Affiliation(s)
- Kathryn A McMillan
- Physical Activity for Health Group,
University
of Strathclyde, Glasgow, UK
| | - Alison Kirk
- Physical Activity for Health Group,
University
of Strathclyde, Glasgow, UK
| | - Allan Hewitt
- Physical Activity for Health Group,
University
of Strathclyde, Glasgow, UK
| | - Sandra MacRury
- Highland Diabetes Institute, University
of Highlands and Islands, Inverness, UK
| | - Marilyn Lennon
- Computer and Information Sciences,
University
of Strathclyde, Glasgow, UK
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Griffin TP, Wall D, Browne GA, Dennedy MC, O'Shea PM. Associations between glycaemic control and activation of the renin-angiotensin-aldosterone system in participants with type 2 diabetes mellitus and hypertension. Ann Clin Biochem 2017; 55:373-384. [DOI: 10.1177/0004563217728964] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction Hyperglycaemia increases succinate concentrations and succinate receptor activation in the kidney resulting in renin release. The aim of our study was to determine if there is an association between glycaemic control as evidenced by glycated haemoglobin values and activation of the renin-angiotensin-aldosterone system in patients with type 2 diabetes mellitus and hypertension. Methods A cross-sectional study was conducted at Galway University Hospitals between December 2014 and March 2015. Participants ( n = 66) were identified following interrogation of the electronic database for patients with type 2 diabetes mellitus. Baseline clinical demographics, aldosterone, plasma renin activity, direct renin concentration, urea and electrolytes, glycated haemoglobin, cholesterol, urine sodium and albumin creatinine ratio were recorded. Results There was a significant positive linear correlation between glycated haemoglobin and renin (both plasma renin activity [ P = 0.002] and direct renin concentration [ P = 0.008]) and between serum creatinine and aldosterone measured using both radioimmunoassay ( P = 0.008) and immunochemiluminometric assay ( P = 0.008). A significant negative linear correlation was demonstrated between serum sodium and plasma renin activity ( P = 0.005) and direct renin concentration ( P = 0.015) and between estimated glomerular filtration rate and aldosterone measured using radioimmunoassay ( P = 0.02) and immunochemiluminometric assay ( P = 0.016). A significant negative linear correlation existed between urine sodium and plasma renin activity ( P = 0.04) and aldosterone measured using radioimmunoassay ( P = 0.045). Conclusions There is a direct positive association between glycaemic control and renin. We advocate for renin measurement to be part of the diabetologist's armamentarium to assess, guide and optimize therapeutic strategies in patients with diabetes.
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Affiliation(s)
- TP Griffin
- Centre for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland
| | - D Wall
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - GA Browne
- Discipline of Pharmacology & Therapeutics, Lambe Institute/Translational Research Facility, School of Medicine, National University of Ireland, Galway, Ireland
| | - MC Dennedy
- Centre for Endocrinology, Diabetes and Metabolism, Galway University Hospitals, Galway, Ireland
- Discipline of Pharmacology & Therapeutics, Lambe Institute/Translational Research Facility, School of Medicine, National University of Ireland, Galway, Ireland
| | - PM O'Shea
- Department of Clinical Biochemistry, Galway University Hospitals, Galway, Ireland
