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Bashir A, Flatt AJ, Richell G, Shaw JAM. A single-site feasibility randomised controlled trial comparing 'my hypo compass' short pyscho-educational intervention with standard care alone in individuals with type 1 diabetes and impaired awareness of hypoglycaemia. Diabet Med 2024:e15389. [PMID: 38927008 DOI: 10.1111/dme.15389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/26/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
AIMS The HypoCOMPaSS multi-centre trial achieved improvement in hypoglycaemia awareness and 20-fold reduction in severe hypoglycaemia (SH) in a cohort with long-standing type 1 diabetes (T1D). All participants received 'my hypo compass' (MHC) brief structured psycho-educational intervention in addition to optimisation of insulin delivery/glucose monitoring. In this 24-week, prospective, single-centre feasibility RCT, we piloted MHC as a sole intervention in comparison to standard clinical care alone (CON). METHODS Participants with T1D and impaired hypoglycaemia awareness (IAH) (Clarke score ≥4) were recruited. MHC comprised a group/individual 1-2 h face-to-face session followed by a telephone call and second face-to-face session at 4 weeks. Outcome measures at 24 weeks were compared with baseline. RESULTS Fifty-two individuals provided consent for screening with 39 fulfilling eligibility criteria. Fifteen withdrew before any study intervention. Twenty-four adults with (mean ± SD) T1D duration 41.0 ± 15.1 years commenced/completed the study (100% visit attendance); 12 randomised to MHC and 12 to CON. All had IAH at baseline and at 24 weeks. Annualised SH rate following MHC was 3.8 ± 19.0 (24 weeks) versus 12.6 ± 3.5 (Baseline) and in CON group 2.0 ± 19.0 (24 weeks) versus 4.6 ± 11.5 (Baseline). 'Immediate Action' for and 'Worry' about hyperglycaemia measured by the Hyperglycaemia Avoidance Scale appeared lower following MHC. Participants attended all study visits and reflected positively on the MHC intervention. CONCLUSIONS Feasibility of MHC implementation without additional intervention has been demonstrated. MHC education was associated with positive changes in attitudes and behaviours with the potential to reduce SH risk. MHC provides a validated, simple, well-received programme to fulfil the educational component within RCTs targeting problematic hypoglycaemia and as part of holistic clinical care.
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Affiliation(s)
- Ayat Bashir
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Diabetes Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anneliese J Flatt
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gez Richell
- Newcastle Diabetes Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - James A M Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Diabetes Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Dei Cas A, Aldigeri R, Bellei G, Raffaeli D, Di Bartolo P, Sforza A, Marchesini G, Ciardullo AV, Manicardi V, Bianco M, Monesi M, Vacirca A, Cimicchi MC, Sordillo PA, Altini M, Fantuzzi F, Bonadonna RC. Effectiveness of the flash glucose monitoring system in preventing severe hypoglycemic episodes and in improving glucose metrics and quality of life in subjects with type 1 diabetes at high risk of acute diabetes complications. Acta Diabetol 2024:10.1007/s00592-024-02298-x. [PMID: 38833007 DOI: 10.1007/s00592-024-02298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/21/2024] [Indexed: 06/06/2024]
Abstract
AIMS To assess the effectiveness of the intermittent-scanned continuous glucose monitoring (isCGM) system in preventing severe hypoglycemic episodes and in improving glucose parameters and quality of life. METHODS Four hundred T1D individuals were enrolled in a prospective real-word study with an intermittently scanned continuous glucose monitoring device during the 12-months follow-up. The primary endpoint was the incidence of severe hypoglycemic events. RESULTS 82% of subjects were naïve to the use of the device (group A) and 18% were already wearing the system (group B). The cumulative incidence of severe hypoglycemia (SH) at 12 months was 12.06 per 100 person-year (95% CI: 8.35-16.85) in group A and 10.14 (95% CI: 4.08-20.90) in group B without inter-group differences. In group A there was a significant decrease in SH at 12 months compared to 3 months period (p = 0.005). Time in glucose range significantly increased in both groups accompanied with a significant decrease in glucose variability. HbA1c showed a progressive significant time-dependent decrease in group A. The use of the device significantly improved the perceived quality of life. CONCLUSION This study confirmed the effectiveness of the isCGM in reducing hypoglycemic risk without glucose deterioration, with potential benefits on adverse outcomes in T1D individuals. TRIAL REGISTRATION ClinicalTrials.gov registration no. NCT04060732.
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Affiliation(s)
- Alessandra Dei Cas
- Department of Medicine and Surgery, Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy.
- Department of Medicine and Surgery, Università di Parma, Parma, Italy.
| | | | - Giulia Bellei
- Department of Medicine and Surgery, Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Davide Raffaeli
- Department of Medicine and Surgery, Division of Nutritional and Metabolic Sciences, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Paolo Di Bartolo
- Diabetes Unit, Azienda Unità Sanitaria Locale (AUSL) Romagna, Ravenna, Italy
| | | | | | | | - Valeria Manicardi
- Diabetes Clinic, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Bianco
- Azienda Unità Sanitaria Locale (AUSL) Piacenza, Piacenza, Italy
| | - Marcello Monesi
- Primary Care Department, Diabetes Unit, Ferrara '''Sant'Anna" Hospital, Ferrara, Italy
| | - Anna Vacirca
- Azienda Unità Sanitaria Locale (AUSL) Imola, Imola, Italy
| | | | - Paola Anna Sordillo
- Diabetes Unit, Azienda Unità Sanitaria Locale (AUSL) Romagna, Ravenna, Italy
| | - Mattia Altini
- Hospital Care Sector Manager, Direzione Generale Cura della Persona, Salute e Welfare, Bologna, Italy
| | - Federica Fantuzzi
- Department of Medicine and Surgery, Università di Parma, Parma, Italy
| | - Riccardo C Bonadonna
- Department of Medicine and Surgery, Università di Parma, Parma, Italy
- Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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James DE, Shen T, Geiser JS, Garhyan P, Chigutsa E. Population pharmacokinetics and pharmacodynamics of nasal glucagon in patients with type 1 or 2 diabetes. CPT Pharmacometrics Syst Pharmacol 2024. [PMID: 38736200 DOI: 10.1002/psp4.13153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
The objective was to characterize the pharmacokinetics (PK) and pharmacodynamics (PD) of glucagon after injectable or nasal administration and confirm the appropriate therapeutic dose of nasal glucagon (NG) for adult patients. Six clinical studies with PK and five clinical studies with PD (glucose) data were included in the analysis. Doses ranging from 0.5 to 6 mg NG, and 0.5 to 1 mg injectable glucagon were studied. A total of 6284 glucagon and 7130 glucose concentrations from 265 individuals (patients and healthy participants) were available. Population PK/PD modeling was performed using NONMEM. Glucagon exposure and glucose response were simulated for patients administered various doses of NG to confirm the optimal dose. Glucagon PK was well-described with a single compartment disposition with first-order absorption and elimination processes. Bioavailability of NG relative to injectable glucagon was 16%. Exposure-response modeling revealed that lower baseline glucose was associated with higher maximum drug effect. The carry-over effect from prior insulin administration was incorporated into the model through a time-dependent increase in elimination rate of glucose. Simulations showed that more than 99% of hypoglycemic adult patients would experience treatment success, defined as an increase in blood glucose to ≥70 mg/dL or an increase of ≥20 mg/dL from nadir within 30 min after administration of NG 3 mg. The population PK/PD model adequately described the PK and PD profiles of glucagon after nasal administration. Modeling and simulations confirmed that NG 3 mg is the most appropriate dose for rescue treatment during hypoglycemia emergencies.
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Affiliation(s)
- Douglas E James
- Global PKPD & Pharmacometrics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Tong Shen
- Former employee Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Jeanne S Geiser
- Global PKPD & Pharmacometrics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Parag Garhyan
- Global PKPD & Pharmacometrics, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Emmanuel Chigutsa
- Global PKPD & Pharmacometrics, Eli Lilly and Company, Indianapolis, Indiana, USA
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4
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Valero Garzón D, Forero Saldarriaga S, Robayo Batancourt AM, Puerta Rojas JD, Aranguren Pardo V, Fajardo Latorre LP, Ibañez Pinilla M. Risk factors for hypoglycaemia in non-critical hospitalised diabetic patients. ENDOCRINOL DIAB NUTR 2024; 71:194-201. [PMID: 38852007 DOI: 10.1016/j.endien.2024.02.006] [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: 01/24/2024] [Accepted: 02/22/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE To determine the risk factors for hypoglycaemia in patients with diabetes on general hospital wards based on a systematic review of the literature since 2013 and meta-analysis. METHODS Systematic review of the literature focused on the conceptual and methodological aspects of the PRISMA Declaration. The search carried out in Pub Med, Web of Science, Medline, Scielo, Lilacs, OVID, grey literature and Google Academic focused on risk factors for hypoglycaemia in patients with diabetes on general hospital wards. The CASPe (Critical Appraisal Skills Programme Spanish) tool was applied for quality control. RESULTS From 805 references, 70 potentially eligible articles were identified for review of abstracts and full text. Finally, according to inclusion and exclusion criteria, seven studies with 554,601 patients of Asian, European and North American ethnicity were selected. A meta-analysis performed using the random effects model found an association between the presence of hypoglycaemia and: the use of insulin (OR 2.89 [95% CI: 1.8-4.5]); the use of long-acting insulin (OR 2.27 [95% CI: 1.8-2.8]) or fast-acting insulin (OR 1.4 [95% CI: 1.18-1.85]); nasogastric tube feeding (OR 1.75 [95% CI: 1.33-2.3]); chronic kidney disease (OR 1.65 [95% CI: 1.14-2.38]); congestive heart failure (OR 1.36 [95% CI: 1.10-1.68]); and elevated levels of glycosylated haemoglobin (OR 1.59 [95% CI: 1.32-1.91]). CONCLUSION The factors associated with the risk of hypoglycaemia in non-critically ill hospitalised patients with type 2 diabetes were: use of any insulin; nasogastric tube feeding; elevated glycosylated haemoglobin levels; history of congestive heart failure; and chronic kidney disease.
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5
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Kang DH, Streja E, You AS, Lee Y, Narasaki Y, Torres S, Novoa-Vargas A, Kovesdy CP, Kalantar-Zadeh K, Rhee CM. Hypoglycemia and Mortality Risk in Incident Hemodialysis Patients. J Ren Nutr 2024; 34:200-208. [PMID: 37918644 DOI: 10.1053/j.jrn.2023.09.001] [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: 06/19/2023] [Revised: 08/14/2023] [Accepted: 09/10/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE Hypoglycemia is a frequent occurrence in chronic kidney disease patients due to alterations in glucose and insulin metabolism. However, there are sparse data examining the predictors and clinical implications of hypoglycemia including mortality risk among incident hemodialysis patients. DESIGN AND METHODS Among 58,304 incident hemodialysis patients receiving care from a large national dialysis organization over 2007-2011, we examined clinical characteristics associated with risk of hypoglycemia, defined as a blood glucose concentration <70 mg/dL, in the first year of dialysis using expanded case-mix + laboratory logistic regression models. We then examined the association between hypoglycemia during the first year of dialysis with all-cause mortality using expanded case-mix + laboratory Cox models. RESULTS In the first year of dialysis, hypoglycemia was observed among 16.8% of diabetic and 6.9% of nondiabetic incident hemodialysis patients. In adjusted logistic regression models, clinical characteristics associated with hypoglycemia included younger age, female sex, African-American race, presence of a central venous catheter, lower residual renal function, and longer dialysis session length. In the overall cohort, patients who experienced hypoglycemia had a higher risk of all-cause mortality risk (reference: absence of hypoglycemia): adjusted hazard ratio (95% confidence interval) 1.08 (1.04, 1.13). In stratified analyses, hypoglycemia was also associated with higher mortality risk in the diabetic and nondiabetic subgroups: adjusted hazard ratios (95% confidence interval's) 1.08 (1.04-1.13), and 1.17 (0.94-1.45), respectively. CONCLUSIONS Hypoglycemia was a frequent occurrence among both diabetic and nondiabetic hemodialysis patients and was associated with a higher mortality risk. Further studies are needed to identify approaches that reduce hypoglycemia risk in the hemodialysis population.
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Affiliation(s)
- Duk-Hee Kang
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Division of Nephrology, Department of Internal Medicine, Ewha Womans University School of Medicine, Ewha Medical Research Center, Seoul, South Korea
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| | - Amy S You
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Yongkyu Lee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Nephrology Division, Department of Internal Medicine, NHIS Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Yoko Narasaki
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Silvina Torres
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Alejandra Novoa-Vargas
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California; Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine School of Medicine, Orange, California.
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6
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Ralston JD, Anderson M, Ng J, Bashir A, Ehrlich K, Burns-Hunt D, Cotton M, Hansell L, Hsu C, Hunt H, Karter AJ, Levy SM, Ludman E, Madziwa L, Omura EM, Rogers K, Sevey B, Shaw JAM, Shortreed SM, Singh U, Speight J, Sweeny A, Tschernisch K, Sergei Tschernisch S, Yarborough L. Preventing severe hypoglycemia in adults with type 2 diabetes (PHT2): Design, delivery and evaluation framework for a randomized controlled trial. Contemp Clin Trials 2024; 139:107456. [PMID: 38253252 DOI: 10.1016/j.cct.2024.107456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Severe hypoglycemia is a common and feared complication of medications used to lower blood glucose levels in individuals with diabetes. Psychoeducational interventions can prevent severe hypoglycemia in individuals with type 1 diabetes (T1D). We aim to determine the effectiveness of this approach among adults with type 2 diabetes (T2D) at elevated risk for severe hypoglycemia. METHODS Preventing Hypoglycemia in Type 2 diabetes (PHT2) is a two-arm, parallel, randomized controlled trial. Participants are eligible if they are adults with T2D receiving care at an integrated group practice in Washington state and have experienced one or more episodes of severe hypoglycemia in the prior 12 months or have impaired awareness of hypoglycemia (Gold score ≥ 4). Participants are randomized to proactive nurse care management with or without my hypo compass, an evidence-based, psychoeducational intervention combining group and individual self-management training. For this study, my hypo compass was adapted to be suitable for adults with T2D and from an in-person to a virtual intervention over videoconference and telephone. The primary outcome is any self-reported severe hypoglycemia in the 12 months following the start of the intervention. Secondary outcomes include biochemical measures of hypoglycemia, self-reported hypoglycemia awareness, fear of hypoglycemia, and emergency department visits and hospitalizations for severe hypoglycemia. The study includes a process evaluation to assess implementation fidelity and clarify the causal pathway. CONCLUSION The PHT2 trial will compare the effectiveness of two approaches for reducing severe hypoglycemia in adults with T2D. TRIAL REGISTRATION clinicaltrials.gov, # NCT04863872.
