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Havaldar AA, Selvam S. Nutritional Prescription in ICU Patients: Does it Matter? Indian J Crit Care Med 2024; 28:657-661. [PMID: 38994260 PMCID: PMC11234123 DOI: 10.5005/jp-journals-10071-24755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
Background The nutritional status of the patients before critical illness and nutrition support given during the critical illness play an important role in the recovery. We aimed to evaluate the nutritional prescription and its effect on ICU mortality. Materials and methods This was a prospective observational study conducted after institutional ethical committee approval (IEC 94/2018, CTRI/2018/06/014625) in a case-mixed (medical and surgical) ICU. Patients admitted to the ICU were enrolled within 24 hours of admission. The amount of calories and proteins prescribed and received by the patients was collected for 7 days. The primary outcome was ICU mortality. Results A total of 100 patients were included. The mean age was 48.63 (16.25) years, and 62% were males. The acute physiology and chronic health evaluation (APACHE II), sequential organ failure assessment (SOFA), and modified Nutric (mNUTRIC) scores were comparable between the two groups. The ICU mortality was 30%. The calorie and protein deficits were comparable between survivors and non-survivors. Among the secondary outcomes, a significant time effect (p = 0.013) and interaction effect (p = 0.004) were noted for maximum glucose levels. The glucose variability calculated by coefficient of variation (CV) was significantly higher in non-survivors than survivors (p = 0.031). Conclusion The calorie and protein deficits did not affect ICU mortality. The maximum glucose variability and CV were significant parameters associated with ICU mortality. How to cite this article Havaldar AA, Selvam S. Nutritional Prescription in ICU Patients: Does it Matter? Indian J Crit Care Med 2024;28(7):657-661.
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Affiliation(s)
- Amarja Ashok Havaldar
- Department of Critical Care, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Sumithra Selvam
- Department of Biostatistics, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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Chauhan YV, Gada JV, Misra S, Dhole CB, Palekar AV, Varthakavi PK, Bhagwat NM. Early Dinner Improves the Glycemic Profile in Habitual Late Eaters With Uncontrolled Type 2 Diabetes Mellitus in the Short Term. Cureus 2024; 16:e59504. [PMID: 38826926 PMCID: PMC11144034 DOI: 10.7759/cureus.59504] [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: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
Background Late dinner (LD) can worsen the glucose profile in type 2 diabetes (T2D). We assessed the short-term effect of early dinner (ED) on glycemic control in habitual late eaters with uncontrolled T2D. Methodology This interventional, single-arm, within-group trial recruited 10 habitual late eaters with uncontrolled T2D (glycosylated hemoglobin: 7-9% and either fasting plasma glucose (FPG): ≥140 mg/dl or post-prandial plasma glucose: ≥200 mg/dl). They had their usual LD (beyond 22:00 hours) on Days 0-3 and ED (before 20:00 hours) on Days 4-10. Continuous glucose monitoring system (CGMS) parameters, two-hour post-dinner, and fasting (10-hour post-dinner) investigations were analyzed. Bedtime hunger was assessed using a Labeled Magnitude Satiety Scale. Results The mean dinner time was reduced from 22:28 hours to 19:29 hours. CGMS revealed that ED lowered the 10-hour post-dinner incremental area under the curve (22,587.9 ± 5,168.3 mg/dl×mins vs. 15,886.3 ± 4,288.7 mg/dl×mins, P < 0.002), 10-hour post-dinner average blood glucose (ABG) (137.5 ± 9.3 mg/dl vs. 125 ± 7.9 mg/dl, P < 0.002), 24-hour ABG (132.2 ± 7.5 mg/dl vs. 124.8 ± 5.4 mg/dl, P = 0.037), and night mean amplitude of glucose excursion (83.7 ± 5.8 mg/dl vs. 69.3 ± 7.5 mg/dl, P = 0.027). ED also reduced FPG (119.8 ± 7.3 mg/dl vs. 105.2 ± 5.7 mg/dl, P = 0.015), fasting insulin (15.0 ± 4.3 µIU/ml vs. 9.7 ± 2.7 µIU/ml, P < 0.002), and HOMA-IR (4.36 ± 1.2 vs. 2.56 ± 0.79, P < 0.002). Post-dinner glucose, insulin, and inflammatory markers were unchanged. Bedtime hunger increased significantly on Days 4 and 5 but returned to baseline by Day 10. Conclusions A simple modification of dinner time in habitual late eaters with uncontrolled T2D improves FPG, glycemic control, and insulin resistance in the short term.
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Affiliation(s)
- Yash V Chauhan
- Department of Endocrinology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, IND
| | - Jugal V Gada
- Department of Endocrinology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, IND
| | - Sukirti Misra
- Department of Endocrinology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, IND
| | - Charushila B Dhole
- Department of Endocrinology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, IND
| | - Anagha V Palekar
- Department of Dietetics, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, IND
| | - Premlata K Varthakavi
- Department of Endocrinology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, IND
| | - Nikhil M Bhagwat
- Department of Endocrinology, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital, Mumbai, IND
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Chaudhry M, Kumar M, Singhal V, Srinivasan B. Metabolic health tracking using Ultrahuman M1 continuous glucose monitoring platform in non- and pre-diabetic Indians: a multi-armed observational study. Sci Rep 2024; 14:6490. [PMID: 38499685 PMCID: PMC10948749 DOI: 10.1038/s41598-024-56933-2] [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: 11/09/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024] Open
Abstract
Continuous glucose monitoring (CGM) device adoption in non- and pre-diabetics for preventive healthcare has uncovered a paucity of benchmarking data on glycemic control and insulin resistance for the high-risk Indian/South Asian demographic. Furthermore, the correlational efficacy between digital applications-derived health scores and glycemic indices lacks clear supportive evidence. In this study, we acquired glycemic variability (GV) using the Ultrahuman (UH) M1 CGM, and activity metrics via the Fitbit wearable for Indians/South Asians with normal glucose control (non-diabetics) and those with pre-diabetes (N = 53 non-diabetics, 52 pre-diabetics) for 14 days. We examined whether CGM metrics could differentiate between the two groups, assessed the relationship of the UH metabolic score (MetSc) with clinical biomarkers of dysglycemia (OGTT, HbA1c) and insulin resistance (HOMA-IR); and tested which GV metrics maximally correlated with inflammation (Hs-CRP), stress (cortisol), sleep, step count and heart rate. We found significant inter-group differences for mean glucose levels, restricted time in range (70-110 mg/dL), and GV-by-SD, all of which improved across days. Inflammation was strongly linked with specific GV metrics in pre-diabetics, while sleep and activity correlated modestly in non-diabetics. Finally, MetSc displayed strong inverse relationships with insulin resistance and dysglycemia markers. These findings present initial guidance GV data of non- and pre-diabetic Indians and indicate that digitally-derived metabolic scores can positively influence glucose management.
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Affiliation(s)
- Monik Chaudhry
- Ultrahuman Healthcare Private Limited, No. 799, V K Paradise Sector2, HSR Layout Bengaluru, Bangalore, Karnataka, 560102, India
| | - Mohit Kumar
- Ultrahuman Healthcare Private Limited, No. 799, V K Paradise Sector2, HSR Layout Bengaluru, Bangalore, Karnataka, 560102, India
| | - Vatsal Singhal
- Ultrahuman Healthcare Private Limited, No. 799, V K Paradise Sector2, HSR Layout Bengaluru, Bangalore, Karnataka, 560102, India
| | - Bhuvan Srinivasan
- Ultrahuman Healthcare Private Limited, No. 799, V K Paradise Sector2, HSR Layout Bengaluru, Bangalore, Karnataka, 560102, India.
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Lazar S, Ionita I, Reurean-Pintilei D, Timar R, Luca SA, Timar B. To What Extent Is Hb A1c Associated with Glycemic Variability in Patients with Type 1 Diabetes? A Retrospective, Noninterventional Study. J Clin Med 2024; 13:450. [PMID: 38256584 PMCID: PMC10816236 DOI: 10.3390/jcm13020450] [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: 12/09/2023] [Revised: 12/25/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Glycemic variability (GV) is a novel parameter used in evaluating the quality of diabetes management. Current guidelines recommend the use of GV indexes alongside the traditional parameter to evaluate glycemic control: hemoglobin A1c (HbA1c). This study aims to evaluate the extent to which HbA1c explains the GV phenomena in patients with Type 1 diabetes (T1DM). METHODS In 147 patients with T1DM, associations between HbA1c and several GV indexes were analyzed. RESULTS Patients with an HbA1c < 7% had a lower median standard deviation of glycemia (60 vs. 48; p < 0.001), a lower coefficient of variation (34.1 vs. 38.0; p < 0.001), and a significantly increased median time in range (78 vs. 58; p < 0.001). HbA1c was positively correlated with the coefficient of variation (r = 0.349; p < 0.001) and the standard deviation (r = 0.656; p < 0.001) but reversely correlated with a lower time in range (r = -0.637; p < 0.001). CONCLUSIONS HbA1c only partially explains the GV phenomena in patients with T1DM. The HbA1c value is associated more strongly with the time in range and standard deviation than with the coefficient of variation.
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Affiliation(s)
- Sandra Lazar
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Hematology, Emergency Municipal Hospital, 300254 Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (R.T.); (S.A.L.); (B.T.)
| | - Ioana Ionita
- First Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Hematology, Emergency Municipal Hospital, 300254 Timisoara, Romania
- Multidisciplinary Research Center for Malignant Hematological Diseases (CCMHM), “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Delia Reurean-Pintilei
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (R.T.); (S.A.L.); (B.T.)