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Roth CL, Elfers C, Hampe CS. Assessment of disturbed glucose metabolism and surrogate measures of insulin sensitivity in obese children and adolescents. Nutr Diabetes 2017; 7:301. [PMID: 29242622 PMCID: PMC5865547 DOI: 10.1038/s41387-017-0004-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/01/2017] [Accepted: 08/28/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND With the rising prevalence of obesity and type 2 diabetes (T2D) in obese children, it is becoming imperative to detect disturbed glucose metabolism as early as possible in order to prevent T2D development. SUBJECTS/METHODS Cross-sectional study of 92 obese children (median age 11.7 years, 51% female) and 7 lean children (median age 11.4 years, 57% female) who underwent an oral glucose tolerance test (OGTT) in a tertiary pediatric care center. Glucose tolerance was assessed and different indices for β-cell function, insulin sensitivity and insulin secretion were calculated. RESULTS Nineteen obese children were identified with prediabetes (PD, 12 impaired glucose tolerance, 4 increased fasting glucose and 3 combined). Compared with the 73 obese children with normal glucose tolerance (nGT), subjects with PD had higher insulin resistance, but lower insulin sensitivity and β-cell function, although their glycated hemoglobin (HbA1c) levels were comparable. The Whole Body Insulin Sensitivity Index (WBISI) and β-cell function by Insulin Secretion-Sensitivity Index-2 (ISSI-2) strongly correlated with the OGTT glucose area under the curve 0-120 min (r = 0.392, p < 0.0002; r = 0.547, p < 0.0001, respectively). When testing the relation between early insulin response during OGTT by insulinogenic index and insulin sensitivity assessed by WBISI, a hyperbolic relationship between insulin secretion and insulin sensitivity was found. The calculated disposition index was lower in subjects with PD vs. nGT (median 459 vs. 792, p = 0.004). We identified the OGTT 30-min/120-min insulin ratio as a simple marker, which is significantly lower in obese children with vs. without PD (median 0.87 vs. 1.29, p = 0.021) and which has a better sensitivity and specificity for detecting PD than HbA1c among obese children. CONCLUSIONS Children with identified PD had changes of several markers for β-cell function, insulin sensitivity and resistance before changes in HbA1c occurred. The lower disposition index indicates that these children have already inadequate β-cell compensation for the degree of insulin resistance.
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Affiliation(s)
- Christian L Roth
- Center for Integrative Brain Research, Seattle Children's Hospital and Research Institute, Endocrine Division, Seattle, WA, 98101, USA.
| | - Clinton Elfers
- Center for Integrative Brain Research, Seattle Children's Hospital and Research Institute, Endocrine Division, Seattle, WA, 98101, USA
| | - Christiane S Hampe
- Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA, 98109, USA
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Osborn CY, van Ginkel JR, Marrero DG, Rodbard D, Huddleston B, Dachis J. One Drop | Mobile on iPhone and Apple Watch: An Evaluation of HbA1c Improvement Associated With Tracking Self-Care. JMIR Mhealth Uhealth 2017; 5:e179. [PMID: 29187344 PMCID: PMC5729227 DOI: 10.2196/mhealth.8781] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/06/2017] [Accepted: 10/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background The One Drop | Mobile app supports manual and passive (via HealthKit and One Drop’s glucose meter) tracking of self-care and glycated hemoglobin A1c (HbA1c). Objective We assessed the HbA1c change of a sample of people with type 1 diabetes (T1D) or type 2 diabetes (T2D) using the One Drop | Mobile app on iPhone and Apple Watch, and tested relationships between self-care tracking with the app and HbA1c change. Methods In June 2017, we identified people with diabetes using the One Drop | Mobile app on iPhone and Apple Watch who entered two HbA1c measurements in the app 60 to 365 days apart. We assessed the relationship between using the app and HbA1c change. Results Users had T1D (n=65) or T2D (n=191), were 22.7% (58/219) female, with diabetes for a mean 8.34 (SD 8.79) years, and tracked a mean 2176.35 (SD 3430.23) self-care activities between HbA1c entries. There was a significant 1.36% or 14.9 mmol/mol HbA1c reduction (F=62.60, P<.001) from the first (8.72%, 71.8 mmol/mol) to second HbA1c (7.36%, 56.9 mmol/mol) measurement. Tracking carbohydrates was independently associated with greater HbA1c improvement (all P<.01). Conclusions Using One Drop | Mobile on iPhone and Apple Watch may favorably impact glycemic control.