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Affiliation(s)
- James D Ralston
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA; Washington Permanente Medical Group, 125 16th Ave E, Seattle, WA, USA.
| | - Melissa Anderson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Janet Ng
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Ayat Bashir
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Kelly Ehrlich
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Dena Burns-Hunt
- Kaiser Permanente Washington, 2715 Naches Ave SW, Renton, WA 98057, USA
| | - Meredith Cotton
- Department of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, USA
| | - Laurel Hansell
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Clarissa Hsu
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Helen Hunt
- Kaiser Permanente Washington, 2715 Naches Ave SW, Renton, WA 98057, USA
| | - Andrew J Karter
- Department of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, USA
| | - Shaula M Levy
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Evette Ludman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Lawrence Madziwa
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Emily M Omura
- Washington Permanente Medical Group, 125 16th Ave E, Seattle, WA, USA
| | - Kristine Rogers
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Brandie Sevey
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - James A M Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA; University of Washington, Department of Biostatistics, 3980 15th Avenue NE, Box 351617, Seattle, WA 98195, USA
| | - Umesh Singh
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
| | - Jane Speight
- Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Suite G01, 15-31 Pelham Street, Carlton, Victoria, Australia; School of Psychology, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Amber Sweeny
- Department of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, USA
| | | | | | - Laura Yarborough
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101, USA
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Patel H, Paracha A, Singhal A, Wang K, Gostanian N. Clinical Warburg Effect in a Patient With Mantle Cell Lymphoma: A Case Report. Cureus 2024; 16:e58768. [PMID: 38779236 PMCID: PMC11111258 DOI: 10.7759/cureus.58768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
The clinical Warburg effect is a rare occurrence in cancer biology where tumor cells primarily utilize glycolysis for energy production, leading to significant hypoglycemia and lactate formation. This presentation is associated with a poor prognosis for the patient. In this context, we describe the case of a 53-year-old woman with stage IV mantle cell lymphoma who developed the clinical Warburg effect with solely arrhythmia and without neurological symptoms. She received prompt treatment for glucose stabilization and underwent inpatient chemotherapy. This case underscores the importance of early intervention to reduce tumor burden and highlights the effectiveness of hemodialysis in stabilizing metabolic acidosis. Further investigation into this approach is warranted.
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Affiliation(s)
- Himanshu Patel
- Internal Medicine, Northwell, New Hyde Park, USA
- Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | | | - Adit Singhal
- Internal Medicine, Northwell, New Hyde Park, USA
| | - Kevin Wang
- Hematology and Oncology, Northwell, New Hyde Park, USA
| | - Nouneh Gostanian
- Hematology and Oncology, Northwell, New Hyde Park, USA
- Hematology and Oncology, Northwell Health Cancer Institute, Lake Success, USA
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Maritsch M, Föll S, Lehmann V, Styger N, Bérubé C, Kraus M, Feuerriegel S, Kowatsch T, Züger T, Fleisch E, Wortmann F, Stettler C. Smartwatches for non-invasive hypoglycaemia detection during cognitive and psychomotor stress. Diabetes Obes Metab 2024; 26:1133-1136. [PMID: 38086545 DOI: 10.1111/dom.15402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 02/06/2024]
Affiliation(s)
- Martin Maritsch
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Simon Föll
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Vera Lehmann
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Naïma Styger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Caterina Bérubé
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
| | - Mathias Kraus
- School of Business, Economics and Society, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany
| | - Stefan Feuerriegel
- Institute of AI in Management, LMU Munich, Munich, Germany
- Munich Center for Machine Learning (MCML), Munich, Germany
| | - Tobias Kowatsch
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St Gallen, St Gallen, Switzerland
| | - Thomas Züger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern, University Hospital, University of Bern, Bern, Switzerland
- Department of Endocrinology and Metabolic Diseases, Kantonsspital Olten, Olten, Switzerland
| | - Elgar Fleisch
- Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
- Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Felix Wortmann
- Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Christoph Stettler
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern, University Hospital, University of Bern, Bern, Switzerland
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9
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Shah VN, Al-Karadsheh A, Barnes C, Mandry J, Nakhle S, Wernicke-Panten K, Kramer D, Schmider W, Pierre S, Teichert L, Rotthaeuser B, Mukherjee B, Bailey TS. Safety and Efficacy of Switching SAR341402 Insulin Aspart and Originator Insulin Aspart vs Continuous Use of Originator Insulin Aspart in Adults With Type 1 Diabetes: The GEMELLI X Trial. J Diabetes Sci Technol 2024:19322968241232709. [PMID: 38420944 DOI: 10.1177/19322968241232709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND SAR341402 insulin aspart (SAR-Asp) is a rapid-acting insulin analog developed as an interchangeable biosimilar to the marketed insulin aspart reference product (NovoLog; NN-Asp). GEMELLI X was a randomized controlled trial to assess outcomes with a biosimilar in line with the US Food and Drug Administration requirements for designation as an interchangeable biosimilar. This report assessed whether multiple switches between SAR-Asp and NN-Asp lead to equivalent safety and efficacy compared with continuous use of NN-Asp in adults with type 1 diabetes (T1D) treated with multiple daily injections, using once-daily insulin glargine U100 (Lantus) as the basal insulin. METHODS This open-label randomized (1:1), parallel-group, phase 3 trial compared four × four weeks of alternating use of individually titrated SAR-Asp and NN-Asp (NN-Asp for first four weeks, SAR-Asp in last four weeks; switching group) vs 16 weeks of continuous use of NN-Asp (nonswitching group). End points included pharmacokinetics, immunogenicity, adverse events, hypoglycemia, insulin dose, and change in efficacy parameters. RESULTS Of the 210 patients randomized, 200 (95.5%) completed the trial. Patients assigned to switching group (n = 104) and nonswitching group (n = 106) showed similar safety and tolerability, including anti-insulin aspart antibody responses, adverse events, and hypoglycemia. At week 16, there was no relevant difference between switching vs nonswitching groups in the change from baseline in glycated hemoglobin (least square [LS] mean difference = 0.05% [95% confidence interval [CI] = -0.13, 0.22]; 0.50 mmol/mol [-1.40, 2.39]), fasting plasma glucose (LS mean difference = 0.23 mmol/L [95% CI = -1.08, 1.53]; 4.12 mg/dL [-19.38, 27.62]), and changes in insulin dosages. CONCLUSIONS Alternating doses of SAR-Asp and NN-Asp compared with continuous use of NN-Asp showed similar safety, immunogenicity, and clinical efficacy in adults with T1D. This study supports interchangeability between SAR-Asp and NN-Asp in T1D management.
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Affiliation(s)
- Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of Endocrinology and Metabolism and Center for Diabetes and Metabolic Diseases, Indiana University, Indianapolis, IN, USA
| | | | - Cathy Barnes
- Suncoast Clinical Research, New Port Richey, FL, USA
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Zuniga-Kennedy M, Wang OH, Fonseca LM, Cleveland MJ, Bulger JD, Grinspoon E, Hansen D, Hawks ZW, Jung L, Singh S, Sliwinski M, Verdejo A, Miller KM, Weinstock RS, Germine L, Chaytor N. Nocturnal hypoglycemia is associated with next day cognitive performance in adults with type 1 diabetes: Pilot data from the GluCog study. Clin Neuropsychol 2024:1-20. [PMID: 38380810 DOI: 10.1080/13854046.2024.2315749] [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: 06/11/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE Individuals with type 1 diabetes (T1D) have increased risk for cognitive dysfunction and high rates of sleep disturbance. Despite associations between glycemia and cognitive performance using cross-sectional and experimental methods few studies have evaluated this relationship in a naturalistic setting, or the impact of nocturnal versus daytime hypoglycemia. Ecological Momentary Assessment (EMA) may provide insight into the dynamic associations between cognition, affective, and physiological states. The current study couples EMA data with continuous glucose monitoring (CGM) to examine the within-person impact of nocturnal glycemia on next day cognitive performance in adults with T1D. Due to high rates of sleep disturbance and emotional distress in people with T1D, the potential impacts of sleep characteristics and negative affect were also evaluated. METHODS This pilot study utilized EMA in 18 adults with T1D to examine the impact of glycemic excursions, measured using CGM, on cognitive performance, measured via mobile cognitive assessment using the TestMyBrain platform. Multilevel modeling was used to test the within-person effects of nocturnal hypoglycemia and hyperglycemia on next day cognition. RESULTS Results indicated that increases in nocturnal hypoglycemia were associated with slower next day processing speed. This association was not significantly attenuated by negative affect, sleepiness, or sleep quality. CONCLUSIONS These results, while preliminary due to small sample size, showcase the power of intensive longitudinal designs using ambulatory cognitive assessment to uncover novel determinants of cognitive fluctuation in real world settings, an approach that may be utilized in other populations. Findings suggest reducing nocturnal hypoglycemia may improve cognition in adults with T1D.
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Affiliation(s)
| | - Olivia H Wang
- Elson S, Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Luciana M Fonseca
- Elson S, Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Old Age Research Group (PROTER), Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Jane D Bulger
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Devon Hansen
- Elson S, Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | | | - Shifali Singh
- Harvard Medical School, McLean Hospital, Belmont, MA, USA
| | - Martin Sliwinski
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
| | | | | | - Ruth S Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Naomi Chaytor
- Elson S, Floyd College of Medicine, Washington State University, Spokane, WA, USA
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11
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Marx N, Kolkailah AA, Rosenstock J, Johansen OE, Cooper ME, Alexander JH, Toto RD, Wanner C, Espeland MA, Mattheus M, Schnaidt S, Perkovic V, Gollop ND, McGuire DK. Hypoglycemia and Cardiovascular Outcomes in the CARMELINA and CAROLINA Trials of Linagliptin: A Secondary Analysis of Randomized Clinical Trials. JAMA Cardiol 2024; 9:134-143. [PMID: 38170502 PMCID: PMC10765314 DOI: 10.1001/jamacardio.2023.4602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/06/2023] [Indexed: 01/05/2024]
Abstract
Importance Previous studies have reported an association between hypoglycemia and cardiovascular (CV) events in people with type 2 diabetes (T2D), but it is unclear if this association is causal or identifies a high-risk patient phenotype. Objective To evaluate the associations between hypoglycemia and CV outcomes. Design, Setting, and Participants This secondary analysis was a post hoc assessment of the multinational, double-blind CARMELINA (Cardiovascular and Renal Microvascular Outcome Study With Linagliptin; 2013-2016) and CAROLINA (Cardiovascular Outcome Trial of Linagliptin vs Glimepiride in Type 2 Diabetes; 2010-2018) randomized clinical trials of the antihyperglycemic drug, linagliptin, a dipeptidyl peptidase 4 inhibitor. Participants were adults with T2D at high CV risk with or without high kidney risk. By design, participants in the CARMELINA trial had longer duration of T2D and had a higher CV risk than participants in the CAROLINA trial. Data analyses were conducted between June 2021 and June 2023. Intervention Linagliptin or placebo in the CARMELINA trial, and linagliptin or glimepiride in the CAROLINA trial. Main Outcomes and Measures The primary outcome for both trials was CV death, myocardial infarction (MI), or stroke (3-point major adverse CV events [3P-MACE]). For the present analyses, hospitalization for heart failure (HF) was added. Hypoglycemia was defined as plasma glucose less than 54 mg/dL or severe hypoglycemia (episodes requiring the assistance of another person). Associations between the first hypoglycemic episode and subsequent CV events and between nonfatal CV events (MI, stroke, hospitalization for HF) and subsequent hypoglycemic episodes were assessed using multivariable Cox proportional hazards regression models. Sensitivity analyses explored the risk of CV events within 60 days after each hypoglycemic episode. Results In the CARMELINA trial (6979 patients; 4390 males [62.9%]; mean [SD] age, 65.9 [9.1] years), there was an association between hypoglycemia and subsequent 3P-MACE plus hospitalization for HF (hazard ratio [HR], 1.23; 95% CI, 1.04-1.46) as well as between nonfatal CV events and subsequent hypoglycemia (HR, 1.39; 95% CI, 1.06-1.83). In the CAROLINA trial (6033 patients; 3619 males (60.0%); mean [SD] age, 64.0 [9.5] years), there was no association between hypoglycemia and subsequent 3P-MACE plus hospitalization for HF (HR, 1.00; 95% CI, 0.76-1.32) and between nonfatal CV events and subsequent hypoglycemia (HR, 1.44; 95% CI, 0.96-2.16). In analyses of CV events occurring within 60 days after hypoglycemia, there was either no association or too few events to analyze. Conclusions and Relevance This study found bidirectional associations between hypoglycemia and CV outcomes in the CARMELINA trial but no associations in either direction in the CAROLINA trial, challenging the notion that hypoglycemia causes adverse CV events. The findings from the CARMELINA trial suggest that both hypoglycemia and CV events more likely identify patients at high risk for both. Trial Registration ClinicalTrials.gov Identifier: NCT01897532 (CARMELINA) and NCT01243424 (CAROLINA).
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Affiliation(s)
- Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Ahmed A. Kolkailah
- Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas
| | | | - Odd Erik Johansen
- Therapeutic Area Cardiometabolism, Boehringer Ingelheim KS, Asker, Norway
| | - Mark E. Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John H. Alexander
- Duke Clinical Research Institute, Duke Health, Durham, North Carolina
| | - Robert D. Toto
- Department of Internal Medicine, Division of Nephrology, The University of Texas Southwestern Medical Center, Dallas
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Mark A. Espeland
- Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michaela Mattheus
- Biostatistics and Data Sciences, Boehringer Ingelheim Pharma GmbH & Co KG, Ingelheim am Rhein, Germany
| | - Sven Schnaidt
- Biostatistics and Data Sciences, Boehringer Ingelheim Pharma GmbH & Co KG, Biberach an der Riß, Germany
| | - Vlado Perkovic
- Renal and Metabolic Division, The George Institute for Global Health, University of New South Wales Sydney, Newtown, New South Wales, Australia
| | - Nicholas D. Gollop
- Therapeutic Area Cardiometabolism, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Darren K. McGuire
- Division of Cardiology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas
- Parkland Health, Dallas, Texas
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12
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Hashmi HZ, Khowaja A, Moheet A. Experimental pharmacological approaches to reverse impaired awareness of hypoglycemia-a review. Front Pharmacol 2024; 15:1349004. [PMID: 38323079 PMCID: PMC10844401 DOI: 10.3389/fphar.2024.1349004] [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: 12/03/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024] Open
Abstract
The colossal global burden of diabetes management is compounded by the serious complication of hypoglycemia. Protective physiologic hormonal and neurogenic counterregulatory responses to hypoglycemia are essential to preserve glucose homeostasis and avert serious morbidity. With recurrent exposure to hypoglycemic episodes over time, these counterregulatory responses to hypoglycemia can diminish, resulting in an impaired awareness of hypoglycemia (IAH). IAH is characterized by sudden neuroglycopenia rather than preceding cautionary autonomic symptoms. IAH increases the risk of subsequent sudden and severe hypoglycemic episodes in patients with diabetes. The postulated causative mechanisms behind IAH are complex and varied. It is therefore challenging to identify a single effective therapeutic strategy. In this review, we closely examine the efficacy and feasibility of a myriad of pharmaceutical interventions in preventing and treating IAH as described in clinical and preclinical studies. Pharmaceutical agents outlined include N-acetyl cysteine, GABA A receptor blockers, opioid receptor antagonists, AMP activated protein kinase agonists, potassium channel openers, dehydroepiandrosterone, metoclopramide, antiadrenergic agents, antidiabetic agents and glucagon.