- Department of Diabetes, Nutrition and Metabolic Diseases, Consultmed Medical Centre, 700544 Iasi, Romania
| | - Romulus Timar
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (R.T.); (S.A.L.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania
| | - Silvia Ana Luca
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (R.T.); (S.A.L.); (B.T.)
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Bogdan Timar
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.R.-P.); (R.T.); (S.A.L.); (B.T.)
- Second Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, “Pius Brinzeu” Emergency Hospital, 300723 Timisoara, Romania
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Wang Y, Su X, Zhang W, Zhou Y, Zhou X, Yang W, Li H, Ma J. Effects of a Novel Glucokinase Activator, Dorzagliatin, on Glycemic Control and Glucose Fluctuation in Drug-Naïve Patients with Type 2 Diabetes Mellitus. Int J Endocrinol 2023; 2023:4996057. [PMID: 38179187 PMCID: PMC10764651 DOI: 10.1155/2023/4996057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 11/18/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
Aim The prevalence rate of type 2 diabetes mellitus (T2DM) has been increasing and a large proportion of patients still do not achieve adequate or sustainable glycemic control on the basis of previous hypoglycemic treatment. In this present study, we explored whether dorzagliatin, a novel glucokinase activator (GKA), could improve glycemic control and lessen glucose fluctuation in drug-naïve patients with T2DM. Methods A self-comparative observational study of 25 drug-naïve patients with T2DM (aged 18-75 years and HbA1c of 7.5%-11.0%) treated with dorzagliatin 75 mg twice daily for 52 weeks. Before and after dorzagliatin intervention, the serum levels of hemoglobin A1c (HbA1c), insulin, and C-peptide were measured repeatedly during fasting and after a mixed meal. The continuous glucose monitoring (CGM) device was also used to obtain 24-hour glucose profiles and assess the changes in glycemic variability parameters. Results After 52 weeks of treatment with dorzagliatin, a numerally greater reduction in HbA1c of 1.03% from the baseline was observed in patients with T2DM, accompanied by significant improvement in insulin resistance and insulin secretion. Moreover, the standard deviation of blood glucose (SDBG) and the mean amplitude of glycemic excursion (MAGE) derived from CGM data were significantly decreased after dorzagliatin therapy. The 24-h glucose variation profile showed that study patients had obviously lower mean glucose levels during the postprandial period from the baseline to week 52, an effect also demonstrated by the significant decrease in the incremental area under glucose concentration versus time curve for 2 h (iAUC0-2 h) after meals. Conclusions This study suggests that dorzagliatin therapy could effectively improve glycemic control and glucose fluctuation in drug-naïve patients with T2DM.
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Affiliation(s)
- Yuming Wang
- Department of Geriatrics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu 210008, China
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Xiaofei Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Wenli Zhang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Yunting Zhou
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Xiao Zhou
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Wei Yang
- Department of Pharmacy, Lai'an County People's Hospital, Chuzhou, Anhui 239200, China
| | - Huiqin Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, China
| | - Jianhua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210000, China
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Horne C, Cranston I, Amos M, Flowers K. Accuracy of Continuous Glucose Monitoring in an Insulin-Treated Population Requiring Haemodialysis. J Diabetes Sci Technol 2023; 17:971-975. [PMID: 37148160 PMCID: PMC10347996 DOI: 10.1177/19322968231173447] [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: 05/07/2023]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) is revolutionizing diabetes care by giving both patients and the healthcare professionals unprecedented insights into glucose variability and patterns. It is established in National Institute for Health and Care Excellence (NICE) guidance as a standard of care for type 1 diabetes and diabetes in pregnancy under certain conditions. Diabetes mellitus (DM) is recognized as an important risk factor for chronic kidney disease (CKD). Around a third of patients receiving in-center haemodialysis as renal replacement therapy (RRT) have diabetes, either as a direct cause of renal failure or as an additional co-morbidity. Evidence of poor compliance with the current standard of care (self-monitoring of blood glucose [SMBG]) and overall greater morbidity and mortality, suggests this patient population as an ideal target group for CGM. However, there exists no strong published evidence showing the validity of CGM devices in insulin-treated diabetes patients requiring haemodialysis. METHODS We applied a Freestyle Libre Pro sensor to 69 insulin-treated diabetes haemodialysis (HD) patients on a dialysis day. Interstitial glucose levels were obtained, and time matched within 7 minutes to capillary blood glucose testing and any plasma blood glucose levels sent. Data cleansing techniques were applied to account for rapidly correcting hypoglycaemia and poor SMBG technique. RESULTS Clarke-error grid analysis showed 97.9% of glucose values in an acceptable range of agreement (97.3% on dialysis days and 99.1% on non-dialysis days). CONCLUSIONS We conclude that the Freestyle Libre sensor is accurate in measuring glucose levels when compared to glucose as measured by capillary SMBG testing and laboratory obtained serum glucose in patients on HD.
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Affiliation(s)
- Christopher Horne
- Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Iain Cranston
- Department of Diabetes and Endocrinology, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Mark Amos
- Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Katey Flowers
- Wessex Kidney Centre, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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Lee YH, Kim DM, Yu JM, Choi KM, Kim SG, Park KS, Son HS, Chung CH, Ahn KJ, Lee SH, Song KH, Kwon SK, Park HK, Won KC, Jang HC. Anagliptin twice-daily regimen improves glycaemic variability in subjects with type 2 diabetes: A double-blind, randomized controlled trial. Diabetes Obes Metab 2022; 25:1174-1185. [PMID: 36564983 DOI: 10.1111/dom.14959] [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: 08/21/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
AIM To determine whether the twice-daily (BID) regimen is superior to the once-daily (QD) regimen for managing glycaemic variability by comparing the effects of anagliptin 100 mg BID versus sitagliptin 100 mg QD. MATERIALS AND METHODS A double-blinded, randomized, multicentre study was performed in 89 patients with type 2 diabetes treated with metformin alone (6.5% < HbA1c < 8.5%). Subjects were randomly assigned to anagliptin 100 mg BID or sitagliptin 100 mg QD in a 1:1 ratio for 12 weeks. Continuous glucose monitoring was used to measure the mean amplitude of glycaemic excursion (MAGE) and postprandial time in range (TIR) before and after dipeptidyl peptidase-4 (DPP-4) inhibitor treatment to compare glycaemic variability. RESULTS The decrease from baseline in MAGE at 12 weeks after DPP-4 inhibitor treatment was significantly greater in the anagliptin BID group than in the sitagliptin QD group (P < .05); -30.4 ± 25.6 mg/dl (P < .001) in the anagliptin group versus -9.5 ± 38.0 mg/dl (P = .215) in the sitagliptin group. The TIR after dinner increased by 33.0% ± 22.0% (P < .001) in the anagliptin group and by 14.6% ± 28.2% (P = .014) in the sitagliptin group, with a statistically significant difference (P = .009). No statistically significant differences were observed between the groups in the changes in HbA1c and fasting plasma glucose (FPG). CONCLUSIONS The anagliptin BID regimen for the treatment of type 2 diabetes was superior in blood glucose control after dinner to improve glycaemic variability, as indicated by MAGE and TIR, but was equivalent to the QD regimen in terms of HbA1c and FPG.
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Affiliation(s)
- Yong-Ho Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Doo-Man Kim
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jae Myung Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Kyung Mook Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Kang Seo Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, South Korea
| | - Hyun-Shik Son
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Choon Hee Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Kyu Jeung Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Soon Hee Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Inje University, Busan, South Korea
| | - Ki-Ho Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Su Kyoung Kwon
- Department of Endocrinology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
| | - Hyeong Kyu Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Kyu Chang Won
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Vásquez-Muñoz M, Arce-Álvarez A, Álvarez C, Ramírez-Campillo R, Crespo FA, Arias D, Salazar-Ardiles C, Izquierdo M, Andrade DC. Dynamic circadian fluctuations of glycemia in patients with type 2 diabetes mellitus. Biol Res 2022; 55:37. [PMID: 36461078 PMCID: PMC9716682 DOI: 10.1186/s40659-022-00406-1] [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: 09/01/2022] [Accepted: 11/22/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) has glucose variability that is of such relevance that the appearance of vascular complications in patients with DM has been attributed to hyperglycemic and dysglycemic events. It is known that T1D patients mainly have glycemic variability with a specific oscillatory pattern with specific circadian characteristics for each patient. However, it has not yet been determined whether an oscillation pattern represents the variability of glycemic in T2D. This is why our objective is to determine the characteristics of glycemic oscillations in T2D and generate a robust predictive model. RESULTS Showed that glycosylated hemoglobin, glycemia, and body mass index were all higher in patients with T2D than in controls (all p < 0.05). In addition, time in hyperglycemia and euglycemia was markedly higher and lower in the T2D group (p < 0.05), without significant differences for time in hypoglycemia. Standard deviation, coefficient of variation, and total power of glycemia were significantly higher in the T2D group than Control group (all p < 0.05). The oscillatory patterns were significantly different between groups (p = 0.032): the control group was mainly distributed at 2-3 and 6 days, whereas the T2D group showed a more homogeneous distribution across 2-3-to-6 days. CONCLUSIONS The predictive model of glycemia showed that it is possible to accurately predict hyper- and hypoglycemia events. Thus, T2D patients exhibit specific oscillatory patterns of glycemic control, which are possible to predict. These findings may help to improve the treatment of DM by considering the individual oscillatory patterns of patients.