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Affiliation(s)
| | | | - David G Marrero
- The University of Arizona Health Sciences, Tucson, AZ, United States
| | - David Rodbard
- Biomedical Informatics Consultants LLC, Potomac, MD, United States
| | | | - Jeff Dachis
- Informed Data Systems Inc, New York, NY, United States
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Chen X, Su T, Chen Y, He Y, Liu Y, Xu Y, Wei Y, Li J, He R. d-Ribose as a Contributor to Glycated Haemoglobin. EBioMedicine 2017; 25:143-153. [PMID: 29033370 PMCID: PMC5704047 DOI: 10.1016/j.ebiom.2017.10.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
Abstract
Glycated haemoglobin (HbA1c) is the most important marker of hyperglycaemia in diabetes mellitus. We show that d-ribose reacts with haemoglobin, thus yielding HbA1c. Using mass spectrometry, we detected glycation of haemoglobin with d-ribose produces 10 carboxylmethyllysines (CMLs). The first-order rate constant of fructosamine formation for d-ribose was approximately 60 times higher than that for d-glucose at the initial stage. Zucker Diabetic Fatty (ZDF) rat, a common model for type 2 diabetes mellitus (T2DM), had high levels of d-ribose and HbA1c, accompanied by a decrease of transketolase (TK) in the liver. The administration of benfotiamine, an activator of TK, significantly decreased d-ribose followed by a decline in HbA1c. In clinical investigation, T2DM patients with high HbA1c had a high level of urine d-ribose, though the level of their urine d-glucose was low. That is, d-ribose contributes to HbA1c, which prompts future studies to further explore whether d-ribose plays a role in the pathophysiological mechanism of T2DM.
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Affiliation(s)
- Xixi Chen
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Tao Su
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Yao Chen
- Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Yingge He
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Ying Liu
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Yong Xu
- Southwest Medical University, Luzhou, Sichuan 646000, China
| | - Yan Wei
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China; CAS Key Laboratory of Mental Health, Institute of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China.
| | - Juan Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Rongqiao He
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, University of Chinese Academy of Sciences, Beijing 100101, China; CAS Key Laboratory of Mental Health, Institute of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China; Alzheimer's Disease Center, Beijing Institute for Brain Disorders, Capital Medical University, Beijing 100069, China.
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Osborn CY, van Ginkel JR, Rodbard D, Heyman M, Marrero DG, Huddleston B, Dachis J. One Drop | Mobile: An Evaluation of Hemoglobin A1c Improvement Linked to App Engagement. JMIR Diabetes 2017; 2:e21. [PMID: 30291059 PMCID: PMC6238886 DOI: 10.2196/diabetes.8039] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/24/2017] [Accepted: 08/04/2017] [Indexed: 12/20/2022] Open
Abstract
Background Three recent reviews evaluated 19 studies testing the hemoglobin A1c (HbA1c) benefit of 16 diabetes apps, including 5 publicly available apps. Most studies relied on small samples and did not link app engagement with outcomes. Objective This study assessed both HbA1c change in a large sample of people using the One Drop | Mobile app and associations between app engagement and changes in HbA1c. Methods The One Drop | Mobile app for iOS and Android is designed to manually and passively (via Apple HealthKit, Google Fit, and the One Drop | Chrome blood glucose meter) store, track, and share data. Users can schedule medication reminders, view statistics, set goals, track health outcomes, and get data-driven insights. In June 2017, we queried data on people with diabetes using the app who had entered at least 2 HbA1c values in the app >60 and ≤365 days apart. Multiple imputation corrected for missing data. Unadjusted and adjusted mixed effects repeated measures models tested mean HbA1c change by time, diabetes type, and their interaction. Multiple regression models assessed relationships between using the app to track food, activity, blood glucose, and medications and HbA1c change. Results The sample (N=1288) included people with type 1 diabetes (T1D) (n=367) or type 2 diabetes (T2D) (n=921) who were 35% female, diagnosed with diabetes for a mean 9.4 (SD 9.9) years, and tracked an average 1646.1 (SD 3621.9) self-care activities in One Drop | Mobile between their first (mean 8.14% [SD 2.06%]) and second HbA1c entry (mean 6.98% [SD 1.1%]). HbA1c values were significantly associated with user-entered average blood glucose 90 days before the second HbA1c entry (rho=.73 to .75, P<.001). HbA1c decreased by an absolute 1.07% (unadjusted and adjusted F=292.03, P<.001) from first to second HbA1c entry. There was a significant interaction between diabetes type and HbA1c. Both groups significantly improved, but users with T2D had a greater HbA1c decrease over time than users with T1D (F=10.54, P<.001). For users with T2D (n=921), HbA1c decreased by an absolute 1.27% (F=364.50, P<.001) from first to second HbA1c entry. Finally, using One Drop | Mobile to record food was associated with greater HbA1c reductions even after adjusting for covariates and after also adjusting for insulin use for users with T2D (all P<.05). Conclusions People with T1D and T2D reported a 1.07% to 1.27% absolute reduction in HbA1c during a median 4 months of using the One Drop | Mobile app. Using the app to track self-care was associated with improved HbA1c. More research is needed on the health benefits of publicly available diabetes apps, particularly studies associating app engagement with short- and long-term effects.