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Affiliation(s)
- Hiba Z. Hashmi
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Ameer Khowaja
- Northeast Endocrinology Associates, San Antonio, TX, United States
| | - Amir Moheet
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, MN, United States
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13
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Zhang B, Cheng Z, Chen J, Zhang X, Liu D, Jiang H, Ma G, Wang X, Gan S, Sun J, Jin P, Yi J, Shi B, Ma J, Ye S, Wang G, Ji L, Gu X, Yu T, An P, Deng H, Li H, Li L, Ma Q, Qian L, Yang W. Efficacy and Safety of Mazdutide in Chinese Patients With Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Phase 2 Trial. Diabetes Care 2024; 47:160-168. [PMID: 37943529 PMCID: PMC10733643 DOI: 10.2337/dc23-1287] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE We conducted a randomized, double-blind, placebo-controlled phase 2 trial to evaluate the efficacy and safety of mazdutide, a once-weekly glucagon-like peptide 1 and glucagon receptor dual agonist, in Chinese patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Adults with type 2 diabetes inadequately controlled with diet and exercise alone or with stable metformin (glycated hemoglobin A1c [HbA1c] 7.0-10.5% [53-91 mmol/mol]) were randomly assigned to receive 3 mg mazdutide (n = 51), 4.5 mg mazdutide (n = 49), 6 mg mazdutide (n = 49), 1.5 mg open-label dulaglutide (n = 50), or placebo (n = 51) subcutaneously for 20 weeks. The primary outcome was change in HbA1c from baseline to week 20. RESULTS Mean changes in HbA1c from baseline to week 20 ranged from -1.41% to -1.67% with mazdutide (-1.35% with dulaglutide and 0.03% with placebo; all P < 0.0001 vs. placebo). Mean percent changes in body weight from baseline to week 20 were dose dependent and up to -7.1% with mazdutide (-2.7% with dulaglutide and -1.4% with placebo). At week 20, participants receiving mazdutide were more likely to achieve HbA1c targets of <7.0% (53 mmol/mol) and ≤6.5% (48 mmol/mol) and body weight loss from baseline of ≥5% and ≥10% compared with placebo-treated participants. The most common adverse events with mazdutide included diarrhea (36%), decreased appetite (29%), nausea (23%), vomiting (14%), and hypoglycemia (10% [8% with placebo]). CONCLUSIONS In Chinese patients with type 2 diabetes, mazdutide dosed up to 6 mg was generally safe and demonstrated clinically meaningful HbA1c and body weight reductions.
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Affiliation(s)
- Bo Zhang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing
| | - Zhifeng Cheng
- Department of Endocrinology and Metabolism, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ji Chen
- Innovent Biologics, Inc., Suzhou, China
| | - Xin Zhang
- Department of Endocrinology and Metabolism, Genertec Liaoyou Gem Flower Hospital, Panjin, China
| | - Dexue Liu
- Department of Endocrinology, First Affiliated Hospital of Nanyang Medical College, Nanyang, China
| | - Hongwei Jiang
- Department of Endocrinology, First Affiliated Hospital and Clinical Medicine College, Henan University of Science and Technology, Luoyang, China
| | - Guoqing Ma
- Department of Endocrinology and Metabolism, Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Xiaoyun Wang
- Department of Endocrinology, Cangzhou Hospital of Integrated TCM-WM, Cangzhou, China
| | - Shenglian Gan
- Department of Endocrinology, First People’s Hospital of Changde City, Changde, China
| | - Juan Sun
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ping Jin
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianjun Yi
- Department of Endocrinology, First People’s Hospital of Xiangtan City, Xiangtan, China
| | - Bimin Shi
- Department of Endocrinology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing, China
| | - Shandong Ye
- Department of Endocrinology, Anhui Provincial Hospital, Hefei, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
| | - Xuejiang Gu
- Department of Endocrinology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ting Yu
- Innovent Biologics, Inc., Suzhou, China
| | - Pei An
- Innovent Biologics, Inc., Suzhou, China
| | - Huan Deng
- Innovent Biologics, Inc., Suzhou, China
| | - Haoyu Li
- Innovent Biologics, Inc., Suzhou, China
| | - Li Li
- Innovent Biologics, Inc., Suzhou, China
| | | | - Lei Qian
- Innovent Biologics, Inc., Suzhou, China
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing
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14
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Selvin E, Stanton RC, Gabbay RA. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S111-S125. [PMID: 38078586 PMCID: PMC10725808 DOI: 10.2337/dc24-s006] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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15
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Park J, Ntelis S, Yunasan E, Downton KD, Yip TCF, Munir KM, Haq N. Glucagon-Like Peptide 1 Analogues as Adjunctive Therapy for Patients With Type 1 Diabetes: An Updated Systematic Review and Meta-analysis. J Clin Endocrinol Metab 2023; 109:279-292. [PMID: 37561012 DOI: 10.1210/clinem/dgad471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 08/11/2023]
Abstract
CONTEXT Concomitant obesity is common among patients with type 1 diabetes mellitus (T1DM), yet adjunctive therapy options are scarce. OBJECTIVE We assess the efficacy and adverse outcomes of glucagon-like peptide 1 (GLP-1) analogues when used as adjunctive therapy for T1DM. METHOD PubMed, EMBASE, Cochrane Central, and Scopus databases were searched for randomized controlled trials up to December 2022. Efficacy outcomes were A1c level, body weight, and total daily insulin (TDI) after ≥12 weeks of GLP-1 therapy. We also assessed 12 different adverse outcomes. Subgroup analysis was done for newly diagnosed or C-peptide positive (C-pos) patients. We report the certainty of evidence based on the GRADE assessment tool. RESULTS A total of 24 studies using 4 different GLP-1 analogues with a total of 3377 patients were included. Liraglutide had the most substantial evidence with effect sizes on A1c (-0.09%/mg), weight (-2.2 kg/mg), and TDI (-4.32 IU/mg). Liraglutide dose was the greatest predictor of greater average weight loss and TDI decrease but was associated with higher odds of nausea (OR 6.5; 95% CI, 5.0-8.4) and ketosis (OR 1.8; 95% CI, 1.1-2.8). Odds of severe (OR 0.67; 95% CI, 0.43-1.04) or symptomatic hypoglycemia (OR 0.89; 95% CI, 0.53-1.51) were not significantly elevated. Among C-pos patients, greater A1c decrease (-0.51% vs -0.28%) but similar weight loss and TDI were seen. Effect sizes for exenatide were similar, but studies had higher risk of bias and safety data were sparse. CONCLUSION Our meta-analysis supports therapeutic benefits of liraglutide for patients with T1DM mainly for weight loss and insulin dose reduction. Newly diagnosed or C-pos patients do not appear to experience greater weight loss benefits.
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Affiliation(s)
- Jeayoung Park
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Spyridon Ntelis
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Elvina Yunasan
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Katherine D Downton
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD 21201, USA
| | - Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Central Ave, Hong Kong
| | - Kashif M Munir
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Nowreen Haq
- Lead Endocrinologist, Diabetes and Obesity Management Clinic, Chase Brexton Healthcare, Baltimore, MD 21201, USA
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16
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Benning TJ, Heien HC, Herges JR, Creo AL, Al Nofal A, McCoy RG. Glucagon fill rates and cost among children and adolescents with type 1 diabetes in the United States, 2011-2021. Diabetes Res Clin Pract 2023; 206:111026. [PMID: 38000667 PMCID: PMC10872944 DOI: 10.1016/j.diabres.2023.111026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/06/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023]
Abstract
AIMS To characterize glucagon fill rates and costs among youth with type 1 diabetes mellitus (T1DM). METHODS Claims-based analysis of commercially-insured youth with T1DM included in OptumLabs® Data Warehouse between 2011 and 2021. Glucagon fill rates and costs were calculated overall and by formulation (injectable, intranasal, autoinjector, and pre-filled syringe). Sociodemographic and clinical factors associated with glucagon fills were examined using Cox regression. RESULTS We identified 13,267 children with T1DM (76.4% non-Hispanic White). Over mean follow-up of 2.81 years (SD 2.62), 70.0% filled glucagon, with stable fill rates from 2011 to 2021. Intranasal glucagon had rapid uptake following initial approval, and it accounted for almost half (46.6%) of all glucagon fills by 2021. Family income was positively associated with glucagon fills in a stepwise fashion (HR 1.39 [95% CI 1.27-1.52] for annual household income ≥$200,000 vs. <$40,000), while Black race was negatively associated with fills (HR 0.83 [95% CI 0.76-0.91]) compared to White race). Annual mean out-of-pocket costs ranged from $21-$68 (IQR $29-$44). CONCLUSION Roughly 30% of commercially-insured youth with T1DM may lack access to unexpired glucagon, with significant disparities among Black and low-income patients. Health systems, clinicians, schools, and caregivers should work together to ensure children have reliable access to this critical medication.
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Affiliation(s)
- Tyler J Benning
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States
| | - Herbert C Heien
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States
| | - Joseph R Herges
- Pharmacy Services, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States
| | - Ana L Creo
- Division of Pediatric Endocrinology, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States
| | - Rozalina G McCoy
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1(st) St. SW, Rochester, MN 55905, United States; Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, 670 West Baltimore Street, Baltimore, MD 21201, United States; University of Maryland Institute for Health Computing, 6116 Executive Blvd, Bethesda, MD 20852, United States; OptumLabs, 11000 Optum Circle, Eden Prairie, MN 55344, United States.
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17
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Pilla SJ, Meza KA, Beach MC, Long JA, Gordon HS, Bates JT, Washington DL, Bokhour BG, Tuepker A, Saha S, Maruthur NM. Assessment and prevention of hypoglycaemia in primary care among U.S. Veterans: a mixed methods study. LANCET REGIONAL HEALTH. AMERICAS 2023; 28:100641. [PMID: 38076413 PMCID: PMC10701452 DOI: 10.1016/j.lana.2023.100641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 02/12/2024]
Abstract
Background Hypoglycaemia from diabetes treatment causes morbidity and lower quality of life, and prevention should be routinely addressed in clinical visits. Methods This mixed methods study evaluated how primary care providers (PCPs) assess for and prevent hypoglycaemia by analyzing audio-recorded visits from five Veterans Affairs medical centres in the US. Two investigators independently coded visit dialogue to classify discussions of hypoglycaemia history, anticipatory guidance, and adjustments to hypoglycaemia-causing medications according to diabetes guidelines. Findings There were 242 patients (one PCP visit per patient) and 49 PCPs. Two thirds of patients were treated with insulin and 40% with sulfonylureas. Hypoglycaemia history was discussed in 78/242 visits (32%). PCPs provided hypoglycaemia anticipatory guidance in 50 visits (21%) that focused on holding diabetes medications while fasting and carrying glucose tabs; avoiding driving and glucagon were not discussed. Hypoglycaemia-causing medications were de-intensified or adjusted more often (p < 0.001) when the patient reported a history of hypoglycaemia (15/51 visits, 29%) than when the patient reported no hypoglycaemia or it was not discussed (6/191 visits, 3%). Haemoglobin A1c (HbA1c) was not associated with diabetes medication adjustment, and only 5/12 patients (42%) who reported hypoglycaemia with HbA1c <7.0% had medications de-intensified or adjusted. Interpretation PCPs discussed hypoglycaemia in one-third of visits for at-risk patients and provided limited hypoglycaemia anticipatory guidance. De-intensifying or adjusting hypoglycaemia-causing medications did not occur routinely after reported hypoglycaemia with HbA1c <7.0%. Routine hypoglycaemia assessment and provision of diabetes self-management education are needed to achieve guideline-concordant hypoglycaemia prevention. Funding U.S. Department of Veterans Affairs and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
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Affiliation(s)
- Scott J. Pilla
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
| | - Kayla A. Meza
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mary Catherine Beach
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judith A. Long
- Corporal Michael J. Cresenz VA Medical Center, Philadelphia, PA, USA
- Division of General Internal Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Howard S. Gordon
- Jesse Brown VA Medical Center, Chicago, IL, USA
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois Chicago College of Medicine, Chicago, IL, USA
| | - Jeffrey T. Bates
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Donna L. Washington
- VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Health Care System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Anais Tuepker
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Somnath Saha
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Nisa M. Maruthur
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Yonamine CY, Michalani MLE, Moreira RJ, Machado UF. Glucose Transport and Utilization in the Hippocampus: From Neurophysiology to Diabetes-Related Development of Dementia. Int J Mol Sci 2023; 24:16480. [PMID: 38003671 PMCID: PMC10671460 DOI: 10.3390/ijms242216480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
The association of diabetes with cognitive dysfunction has at least 60 years of history, which started with the observation that children with type 1 diabetes mellitus (T1D), who had recurrent episodes of hypoglycemia and consequently low glucose supply to the brain, showed a deficit of cognitive capacity. Later, the growing incidence of type 2 diabetes mellitus (T2D) and dementia in aged populations revealed their high association, in which a reduced neuronal glucose supply has also been considered as a key mechanism, despite hyperglycemia. Here, we discuss the role of glucose in neuronal functioning/preservation, and how peripheral blood glucose accesses the neuronal intracellular compartment, including the exquisite glucose flux across the blood-brain barrier (BBB) and the complex network of glucose transporters, in dementia-related areas such as the hippocampus. In addition, insulin resistance-induced abnormalities in the hippocampus of obese/T2D patients, such as inflammatory stress, oxidative stress, and mitochondrial stress, increased generation of advanced glycated end products and BBB dysfunction, as well as their association with dementia/Alzheimer's disease, are addressed. Finally, we discuss how these abnormalities are accompained by the reduction in the expression and translocation of the high capacity insulin-sensitive glucose transporter GLUT4 in hippocampal neurons, which leads to neurocytoglycopenia and eventually to cognitive dysfunction. This knowledge should further encourage investigations into the beneficial effects of promising therapeutic approaches which could improve central insulin sensitivity and GLUT4 expression, to fight diabetes-related cognitive dysfunctions.
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Affiliation(s)
- Caio Yogi Yonamine
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark;
| | - Maria Luiza Estimo Michalani
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil; (M.L.E.M.); (R.J.M.)
| | - Rafael Junges Moreira
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil; (M.L.E.M.); (R.J.M.)
| | - Ubiratan Fabres Machado
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo 05508-000, Brazil; (M.L.E.M.); (R.J.M.)
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19
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Battelino T, Brosius F, Ceriello A, Cosentino F, Green J, Kellerer M, Koob S, Kosiborod M, Lalic N, Marx N, Nedungadi TP, Rydén L, Rodbard HW, Ji L, Sheu WHH, Standl E, Parkin CG, Schnell O. Guideline Development for Medical Device Technology: Issues for Consideration. J Diabetes Sci Technol 2023; 17:1698-1710. [PMID: 35531901 PMCID: PMC10658688 DOI: 10.1177/19322968221093355] [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] [Indexed: 11/15/2022]
Abstract
Advances in the development of innovative medical devices and telehealth technologies create the potential to improve the quality and efficiency of diabetes care through collecting, aggregating, and interpreting relevant health data in ways that facilitate more informed decisions among all stakeholder groups. Although many medical societies publish guidelines for utilizing these technologies in clinical practice, we believe that the methodologies used for the selection and grading of the evidence should be revised. In this article, we discuss the strengths and limitations of the various types of research commonly used for evidence selection and grading and present recommendations for modifying the process to more effectively address the rapid pace of device and technology innovation and new product development.