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Affiliation(s)
- Manuel Vásquez-Muñoz
- grid.412882.50000 0001 0494 535XExercise Applied Physiology Laboratory, Centro de Investigación en Fisiología Y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de La Salud, Universidad de Antofagasta, Antofagasta, Chile ,grid.482859.a0000 0004 0628 7639Clínica Santa María, Santiago, Chile ,Navarrabiomed, Hospital Universitario de Navarra (UHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra Spain
| | - Alexis Arce-Álvarez
- grid.441800.90000 0001 2227 4350Escuela de Kinesiología, Facultad de Salud, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Cristian Álvarez
- grid.412848.30000 0001 2156 804XExercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of RehabilitationSciences, Universidad Andres Bello, Santiago, Chile
| | - Rodrigo Ramírez-Campillo
- grid.412848.30000 0001 2156 804XExercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of RehabilitationSciences, Universidad Andres Bello, Santiago, Chile
| | - Fernando A. Crespo
- grid.441791.e0000 0001 2179 1719Departamento de Gestion Y Negocios, Facultad de Economía Y Negocios, Universidad Alberto Hurtado, Santiago, Chile
| | - Dayana Arias
- grid.412882.50000 0001 0494 535XDepartamento de Biotecnología, Facultad de Ciencias del Mar Y Recursos Biológicos, Universidad de Antofagasta, Antofagasta, Chile
| | - Camila Salazar-Ardiles
- grid.412882.50000 0001 0494 535XExercise Applied Physiology Laboratory, Centro de Investigación en Fisiología Y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de La Salud, Universidad de Antofagasta, Antofagasta, Chile ,Navarrabiomed, Hospital Universitario de Navarra (UHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra Spain
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (UHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Navarra Spain ,grid.413448.e0000 0000 9314 1427CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - David C. Andrade
- grid.412882.50000 0001 0494 535XExercise Applied Physiology Laboratory, Centro de Investigación en Fisiología Y Medicina de Altura, Departamento Biomedico, Facultad de Ciencias de La Salud, Universidad de Antofagasta, Antofagasta, Chile
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Kim SH, Kim JY, Kim ES, Park IR, Ha EY, Chung SM, Moon JS, Yoon JS, Won KC, Lee HW. Early glycaemic variability increases 28-day mortality and prolongs intensive care unit stay in critically ill patients with pneumonia. Ann Med 2022; 54:2736-2743. [PMID: 36205625 PMCID: PMC9553150 DOI: 10.1080/07853890.2022.2128399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of early glycaemic variability (GV) on 28-day mortality in critically ill patients with pneumonia. PATIENTS AND METHODS This single-centre retrospective study included patients admitted to the intensive care unit (ICU) due to pneumonia between 2018 and 2019. A total of 282 patients (mean age, 68.6 years) with blood sugar test (BST) results measured more than three times within 48 h after hospitalization and haemoglobin A1c (HbA1c) levels recorded within 2 months were enrolled. Coefficient of variation (CV) was calculated using the BST values. The effects of GV on 28-day mortality and prolonged ICU stay (>14 days) were also assessed. RESULTS The mean age was 60.6 years (male to female ratio, 2.5:1). The 28-day mortality rate was 31.6% (n = 89) and was not different according to the presence of diabetes (DM vs. non-DM) or HbA1c levels (≥7.5 vs. <7.5%; both p > .05). However, the mortality rate was significantly higher in patients with high GV (CV ≥ 36%) than in those with low GV (CV < 36%; 37.5 vs. 25.4%, p = .028). The risk of mortality in patients with high GV was prominent in the subgroups with DM or low HbA1c levels. Among the surviving patients (n = 193), 44 remained in the ICU for more than 14 days. Compared to low GV, high GV was associated with a higher rate of prolonged ICU stay, although not statistically significant (27.8 vs. 18.5%, p = .171). After adjusting for the severity of illness and treatment strategy, CV was an independent risk factor for 28-day mortality (hazard ratio [HR], 1.01, p = .04) and prolonged ICU stay (odds ratio, 1.02; p = .04). CONCLUSIONS High GV within 48 h of ICU admission was associated with an increased 28-day mortality risk and prolonged ICU stay. Early phase GV should be carefully managed in critically ill patients with pneumonia.KEY MESSAGESThe presence of diabetes or HbA1c alone is insufficient to predict 28-day mortality and prolonged ICU stay in critically ill patients with pneumonia.High glycaemic variability (GV) within 48 h of ICU admission increases 28-day mortality and prolongs ICU stay, which is consistent after adjusting for severity of illness and treatment strategy.Patients with high GV, especially those with DM or low HbA1c levels (<7.5%) should be more carefully treated to reduce mortality.
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Affiliation(s)
- Seong Ho Kim
- College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Ji Young Kim
- College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Eun Song Kim
- College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Il Rae Park
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Eun Yeong Ha
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Seung Min Chung
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jun Sung Moon
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Ji Sung Yoon
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Kyu Chang Won
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Hyoung Woo Lee
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Yeungnam University College of Medicine, Daegu, Republic of Korea
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Association between visit-to-visit fasting glycemic variability and depression: a retrospective cohort study in a representative Korean population without diabetes. Sci Rep 2022; 12:18692. [PMID: 36333430 PMCID: PMC9636237 DOI: 10.1038/s41598-022-22302-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Glycemic variability (GV) is a risk factor for depression in patients with diabetes. However, whether it is also a predictor of incident depression in people without diabetes remains unclear. We aimed to investigate the association between visit-to-visit variability in fasting serum glucose (FSG) levels and the incidence of depression among Koreans without diabetes. This retrospective cohort study included data of people without diabetes who did not have depression at baseline and had at least three FSG measurements (n = 264,480) extracted from the 2002-2007 Korean National Health Insurance Service-National Health Screening Cohort. GV was calculated as the average successive variability of FSG. Among 264,480 participants, 198,267 were observed during 2008-2013 and their hazard ratios (HR) of incident depression were calculated. Participants with the highest GV showed a higher risk of depression in fully adjusted models than those with the lowest GV (HR, 1.09; 95% CI, 1.02-1.16). The risk of incident depression heightened with increasing GV (p for trend < 0.001). Greater visit-to-visit GV may be associated with the risk of developing depression in people without diabetes. Conversely, maintaining steady FSG levels may reduce the risk of incident depression in people without diabetes.
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11
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Continuous Glucose Monitoring in Preterm Infants: The Role of Nutritional Management in Minimizing Glycemic Variability. Antioxidants (Basel) 2022; 11:antiox11101945. [PMID: 36290668 PMCID: PMC9598281 DOI: 10.3390/antiox11101945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022] Open
Abstract
Glycemic variability (GV) is common in preterm infants. In the premature population, GV is a risk factor for morbidity and mortality. Both hypo- and hyperglycemia can impair neurodevelopment. We investigated the impact of continuous versus intermittent tube enteral feeding on GV. In our prospective observational study, 20 preterm infants with a gestational age ≤ 34 weeks at either continuous or intermittent bolus full enteral feeding. For five days, continuous glucose monitoring (CGM) was utilized, which was achieved through the subcutaneous insertion of a sensor. A total of 27,532 measurements of blood glucose were taken. The mean amplitude of glycemic excursions did not differ between the two cohorts statistically. Continuous feeding resulted in higher positive values, increasing the risk of hypo- and hyperglycemia. Subjects who were small for their gestational age had a higher standard deviation during continuous feeding (p = 0.001). Data suggest that intermittent bolus nutrition is better for glycemic control than continuous nutrition. Nutritional management optimization of preterm infants appears to be critical for long-term health. In the future, CGM may provide a better understanding of the optimal glucose targets for various clinical conditions, allowing for a more personalized approach to management.
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12
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Does a Gluten-Free Diet Affect BMI and Glycosylated Hemoglobin in Children and Adolescents with Type 1 Diabetes and Asymptomatic Celiac Disease? A Meta-Analysis and Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081247. [PMID: 36010137 PMCID: PMC9406674 DOI: 10.3390/children9081247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
Background: Children diagnosed with type 1 diabetes mellitus (T1DM) are more prone to having celiac disease (CD) than the normal population. Moreover, patients with this dual diagnosis who are also on a diabetic and gluten-free diet (GFD) risk faltering growth and uncontrolled blood glucose levels. This review aims to assess the efficacy and effectiveness of managing patients with T1DM screened for CD with GFD to prevent complications associated with these chronic pathologies in childhood and adulthood. Materials and Methods: We abided by the PRISMA guidelines in this meta-analysis and used multiple databases and search engines. We included case−control studies. The primary outcomes were changes in the standard deviation score, body mass index (SDS BMI), and glycosylated hemoglobin (HA1C) after being on a GFD for at least twelve months. Results: The pooled data from the six studies included showed that there was neither a statistically significant difference in the mean SDS BMI (−0.28 (95% CI −0.75, 0.42)) (p = 0.24) nor in the mean of HA1C (mean −0.07 (95% CI −0.44, 0.30)) (p = 0.36) for the same group. HDL cholesterol improved significantly in patients on a strict GFD (p < 0.01). Conclusions: In children with T1DM and asymptomatic CD, being on a GFD had no significant effect on BMI or HA1C. However, it can have a protective effect on the other complications found in both chronic pathologies.