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Affiliation(s)
| | | | - David Rodbard
- Biomedical Informatics Consultants LLC, Potomac, MD, United States
| | - Mark Heyman
- Informed Data Systems, Inc, New York, NY, United States.,University of California, San Diego, San Diego, CA, United States
| | - David G Marrero
- The University of Arizona Health Sciences, Tucson, AZ, United States
| | | | - Jeff Dachis
- Informed Data Systems, Inc, New York, NY, United States
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44
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Villa-Manríquez JF, Castro-Ramos J, Gutiérrez-Delgado F, Lopéz-Pacheco MA, Villanueva-Luna AE. Raman spectroscopy and PCA-SVM as a non-invasive diagnostic tool to identify and classify qualitatively glycated hemoglobin levels in vivo. JOURNAL OF BIOPHOTONICS 2017; 10:1074-1079. [PMID: 28009134 DOI: 10.1002/jbio.201600169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 06/06/2023]
Abstract
In this study we identify and classify high and low levels of glycated hemoglobin (HbA1c) in healthy volunteers (HV) and diabetic patients (DP). Overall, 86 subjects were evaluated. The Raman spectrum was measured in three anatomical regions of the body: index fingertip, right ear lobe, and forehead. The measurements were performed to compare the difference between the HV and DP (22 well controlled diabetic patients (WCDP) (HbA1c <6.5%), and 49 not controlled diabetic patients (NCDP) (HbA1c ≥6.5%)). Multivariable methods such as principal components analysis (PCA) combined with support vector machine (SVM) were used to develop effective diagnostic algorithms for classification among these groups. The forehead of HV versus WCDP showed the highest sensitivity (100%) and specificity (100%). Sensitivity (100%) and specificity (60%), were highest in the forehead of WCDP, versus NCDP. In HV versus NCDP, the fingertip had the highest sensitivity (100%) and specificity (80%). The efficacy of the diagnostic algorithm by receiver operating characteristic (ROC) curve was confirmed. Overall, our study demonstrated that the combination of Raman spectroscopy and PCA-SVM are feasible non-invasive diagnostic tool in diabetes to classify qualitatively high and low levels of HbA1c in vivo.