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Affiliation(s)
- Tadej Battelino
- University Medical Center Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Frank Brosius
- University of Arizona College of Medicine–Tucson, AZ, USA
| | | | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Mikhail Kosiborod
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Nebojsa Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, University Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | | | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden
| | | | - Linong Ji
- Peking University People’s Hospital, Beijing, China
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City
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20
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Mesa A, Beneyto A, Martín-SanJosé JF, Viaplana J, Bondia J, Vehí J, Conget I, Giménez M. Safety and performance of a hybrid closed-loop insulin delivery system with carbohydrate suggestion in adults with type 1 diabetes prone to hypoglycemia. Diabetes Res Clin Pract 2023; 205:110956. [PMID: 37844798 DOI: 10.1016/j.diabres.2023.110956] [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: 05/30/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
AIMS To evaluate the safety and performance of a hybrid closed-loop (HCL) system with automatic carbohydrate suggestion in adults with type 1 diabetes (T1D) prone to hypoglycemia. METHODS A 32-hour in-hospital pilot study, including a night period, 4 meals and 2 vigorous unannounced 45-minute aerobic sessions, was conducted in 11 adults with T1D prone to hypoglycemia. The primary outcome was the percentage of time in range 70-180 mg/dL (TIR). Main secondary outcomes were time below range < 70 mg/dL (TBR < 70) and < 54 (TBR < 54). Data are presented as median (10th-90th percentile ranges). RESULTS The participants, 6 (54.5%) men, were 24 (22-48) years old, and had 22 (9-32) years of T1D duration. All of them regularly used an insulin pump and a continuous glucose monitoring system. The median TIR was 78.7% (75.6-91.2): 92.7% (68.2-100.0) during exercise and recovery period, 79.3% (34.9-100.0) during postprandial period, and 95.4% (66.4-100.0) during overnight period. The TBR < 70 and TBR < 54 were 0.0% (0.0-6.6) and 0.0% (0.0-1.2), respectively. A total of 4 (3-9) 15-g carbohydrate suggestions were administered per person. No severe acute complications occurred during the study. CONCLUSIONS The HCL system with automatic carbohydrate suggestion performed well and was safe in this population during challenging conditions in a hospital setting.
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Affiliation(s)
- Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Aleix Beneyto
- Institute of Informatics and Applications, University of Girona, Girona, Spain
| | - Juan-Fernando Martín-SanJosé
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain
| | - Judith Viaplana
- Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain
| | - Jorge Bondia
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain
| | - Josep Vehí
- Institute of Informatics and Applications, University of Girona, Girona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain.
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer). Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III. Madrid, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer). Barcelona, Spain.
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21
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Verhulst CEM, van Heck JIP, Fabricius TW, Stienstra R, Teerenstra S, McCrimmon RJ, Tack CJ, Pedersen-Bjergaard U, de Galan BE. Hypoglycaemia induces a sustained pro-inflammatory response in people with type 1 diabetes and healthy controls. Diabetes Obes Metab 2023; 25:3114-3124. [PMID: 37485887 DOI: 10.1111/dom.15205] [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: 03/14/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023]
Abstract
AIM To determine the duration and the extension of the pro-inflammatory response to hypoglycaemia both in people with type 1 diabetes and healthy controls. MATERIALS AND METHODS Adults with type 1 diabetes (n = 47) and matched controls (n = 16) underwent a hyperinsulinaemic-euglycaemic hypoglycaemic (2.8 ± 0.1 mmoL/L [49.9 ± 2.3 mg/dL]) glucose clamp. During euglycaemia, hypoglycaemia, and 1, 3 and 7 days later, blood was drawn to determine immune cell phenotype, monocyte function and circulating inflammatory markers. RESULTS Hypoglycaemia increased lymphocyte and monocyte counts, which remained elevated for 1 week. The proportion of CD16+ monocytes increased and the proportion of CD14+ monocytes decreased. During hypoglycaemia, monocytes released more tumour necrosis factor-α and interleukin-1β, and less interleukin-10, after ex vivo stimulation. Hypoglycaemia increased the levels of 19 circulating inflammatory proteins, including high sensitive C-reactive protein, most of which remained elevated for 1 week. The epinephrine peak in response to hypoglycaemia was positively correlated with immune cell number and phenotype, but not with the proteomic response. CONCLUSIONS Overall, despite differences in prior exposure to hypoglycaemia, the pattern of the inflammatory responses to hypoglycaemia did not differ between people with type 1 diabetes and healthy controls. In conclusion, hypoglycaemia induces a range of pro-inflammatory responses that are sustained for at least 1 week in people with type 1 diabetes and healthy controls.
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Affiliation(s)
- Clementine E M Verhulst
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Julia I P van Heck
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Therese W Fabricius
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Rinke Stienstra
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Steven Teerenstra
- Section Biostatistics, Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Cees J Tack
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ulrik Pedersen-Bjergaard
- Department of Endocrinology and Nephrology, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bastiaan E de Galan
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, MUMC+, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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22
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Lee WK, Ko MSM, Ang LC, Zhu L, Bee YM, Goh SY, Teh MM. A real-life comparison of hypoglycaemia symptomatology between insulin-treated type 2 diabetes participants with and without impaired awareness of hypoglycaemia. Diabet Med 2023; 40:e15215. [PMID: 37640970 DOI: 10.1111/dme.15215] [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: 04/13/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
AIMS We aim to compare and correlate Gold and Clarke questionnaire scores with hypoglycaemic symptomatic responses between insulin-treated type 2 diabetes participants with and without IAH in a real-life study. METHODS Insulin-treated type 2 diabetes participants attending an outpatient diabetes clinic in Singapore were asked to complete the Gold and Clarke questionnaires, record capillary blood glucose (CBG) and hypoglycaemic symptoms for 4 weeks. RESULTS Data were collected from 153 participants (M:F = 98:55) with mean age 61.0 ± 9.4 years, duration of diabetes 19.5 ± 8.8 years and HbA1c 68 ± 17 mmol/mol (8.4 ± 1.5%). Gold and Clarke methods classified 19.6% and 26.8% of participants with IAH, respectively. Using CBG threshold of <3 mmol/L, significantly greater proportion of participants with intact awareness were experiencing autonomic symptoms than those with IAH with either method (Gold: 69% vs. 18%, p = 0.006; Clarke: 85% vs. 46%, p = 0.010). Significantly greater proportion of participants with IAH experienced no hypoglycaemia symptoms than those with intact awareness (Gold: 3.4% vs. 36%, p = 0.015; Clarke: 3.7% vs. 31%, p = 0.031). Participants with IAH had significantly higher rates of severe hypoglycaemia in the preceding year compared to those without (Gold: 17% vs. 3.3%; Clarke: 15% vs. 2.7%, p = 0.012). CONCLUSIONS Gold and Clarke questionnaires are appropriate tools in ascertaining IAH status in insulin-treated type 2 diabetes participants. This is the first time whereby the hypoglycaemia symptomology has robustly validated the Gold and Clarke questionnaire in insulin-treated type 2 diabetes participants.
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Affiliation(s)
- Wai Kit Lee
- Academic Clinical Program, Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Li Chang Ang
- Academic Clinical Program, Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Ling Zhu
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Su Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Ming Ming Teh
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
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23
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Wood M, Moses J, Andrade DC, De la Cova M, Parmar J, Middlebrook G, Beltran DC. Pharmacy stewardship to reduce recurrent hypoglycemia. J Am Pharm Assoc (2003) 2023; 63:1813-1820. [PMID: 37696492 DOI: 10.1016/j.japh.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/27/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Inpatient hypoglycemia is associated with increased morbidity and mortality. After a hypoglycemic event, the likelihood of additional episodes increases. The Joint Commission recommends evaluating all episodes of hypoglycemia for root-cause analysis. Studies have shown that pharmacists' involvement with glycemic control protocols can prevent hypoglycemia. OBJECTIVES This study aimed to assess whether the implementation of pharmacists' real-time assessment of hypoglycemic events using an electronic alert messaging system contributes to the reduction of the number of recurrent hypoglycemia during hospitalization. PRACTICE DESCRIPTION A community hospital that provides a wide range of health care services. The pharmacy department provides fully decentralized clinical services and team-based specialist services. PRACTICE INNOVATION The pharmacist-led hypoglycemia stewardship initiative included a comprehensive review of hypoglycemic alerts received via an automated message. The alerts generated in the electronic health record (EHR) every time a patient's blood glucose resulted in less than 70 mg/dL if there was a documented administration of a hypoglycemic agent 48 hours before the hypoglycemia event. Once the alert was received by the pharmacists via an EHR in-basket, a real-time review was conducted to identify the potential causes of the event and opportunities for therapy modification. EVALUATION METHODS A single-center retrospective observational study including a pre- and post-implementation phase from January 1 to June 3, 2020, and January 1 to June 30, 2021, respectively. Continuous data were analyzed using paired and equal variance t test. Noncontinuous data were analyzed using Fisher exact and chi-square test. Descriptive statistics were used to describe distribution and frequency of data. RESULTS There was a 5.1% absolute reduction in recurrent hypoglycemic events (P < 0.001) and a 0.6% reduction of severe hypoglycemic days (P = 0.269) in the postimplementation group. The average time to pharmacist intervention was 4 (± 3.5) hours with a 92% acceptance rate. CONCLUSION This study demonstrated the utility of pharmacist-led hypoglycemia reviews in the reduction of recurrent hypoglycemic events in the inpatient setting.
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24
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Surrati AMQ, Alanazi AA, Bukhari SS, Alfadhli EM. Hypoglycemia unawareness among insulin-treated diabetic patients in Madinah, Saudi Arabia: prevalence and risk factors. Front Endocrinol (Lausanne) 2023; 14:1239524. [PMID: 37964960 PMCID: PMC10640969 DOI: 10.3389/fendo.2023.1239524] [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: 06/13/2023] [Accepted: 08/17/2023] [Indexed: 11/16/2023] Open
Abstract
Background Hypoglycemia unawareness (HU) is associated with significant risks. Screening for impaired awareness of hypoglycemia in patients with diabetes is important to minimize those risks. There are limited data on the prevalence of HU in patients with diabetes in Saudi Arabia (KSA). In the current study, we investigated the frequency of HU and its risk factors among insulin treated diabetic patients in Madinah, KSA. Methods A cross-sectional study was conducted in a diabetes center and four primary healthcare centers at Madinha, KSA. Patients ≥14 years old with type 1 or type 2 diabetes treated with insulin for more than a year were included. HU was assessed by Clarke's and modified Pedersen-Bjergaard's scores. The risk factors for HU were determined. Results Of the 413 included patients, 60.3% were women, and 60.8% were on insulin alone. One-third of the participants had T1DM, while 68.5% had T2DM, with median ages of 25 and 56 years, diabetes durations of 10 and 15 years, and durations of insulin use of 10 and 5 years, respectively. The prevalence of HU was 25.2% by Clarke's survey. The risk factors for HU were poor knowledge of the patient's latest HbA1c, type of insulin, and dose of insulin. Poor medical follow-up, previous stroke, and ischemic heart disease were the other risk factors for HU. When the modified Pedersen-Bjergaard method was used, the prevalence of HU was 48.9%. Conclusion Despite the advances in diabetes management, HU continues to be prevalent among diabetic patients on insulin, and poor diabetes knowledge is a major risk factor. Diabetes education on self-management is of utmost importance to reduce hypoglycemia and HU.
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Affiliation(s)
| | | | - Samyah Sami Bukhari
- Department of Adult Endocrine, Medicine, King Fahad Hospital, Madinah, Saudi Arabia
| | - Eman Mohammed Alfadhli
- College of Medicine, Taibah University, Madinah, Saudi Arabia
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Madinah, Saudi Arabia
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25
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Tripyla A, Ferreira A, Schönenberger KA, Näf NH, Inderbitzin LE, Prendin F, Cossu L, Cappon G, Facchinetti A, Herzig D, Bally L. Relationship Between Symptom Perception and Postprandial Glycemic Profiles in Patients With Postbariatric Hypoglycemia After Roux-en-Y Gastric Bypass Surgery. Diabetes Care 2023; 46:1792-1798. [PMID: 37499048 DOI: 10.2337/dc23-0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/12/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Post-bariatric surgery hypoglycemia (PBH) is a metabolic complication of Roux-en-Y gastric bypass (RYGB). Since symptoms are a key component of the Whipple's triad to diagnose nondiabetic hypoglycemia, we evaluated the relationship between self-reported symptoms and postprandial sensor glucose profiles. RESEARCH DESIGN AND METHODS Thirty patients with PBH after RYGB (age: 50.1 [41.6-60.6] years, 86.7% female, BMI: 26.5 [23.5-31.2] kg/m2; median [interquartile range]) wore a blinded Dexcom G6 sensor while recording autonomic, neuroglycopenic, and gastrointestinal symptoms over 50 days. Symptoms (overall and each type) were categorized into those occurring in postprandial periods (PPPs) without hypoglycemia, or in the preceding dynamic or hypoglycemic phase of PPPs with hypoglycemia (nadir sensor glucose <3.9 mmol/L). We further explored the relationship between symptoms and the maximum negative rate of sensor glucose change and nadir sensor glucose levels. RESULTS In 5,851 PPPs, 775 symptoms were reported, of which 30.6 (0.0-59.9)% were perceived in PPPs without hypoglycemia, 16.7 (0.0-30.1)% in the preceding dynamic phase and 45.0 (13.7-84.7)% in the hypoglycemic phase of PPPs with hypoglycemia. Per symptom type, 53.6 (23.8-100.0)% of the autonomic, 30.0 (5.6-80.0)% of the neuroglycopenic, and 10.4 (0.0-50.0)% of the gastrointestinal symptoms occurred in the hypoglycemic phase of PPPs with hypoglycemia. Both faster glucose dynamics and lower nadir sensor glucose levels were related with symptom perception. CONCLUSIONS The relationship between symptom perception and PBH is complex, challenging clinical judgement and decision-making in this population.