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Mader JK, Gölz S, Bilz S, Bramlage P, Danne T. Controlling glycemic variability in people living with type 1 diabetes receiving insulin glargine 300 U/mL (Gla-300). BMJ Open Diabetes Res Care 2022; 10:10/4/e002898. [PMID: 36007982 PMCID: PMC9422797 DOI: 10.1136/bmjdrc-2022-002898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/09/2022] [Indexed: 11/04/2022] Open
Abstract
Short-term glycemic variability is associated with the risk of hypoglycemia and hyperglycemia in people living with type 1 diabetes and can potentially affect clinical outcomes. Continuous glucose monitoring (CGM) is of increasing importance to evaluate glycemic variability in greater detail. Specific metrics for assessing glycemic variability were proposed, such as the SD of mean glucose level and associated coefficient of variation, and time in target glucose range to guide study designs, therapy and allow people with diabetes more transparency in interpreting their own CGM data. Randomized controlled trials (RCT) and real-world evidence provide complementary information about the efficacy/effectiveness and safety of interventions. Insulin glargine 300 U/mL (Gla-300) has a longer lasting and less variable action than insulin glargine U100 (Gla-100) with a lower risk of hypoglycemia. While insulin degludec U100 (iDeg-100) was associated with lower glucose values but more time below range in one randomized study compared with Gla-300, Gla-300 was associated with a higher per cent time in range, but also above the therapeutic range. However, a real-world study did not find differences during the day between Gla-300 and iDeg-100. The upcoming InRange RCT is the first head-to-head comparison of Gla-300 with iDeg-100 using CGM in an international population using CGM metrics as the primary endpoint. The non-interventional COMET-T real-world study will determine the real-world effectiveness of Gla-300 using CGM metrics and cover a broad spectrum of clinical practice decisions irrespective of the prior basal insulin.
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Affiliation(s)
- Julia K Mader
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Stefan Gölz
- Diabetes Schwerpunktpraxis Dr Gölz, Esslingen, Germany
| | - Stefan Bilz
- Internal Medicine and Endocrinology/Diabetes, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Thomas Danne
- Kinder- und Jugendkrankenhaus AUF DER BULT, Diabetes-Zentrum für Kinder und Jugendliche, Hannover, Germany
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Jódar E, Romera I, Wang Q, Roche SL, García‐Pérez L. Glycaemic variability in patients with type 2 diabetes mellitus treated with dulaglutide, with and without concomitant insulin: Post hoc analyses of randomized clinical trials. Diabetes Obes Metab 2022; 24:631-640. [PMID: 34866291 PMCID: PMC9300025 DOI: 10.1111/dom.14615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/19/2021] [Accepted: 12/01/2021] [Indexed: 01/17/2023]
Abstract
AIM To investigate the association between treatment with dulaglutide and glycaemic variability (GV) in adult patients with type 2 diabetes mellitus (T2D). MATERIALS AND METHODS Post hoc analyses of six randomized, phase 3 studies were conducted to investigate the association between treatment with dulaglutide 1.5 mg once weekly and GV in adult patients with T2D. Using data from seven- and eight-point self-monitored plasma glucose (SMPG) profiles over up to 28 weeks of treatment, GV in within- and between-day SMPG, and between-day fasting glucose from SMPG (FSMPG) was assessed according to standard deviation and coefficient of variation. RESULTS Pooled data from five studies with dulaglutide as monotherapy or added to oral glucose-lowering medication, without concomitant insulin treatment, revealed clinically meaningful reductions in within- and between-day SMPG, and between-day FSMPG variability from baseline in the dulaglutide group. Comparisons between treatment groups in two studies demonstrated that reductions from baseline in within-day and between-day SMPG, and between-day FSMPG variability were greater for treatment with dulaglutide compared with insulin glargine, as well as for treatment with dulaglutide when added to insulin glargine compared with insulin glargine alone. CONCLUSIONS In patients with T2D, treatment with dulaglutide as monotherapy or added to oral glucose-lowering medication, without concomitant insulin treatment, was potentially associated with a reduction in GV. Treatment with dulaglutide was associated with a reduction in GV to a greater degree than insulin glargine. When added to insulin glargine, treatment with dulaglutide was associated with greater decreases in GV compared with insulin glargine alone. As reduced GV may be associated with better outcomes, these findings may have clinical relevance.
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Affiliation(s)
- Esteban Jódar
- Hospital Universitario Quirón Madrid, Universidad EuropeaMadridSpain
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15
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Baudu J, Gerbaud E, Catargi B, Montaudon M, Beauvieux MC, Sagnier S, Debruxelles S, Renou P, Poli M, Olindo S, Couture M, Marnat G, Sibon I. High glycemic variability: An underestimated determinant of stroke functional outcome following large vessel occlusion. Rev Neurol (Paris) 2022; 178:732-740. [DOI: 10.1016/j.neurol.2021.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/19/2022]
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Lopes ROP, Santos JDC, Oliveira HCD, Campos JF, Primo CC, Lopes CT, Brandão MAG. Risk for Imbalanced Blood Glucose Pattern: Construct Analysis and Nursing Diagnosis Proposal. Clin Nurs Res 2022; 31:1241-1249. [PMID: 35100892 DOI: 10.1177/10547738211073395] [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: 11/15/2022]
Abstract
To identify a clinical judgment of susceptibility referring to the development of glycemic fluctuations in adults with Diabetes Mellitus undergoing treatment. Theoretical study with construct analysis. The exploration of the phenomena of glycemic variations provided clues for the description of the blood glucose pattern construct and the proposal of a new risk Nursing diagnosis as a judgment of susceptibility to the balance of this pattern. The risk factors for "Risk for Imbalanced Blood Glucose Pattern" are cognitive dysfunction; excessive alcohol consumption; excessive daily exercise; inadequate follow through with treatment regimen; increased frequency of self-monitoring of blood glucose; inadequate knowledge of disease process; inadequate management of amount of food; inadequate regularity of meal consumption; obesity; overweight; smoking; underweight. The elaboration of "Risk for Imbalanced Blood Glucose Pattern" Nursing diagnosis contributes to the advancement in the Nursing classifications and to the elaboration of planning actions and specific interventions.
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Matsuoka-Uchiyama N, Uchida HA, Okamoto S, Onishi Y, Katayama K, Tsuchida-Nishiwaki M, Takeuchi H, Takemoto R, Hada Y, Umebayashi R, Kurooka N, Tsuji K, Eguchi J, Nakajima H, Shikata K, Wada J. The Association of Postprandial Triglyceride Variability with Renal Dysfunction and Microalbuminuria in Patients with Type 2 Diabetic Mellitus: A Retrospective and Observational Study. J Diabetes Res 2022; 2022:3157841. [PMID: 35047644 PMCID: PMC8763569 DOI: 10.1155/2022/3157841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE We examined whether or not day-to-day variations in lipid profiles, especially triglyceride (TG) variability, were associated with the exacerbation of diabetic kidney disease. METHODS We conducted a retrospective and observational study. First, 527 patients with type 2 diabetes mellitus (DM) who had had their estimated glomerular filtration rate (eGFR) checked every 6 months since 2012 for over 5 years were registered. Variability in postprandial TG was determined using the standard deviation (SD), SD adjusted (Adj-SD) for the number of measurements, and maximum minus minimum difference (MMD) during the first three years of follow-up. The endpoint was a ≥40% decline from baseline in the eGFR, initiation of dialysis or death. Next, 181 patients who had no micro- or macroalbuminuria in February 2013 were selected from among the 527 patients for an analysis. The endpoint was the incidence of microalbuminuria, initiation of dialysis, or death. RESULTS Among the 527 participants, 110 reached a ≥40% decline from baseline in the eGFR or death. The renal survival was lower in the higher-SD, higher-Adj-SD, and higher-MMD groups than in the lower-SD, lower-Adj-SD, and lower-MMD groups, respectively (log-rank test p = 0.0073, 0.0059, and 0.0195, respectively). A lower SD, lower Adj-SD, and lower MMD were significantly associated with the renal survival in the adjusted model (hazard ratio, 1.62, 1.66, 1.59; 95% confidence intervals, 1.05-2.53, 1.08-2.58, 1.04-2.47, respectively). Next, among 181 participants, 108 developed microalbuminuria or death. The nonincidence of microalbuminuria was lower in the higher-SD, higher-Adj-SD, and higher-MMD groups than in the lower-SD, lower-Adj-SD, and lower-MMD groups, respectively (log-rank test p = 0.0241, 0.0352, and 0.0474, respectively). CONCLUSIONS Postprandial TG variability is a novel risk factor for eGFR decline and the incidence of microalbuminuria in patients with type 2 DM.