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Affiliation(s)
- J F Villa-Manríquez
- Instituto Nacional de Astrofísica Óptica y Electrónica, apartado postal 51 y 216, Tonantzintla, Puebla, CP 72000, México
| | - J Castro-Ramos
- Instituto Nacional de Astrofísica Óptica y Electrónica, apartado postal 51 y 216, Tonantzintla, Puebla, CP 72000, México
| | - F Gutiérrez-Delgado
- Centro de Estudios y Prevención del Cáncer, Bugambilias 30, Fraccionamiento la Rivera, Juchitan, Oaxaca, CP 70020, México
| | - M A Lopéz-Pacheco
- Instituto Nacional de Astrofísica Óptica y Electrónica, apartado postal 51 y 216, Tonantzintla, Puebla, CP 72000, México
| | - A E Villanueva-Luna
- Universidad Tecnológica de Campeche, Carretera Federal 180 S/N, San Antonio Cárdenas, Carmen, Campeche, CP 24100, México
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Han YD, Kim KR, Park YM, Song SY, Yang YJ, Lee K, Ku Y, Yoon HC. Boronate-functionalized hydrogel as a novel biosensing interface for the glycated hemoglobin A1c (HbA 1c) based on the competitive binding with signaling glycoprotein. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 77:1160-1169. [PMID: 28531992 DOI: 10.1016/j.msec.2017.04.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 01/22/2023]
Abstract
According to recent increases in public healthcare costs associated with diabetes mellitus, the development of new glycemic monitoring techniques based on the biosensing of glycated hemoglobin A1c (HbA1c), a promising long-term glycemic biomarker, has become a major challenge. In the development of HbA1c biosensors for point-of-care applications, the selection of an effective biorecognition layer that provides a high reaction yield and specificity toward HbA1c is regarded as the most significant issue. To address this, we developed a novel HbA1c biosensing interfacial material by the integration of boronate hydrogel with glass fiber membrane. In the present study, a new boronate-functionalized hydrogel was designed and spatio-selectively photopolymerized on a hydrophilic glass fiber membrane by using N-hydroxyethyl acrylamide, 3-(acrylamido)phenylboronic acid, and bis(N,N'-methylene-bis-acrylamide). Using this approach, the boronic acid group, which specifically recognizes the cis-diol residue of glucose on the HbA1c molecule, can be three-dimensionally coated on the surface of the glass fiber network with a high density. Because this network structure of boronate hydrogel-grafted fibers enables capillary-driven fluid control, facile HbA1c biosensing in a lateral flow assay concept could be accomplished. On the proposed HbA1c biosensing interface, various concentrations of HbA1c (5-15%) in blood-originated samples were sensitively measured by a colorimetric assay using horseradish peroxidase, a glycoenzyme can generate chromogenic signal after the competitive binding against HbA1c to the boronic acid residues. Based on the demonstrated advantages of boronate hydrogel-modified membrane including high analytical performance, easy operation, and cost-effectiveness, we expect that the proposed biorecognition interfacial material can be applied not only to point-of-care HbA1c biosensors, but also to the quantitative analysis of other glycoprotein biomarkers.
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Affiliation(s)
- Yong Duk Han
- Department of Molecular Science & Technology, Ajou University, Suwon 443749, Republic of Korea
| | - Ka Ram Kim
- Department of Molecular Science & Technology, Ajou University, Suwon 443749, Republic of Korea
| | - Yoo Min Park
- Department of Molecular Science & Technology, Ajou University, Suwon 443749, Republic of Korea
| | - Seung Yeon Song
- Materials & Production Engineering Research Institute, LG Electronics, Seoul 137724, Republic of Korea
| | - Yong Ju Yang
- Materials & Production Engineering Research Institute, LG Electronics, Seoul 137724, Republic of Korea
| | - Kangsun Lee
- Materials & Production Engineering Research Institute, LG Electronics, Seoul 137724, Republic of Korea
| | - Yunhee Ku
- Materials & Production Engineering Research Institute, LG Electronics, Seoul 137724, Republic of Korea
| | - Hyun C Yoon
- Department of Molecular Science & Technology, Ajou University, Suwon 443749, Republic of Korea.