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Affiliation(s)
- Afroditi Tripyla
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Ferreira
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katja A Schönenberger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Noah H Näf
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas E Inderbitzin
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Francesco Prendin
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Luca Cossu
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giacomo Cappon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Andrea Facchinetti
- Department of Information Engineering, University of Padova, Padova, Italy
| | - David Herzig
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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26
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Kladov DE, Berikov VB, Semenova JF, Klimontov VV. Nocturnal Glucose Patterns with and without Hypoglycemia in People with Type 1 Diabetes Managed with Multiple Daily Insulin Injections. J Pers Med 2023; 13:1454. [PMID: 37888065 PMCID: PMC10608186 DOI: 10.3390/jpm13101454] [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: 09/03/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Nocturnal hypoglycemia (NH) is a potentially dangerous and underestimated complication of insulin therapy. In this study, we aimed to determine which patterns of nocturnal glucose profiles are associated with NH in patients with type 1 diabetes (T1D) managed with multiple daily insulin injections. A dataset of continuous glucose monitoring (CGM) recordings obtained from 395 adult subjects with T1D was used for modeling. The clustering of CGM data was performed using a hierarchical clustering algorithm. Ten clusters without hypoglycemia and six clusters with NH episode(s) were identified. The differences among the clusters included initial and final glucose levels, glucose change during the night, and the presence of uptrends or downtrends. Post-midnight hyperglycemia was revealed in 5 out of 10 clusters without NH; in patterns with downtrends, initially elevated glucose prevented NH episodes. In clusters with initially near-normal glucose levels and downtrends, most episodes of NH were observed from midnight to 4 a.m.; if glucose was initially elevated, the episodes occurred at 2-4 a.m. or 4-6 a.m., depending on the time of the start of the downtrend. The results demonstrate the diversity of nocturnal glucose profiles in patients with T1D, which highlights the need for a differentiated approach to therapy adjustment.
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Affiliation(s)
- Danil E. Kladov
- Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL—Branch of IC&G SB RAS), 630060 Novosibirsk, Russia (J.F.S.)
- Department of Mathematics and Mechanics, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Vladimir B. Berikov
- Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL—Branch of IC&G SB RAS), 630060 Novosibirsk, Russia (J.F.S.)
- Laboratory of Data Analysis, Sobolev Institute of Mathematics, Siberian Branch of Russian Academy of Sciences, 630090 Novosibirsk, Russia
| | - Julia F. Semenova
- Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL—Branch of IC&G SB RAS), 630060 Novosibirsk, Russia (J.F.S.)
| | - Vadim V. Klimontov
- Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology—Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL—Branch of IC&G SB RAS), 630060 Novosibirsk, Russia (J.F.S.)
- V. Zelman Institute of Medicine and Psychology, Novosibirsk State University, 630090 Novosibirsk, Russia
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27
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Stimson RH, Dover AR, Strachan MWJ, Wright RJ, Lyall MJ, Jeeyavudeen MS, Forbes S, Gibb FW. Associations between glucagon prescribing, hospital admissions for hypoglycaemia and continuous glucose monitoring metrics in adults with type 1 diabetes. J Diabetes Complications 2023; 37:108561. [PMID: 37499292 DOI: 10.1016/j.jdiacomp.2023.108561] [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: 05/11/2023] [Revised: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
AIMS To assess features associated with glucagon prescribing and hospital admissions with hypoglycaemia in type one diabetes. METHODS Observational study of 4462 adults. Outcome measures were features associated with glucagon prescriptions and predictors of hospital admissions with hypoglycaemia and high levels of glucagon prescribing. RESULTS 74 % did not collect any glucagon prescriptions and 2.7 % collected >6 over 3.5 years. Hospital admission with hypoglycaemia (P = 0.032), impaired awareness (P = 0.049) and female sex (P < 0.001) were associated with glucagon collection. More frequent prescribing of glucagon was associated with diabetes duration (P < 0.001) and socioeconomic deprivation (P < 0.001). Higher average glucose (P = 0.047), higher time above 13.9 mM (P = 0.008) and higher SD (P = 0.002) were associated with glucagon prescribing. Diabetes duration (P < 0.001) and HbA1c (P < 0.001) were higher in people with hospitalised hypoglycaemia. Higher time above 13.9 mM (P = 0.004) and SD glucose (P < 0.001) were most clearly associated with hospitalised hypoglycaemia. CONCLUSIONS A minority of people with type 1 diabetes have access to glucagon suggesting more could be done to better target this treatment. Individuals with risk factors and those with frequent glucagon prescriptions should be identified for interventions known to reduce hypoglycaemia.
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Affiliation(s)
- Roland H Stimson
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK; University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Anna R Dover
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mark W J Strachan
- Edinburgh Centre for Endocrinology & Diabetes, Western General Hospital, Edinburgh, UK
| | - Rohana J Wright
- Edinburgh Centre for Endocrinology & Diabetes, St John's Hospital, Edinburgh, UK
| | - Marcus J Lyall
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mohammad S Jeeyavudeen
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Shareen Forbes
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK; University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Fraser W Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK; University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
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Kostopoulou E, Andreopoulou O, Daskalaki S, Kotanidou E, Vakka A, Galli-Tsinopoulou A, Spiliotis BE, Gonder-Frederick L, Fouzas S. Translation and Validation Study of the Hypoglycemia Fear Survey in a Greek Population of Children and Adolescents with Type 1 Diabetes Mellitus and their Parents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1458. [PMID: 37761419 PMCID: PMC10529311 DOI: 10.3390/children10091458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
The present study attempted to translate and culturally adapt an established research instrument, the Hypoglycemia Fear Survey (HFS) questionnaire, to the Greek population and evaluate its validity and internal consistency so that it can be used for the assessment of hypoglycemia fear in Greek children and adolescents with T1DM and their parents. One hundred Greek children and adolescents with T1DM, 54 males, 6-18 years old, and one of their parents participated in this validation study. The participants completed the translated Greek HFS, which includes one version for children (CHFS) and one for parents (PHFS). Exploratory Factor Analysis (EFA) was used to assess construct validity. Internal consistency was assessed using Cronbach's alpha, and convergent validity was established by estimating the correlation coefficients between the scores of the HFS scales/subscales and the different constructs of the Pediatric Quality of Life Inventory. The CHFS and PHFS exhibited adequate internal consistency for the total score and the Worry subscale, but lower consistency for the Behavior subscale. High test-retest reliability was also shown. We conclude that the Greek version of the HFS is a valid and reliable instrument to assess the fear of hypoglycemia in Greek children and adolescents with T1DM and their parents.
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Affiliation(s)
- Eirini Kostopoulou
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Patras School of Medicine, 26500 Patras, Greece; (E.K.); (A.V.); (B.E.S.)
| | - Ourania Andreopoulou
- Department of Psychiatry, University of Patras School of Medicine, 26500 Patras, Greece;
| | - Sophia Daskalaki
- Department of Electrical and Computer Engineering, School of Engineering, University of Patras, 26500 Patras, Greece;
| | - Eleni Kotanidou
- Unit of Pediatric and Adolescent Diabetes Mellitus, Second Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (E.K.); (A.G.-T.)
| | - Angeliki Vakka
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Patras School of Medicine, 26500 Patras, Greece; (E.K.); (A.V.); (B.E.S.)
| | - Assimina Galli-Tsinopoulou
- Unit of Pediatric and Adolescent Diabetes Mellitus, Second Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece; (E.K.); (A.G.-T.)
| | - Bessie E. Spiliotis
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Patras School of Medicine, 26500 Patras, Greece; (E.K.); (A.V.); (B.E.S.)
| | | | - Sotirios Fouzas
- Department of Pediatrics, University of Patras School of Medicine, 26500 Patras, Greece
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Heidari M, Khodadadi Jokar Y, Madani S, Shahi S, Shahi MS, Goli M. Influence of Food Type on Human Psychological-Behavioral Responses and Crime Reduction. Nutrients 2023; 15:3715. [PMID: 37686747 PMCID: PMC10490081 DOI: 10.3390/nu15173715] [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: 07/30/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
The purpose of this narrative review is to emphasize the importance of food consumption and meal selection on mental health and brain function, including psychological and behavioral reactions such as mood, loving relationships, violence, and criminal activity. Additionally, by being aware of the link between food and mental health, the community can be encouraged to make informed food choices in order to avoid unfavorable outcomes like criminality. Food behaviors are shifting significantly over the world. There are also significant changes in mood, sadness, happiness, and violence, as well as the spread of the variety and severity of mental diseases that lead to violent acts. Food intake and meal selection have evolved over the last ten years as the variety and accessibility of food options have become easier and more diverse. These modifications might have both beneficial and bad consequences. This article examines the relationship between food intake and its impact on marital satisfaction. The goal of this review is to support or refute the claim that food influences mood, love, or criminal behavior, or vice versa. Various diets can have an impact on one's mental health and brain, influencing psychological reactions and behavioral responses such as mood, loving relationships, violence, and even criminal activity. Food insecurity has been demonstrated in various studies to have a negative impact on health and psychological well-being, leading to despair, loss of happiness, marital conflict, and violence. For example, herbal extracts and flavonoids have the potential to improve gut microbiota and treat mood disorders. Understanding how the gut-brain axis communicates might help guide interventions for mood and cognitive function. Since the root of most diseases and behaviors is significantly related to the type of food consumed, this research addresses this issue in order to reduce the cost of treatment and prevention of crime and delinquency at the community level by consciously choosing the food consumed by the society. In other words, prevention is always better than cure.
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Affiliation(s)
- Masoud Heidari
- Department of Humanities and Law, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan 81551-39998, Iran; (M.H.); (M.S.S.)
| | - Yalda Khodadadi Jokar
- Department of Food Science and Technology, Laser and Biophotonics in Biotechnologies Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan 81551-39998, Iran
| | - Shirin Madani
- Department of Food Science and Technology, Laser and Biophotonics in Biotechnologies Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan 81551-39998, Iran
| | - Sharifeh Shahi
- Department of Medical Engineering, Laser and Biophotonics in Biotechnologies Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan 81551-39998, Iran
| | - Mohammad Sharif Shahi
- Department of Humanities and Law, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan 81551-39998, Iran; (M.H.); (M.S.S.)
| | - Mohammad Goli
- Department of Food Science and Technology, Laser and Biophotonics in Biotechnologies Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan 81551-39998, Iran
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Bellon F, Solà I, Gimenez-Perez G, Hernández M, Metzendorf MI, Rubinat E, Mauricio D. Perioperative glycaemic control for people with diabetes undergoing surgery. Cochrane Database Syst Rev 2023; 8:CD007315. [PMID: 37526194 PMCID: PMC10392034 DOI: 10.1002/14651858.cd007315.pub3] [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] [Indexed: 08/02/2023]
Abstract
BACKGROUND People with diabetes mellitus are at increased risk of postoperative complications. Data from randomised clinical trials and meta-analyses point to a potential benefit of intensive glycaemic control, targeting near-normal blood glucose, in people with hyperglycaemia (with and without diabetes mellitus) being submitted for surgical procedures. However, there is limited evidence concerning this question in people with diabetes mellitus undergoing surgery. OBJECTIVES To assess the effects of perioperative glycaemic control for people with diabetes undergoing surgery. SEARCH METHODS For this update, we searched the databases CENTRAL, MEDLINE, LILACS, WHO ICTRP and ClinicalTrials.gov. The date of last search for all databases was 25 July 2022. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled clinical trials (RCTs) that prespecified different targets of perioperative glycaemic control for participants with diabetes (intensive versus conventional or standard care). DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the risk of bias. Our primary outcomes were all-cause mortality, hypoglycaemic events and infectious complications. Secondary outcomes were cardiovascular events, renal failure, length of hospital and intensive care unit (ICU) stay, health-related quality of life, socioeconomic effects, weight gain and mean blood glucose during the intervention. We summarised studies using meta-analysis with a random-effects model and calculated the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, using a 95% confidence interval (CI), or summarised outcomes with descriptive methods. We used the GRADE approach to evaluate the certainty of the evidence (CoE). MAIN RESULTS A total of eight additional studies were added to the 12 included studies in the previous review leading to 20 RCTs included in this update. A total of 2670 participants were randomised, of which 1320 were allocated to the intensive treatment group and 1350 to the comparison group. The duration of the intervention varied from during surgery to five days postoperative. No included trial had an overall low risk of bias. Intensive glycaemic control resulted in little or no difference in all-cause mortality compared to conventional glycaemic control (130/1263 (10.3%) and 117/1288 (9.1%) events, RR 1.08, 95% CI 0.88 to 1.33; I2 = 0%; 2551 participants, 18 studies; high CoE). Hypoglycaemic events, both severe and non-severe, were mainly experienced in the intensive glycaemic control group. Intensive glycaemic control may slightly increase hypoglycaemic events compared to conventional glycaemic control (141/1184 (11.9%) and 41/1226 (3.3%) events, RR 3.36, 95% CI 1.69 to 6.67; I2 = 64%; 2410 participants, 17 studies; low CoE), as well as those considered severe events (37/927 (4.0%) and 6/969 (0.6%), RR 4.73, 95% CI 2.12 to 10.55; I2 = 0%; 1896 participants, 11 studies; low CoE). Intensive glycaemic control, compared to conventional glycaemic control, may result in little to no difference in the rate of infectious complications (160/1228 (13.0%) versus 224/1225 (18.2%) events, RR 0.75, 95% CI 0.55 to 1.04; P = 0.09; I2 = 55%; 2453 participants, 18 studies; low CoE). Analysis of the predefined secondary outcomes revealed that intensive glycaemic control may result in a decrease in cardiovascular events compared to conventional glycaemic control (107/955 (11.2%) versus 125/978 (12.7%) events, RR 0.73, 95% CI 0.55 to 0.97; P = 0.03; I2 = 44%; 1454 participants, 12 studies; low CoE). Further, intensive glycaemic control resulted in little or no difference in renal failure events compared to conventional glycaemic control (137/1029 (13.3%) and 158/1057 (14.9%), RR 0.92, 95% CI 0.69 to 1.22; P = 0.56; I2 = 38%; 2086 participants, 14 studies; low CoE). We found little to no difference between intensive glycaemic control and conventional glycaemic control in length of ICU stay (MD -0.10 days, 95% CI -0.57 to 0.38; P = 0.69; I2 = 69%; 1687 participants, 11 studies; low CoE), and length of hospital stay (MD -0.79 days, 95% CI -1.79 to 0.21; P = 0.12; I2 = 77%; 1520 participants, 12 studies; very low CoE). Due to the differences within included studies, we did not pool data for the reduction of mean blood glucose. Intensive glycaemic control resulted in a mean lowering of blood glucose, ranging from 13.42 mg/dL to 91.30 mg/dL. One trial assessed health-related quality of life in 12/37 participants in the intensive glycaemic control group, and 13/44 participants in the conventional glycaemic control group; no important difference was shown in the measured physical health composite score of the short-form 12-item health survey (SF-12). One substudy reported a cost analysis of the population of an included study showing a higher total hospital cost in the conventional glycaemic control group, USD 42,052 (32,858 to 56,421) compared to the intensive glycaemic control group, USD 40,884 (31.216 to 49,992). It is important to point out that there is relevant heterogeneity between studies for several outcomes. We identified two ongoing trials. The results of these studies could add new information in future updates on this topic. AUTHORS' CONCLUSIONS High-certainty evidence indicates that perioperative intensive glycaemic control in people with diabetes undergoing surgery does not reduce all-cause mortality compared to conventional glycaemic control. There is low-certainty evidence that intensive glycaemic control may reduce the risk of cardiovascular events, but cause little to no difference to the risk of infectious complications after the intervention, while it may increase the risk of hypoglycaemia. There are no clear differences between the groups for the other outcomes. There are uncertainties among the intensive and conventional groups regarding the optimal glycaemic algorithm and target blood glucose concentrations. In addition, we found poor data on health-related quality of life, socio-economic effects and weight gain. It is also relevant to underline the heterogeneity among studies regarding clinical outcomes and methodological approaches. More studies are needed that consider these factors and provide a higher quality of evidence, especially for outcomes such as hypoglycaemia and infectious complications.