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Affiliation(s)
- Natsumi Matsuoka-Uchiyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Haruhito A. Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Academic Field of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shugo Okamoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuhiro Onishi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyoshi Katayama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Mariko Tsuchida-Nishiwaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Rika Takemoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
- Center of Ultrasonic Diagnostics, Okayama University Hospital, Okayama, Japan
| | - Yoshiko Hada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Ryoko Umebayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Naoko Kurooka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kenji Tsuji
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Eguchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | | | - Kenichi Shikata
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Academic Field of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Chawla R, Gangopadhyay K, Lathia T, Punyani H, Kanungo A, Sahoo A, Seshadri K. Management of hyperglycemia in critical care. JOURNAL OF DIABETOLOGY 2022. [DOI: 10.4103/jod.jod_69_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kim YJ, Lee NY, Lee KA, Park TS, Jin HY. Influence of Glucose Fluctuation on Peripheral Nerve Damage in Streptozotocin-Induced Diabetic Rats. Diabetes Metab J 2022; 46:117-128. [PMID: 34496549 PMCID: PMC8831810 DOI: 10.4093/dmj.2020.0275] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND It is unclear whether glycemic variability (GV) is a risk factor for diabetic peripheral neuropathy (DPN), and whether control of GV is beneficial for DPN. The purpose of this study was to investigate the effect of GV on peripheral nerve damage by inducing glucose fluctuation in streptozotocin-induced diabetic rats. METHODS Rats were divided into four groups: normal (normal glucose group [NOR]), diabetes without treatment (sustained severe hyperglycemia group; diabetes mellitus [DM]), diabetes+once daily insulin glargine (stable hyperglycemia group; DM+LAN), and diabetes+once daily insulin glargine with twice daily insulin glulisine (unstable glucose fluctuation group; DM+Lantus [LAN]+Apidra [API]). We measured anti-oxidant enzyme levels and behavioral responses against tactile, thermal, and pressure stimuli in the plasma of rats. We also performed a quantitative comparison of cutaneous and sciatic nerves according to glucose fluctuation. RESULTS At week 24, intraepidermal nerve fiber density was less reduced in the insulin-administered groups compared to the DM group (P<0.05); however, a significant difference was not observed between the DM+LAN and DM+LAN+API groups irrespective of glucose fluctuation (P>0.05; 16.2±1.6, 12.4±2.0, 14.3±0.9, and 13.9±0.6 for NOR, DM, DM+LAN, and DM+LAN+API, respectively). The DM group exhibited significantly decreased glutathione levels compared to the insulin-administered groups (2.64±0.10 μmol/mL, DM+LAN; 1.93±0.0 μmol/mL, DM+LAN+API vs. 1.25±0.04 μmol/mL, DM; P<0.05). CONCLUSION Our study suggests that glucose control itself is more important than glucose fluctuation in the prevention of peripheral nerve damage, and intra-day glucose fluctuation has a limited effect on the progression of peripheral neuropathy in rats with diabetes.
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Affiliation(s)
- Yu Ji Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University Medical School-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Na Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University Medical School-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Kyung Ae Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University Medical School-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University Medical School-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Heung Yong Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Research Institute of Clinical Medicine of Jeonbuk National University Medical School-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
- Corresponding author: Heung Yong Jin https://orcid.org/0000-0002-1841-2092 Division of Endocrinology and Metabolism, Department of Internal Medicine, Jeonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea E-mail:
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Contador S, Velasco JM, Garnica O, Hidalgo JI. Glucose forecasting using genetic programming and latent glucose variability features. Appl Soft Comput 2021. [DOI: 10.1016/j.asoc.2021.107609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Oscillatory pattern of glycemic control in patients with diabetes mellitus. Sci Rep 2021; 11:5789. [PMID: 33707491 PMCID: PMC7970978 DOI: 10.1038/s41598-021-84822-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/18/2021] [Indexed: 12/21/2022] Open
Abstract
Daily glucose variability is higher in diabetic mellitus (DM) patients which has been related to the severity of the disease. However, it is unclear whether glycemic variability displays a specific pattern oscillation or if it is completely random. Thus, to determine glycemic variability pattern, we measured and analyzed continuous glucose monitoring (CGM) data, in control subjects and patients with DM type-1 (T1D). CGM data was assessed for 6 days (day: 08:00-20:00-h; and night: 20:00-08:00-h). Participants (n = 172; age = 18-80 years) were assigned to T1D (n = 144, females = 65) and Control (i.e., healthy; n = 28, females = 22) groups. Anthropometry, pharmacologic treatments, glycosylated hemoglobin (HbA1c) and years of evolution were determined. T1D females displayed a higher glycemia at 10:00-14:00-h vs. T1D males and Control females. DM patients displays mainly stationary oscillations (deterministic), with circadian rhythm characteristics. The glycemia oscillated between 2 and 6 days. The predictive model of glycemia showed that it is possible to predict hyper and hypoglycemia (R2 = 0.94 and 0.98, respectively) in DM patients independent of their etiology. Our data showed that glycemic variability had a specific oscillation pattern with circadian characteristics, with episodes of hypoglycemia and hyperglycemia at day phases, which could help therapeutic action for this population.
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Kasthuri S, Poongothai S, Anjana RM, Selvakumar J, Muthukumar S, Kayalvizhi S, Tariq S, Honey E, Gupta PK, Venkatesan U, Mohan V. Comparison of Glycemic Excursion Using Flash Continuous Glucose Monitoring in Patients with Type 2 Diabetes Mellitus Before and After Treatment with Voglibose. Diabetes Technol Ther 2021; 23:213-220. [PMID: 32916063 PMCID: PMC7906864 DOI: 10.1089/dia.2019.0484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose: To determine the effect of Voglibose add-on therapy on daily glycemic excursions (using FreeStyle® Libre Pro™, a Flash glucose monitoring system) in Indian patients with type 2 diabetes mellitus (T2DM) receiving a stable dose of metformin (Met) or metformin+sulfonylurea (Met+SU). Patients and Methods: T2DM patients with glycosylated hemoglobin (HbA1c) ≥7.0% and at least two postprandial excursions ≥140 mg/dL (within 2 h of meal) during the screening phase (visit 1/day -14 ± 2) were enrolled in this prospective, multicenter interventional study. The patients were randomized at visit 2 (day 0 ± 2) to receive Voglibose 0.2 or 0.3 mg tablets (BID/TID) as add-on therapy to Met and Met+SU. All the patients were followed at day 14 ± 2 (visit 3), month 3 ± 14 days (visit 4), 14 weeks (i.e., visit 4 + 14 days) ±2 days (visit 5), and month 6 ± 14 days (visit 6). Continuous glucose monitoring was performed to study glycemic excursions at visits 2, 3, and 5. The study outcomes were: change in average number of glycemic excursions per day, percent time spent in glucose fluctuations, mean Postprandial glucose (PPG), Fasting plasma glucose (FPG), day and night time mean glucose levels from baseline to day 14 and week 14; change in mean amplitude of glycemic excursion (MAGE) from baseline to 14 weeks; and mean HbA1c level at 3 and 6 months. Results: Out of 110 patients enrolled, 101 patients (91.8%) (Met+SU+Voglibose: 73 and Met+Voglibose: 28) completed the study. There was a significant decrease in average number of glycemic excursions per day from baseline to day 14 in the Met+Sul+Voglibose group and to week 14 in the Met+Voglibose group. There was also a significant reduction in percent time spent above target glucose range from baseline to day 14 in both treatment groups and to week 14 in the Met+SU+Voglibose group. A significant reduction in mean PPG area under the curve, day and night time mean glucose levels, and mean FPG levels from baseline to day 14 was reported in both treatment groups. A significant reduction in night time glucose, and average MAGE and HbA1c levels was reported from baseline to week 14 in the Met+Voglibose group and the Met+SU+Voglibose group, respectively. At 6 months, body weight, glucose levels, cholesterol, low-density lipoprotein-cholesterol, and HbA1c were significantly lower, especially in the Met+SU+Voglibose arm. Conclusion: Voglibose was useful in reducing glycemic variability and improving glycemic control in Asian Indian adults with T2DM. (CTRI/2018/04/013074).
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Affiliation(s)
| | | | - Ranjit Mohan Anjana
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Gopalapuram, Chennai
| | | | | | | | - Syed Tariq
- Dr. Mohan's Diabetes Specialties Centre, Avadi, Chennai
| | | | | | | | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Gopalapuram, Chennai
- Address correspondence to: Viswanathan Mohan, MD, FRCP (London, Edinburgh, Glasgow, Ireland), PhD, DSc, DSc (Hon. Causa), FNASc, FASc, FNA, FACP, FACE, FTWAS, MACP, FRSE, Dr. Mohan's Diabetes Specialities Centre, Madras Diabetes Research Foundation, No. 4, Conran Smith Road, Gopalapuram, Chennai 600086, India
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Kim TJ, Lee JS, Park SH, Ko SB. Short-term glycemic variability and hemorrhagic transformation after successful endovascular thrombectomy. Transl Stroke Res 2021; 12:968-975. [PMID: 33576937 DOI: 10.1007/s12975-021-00895-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Glycemic variability (GV) is a risk factor for poor outcomes after ischemic stroke. However, its effect on hemorrhagic transformation after endovascular recanalization therapy (ERT) remains to be elucidated. METHODS Patients with acute ischemic stroke due to large vessel occlusion with successful recanalization after ERT (modified thrombolysis in cerebral infarction 2b or 3) were enrolled between January 2013 and November 2019. Blood glucose level data were obtained during the first 36 h after ERT, and ten GV parameters including time rate (TR) of glucose variation were assessed. The TR of glucose variation reflects the speed of glucose fluctuations over time (mg/dL/hour) during the monitoring period. Symptomatic intracerebral hemorrhage (sICH) and unfavorable outcomes at 3 months after ERT were analyzed. The sICH was defined as parenchymal hematoma type 2 with a neurological deterioration of 4 points or more on the National Institute of Health Stroke Scale. Moreover, a modified Rankin Scale of 3-6 at 3 months was considered an unfavorable outcome. RESULTS Among all patients (n = 176; mean age, 69.3 years; 47.7 % female), sICH developed after successful ERT in 16 (9.1%) patients. In addition, 54% (n = 95) patients had an unfavorable outcome at 3 months. Patients with sICH and unfavorable outcome had higher the TR of glucose variation. After adjusting for potential confounders, the TR of glucose (per 1 mg/dL/h increase) variation was independently associated with sICH (odds ratio, 1.17; 95% confidence interval [CI], 1.012-1.343) and 3-month unfavorable outcome (OR 1.14, 95% CI, 1.000-1.297). CONCLUSIONS Time-related GV during the first 36 h after successful ERT has a stronger correlation with sICH and poor functional outcomes compared to any GV parameters. This suggests that maintaining stable glucose may be an important factor in the prevention of sICH after undergoing successful ERT.