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Beltran Del Rio M, Tiwari M, Amodu LI, Cagliani J, Rodriguez Rilo HL. Glycated Hemoglobin, Plasma Glucose, and Erythrocyte Aging. J Diabetes Sci Technol 2016; 10:1303-1307. [PMID: 27422013 PMCID: PMC5094338 DOI: 10.1177/1932296816659885] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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 The relationship between HbA1c and blood glucose averages has been characterized many times, yet, a unifying, mechanistic description is still lacking. METHODS We calculated the level of HbA1c from plasma glucose averages based solely on the in vivo rate of hemoglobin glycation, and the different turnover rates for erythrocytes of different ages. These calculations were then compared to the measured change of HbA1c due to changes in mean blood glucose (MBG), to complex models in the literature, and our own experiments. RESULTS Analysis of data on erythrocyte ageing patterns revealed that 2 separate RBC turnover mechanisms seem to be present. We calculated the mean red blood cell (RBC) life span within individuals to lie between 60 and 95 days. Comparison of expected HbA1c levels to data taken from continuous glucose monitors and finger-stick MBG yielded good agreement (r = .87, P < .0001). Experiments on the change with time of HbA1c induced by a change of MBG were in excellent agreement with our calculations (r = .98, P < .0001). CONCLUSIONS RBC turnover seems to be dominated by a constant rate of cell loss, and a mechanism that targets cells of a specific age. Average RBC life span is 80 ± 10.9 days. Of HbA1c change toward treatment goal value, 50% is reached in about 30 days. Many factors contribute to the ratio of glycated hemoglobin, yet we can make accurate estimations considering only the in vivo glycation constant, MBG, and the age distribution of erythrocytes.
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Affiliation(s)
- Manuel Beltran Del Rio
- Pancreas Disease Center, Department of Surgery, Northwell Health System, Manhasset, NY, USA
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Mukesh Tiwari
- Pancreas Disease Center, Department of Surgery, Northwell Health System, Manhasset, NY, USA
| | - Leo I Amodu
- Pancreas Disease Center, Department of Surgery, Northwell Health System, Manhasset, NY, USA
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Zhao JV, Xu L, Lin SL, Schooling CM. Spironolactone and glucose metabolism, a systematic review and meta-analysis of randomized controlled trials. ACTA ACUST UNITED AC 2016; 10:671-82. [DOI: 10.1016/j.jash.2016.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/25/2016] [Accepted: 05/28/2016] [Indexed: 01/04/2023]
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48
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Kim HJ, Kim YG, Park JS, Ahn YH, Ha KH, Kim DJ. Association between blood glucose level derived using the oral glucose tolerance test and glycated hemoglobin level. Korean J Intern Med 2016; 31:535-42. [PMID: 26898598 PMCID: PMC4855099 DOI: 10.3904/kjim.2015.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/AIMS Glycated hemoglobin (HbA1c) is widely used as a marker of glycemic control. Translation of the HbA1c level to an average blood glucose level is useful because the latter figure is easily understood by patients. We studied the association between blood glucose levels revealed by the oral glucose tolerance test (OGTT) and HbA1c levels in a Korean population. METHODS A total of 1,000 subjects aged 30 to 64 years from the Cardiovascular and Metabolic Diseases Etiology Research Center cohort were included. Fasting glucose levels, post-load glucose levels at 30, 60, and 120 minutes into the OGTT, and HbA1c levels were measured. RESULTS Linear regression of HbA1c with mean blood glucose levels derived using the OGTT revealed a significant correlation between these measures (predicted mean glucose [mg/dL] = 49.4 × HbA1c [%] - 149.6; R (2) = 0.54, p < 0.001). Our linear regression equation was quite different from that of the Alc-Derived Average Glucose (ADAG) study and Diabetes Control and Complications Trial (DCCT) cohort. CONCLUSIONS Discrepancies between our results and those of the ADAG study and DCCT cohort may be attributable to differences in the test methods used and the extent of insulin secretion. More studies are needed to evaluate the association between HbA1c and self monitoring blood glucose levels.