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Affiliation(s)
- Filip Bellon
- Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain
- GESEC group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gabriel Gimenez-Perez
- Endocrinology Section, Department of Medicine, Hospital General de Granollers, Granollers, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA), Lleida, Spain
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Esther Rubinat
- Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain
- GESEC group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- CIBER of Diabetes and Associated Metabolic Disease, Barcelona, Spain
| | - Didac Mauricio
- CIBER of Diabetes and Associated Metabolic Disease, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Faculty of Medicine, University of Vic & Central University of Catalonia, Vic, Spain
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Li L, Liang T, Jiang T, Li Y, Yang L, Wu L, Yang J, Ding Y, Wang J, Chen M, Zhang J, Xie X, Wu Q. Gut microbiota: Candidates for a novel strategy for ameliorating sleep disorders. Crit Rev Food Sci Nutr 2023:1-17. [PMID: 37477274 DOI: 10.1080/10408398.2023.2228409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
The aim of this review was to evaluate the feasibility of treating sleep disorders using novel gut microbiota intervention strategies. Multiple factors can cause sleep disorders, including an imbalance in the gut microbiota. Studies of the microbiome-gut-brain axis have revealed bidirectional communication between the central nervous system and gut microbes, providing a more comprehensive understanding of mood and behavioral regulatory patterns. Changes in the gut microbiota and its metabolites can stimulate the endocrine, nervous, and immune systems, which regulate the release of neurotransmitters and alter the activity of the central nervous system, ultimately leading to sleep disorders. Here, we review the main factors affecting sleep, discuss possible pathways and molecular mechanisms of the interaction between sleep and the gut microbiota, and compare common gut microbiota intervention strategies aimed at improving sleep physiology.
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Affiliation(s)
- Longyan Li
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
- College of Food Science, South China Agricultural University, Guangzhou, China
| | - Tingting Liang
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
| | - Tong Jiang
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
| | - Ying Li
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
| | - Lingshuang Yang
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
- College of Food Science, South China Agricultural University, Guangzhou, China
| | - Lei Wu
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
| | - Juan Yang
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
| | - Yu Ding
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
| | - Juan Wang
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
- College of Food Science, South China Agricultural University, Guangzhou, China
| | - Moutong Chen
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
| | - Jumei Zhang
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
| | - Xinqiang Xie
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
| | - Qingping Wu
- Guangdong Provincial Key Laboratory of Microbial Safety and Health, State Key Laboratory of Applied Microbiology Southern China, Key Laboratory of Agricultural Microbiomics and Precision Application, Ministry of Agriculture and Rural Affairs, Institute of Microbiology, Guangdong Academy of Sciences, Guangzhou, People's Republic of China
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Contreras M, Mesa A, Pueyo I, Claro M, Milad C, Viñals C, Roca D, Granados M, Giménez M, Conget I. Effectiveness of flash glucose monitoring in patients with type 1 diabetes and recurrent hypoglycemia between early and late stages after flash glucose monitoring initiation. J Diabetes Complications 2023; 37:108560. [PMID: 37480703 DOI: 10.1016/j.jdiacomp.2023.108560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
AIMS Evaluate the effectiveness of reimbursed flash glucose monitoring with optional alarms (FGM) in preventing severe hypoglycemia (SH) and reducing hypoglycemia exposure in T1D patients prone to hypoglycemia. METHODS Ambispective study in T1D patients treated with multiple daily injections (MDI) and prone to hypoglycemia, initiating reimbursed FGM (FreeStyle Libre 2). The primary outcome was the number of SH events (requiring third party assistance) and main secondary outcomes were time below range < 70 (TBR < 70) and < 54 mg/dL (TBR < 54), impaired awareness of hypoglycemia (IAH) and quality of life (QoL). Logistic regression models were constructed to explore variables associated with success of the intervention. RESULTS We included 110 patients (52.7 % women, mean age 47.8 ± 17.0 years). SH events at 1-year follow-up decreased from 0.3 ± 0.6 to 0.03 ± 0.2 (p < 0.001). Significant reductions in patients presenting an SH (26.4 % vs. 2.9 %, p < 0.001) and IAH (47.1 % vs. 25.9 %, p = 0.002) were observed, as well as improvements in QoL. TBR < 70 and TBR < 54 were not significantly reduced. Baseline GMI was inversely associated with a decrease in TBR < 70 [OR 0.37 (0.15-0.93)] and directly with an increase in time in range 70-180 mg/dL [OR 2.10 (1.03-4.28)]. CONCLUSIONS FGM decreased SH and improved hypoglycemia awareness and QoL. Initial tight glycemic control was associated with a decrease in hypoglycemia, while patients with suboptimal control reduced hyperglycemia.
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Affiliation(s)
- Macarena Contreras
- Endocrinology and Nutrition Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain; Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Alex Mesa
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Irene Pueyo
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Maria Claro
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Camila Milad
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Clara Viñals
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Daria Roca
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Montse Granados
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain
| | - Marga Giménez
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain.
| | - Ignacio Conget
- Diabetes Unit, Endocrinology and Nutrition Department, ICMDM, Hospital Clínic de Barcelona, Spain; IDIBAPS (Institut d'investigacions biomèdiques August Pi i Sunyer), Barcelona, Spain; CIBERDEM (Centro de Investigación en Red de Diabetes y Enfermedades Metabólicas), Madrid, Spain
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Alsharif AA, Wong ICK, Ma T, Lau W, Alhamed M, Alwafi H, Wei L. The association between dementia and the risk of hypoglycaemia events among patients with diabetes mellitus: a propensity-score matched cohort analysis. Front Med (Lausanne) 2023; 10:1177636. [PMID: 37476614 PMCID: PMC10354255 DOI: 10.3389/fmed.2023.1177636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/02/2023] [Indexed: 07/22/2023] Open
Abstract
Background Hypoglycaemia commonly occurs in patients diagnosed with diabetes mellitus (DM) and dementia. The impact of dementia on hypoglycaemic events is controversial. Thus, we evaluated whether dementia increases the risk of hypoglycaemic events in older patients diagnosed with DM. Design A retrospective cohort study. Setting We used the IQVIA Medical Research Data (IMRD-UK) database (formerly known as the THIN database). Participants All patients aged ≥55 years and diagnosed with DM who were prescribed at least two prescriptions of antidiabetic medication between 2000 and 2017. Two groups of patients, dementia and non-dementia group, were propensity-score (PS) matched at 1:2. The risk of hypoglycaemia was assessed through a Cox regression analysis. Main outcome and measures Hypoglycaemic events were determined during the follow-up period by Read codes. Results From the database, 133,664 diabetic patients were identified, with a mean follow-up of 6.11 years. During the study period, 7,762 diabetic patients diagnosed with dementia were matched with 12,944 diabetic patients who had not been diagnosed with dementia. The PS-matched Cox regression analysis showed that patients diagnosed with dementia were at a 2-fold increased risk for hypoglycaemic events compared with those not diagnosed with dementia (hazard ratio [HR], 2.00; 95% CI, 1.63-2.66). A similar result was shown for a multivariable analysis using all patient data (adjusted HR, 2.25; 95% CI, 2.22-2.32). Conclusion Our findings suggest that diabetic patients with a diagnosis of dementia have a statistically significant higher risk of experiencing hypoglycaemia.
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Affiliation(s)
- Alaa A. Alsharif
- Department of Pharmacy Practice, Faculty of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
| | - Ian C. K. Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - Tian Ma
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
| | - Wallis Lau
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - Meshari Alhamed
- Department of Emergency Medicine, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia
| | - Li Wei
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
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Zeitoun MH, Abdel Reheem AA, Kharboush IF, Sheshtawy H, Assad DH, El Feky AY. Relationship between depressive and anxiety symptoms and fear of hypoglycemia among adolescents and adults with type 1 diabetes mellitus. Prim Care Diabetes 2023; 17:255-259. [PMID: 36925404 DOI: 10.1016/j.pcd.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND AND AIMS Emotional problems including anxiety, depression and fear of hypoglycemia (FOH) are common in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to determine the prevalence of depressive and anxiety symptoms among patients with T1DM and their relation to glycemic control, diabetes complications and to FOH. METHODS This study included 325 patients with T1DM. Anxiety and depressive symptoms were assessed by Hospital Anxiety and Depression Scale (HADS) and FOH was assessed by Hypoglycemia Fear Survey II (HFS-II). Glycemic control was assessed by both fasting plasma glucose and HbA1c. A subsample of 75 patients was screened for diabetes complications. RESULTS The prevalence of anxiety symptoms, depressive symptoms and FOH was 76.3%, 61.8% and 20% respectively. Female sex was related to depressive symptoms but not to anxiety symptoms. Logistic regression analysis showed that both HbA1c and HFS-II total score were independently correlated with both anxiety symptoms and depressive symptoms. Age showed independent correlation with both HFS-II (total score) and with Hypoglycemia Fear Survey-worry (HFS-W) while HbA1c showed independent correlation with Hypoglycemia Fear Survey-behavior (HFS-B). Both anxiety and depressive symptoms were positively correlated to HFS-B score, HFS-W score and HFS-II total score. CONCLUSIONS FOH is not uncommon among Egyptian patients with T1DM and it seems to be one of the factors contributing to the increased prevalence of anxiety and depressive symptoms among those individuals. Addressing and managing the different psychological aspects of diabetes should be integrated within the routine diabetes care services for people with T1DM.
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Affiliation(s)
| | | | - Ibrahim F Kharboush
- Department of Maternal and Child Health, High Institute of Public Health, Alexandria University, Egypt
| | - Hesham Sheshtawy
- Department of Neurology and Psychiatry, Alexandria University, Egypt
| | - Dalia H Assad
- Department of Internal Medicine, Abu Qir general hospital, Alexandria, Egypt
| | - Amr Y El Feky
- Department of Internal Medicine, Alexandria University, Egypt.
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St-Onge MP, Cherta-Murillo A, Darimont C, Mantantzis K, Martin FP, Owen L. The interrelationship between sleep, diet, and glucose metabolism. Sleep Med Rev 2023; 69:101788. [PMID: 37156196 PMCID: PMC10247426 DOI: 10.1016/j.smrv.2023.101788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023]
Abstract
Obesity and type 2 diabetes (T2D) are increasingly common worldwide. While these disorders have increased in prevalence over the past several decades, there has been a concomitant reduction in sleep duration. Short sleep duration has been associated with higher rates of obesity and T2D, and the causality of these associations and their directionality, continue to necessitate evaluation. In this review we consider the evidence that sleep is an intrinsic factor in the development of obesity and chronic metabolic disorders, such as insulin resistance and T2D, while evaluating a potential bi-directional association. We consider the evidence that diet and meal composition, which are known to impact glycemic control, may have both chronic and acute impact upon sleep. Moreover, we consider that postprandial nocturnal metabolism and peripheral glycemia may affect sleep quality. We propose putative mechanisms whereby acute effects of nighttime glucose excursions may lead to increased sleep fragmentation. We conclude that dietary manipulations, particularly with respect to carbohydrate quality, may confer sleep benefits. Future research may seek to evaluate the effectiveness of synergistic nutrient strategies to promote sleep quality, with particular attention to carbohydrate quality, quantity, and availability as well as carbohydrate to protein ratio.
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Affiliation(s)
- Marie-Pierre St-Onge
- Division of General Medicine and Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | | | - Christian Darimont
- Nestlé Research, Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | | | | | - Lauren Owen
- Nestlé Research, Nestlé Institute of Health Sciences, Lausanne, Switzerland
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Wahid Satar SNA, Norhayati MN, Yaacob LH. Recurrent hypoglycemia in a patient with hepatocellular carcinoma. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hypoglycemia is a common complication of diabetes mellitus. Patients may present with any kind of symptoms, either autonomic or neuroglycopenic. Here, we report a case of a 70-year-old man with type 2 diabetes mellitus with a newly diagnosed hepatocellular carcinoma presenting with recurrent episodes of hypoglycemia. The insulin treatment was withheld initially. However, the patient's diabetic control worsened after starting treatment for his hepatocellular carcinoma. Hence, the insulin treatment was resumed. This case highlighted the challenge in balancing the management of hypoglycaemia and poor diabetic control in a patient who has diabetes mellitus and hepatocellular carcinoma. Primary care practitioners need to have high clinical suspicion to monitor these patients to prevent hypoglycemia and manage them accordingly.
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Affiliation(s)
- Siti Nor Ain Wahid Satar
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
| | - Lili Husniati Yaacob
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
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Dmitriev IV, Severina AS, Zhuravel NS, Yevloyeva MI, Salimkhanov RK, Shchelykalina SP, Bezunov EA, Shamkhalova MS, Semenova JF, Klimontov VV, Shestakova MV. Continuous Glucose Monitoring in Patients Following Simultaneous Pancreas-Kidney Transplantation: Time in Range and Glucose Variability. Diagnostics (Basel) 2023; 13:diagnostics13091606. [PMID: 37174997 PMCID: PMC10177867 DOI: 10.3390/diagnostics13091606] [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: 03/23/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Simultaneous pancreas-kidney transplantation (SPKT) can improve long-term patient survival and restore endogenous insulin secretion in recipients with type 1 diabetes (T1D). There are currently few data on glucose fluctuations assessed by continuous glucose monitoring (CGM) after SPKT. Aim: to evaluate CGM-derived time in range (TIR) and glucose variability (GV) in patients with T1D and functioning pancreatic grafts after SPKT. Fifty-four CGM recordings from 43 patients, 15 men and 28 women, aged 34 (31; 39) years were analyzed. Time since SKPT was up to 1 year (group 1, n = 13), from 1 to 5 years (group 2, n = 15), and from 5 to 12 years (group 3, n = 26). TIR (3.9-10 mmol/L), Time Above Range (TAR), Time Below Range (TBR), and GV parameters were estimated. There were no differences in mean glucose (5.5 [5.1; 6.2], 5.9 [5.4; 6.2], and 5.9 [5.6; 6.7] mmol/L), TIR (97.6 [92.8-99.1], 97.2 [93.2; 99.1], and 97.5 [93.4; 99]%); TAR (0, 1.8 [1.3; 3.7], and 2.5 [2; 5]%), TBR (5 [3.3; 12.7], 4.1 [2.2; 10.1], and 3.5 [1.3; 6.5]%) and GV parameters between three groups (all p > 0.05). Thus, recipients with functioning pancreatic grafts demonstrate remarkably high TIR and low GV after SPKT.