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Affiliation(s)
- Tae Jung Kim
- Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Sung Lee
- Department of Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Hyun Park
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
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Liu CS, Li CI, Wang MC, Yang SY, Li TC, Lin CC. Building clinical risk score systems for predicting the all-cause and expanded cardiovascular-specific mortality of patients with type 2 diabetes. Diabetes Obes Metab 2021; 23:467-479. [PMID: 33118688 DOI: 10.1111/dom.14240] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/05/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022]
Abstract
AIM To develop and validate risk score systems by examining the effects of glycaemic and blood pressure variabilities on the all-cause and expanded cardiovascular-specific mortality of people with type 2 diabetes. MATERIALS AND METHODS This retrospective cohort study consisted of 9692 patients aged 30-85 years, diagnosed with type 2 diabetes and enrolled in a managed care programme of a medical centre from 2002 to 2016. All the patients were randomly allocated into two groups, namely, training and validation sets (2:1 ratio), and followed up until death or August 2019. Cox's proportional hazard regression was performed to develop all-cause and expanded cardiovascular-specific mortality prediction models. The performance of the prediction model was assessed by using the area under the receiver operating characteristic curve (AUROC). RESULTS Overall, 2036 deaths were identified after a mean of 8.6 years of follow-up. The AUROC-measured prediction accuracies of 3-, 5-, 10- and 15-year all-cause mortalities based on a model containing the identified traditional risk factors, biomarkers and variabilities in fasting plasma glucose, HbA1c and blood pressure in the validation set were 0.79 (0.76-0.83), 0.78 (0.76-0.81), 0.80 (0.78-0.82) and 0.80 (0.78-0.82), respectively. The corresponding values of the expanded cardiovascular-specific mortalities were 0.85 (0.80-0.90), 0.83 (0.79-0.86), 0.80 (0.77-0.83) and 0.79 (0.77-0.82), respectively. CONCLUSIONS Our prediction models considering glycaemic and blood pressure variabilities had good prediction accuracy for the expanded cardiovascular-specific and all-cause mortalities of patients with type 2 diabetes.
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Affiliation(s)
- Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Mu-Cyun Wang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Sing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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Pérez-Galarza J, Prócel C, Cañadas C, Aguirre D, Pibaque R, Bedón R, Sempértegui F, Drexhage H, Baldeón L. Immune Response to SARS-CoV-2 Infection in Obesity and T2D: Literature Review. Vaccines (Basel) 2021; 9:102. [PMID: 33572702 PMCID: PMC7911386 DOI: 10.3390/vaccines9020102] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/09/2021] [Accepted: 01/22/2021] [Indexed: 12/12/2022] Open
Abstract
In December 2019, a novel coronavirus known as SARS-CoV-2 was first detected in Wuhan, China, causing outbreaks of the coronavirus disease COVID-19 that has now spread globally. For this reason, The World Health Organization (WHO) declared COVID-19 a public health emergency in March 2020. People living with pre-existing conditions such as obesity, cardiovascular diseases, type 2 diabetes (T2D), and chronic kidney and lung diseases, are prone to develop severe forms of disease with fatal outcomes. Metabolic diseases such as obesity and T2D alter the balance of innate and adaptive responses. Both diseases share common features characterized by augmented adiposity associated with a chronic systemic low-grade inflammation, senescence, immunoglobulin glycation, and abnormalities in the number and function of adaptive immune cells. In obese and T2D patients infected by SARS-CoV-2, where immune cells are already hampered, this response appears to be stronger. In this review, we describe the abnormalities of the immune system, and summarize clinical findings of COVID-19 patients with pre-existing conditions such as obesity and T2D as this group is at greater risk of suffering severe and fatal clinical outcomes.
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Affiliation(s)
- Jorge Pérez-Galarza
- Research Institute of Biomedicine, Central University of Ecuador, Quito 170201, Ecuador; (J.P.-G.); (C.C.); (D.A.); (R.P.)
- Faculty of Medicine, Central University of Ecuador, Quito 170403, Ecuador; (R.B.); (F.S.)
| | | | - Cristina Cañadas
- Research Institute of Biomedicine, Central University of Ecuador, Quito 170201, Ecuador; (J.P.-G.); (C.C.); (D.A.); (R.P.)
| | - Diana Aguirre
- Research Institute of Biomedicine, Central University of Ecuador, Quito 170201, Ecuador; (J.P.-G.); (C.C.); (D.A.); (R.P.)
| | - Ronny Pibaque
- Research Institute of Biomedicine, Central University of Ecuador, Quito 170201, Ecuador; (J.P.-G.); (C.C.); (D.A.); (R.P.)
| | - Ricardo Bedón
- Faculty of Medicine, Central University of Ecuador, Quito 170403, Ecuador; (R.B.); (F.S.)
- Hospital General Docente de Calderón, Quito 170201, Ecuador
| | - Fernando Sempértegui
- Faculty of Medicine, Central University of Ecuador, Quito 170403, Ecuador; (R.B.); (F.S.)
| | - Hemmo Drexhage
- Immunology Department, Erasmus Medical Center, 3015 Rotterdam, The Netherlands;
| | - Lucy Baldeón
- Research Institute of Biomedicine, Central University of Ecuador, Quito 170201, Ecuador; (J.P.-G.); (C.C.); (D.A.); (R.P.)
- Faculty of Medicine, Central University of Ecuador, Quito 170403, Ecuador; (R.B.); (F.S.)
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Biological Activity of c-Peptide in Microvascular Complications of Type 1 Diabetes-Time for Translational Studies or Back to the Basics? Int J Mol Sci 2020; 21:ijms21249723. [PMID: 33419247 PMCID: PMC7766542 DOI: 10.3390/ijms21249723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022] Open
Abstract
People with type 1 diabetes have an increased risk of developing microvascular complications, which have a negative impact on the quality of life and reduce life expectancy. Numerous studies in animals with experimental diabetes show that c-peptide supplementation exerts beneficial effects on diabetes-induced damage in peripheral nerves and kidneys. There is substantial evidence that c-peptide counteracts the detrimental changes caused by hyperglycemia at the cellular level, such as decreased activation of endothelial nitric oxide synthase and sodium potassium ATPase, and increase in formation of pro-inflammatory molecules mediated by nuclear factor kappa-light-chain-enhancer of activated B cells: cytokines, chemokines, cell adhesion molecules, vascular endothelial growth factor, and transforming growth factor beta. However, despite positive results from cell and animal studies, no successful c-peptide replacement therapies have been developed so far. Therefore, it is important to improve our understanding of the impact of c-peptide on the pathophysiology of microvascular complications to develop novel c-peptide-based treatments. This article aims to review current knowledge on the impact of c-peptide on diabetic neuro- and nephropathy and to evaluate its potential therapeutic role.
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27
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Leng Y, Zhou X, Xie Z, Hu Z, Gao H, Liu X, Xie H, Fu X, Xie C. Efficacy and safety of Chinese herbal medicine on blood glucose fluctuations in patients with type 2 diabetes mellitus: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21904. [PMID: 32846855 PMCID: PMC7447466 DOI: 10.1097/md.0000000000021904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND As one of the major chronic diseases that seriously threaten human health, type 2 diabetes mellitus (T2DM) has become a global public health problem. Blood glucose fluctuation is a risk factor independent of hyperglycemia. At present, the measures to treat blood glucose fluctuations in patients with T2DM are insufficient in effectiveness and safety. Medical practice and clinical studies have proved that Chinese herbal medicine has obvious advantages in reducing blood glucose fluctuations. In this systematic review, we will assess the efficacy and safety of Chinese herbal medicine in the treatment of blood glucose fluctuations in patients with T2DM. METHODS We will search related literature of PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database, and will manually search grey documents such as literature such as conference articles and references articles. Eligible randomized controlled trials will be screened based on inclusion criteria, and data extraction, risk of bias assessment, publication bias assessment, subgroup analysis, and quality assessment will be performed. Review Manager version 5.3 software and stata version 13 software will be used for data analysis. Each process is independently conducted by 2 researchers, and if there is any objection, it will be submitted to the third researcher for resolution. RESULTS This study will provide evidence for the efficacy and safety of Chinese herbal medicine in the treatment of blood glucose fluctuations in patients with T2DM. Outcome measures include mean amplitude of glycemic excursions, 24 hours mean blood glucose, standard deviations of blood glucose, mean of daily differences, coefficient of variation, glucose time in range, fasting blood glucose, 2 hours postprandial blood glucose, glycated hemoglobin, HOMA-β, HOMA-IR, quality of life questionnaire, traditional Chinese medicine syndrome score, and adverse event.