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Affiliation(s)
- Hyoung Joo Kim
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Young Geon Kim
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jin Soo Park
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Young Hwan Ahn
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Kyoung Hwa Ha
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Department of Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
- Department of Cardiovascular and Metabolic Disease Etiology Research Center, Ajou University School of Medicine, Suwon, Korea
- Correspondence to Dae Jung Kim, M.D. Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-5128 Fax: +82-31-219-4497 E-mail:
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Davydov DM, Nurbekov MK. Central and peripheral pathogenetic forms of type 2 diabetes: a proof-of-concept study. Endocr Connect 2016; 5:55-64. [PMID: 26846149 PMCID: PMC8450667 DOI: 10.1530/ec-16-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/04/2016] [Indexed: 12/15/2022]
Abstract
HYPOTHESIS Previous studies provide evidence that glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) should not be considered as interchangeable alternatives in the diagnosis of the same type 2 diabetes, but as indicators of its different pathogenetic subtypes. This study was conducted to determine whether a particularly high amount of glucose in either HbA1c form or in fasting plasma would be found in diabetic patients genetically predisposed for either intensive cognitive or intensive muscle metabolic activity, respectively. METHODS HbA1c and FPG levels, polymorphisms of genes indicating the predisposition to different cognitive activity (the dopamine D2 receptor (DRD2/ANKK1)), muscle activity (peroxisome proliferator-activated receptor gamma, coactivator 1 alpha (PGC1A(PPARGC1A))), and vascular regulation of general metabolic activity (the angiotensin 1 converting enzyme (ACE)) were assessed in diabetic patients and nondiabetic controls. RESULTS DRD2/ANKK1 polymorphism that affects baseline central arousal determined HbA1c variations uncorrelated with FPG in total and clinical groups. The mutation of PGC1A mainly affecting peripheral glucose metabolism had an effect on FPG correlated or uncorrelated with HbA1c depending on the effect assessment in the total sample or in the nondiabetic group, respectively. ACE insertion/deletion (I/D) gene polymorphism was associated with both HbA1c and FPG fluctuations, but only in diabetic patients. CONCLUSION The findings provide evidence that the HbA1c and FPG may predict the risks for different subtypes of type 2 diabetes associated with either brain or muscle metabolic activity in genetically vulnerable people.
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Affiliation(s)
- Dmitry M Davydov
- Laboratory of NeuroimmunopathologyInstitute of General Pathology and Pathophysiology, Russian Academy of Medical Sciences, Moscow, Russia
| | - Malik K Nurbekov
- Laboratory of SociogenomicsMoscow State Pedagogical University, Moscow, Russia
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Ayyappan S, Philips S, Kumar CK, Vaithiyanandane V, Sasikala C. Serum fructosamine a better indicator than glycated hemoglobin for monitoring gestational diabetes mellitus. J Pharm Bioallied Sci 2015; 7:S32-4. [PMID: 26015742 PMCID: PMC4439702 DOI: 10.4103/0975-7406.155786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 10/31/2014] [Accepted: 11/09/2014] [Indexed: 02/04/2023] Open
Abstract
Gestational Diabetes mellitus is the condition of glucose intolerance that begins during pregnancy which is associated with both fetal and maternal complications. The measurement of serum fructosamine and glycated hemoglobin in normal and diabetic pregnancy used to investigate the influence of maternal and gestational age on concentrations of glycated proteins in serum and used to evaluate the patient's treatment. This study was done to measure the level of serum fructosamine and Glycated hemoglobin (HbA1c) in Gestational Diabetes mellitus (GDM) patients and to compare with pregnant women without diabetes and healthy non-pregnant adults, to determine the pattern of change in serum fructosamine, influence of serum fructosamine and HbA1c values and to evaluate the efficacy of patient's treatment. In this study the level of fructosamine was positively correlated to HbA1c during 2nd trimesters of gestational period, implying that the level of fructosamine can be used to screen Gestational diabetes mellitus. Correlation of glycated hemoglobin values with serum fructosamine measurements in the accurate determination of glycaemic control provides confirmation of the utility of fructosamine measurement.
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Affiliation(s)
- S Ayyappan
- Department of Biochemistry, Vivekanandha Dental College for Women, Tirchengodu, Namakkal, Tamil Nadu, India
| | - Sachu Philips
- Department of Biochemistry, Vivekanandha Dental College for Women, Tirchengodu, Namakkal, Tamil Nadu, India
| | - C Kishore Kumar
- Department of Physiology, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, Affiliated to Bharath University, Chennai, Tamil Nadu, India
| | - V Vaithiyanandane
- Department of Physiology, Vivekanandha Dental College for Women, Tirchengodu, Namakkal, Tamil Nadu, India
| | - C Sasikala
- Department of Pharmacology, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, Affiliated to Bharath University, Chennai, Tamil Nadu, India
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