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Affiliation(s)
- Ilya V Dmitriev
- Sklifosovsky Research Institute for Emergency Medicine, 129090 Moscow, Russia
| | | | - Nikita S Zhuravel
- Sklifosovsky Research Institute for Emergency Medicine, 129090 Moscow, Russia
| | | | | | - Svetlana P Shchelykalina
- Department of Medical Cybernetics and Computer Science MBF Pirogov Russian National Research Medical University (RNRMU), 117997 Moscow, Russia
| | - Evgeniy A Bezunov
- FSBI "Central Clinical Hospital with Polyclinic" of the Presidential Department of the Russian Federation, 121359 Moscow, Russia
| | | | - Julia F Semenova
- Research Institute of Clinical and Experimental Lymphology-Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL-Branch of IC&G SB RAS), 630060 Novosibirsk, Russia
| | - Vadim V Klimontov
- Research Institute of Clinical and Experimental Lymphology-Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL-Branch of IC&G SB RAS), 630060 Novosibirsk, Russia
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Tzogiou C, Wieser S, Eichler K, Carlander M, Djalali S, Rosemann T, Brändle M. Incidence and costs of hypoglycemia in insulin-treated diabetes in Switzerland: A health-economic analysis. J Diabetes Complications 2023; 37:108476. [PMID: 37141836 DOI: 10.1016/j.jdiacomp.2023.108476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/27/2023] [Accepted: 04/11/2023] [Indexed: 05/06/2023]
Abstract
AIMS We assess the incidence and economic burden of severe and non-severe hypoglycemia in insulin-treated diabetes type 1 and 2 patients in Switzerland. METHODS We developed a health economic model to assess the incidence of hypoglycemia, the subsequent medical costs, and the production losses in insulin-treated diabetes patients. The model distinguishes between severity of hypoglycemia, type of diabetes, and type of medical care. We used survey data, health statistics, and health care utilization data extracted from primary studies. RESULTS The number of hypoglycemic events in 2017 was estimated at 1.3 million in type 1 diabetes patients and at 0.7 million in insulin-treated type 2 diabetes patients. The subsequent medical costs amount to 38 million Swiss Francs (CHF), 61 % of which occur in type 2 diabetes. Outpatient visits dominate costs in both types of diabetes. Total production losses due to hypoglycemia amount to CHF 11 million. Almost 80 % of medical costs and 39 % of production losses are due to non-severe hypoglycemia. CONCLUSIONS Hypoglycemia leads to substantial socio-economic burden in Switzerland. Greater attention to non-severe hypoglycemic events and to severe hypoglycemia in type 2 diabetes could have a major impact on reducing this burden.
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Affiliation(s)
- Christina Tzogiou
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland.
| | - Simon Wieser
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland.
| | - Klaus Eichler
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland
| | - Maria Carlander
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Gertrudstrasse 15, 8401 Winterthur, Switzerland.
| | - Sima Djalali
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland.
| | - Michael Brändle
- Division of Endocrinology and Diabetes, Department of Internal Medicine, Saint Gallen Cantonal Hospital, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland.
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Cisuelo O, Stokes K, Oronti IB, Haleem MS, Barber TM, Weickert MO, Pecchia L, Hattersley J. Development of an artificial intelligence system to identify hypoglycaemia via ECG in adults with type 1 diabetes: protocol for data collection under controlled and free-living conditions. BMJ Open 2023; 13:e067899. [PMID: 37072364 PMCID: PMC10124264 DOI: 10.1136/bmjopen-2022-067899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION Hypoglycaemia is a harmful potential complication in people with type 1 diabetes mellitus (T1DM) and can be exacerbated in patients receiving treatment, such as insulin therapies, by the very interventions aiming to achieve optimal blood glucose levels. Symptoms can vary greatly, including, but not limited to, trembling, palpitations, sweating, dry mouth, confusion, seizures, coma, brain damage or even death if untreated. A pilot study with healthy (euglycaemic) participants previously demonstrated that hypoglycaemia can be detected non-invasively with artificial intelligence (AI) using physiological signals obtained from wearable sensors. This protocol provides a methodological description of an observational study for obtaining physiological data from people with T1DM. The aim of this work is to further improve the previously developed AI model and validate its performance for glycaemic event detection in people with T1DM. Such a model could be suitable for integrating into a continuous, non-invasive, glucose monitoring system, contributing towards improving surveillance and management of blood glucose for people with diabetes. METHODS AND ANALYSIS This observational study aims to recruit 30 patients with T1DM from a diabetes outpatient clinic at the University Hospital Coventry and Warwickshire for a two-phase study. The first phase involves attending an inpatient protocol for up to 36 hours in a calorimetry room under controlled conditions, followed by a phase of free-living, for up to 3 days, in which participants will go about their normal daily activities unrestricted. Throughout the study, the participants will wear wearable sensors to measure and record physiological signals (eg, ECG and continuous glucose monitor). Data collected will be used to develop and validate an AI model using state-of-the-art deep learning methods. ETHICS AND DISSEMINATION This study has received ethical approval from National Research Ethics Service (ref: 17/NW/0277). The findings will be disseminated via peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER NCT05461144.
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Affiliation(s)
- Owain Cisuelo
- School of Engineering, University of Warwick, Coventry, UK
| | - Katy Stokes
- School of Engineering, University of Warwick, Coventry, UK
| | | | | | - Thomas M Barber
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Martin O Weickert
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, UK
- Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - John Hattersley
- School of Engineering, University of Warwick, Coventry, UK
- Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Ushiogi Y, Kanehara H, Kato T. Frequency of Hypoglycemia Assessed by Continuous Glucose Monitoring in Advanced CKD. Clin J Am Soc Nephrol 2023; 18:475-484. [PMID: 36723294 PMCID: PMC10103209 DOI: 10.2215/cjn.0000000000000102] [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: 07/29/2022] [Accepted: 01/17/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hypoglycemia represents a risk for serious morbidity. We evaluated the prevalence and risk factors of hypoglycemia by continuous glucose monitoring (CGM) in patients with CKD with or without diabetes. METHODS In this cross-sectional study, outpatients with CKD stages G3-G5 (including hemodialysis) and type 2 diabetes without CKD were enrolled and underwent intermittently scanned CGM measurements for 7 days. The burden of CGM-measured hypoglycemia was assessed using the 7-day sum of area over the curve with glucose levels <70 mg/dl and the sum of time spent <54 mg/dl. RESULTS A total of 366 participants (148 participants with CKD and diabetes, 115 with CKD and without diabetes, and 103 without CKD and with diabetes) were included. Glucose levels of <54 mg/dl were observed in 41% of participants with CKD and diabetes, 48% of participants with CKD and without diabetes, and 14% of participants with diabetes and without CKD. However, only two participants reported hypoglycemic symptoms during CGM measurements, which were confirmed and documented by capillary blood glucose measurements. Between-group differences of 7-day area over the curve (<70 mg/dl) were as follows: hemodialysis group versus CKD stage G4 and G5 groups, -0.25 min·mg/dl per hour (95% confidence interval [CI], -6.40 to -0.59) P <0.001; CKD stage G4 and G5 groups versus CKD stage G3 group, -0.08 min·mg/dl per hour (95% CI, -0.0 to -0.50) P =0.15; and CKD stage G3 group versus diabetes without CKD group, -0.14 min·mg/dl per hour (95% CI, -0.0 to -0.20) P =0.01. In addition, the subgroup analysis of the diabetic or nondiabetic and at daytime or nighttime showed that the 7-day area over the curve (<70 mg/dl) and time spent (<54 mg/dl) was larger with worse kidney function. CONCLUSIONS The lowering level of kidney function was strongly associated with the burden of hypoglycemia in patients with CKD.
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Affiliation(s)
- Yasuyuki Ushiogi
- Department of Nephrology, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Hideo Kanehara
- Department of Endocrinology, Diabetes and Metabolism, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Tamayo Kato
- Department of Nephrology, Fukui-ken Saiseikai Hospital, Fukui, Japan
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Haluzík M, Seufert J, Guja C, Bonnemaire M, Bigot G, Tournay M, Kis JT, Freemantle N. Effectiveness and Safety of iGlarLixi (Insulin Glargine 100 U/mL Plus Lixisenatide) in Type 2 Diabetes According to the Timing of Daily Administration: Data from the REALI Pooled Analysis. Diabetes Ther 2023; 14:639-652. [PMID: 36787044 PMCID: PMC10064361 DOI: 10.1007/s13300-023-01375-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION iGlarLixi (insulin glargine 100 U/mL plus lixisenatide) has demonstrated glycaemic efficacy and safety in adults with inadequately controlled type 2 diabetes mellitus (T2DM). Per the European Medicines Agency's product label, iGlarLixi should be injected once a day within 1 h prior to a meal, preferably the same meal every day when the most convenient meal has been chosen. It is however unknown whether iGlarLixi administration timing affects glycaemic control and safety, as clinical trial evidence is mainly based on pre-breakfast iGlarLixi administration. Therefore, we assessed the effectiveness and safety of iGlarLixi in clinical practice, according to its administration timing. METHODS Data were pooled from two prospective observational studies including 1303 European participants with T2DM inadequately controlled on oral antidiabetic drugs with or without basal insulin who initiated iGlarLixi therapy for 24 weeks. Participants were classified into four subgroups based on daily timing of iGlarLixi injection: pre-breakfast (N = 436), pre-lunch (N = 262), pre-dinner (N = 399), and those who switched iGlarLixi injection time during the study (N = 206). RESULTS No meaningful differences in baseline characteristics were observed between the study groups. Least-squares mean reductions in haemoglobin A1c (HbA1c) from baseline to week 24 were substantial in all groups, with the numerically largest decrease observed in the pre-breakfast group (1.57%) compared with the pre-lunch (1.27%), pre-dinner (1.42%), or changed injection time (1.33%) groups. Pre-breakfast iGlarLixi injection also resulted in a numerically greater proportion of participants achieving HbA1c < 7.0% at week 24 (33.7% versus 19.0% for pre-lunch, 25.6% pre-dinner, and 23.2% changed injection time). iGlarLixi was well tolerated across all groups, with low rates of gastrointestinal disorders and hypoglycaemia. Mean body weight decreased similarly in all groups (by 1.3-2.3 kg). CONCLUSION iGlarLixi was effective and safe regardless of its daily administration time. However, pre-breakfast iGlarLixi injection resulted in a more effective glycaemic control.
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Affiliation(s)
- Martin Haluzík
- Institute for Clinical and Experimental Medicine and Charles University, Prague, Czech Republic
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Centre-Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cristian Guja
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Mathilde Tournay
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - János Tibor Kis
- Department of Internal Medicine Centrum, Szent János Hospital, Budapest, Hungary
| | - Nick Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
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Nattero-Chávez L, Lecumberri Pascual E, De La Calle E, Bayona Cebada A, Ruiz T, Quintero Tobar A, Lorenzo M, Sánchez C, Izquierdo A, Luque-Ramírez M, Escobar-Morreale HF. Switching to an advanced hybrid closed-loop system in real-world practice improves hypoglycemia awareness and metabolic control in adults with type 1 diabetes, particularly in those with impaired perception of hypoglycemia symptoms. Diabetes Res Clin Pract 2023; 199:110627. [PMID: 36940793 DOI: 10.1016/j.diabres.2023.110627] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/20/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
AIMS To evaluate the efficacy of an advance closed-loop (AHCL) system in restoring awareness of hypoglycemia in patients with type 1 diabetes (T1D). METHODS We conducted a prospective study including 46 subjects with T1D flash glucose monitoring (FGM) or continuous glucose monitoring (CGM) switching to a Minimed 780G® system. Patients were classified in three groups according to the therapy used before switching to Minimed® 780G: multiple dose insulin (MDI) therapy + FGM (n = 6), continuous subcutaneous insulin infusion + FGM (n = 21), and sensor-augmented pump with predictive low-glucose suspend (n = 19). FGM/CGM data were analyzed at baseline, after 2 and 6 months on AHCL. Clarke's score of hypoglycemia awareness was compared at baseline and 6 months recordings. We also compared the efficacy of the AHCL system in improving A1c among patients with appropriate perception of symptoms of hypoglycemia compared to those presenting with impaired awareness of hypoglycemia (IAH). RESULTS Participants had a mean age of 37 ± 15 and a diabetes duration of 20 ± 10 years. At baseline, 12 patients (27%) showed IAH as defined by a Clarke's score ≥ 3. Patients with IAH were older and had lower estimated glomerular filtration rate (eGFR) compared with those who did not have IAH; with no differences in baseline CGM metrics or A1c. An overall decrease in A1c was observed after 6 months on AHCL system (from 6.9 ± 0.5% to 6.7 ± 0.6%, P < 0.001), regardless of prior insulin therapy. The improvement in metabolic control was greater in patients with IAH, showing a reduction in A1c from 6.9 ± 0.5 to 6.4 ± 0.4% vs 6.9 ± 0.5 to 6.8 ± 0.6% (P = 0.003), showing a parallel increase in total daily boluses of insulin and automatic bolus correction administered by the AHCL system. In patients with IAH Clarke's score decreased from 3.6 ± 0.8 at baseline to 1.9 ± 1.6 after 6 months (P < 0.001). After 6 months on AHCL system, only 3 patients (7%) presented with a Clarke's score ≥ 3, resulting in an absolute risk reduction of 20% (95% confidence interval: 7-32) of having IAH. CONCLUSIONS Switching from any type of insulin administration to AHCL system improves restoration of hypoglycemia awareness and metabolic control in patients with T1D, particularly in adults with impaired perception of hypoglycemia symptoms. TRIAL REGISTRATION ClinicalTrial.gov ID NCT04900636.
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Affiliation(s)
- Lía Nattero-Chávez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) & Universidad de Alcalá, Madrid, Spain.
| | | | - Esther De La Calle
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ane Bayona Cebada
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) & Universidad de Alcalá, Madrid, Spain
| | - Teresa Ruiz
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alejandra Quintero Tobar
- Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) & Universidad de Alcalá, Madrid, Spain
| | - Mar Lorenzo
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Cristina Sánchez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Izquierdo
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Manuel Luque-Ramírez
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) & Universidad de Alcalá, Madrid, Spain; Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Héctor F Escobar-Morreale
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain; Grupo de Investigación en Diabetes, Obesidad y Reproducción Humana, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) & Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) & Universidad de Alcalá, Madrid, Spain; Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
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El Kantar Y, Durán S, Lanes R, Paoli M. Evaluación del desempeño cognitivo en escolares y adolescentes con diabetes mellitus tipo 1. INVESTIGACIÓN CLÍNICA 2023. [DOI: 10.54817/ic.v64n1a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
The study aimedto evaluate the cognitive functioning of children and adolescents with type 1 diabetes mellitus (T1DM) recruited from the IAHULA Endocrinology Outpatient Unit and to compare it to that of non-diabetics as to investigate the influence on cognition of factors re-lated to the disease. An analytical, cross-sectional observational study was carried out on a group of 30 patients with T1DM between 8 and 16 years of age and on a control group of 30 individuals matched by age, gender, education, and socioeconomic status. Interrogation and review of medi-cal records to obtain data on the clinical characteristics and treatment of T1DM were conducted. The WISC IV test was then applied to evaluate cognition and intellectual coefficient (IQ). The average age of the diabetic patients was 13.27±2.31 years, and half of them were male. Lower scores were found in the different domains of the WISC IV in the group with T1DM (p<0.01). The IQ was found to be lower in children with T1DM than in con-trols (75.47±13.87 vs. 88.57±11.06; p=0.0001). Likewise, a higher fre-quency of IQ scores below the 10th percentile was observed in the diabetic children (63.3% vs. 33.3%; p=0.02; Odds ratio: 3.45; 95%CI: 1.19-9.99). It was concluded that T1DM negatively impacts the cognitive performance of children and adolescents. Cognitive evaluation of these patients is recom-mended, as it could affect their daily life.