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28
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Fechner E, Op 't Eyndt C, Mulder T, Mensink RP. Diet-induced differences in estimated plasma glucose concentrations in healthy, non-diabetic adults are detected by continuous glucose monitoring-a randomized crossover trial. Nutr Res 2020; 80:36-43. [PMID: 32679434 DOI: 10.1016/j.nutres.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/08/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
Continuous glucose monitors (CGMs) have been developed for diabetic patients for estimating and controlling plasma glucose changes throughout the day. However, elevated postprandial glucose concentrations may also be detrimental for non-diabetic subjects by increasing the risk of developing vascular complications and type 2 diabetes. Therefore, CGMs may also be valuable in clinical research and we hypothesized that diet-induced differences in estimated plasma glucose concentrations in healthy, non-diabetic adults could be detected by the Abbott FreeStyle Libre Pro CGM. In this single-blind randomized cross-over trial, 23 healthy but overweight or obese men and women therefore consumed two diets differing in glycemic load in randomized order for three consecutive days. Based on the CGM measurements, two-hour total areas under the curve (tAUCs) after breakfast, lunch and dinner were calculated. Additionally, postprandial glucose was measured with the CGM and in plasma during a rice meal challenge. The average tAUC was significantly lower on the low GL diet compared to the high GL diet (P < .0001). The same conclusions were drawn when tAUCs for breakfast (P < .0001), lunch (P < .0001) and dinner (P < .0001) were analyzed separately. During the rice meal challenge, significantly higher glucose responses were observed after the low GL period, as monitored by both the CGM device (P < .0001) and the plasma glucose analysis (P < .0001). The difference between the means of both methods was 0.11 mmol/L (1.78%) with a higher glucose value in plasma. The absolute mean difference was 0.66 mmol/L (10.5%). We conclude that the CGM detected diet-induced differences in estimated plasma glucose concentrations, which supports its use not only in clinical practice, but also for research purposes during dietary interventions in non-diabetic participants.
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Affiliation(s)
- Eva Fechner
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, PO Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Cara Op 't Eyndt
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, PO Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Theo Mulder
- Unilever Foods Innovation Center - Hive, Bronland 14, 6708, WH, Wageningen, The Netherlands.
| | - Ronald P Mensink
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, PO Box 616, 6200, MD, Maastricht, The Netherlands.
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Mphwanthe G, Weatherspoon D, Kalimbira A, Weatherspoon L. Non-Dietary Factors Associated with Glycemic Status among Adults Diagnosed with Type 2 Diabetes Mellitus in Malawi. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:380-391. [PMID: 32633647 DOI: 10.1080/19371918.2020.1785367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We assessed glycemic status and associations with socio-demographic, biomedical, anthropometric, and physical activity (PA) levels among adults with type 2 diabetes mellitus (T2DM) (n = 428; urban n = 288; semi-urban n = 140) using a cross-sectional study. Multivariate linear regression was used to determine factors associated with glycosylated hemoglobin (A1C) . A1C was clinically elevated ≥8% for 60.3% of the participants. Overall, age and PA levels showed a negative association with A1C, and positively with underweight status, duration of diabetes, and participants' view of fluctuating/unstable blood glucose and blood glucose not improved compared to first diagnosed. A significant negative association with A1C was shown with PA levels and additional blood glucose monitoring (BGM) beyond that received at the public clinic in the urban area. Whilst, in the semi-urban area, there was a significant positive association with A1C with regards to duration of diabetes and insulin regimen. Determinants of A1C in this target group are multifactorial, therefore, interventions aiming to improve diabetes clinical outcomes are needed to reduce the likelihood of serious ramifications. Additionally, a team approach from healthcare professionals is needed in conjunction with active patient engagement as well as the development of more comprehensive diabetes care guidelines and policies.
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Affiliation(s)
- Getrude Mphwanthe
- Department of Food Science and Human Nutrition, Michigan State University , East Lansing, Michigan, USA
- Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources (LUANAR) , Lilongwe, Malawi
| | - Dave Weatherspoon
- Department of Agricultural, Food and Resource Economics, Michigan State University , East Lansing, Michigan, USA
| | - Alexander Kalimbira
- Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources (LUANAR) , Lilongwe, Malawi
| | - Lorraine Weatherspoon
- Department of Food Science and Human Nutrition, Michigan State University , East Lansing, Michigan, USA
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30
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Kovatchev B, Meng Z, Cali AMG, Perfetti R, Breton MD. Low Blood Glucose Index and Hypoglycaemia Risk: Insulin Glargine 300 U/mL Versus Insulin Glargine 100 U/mL in Type 2 Diabetes. Diabetes Ther 2020; 11:1293-1302. [PMID: 32304086 PMCID: PMC7261296 DOI: 10.1007/s13300-020-00808-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION We examined differences in hypoglycaemia risk between insulin glargine 300 U/mL (Gla-300) and insulin glargine 100 U/mL (Gla-100) in individuals with type 2 diabetes (T2DM) using the low blood glucose index (LBGI). METHODS Daily profiles of self-monitored plasma glucose (SMPG) from the EDITION 2, EDITION 3 and SENIOR treat-to-target trials of Gla-300 versus Gla-100 were used to compute the LBGI, which is an established metric of hypoglycaemia risk. The analysis also examined documented (blood glucose readings < 3.0 mmol/L [54 mg/dL]) symptomatic hypoglycaemia (DSH). RESULTS Overall LBGI in EDITION 2 and SENIOR and night-time LBGI in all three trials were significantly (p < 0.05) lower with Gla-300 versus Gla-100. The largest differences between Gla-300 and Gla-100 were observed during the night. In all three trials, individual LBGI results correlated with the observed number of DSH episodes per participant (EDITION 2 [r = 0.35, p < 0.001]; EDITION 3 [r = 0.26, p < 0.001]; SENIOR [r = 0.30, p < 0.001]). Participants at moderate risk of experiencing hypoglycaemia (defined as LBGI > 1.1) reported 4- to 8-fold more frequent DSH events than those at minimal risk (LBGI ≤ 1.1) (p ≤ 0.009). CONCLUSIONS The LBGI identified individuals with T2DM at risk for hypoglycaemia using SMPG data and correlated with the number of DSH events. Using the LBGI metric, a lower risk of hypoglycaemia with Gla-300 than Gla-100 was observed in all three trials. The finding that differences in LBGI are greater at night is consistent with previously published differences in the pharmacokinetic profiles of Gla-300 and Gla-100, which provides the physiological foundation for the presented results.
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Affiliation(s)
- Boris Kovatchev
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
| | | | | | | | - Marc D Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
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Xing Y, Chen J, Zhao L, Ma H. Analysis of the effect of liraglutide on glycemic variability in patients with type 2 diabetes. Endocr J 2020; 67:455-468. [PMID: 31996492 DOI: 10.1507/endocrj.ej19-0530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The efficacy of liraglutide in the treatment of glycemic variability in type 2 diabetic patients remains to be fully elucidated. Some studies evaluated the efficacy and safety of liraglutide in glycemic variability, and this meta-analysis was performed to evaluate the accuracy of the results of existing studies on the efficacy of liraglutide. We conducted a comprehensive search for all relevant studies published in PubMed, EMBASE, Cochrane Library, and China Academic Journal Full-Text Database from the beginning of 2011 to October 31, 2019. The mean ± SD and 95% confidence interval were used for evaluation, and subgroup and sensitivity analysis were carried out. Publication bias was estimated by funnel plots and Egger's tests. A total of 16 studies were included in the meta-analysis involving 492 participants. MAGE (mean amplitude of glycemic excursion), LAGE (largest amplitude of glycemic excursions), SD (standard deviation of blood glucose), and MODD (mean of daily differences) were collected to reflect the variability of blood glucose. The glycemic variability indexes of patients before and after treatment with liraglutide were compared. Patients with treatment had lower glycemic variability compared with patients receiving treatment of liraglutide. Compared with the patients before the treatment, the patients after the treatment had a smaller glycemic variability (MAGE: I2 = 92%, p < 0.01, Z = 11.91, p < 0.01, MD = -2.78, 95%CI: -3.24 - -2.32; LAGE: I2 = 76%, p = 0.08, Z = 9.94, p < 0.01, MD = -2.20, 95%CI: -2.59 - -1.81; MODD: I2 = 74%, p = 0.002, Z = 14.03, p < 0.01, MD = -0.90, 95%CI: -1.02 - -0.77; SD: I2 = 93%, p < 0.01, Z = 3.62, p < 0.01, SMD = -1.77, 95%CI: -2.73 - -0.81). Sensitivity analysis showed that our results were reliable and no evidence of significant publication bias was detected. The results of this study suggest that patients with type 2 diabetes treated with liraglutide are associated with lower glycemic variability.