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Affiliation(s)
- Yusmary El Kantar
- Servicio de Endocrinología del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA), Mérida, Venezuela
| | - Samy Durán
- Oficina Estadal Antidrogas, Mérida, Venezuela
| | - Roberto Lanes
- Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
| | - Mariela Paoli
- Servicio de Endocrinología del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA), Mérida, Venezuela
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Kaur J, Seaquist ER. Hypoglycaemia in type 1 diabetes mellitus: risks and practical prevention strategies. Nat Rev Endocrinol 2023; 19:177-186. [PMID: 36316392 DOI: 10.1038/s41574-022-00762-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 01/06/2023]
Abstract
Hypoglycaemia, which occurs when blood levels of glucose fall below what is considered a normal range, is a well-known complication of insulin therapy in individuals with type 1 diabetes mellitus. Despite advances in diabetes mellitus management, hypoglycaemia has continued to affect the majority of these individuals, leading to suboptimal care and decreased quality of life. Multiple epidemiological studies have demonstrated the risks associated with hypoglycaemic events. With this understanding, various advances have been made in therapeutics for diabetes mellitus management. Diabetes mellitus education continues to form the foundation for management and prevention of hypoglycaemia. The advent of newer diabetes mellitus technologies and newer insulins herald improvements in management strategies and hypoglycaemia prevention. Improved understanding of these newer approaches is needed to ensure delivery of safe and effective care to individuals with type 1 diabetes mellitus, leading to reductions in both the short-term and long-term morbidity and mortality associated with hypoglycaemic events.
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Affiliation(s)
- Jasleen Kaur
- Department of Medicine, Division of Endocrinology and Diabetes, University of Minnesota, Minneapolis, MN, USA
| | - Elizabeth R Seaquist
- Department of Medicine, Division of Endocrinology and Diabetes, University of Minnesota, Minneapolis, MN, USA.
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Fan Y, Lau ES, Wu H, Yang A, Chow E, Kong AP, Ma RC, Chan JC, Luk AO. Incident cardiovascular-kidney disease, diabetic ketoacidosis, hypoglycaemia and mortality in adult-onset type 1 diabetes: a population-based retrospective cohort study in Hong Kong. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2023. [DOI: 10.1016/j.lanwpc.2023.100730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Skow RJ, Steinback CD, Davenport MH. Prenatal Exercise and Cardiovascular Health (PEACH) study: impact of meal timing and pre-exercise blood glucose values on glycemic responses to acute exercise in pregnancy. Appl Physiol Nutr Metab 2023; 48:345-349. [PMID: 36753722 DOI: 10.1139/apnm-2022-0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
We retrospectively analyzed data from 28 participants engaging in moderate-intensity aerobic exercise (265 sessions; 25-40 min) between 18-34 weeks gestation (NCT02948439). The mean change in blood glucose (BG) from pre- to post-acute exercise session was -1.0 ± 1.2 mmol/L. Pre-exercise BG significantly predicted the change in BG (p < 0.001), even when controlling for meal timing, exercise duration, and gestational age. Hypoglycemia only occurred in 3% of sessions. Therefore, in healthy pregnancy the change in BG during exercise is small and primarily related to pre-exercise BG values.
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Affiliation(s)
- Rachel J Skow
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton AB, Canada.,Alberta Diabetes Institute, University of Alberta, Edmonton AB, Canada
| | - Craig D Steinback
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton AB, Canada.,Alberta Diabetes Institute, University of Alberta, Edmonton AB, Canada
| | - Margie H Davenport
- Program for Pregnancy and Postpartum Health, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton AB, Canada.,Alberta Diabetes Institute, University of Alberta, Edmonton AB, Canada
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Farhadnejad H, Sadat S, Jahromi MK, Teymoori F, Tehrani AN, Mokhtari E, Teymouri H, Mirmiran P. The association of dietary glycemic index and glycemic load with the risk of insomnia in the adult population. BMC Nutr 2023; 9:28. [PMID: 36750913 PMCID: PMC9903533 DOI: 10.1186/s40795-023-00689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND A dietary pattern with a high glycemic index (GI) and glycemic load (GL) can be a precursor to sleep disorders that link to many chronic diseases. We aimed to assess the association of dietary GI and GL with the risk of insomnia in Iranian adults. METHODS A total of 111 newly diagnosed insomnia cases and 333 controls aged 18-60 years were included in this case-control study. The participants' dietary intakes were collected using a valid and reliable food frequency questionnaire. The diagnosis of insomnia in subjects was performed by a neurologist using the Insomnia Severity Index (ISI) questionnaire. Multivariable logistic regression models, adjusted for the potential confounders, were used to determine the risk of insomnia according to tertiles of dietary glycemic indices. RESULTS The mean (SD) age and BMI of the study population (78.6% female) were 31.8 (10.0) years and 24.70 (3.62) kg/m2, respectively. The median (IQR) of dietary GI and GL in subjects was 62.7 (57.0-68.6) and 213.5(167.4-268.5), respectively. Based on the multivariable-adjusted model, after controlling for age, sex, physical activity, obesity, smoking, socioeconomic score, general health questionnaire (GHQ) score, and dietary energy intake, the odds of insomnia were increased across tertiles of dietary GL[(OR:2.72,95%CI:1.10-6.70),(Ptrend = 0.017)], however, no significant association was observed between high GI diet and insomnia risk [(OR:1.38,95%CI:0.77-2.47),(Ptrend = 0.298)]. CONCLUSIONS Our results revealed that greater adherence to dietary pattern with high GL could be increased the odds of insomnia in Iranian adults.
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Affiliation(s)
- Hossein Farhadnejad
- grid.411600.2Student Research Committee, Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Sadat
- grid.411036.10000 0001 1498 685XResearch Committee and Department of Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mitra Kazemi Jahromi
- grid.412237.10000 0004 0385 452XEndocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Farshad Teymoori
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asal Neshatbini Tehrani
- grid.411230.50000 0000 9296 6873Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran ,grid.411230.50000 0000 9296 6873Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ebrahim Mokhtari
- grid.411600.2Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Teymouri
- grid.411705.60000 0001 0166 0922Deputy for Health Affairs, Psychosocial Unit, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Getawa S, Bayleyegn B. Platelet, Neutrophil and Lymphocyte Quantitative Abnormalities in Patients with Heart Failure: A Retrospective Study. Vasc Health Risk Manag 2023; 19:69-78. [PMID: 36776273 PMCID: PMC9911900 DOI: 10.2147/vhrm.s394765] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
Background Heart failure pathophysiology and its clinical symptoms are characterized by inflammation. Elevated levels of leukocyte subpopulations are a well-known indicator of inflammation and play a predictive role in determining the prognosis of patients with cardiovascular diseases. Besides, platelets are essential mediators of inflammation, especially when they interact with leukocytes. Platelet synthesis, activation, and function are all impacted by heart failure. Thus, the study was aimed at determining the magnitude of platelet, neutrophil, and lymphocyte abnormalities in patients with heart failure. Methods A retrospective cross-sectional study was conducted from June to July 2022 at the University of Gondar comprehensive specialized hospital. A total of 245 medical records of heart failure patients were included. Data regarding socio-demographic, clinical, and some hematological and biochemical parameters were collected from medical records. Data was entered into Epi-Data 4.6.0.2 and then exported to Stata 11.0 statistical software for analysis. A binary logistic regression analysis with its odds ratio was calculated to identify factors associated with the outcome variables. P-value <0.05 was considered statistically significant. Results The most frequent leukocyte abnormality among adults with heart failure was neutrophilia, which was detected in 17.55% (95% CI: 13.26-22.87). Besides, lymphocytosis was observed in 10.20% (95% CI: 6.97-14.70) of patients. The magnitude of thrombocytopenia and thrombocytosis among patients with heart failure was 12.24% (95% CI: 8.67-17.01%) and 2.86% (95% CI: 1.36-5.90%), respectively. Only being female was significantly associated with neutrophilia in patients with heart failure (AOR = 2.33; 95% CI: 1.05-5.16). However, none of the variables were significantly associated with platelet and lymphocyte abnormalities. Conclusion Neutrophilia, lymphocytosis, and thrombocytopenia are the common leukocyte and platelet abnormalities in heart failure patients. Therefore, early detection and management of the underlying causes of those abnormalities may be important to improve patients' outcomes and prevent further complications.
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Affiliation(s)
- Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,Correspondence: Solomon Getawa, Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O.Box: 196, Gondar, Ethiopia, Tel +251-914-665-736, Email
| | - Biruk Bayleyegn
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hoffman EG, D'Souza NC, Aiken J, Atherley S, Liggins R, Riddell MC. Effects of somatostatin receptor type 2 antagonism during insulin-induced hypoglycaemia in male rats with prediabetes. Diabetes Obes Metab 2023; 25:1547-1556. [PMID: 36734462 DOI: 10.1111/dom.15002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/16/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
AIMS To examine if glucagon counterregulatory defects exist in a rat model of prediabetes (pre-T2D) and to assess if a selective somatostatin receptor 2 antagonist (SSTR2a), ZT-01, enhances the glucagon response to insulin-induced hypoglycaemia. MATERIALS AND METHODS Hyperglycaemia was induced in 8- to 9-week-old male, Sprague-Dawley rats via 7 weeks of high-fat diet followed by a single, low-dose intraperitoneal injection of streptozotocin (30 mg/kg). After 2 weeks of basal insulin therapy (0-4 U/d insulin glargine, administered subcutaneously [SC]) to facilitate partial glycaemic recovery and a pre-T2D phenotype, n = 17 pre-T2D and n = 10 normal chow-fed control rats underwent the first of two hypoglycaemic treatment-crossover experiments, separated by a 1-week washout period. On each experimental day, SSTR2a (3 mg/kg ZT-01, SC) or vehicle was administered 1 hour prior to insulin-induced hypoglycaemia (insulin aspart, 6 U/kg, SC). RESULTS Glucagon counterregulation was marginally reduced with the induction of pre-T2D. Treatment with SSTR2a raised peak plasma glucagon levels and glucagon area under the curve before and after insulin overdose in both and pre-T2D rats. Blood glucose concentration was elevated by 30 minutes after SSTR2a treatment in pre-T2D rats, and hypoglycaemia onset (≤3.9 mmol/L) was delayed by 15 ± 12 minutes compared with vehicle (P < 0.001), despite similar glucose nadirs in the two treatment groups (1.4 ± 0.3 mmol/L). SSTR2a treatment had no effect on blood glucose levels in the control group or on the hypoglycaemia-induced decline in plasma C-peptide levels in either group. CONCLUSIONS Treatment with an SSTR2a increases glucagon responsiveness and delays the onset of insulin-induced hypoglycaemia in this rat model of pre-T2D where only a modest deficiency in glucagon counterregulation exists.
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Affiliation(s)
- Emily G Hoffman
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Ninoschka C D'Souza
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Julian Aiken
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Sara Atherley
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | | | - Michael C Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
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Mathiesen ER, Alibegovic AC, Corcoy R, Dunne F, Feig DS, Hod M, Jia T, Kalyanam B, Kar S, Kautzky-Willer A, Marchesini C, Rea RD, Damm P. Insulin degludec versus insulin detemir, both in combination with insulin aspart, in the treatment of pregnant women with type 1 diabetes (EXPECT): an open‑label, multinational, randomised, controlled, non-inferiority trial. Lancet Diabetes Endocrinol 2023; 11:86-95. [PMID: 36623517 DOI: 10.1016/s2213-8587(22)00307-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Insulin degludec (degludec) is a second-generation basal insulin with an improved pharmacokinetic-pharmacodynamic profile compared with first-generation basal insulins, but there are few data regarding its use during pregnancy. In this non-inferiority trial, we aimed to compare the efficacy and safety of degludec with insulin detemir (detemir), both in combination with insulin aspart (aspart), in pregnant women with type 1 diabetes. METHODS This open-label, multinational, randomised, controlled, non-inferiority trial (EXPECT) was conducted at 56 sites (hospitals and medical centres) in 14 countries. Women aged at least 18 years with type 1 diabetes who were between gestational age 8 weeks (+0 days) and 13 weeks (+6 days) or planned to become pregnant were randomly assigned (1:1), via an interactive web response system, to degludec (100 U/mL) once daily or detemir (100 U/mL) once or twice daily, both with mealtime insulin aspart (100 U/mL), all via subcutaneous injection. Participants who were pregnant received the trial drug at randomisation, throughout pregnancy and until 28 days post-delivery (end of treatment). Participants not pregnant at randomisation initiated the trial drug before conception. The primary endpoint was the last planned HbA1c measurement before delivery (non-inferiority margin of 0·4% for degludec vs detemir). Secondary endpoints included efficacy, maternal safety, and pregnancy outcomes. The primary endpoint was assessed in all randomly assigned participants who were pregnant during the trial. Safety was assessed in all randomly assigned participants who were pregnant during the trial and exposed to at least one dose of trial drug. This study is registered with ClinicalTrials.gov, NCT03377699, and is now completed. FINDINGS Between Nov 22, 2017, and Nov 8, 2019, from 296 women screened, 225 women were randomly assigned to degludec (n=111) or detemir (n=114). Mean HbA1c at pregnancy baseline was 6·6% (SD 0·6%; approximately 49 mmol/mol; SD 7 mmol/mol) in the degludec group and 6·5% (0·8%; approximately 48 mmol/mol; 9 mmol/mol) in the detemir group. Mean last planned HbA1c measurement before delivery was 6·2% (SE 0·07%; approximately 45 mmol/mol; SE 0·8 mmol/mol) in the degludec group and 6·3% (SE 0·07%; approximately 46 mmol/mol; SE 0·8 mmol/mol) in the detemir group (estimated treatment difference -0·11% [95% CI -0·31 to 0·08]; -1·2 mmol/mol [95% CI: -3·4 to 0·9]; pnon-inferiority<0·0001), confirming non-inferiority. Compared with detemir, no additional safety issues were observed with degludec. INTERPRETATION In pregnant women with type 1 diabetes, degludec was found to be non-inferior to detemir. FUNDING Novo Nordisk.
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Affiliation(s)
- Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - Rosa Corcoy
- Servei d'Endocrinologia i Nutrició, Hospital de la Santa Creu i Sant Pau-Dos de Maig, Barcelona, Spain; CIBER-Bioengineering Biomaterials and Nanomedicine, Madrid, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Fidelma Dunne
- Clinical Research Facility, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Denice S Feig
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto and the Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada
| | - Moshe Hod
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ting Jia
- Novo Nordisk A/S, Søborg, Denmark
| | | | - Soumitra Kar
- Novo Nordisk Service Centre India Private, Bangalore, India
| | | | | | - Rustam D Rea
- Oxford Centre for Diabetes Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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