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Affiliation(s)
- Yuling Xing
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, China
- Graduate School of Hebei Medical University, Shijiazhuang 050017, China
| | - Jinhu Chen
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, China
| | - Liying Zhao
- Graduate School of Hebei Medical University, Shijiazhuang 050017, China
| | - Huijuan Ma
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, China
- Hebei Key Laboratory of Metabolic Diseases, Hebei General Hospital Shijiazhuang, Hebei 050051, China
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei 050017, China
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Can Visceral Adiposity Index Serve as a Simple Tool for Identifying Individuals with Insulin Resistance in Daily Clinical Practice? ACTA ACUST UNITED AC 2019; 55:medicina55090545. [PMID: 31470593 PMCID: PMC6780575 DOI: 10.3390/medicina55090545] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/14/2019] [Accepted: 08/24/2019] [Indexed: 01/14/2023]
Abstract
Background and objectives: The visceral adiposity index (VAI), estimating visceral adiposity dysfunction through a simple formula, could serve as a useful tool for identifying individuals at higher cardiometabolic risk. Its relationship with insulin resistance (IR), assessed using the homeostasis model assessment of IR (HOMA-IR), and metabolic syndrome (MetS) components remains unclear. The study aimed to investigate the association of VAI with both HOMA-IR and MetS. Materials and Methods: After undergoing anthropometric and biochemical studies, 783 individuals were divided into three groups according to a number of present MetS components. The VAI cut-offs signaling MetS and HOMA-IR were determined by maximizing the sum of the sensitivity and specificity. Correlation analysis was performed to explore the associations between VAI and other tested parameters. A logistic stepwise regression analysis was applied to identify statistically significant determinants of HOMA-IR. Given the variability of reference values, two thresholds of HOMA-IR were applied, namely 2.0 and 3.8. Results: VAI increased significantly between the groups with a rising number of MetS components. The VAI cut-off for MetS was 2.37, with a sensitivity of 0.86 and a specificity of 0.78. The same cut-off point identified subjects with HOMA-IR = 3.8, with a sensitivity of 0.79 and a specificity of 0.66. The VAI cut-off for HOMA-IR = 2.0 was 1.89, with a sensitivity of 0.74 and a specificity of 0.68. The strongest correlations of VAI were noted with HOMA-IR (r = 0.51) and insulin (r = 0.49), respectively, while the strongest correlation of HOMA-IR was with waist circumference (r = 0.54). Not one of the routine parameters was a significant predictor in the regression analysis. Conclusions: The obtained results show an existing association of VAI with HOMA-IR. The high sensitivity and specificity of the cut-offs may allow the application of VAI in common clinical practice.
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Ch'ng LZ, Barakatun-Nisak MY, Wan Zukiman WZH, Abas F, Wahab NA. Nutritional strategies in managing postmeal glucose for type 2 diabetes: A narrative review. Diabetes Metab Syndr 2019; 13:2339-2345. [PMID: 31405640 DOI: 10.1016/j.dsx.2019.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/22/2019] [Indexed: 12/13/2022]
Abstract
Medical Nutrition Therapy (MNT) plays an essential role in overall glycemic management. Less focus is given on managing postmeal hyperglycemia despite the facts that, it is a common feature of Type 2 Diabetes (T2D). The purpose of this narrative review is to provide a comprehensive understanding of the existing literature on the nutritional approaches to improve postmeal hyperglycemia in patients with T2D. We searched multiple databases for the studies examining the nutritional approaches to manage postmeal glucose in patients with T2D. We included studies that involve human trials that were published in English for the past 10 years. Our review of the current literature indicates that the postmeal hyperglycemia can be improved with four nutritional approaches. These approaches include (i) utilizing the appropriate amount and selecting the right type of carbohydrates, (ii) using specific types of dietary protein, (iii) manipulating the meal timing and orders and (iv) others (promoting postmeal physical activity, incorporating diabetes-specific formula and certain functional foods). The potential mechanisms underlying these approaches are discussed and the identified gaps warranted further research. This array of nutritional strategies provide a set of options for healthcare professionals to facilitate patients with T2D in achieving the optimal level of postmeal glucose.
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Affiliation(s)
- Lau Zhi Ch'ng
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra, Malaysia
| | - Mohd Yusof Barakatun-Nisak
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra, Malaysia; Research Centre of Excellent for Nutrition and Noncommunicable Diseases (NNCD), Faculty of Medicine and Health Sciences, Universiti Putra, Malaysia.
| | | | - Faridah Abas
- Department of Food Science, Faculty of Food Science and Technology, Universiti Putra, Malaysia
| | - Norasyikin A Wahab
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan, Malaysia
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Rashid F, Abdelgadir E, Alsaeed M, Alemadi B, Khalifa A, Farooqi MH, Alawadi F, Bashier A. Glycemic and lipids control in patients with diabetes and cardiovascular or renal diseases across all the government health sectors in the Emirate of Dubai, United Arab Emirates. Diabetes Metab Syndr 2019; 13:590-594. [PMID: 30641771 DOI: 10.1016/j.dsx.2018.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 11/02/2018] [Indexed: 12/17/2022]
Abstract
UNLABELLED The guidelines suggest setting the glycemic and lipid targets according to the stage of the disease and other co -existing complications in the patients with diabetes. AIMS We aimed to evaluate the HbA1c and lipids level in patients with high risk diabetes from 2012-2016, attending different level of care in Dubai health authority. MATERIALS AND METHODS This is a retrospective analysis of the electronic medical records of all patients who attended the Dubai Health authority between 2012-2016. All patients with an ICD code of any type of diabetes in addition to cardiovascular or renal diseases were. Patients were categorized based on their HbA1c into control of<7.5, 7.5 - 8, and >8%. While lipids were categorized as f LDL < 70 mg/dl, and the Non-HDL <100 mg/dl. RESULTS Out of total number of 26647 patients diagnosed with diabetes, 2015 patients did fit the criteria of this study. The desired mean of HbA1c of <7.5% achieved by 21.76% and 28.94% in T1DM and T2DM, respectively. The LDL of < 70 mg/dl was achieved by 27.8% of the patients. CONCLUSION In patients with diabetes and multiple complications, the glycemic and lipids control is suboptimal. However, the pattern showed numerical improvement over the years.
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Papelbaum M, de Oliveira Moreira R, Coutinho WF, Kupfer R, Freitas S, Raggio Luz R, Appolinario JC. Does binge-eating matter for glycemic control in type 2 diabetes patients? J Eat Disord 2019; 7:30. [PMID: 31516703 PMCID: PMC6728934 DOI: 10.1186/s40337-019-0260-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/15/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Eating behavior is an important aspect related to type 2 diabetes mellitus (T2DM) treatment and may have an impact on glycemic control. Previous reports showed elevated prevalence of eating disordered behaviors, especially binge eating disorder in clinical samples of type 2 diabetes patients. However, results regarding the impact of an eating disorder on the glycemic and clinical control of T2DM is inconsistent. The purpose of this study was to assess the impact of a comorbid eating disorder on glycemic control (GC) in a group of patients with T2DM. METHODS Eating behaviors of 70 consecutive patients with T2DM were assessed using a Structured Clinical Interview for DSM-IV and the Binge Eating Scale. The GC was examined with fasting blood glucose (FBG) and glycated hemoglobin (A1c) levels. In addition, secondary clinical variables were assessed, including body mass index (BMI) and lipids. Chi-square and Student's T tests were used to compare clinical and psychopathological characteristics of patients with and without an ED. In order to evaluate the relationship between GC and eating disorder (ED) a linear regression analysis was performed, controlling for BMI. A significance level of 5% was adopted. RESULTS Seventy-seven percent of the sample (n = 54) were female and 50% were obese. Fourteen patients exhibited an ED, mostly binge eating disorder (BED). In a regression analysis, both FBG (beta coefficient = 47.4 (22.3); p = 0.037) and A1c (beta coefficient = 1.12 (0.57); p = 0.05) were predicted by the presence of an ED. However, the presence of an ED lost its impact on glycemic control outcomes after the addition of the BMI in the models. CONCLUSIONS Eating psychopathology is frequently observed in patients with T2DM. Among individuals with T2DM, co-morbid ED is associated with a poorer glycemic control in the presence of a higher BMI. The presence of an eating disordered behavior in patients with T2DM seems to have clinical relevance in the usual care of patients with diabetes. Therefore, we recommend eating psychopathology should be routinely assessed in T2DM patients.
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Affiliation(s)
- Marcelo Papelbaum
- State Institute Diabetes and Endocrinology, Rio de Janeiro, Brazil.,2Group of Obesity and Eating Disorders, Institute of Psychiatry of the Federal University of Rio de Janeiro and State Institute Diabetes and Endocrinology, Avenida Ataulfo de Paiva 204, 707, Leblon, Rio de Janeiro, 22440-033 Brazil
| | | | | | - Rosane Kupfer
- State Institute Diabetes and Endocrinology, Rio de Janeiro, Brazil
| | - Silvia Freitas
- State Institute Diabetes and Endocrinology, Rio de Janeiro, Brazil
| | - Ronir Raggio Luz
- 3Institute for Studies in Public Health, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - José Carlos Appolinario
- State Institute Diabetes and Endocrinology, Rio de Janeiro, Brazil.,2Group of Obesity and Eating Disorders, Institute of Psychiatry of the Federal University of Rio de Janeiro and State Institute Diabetes and Endocrinology, Avenida Ataulfo de Paiva 204, 707, Leblon, Rio de Janeiro, 22440-033 Brazil
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Pratley RE, Rosenstock J, Heller SR, Sinclair A, Heine RJ, Kiljański J, Brusko CS, Duan R, Festa A. Reduced Glucose Variability With Glucose-Dependent Versus Glucose-Independent Therapies Despite Similar Glucose Control and Hypoglycemia Rates in a Randomized, Controlled Study of Older Patients With Type 2 Diabetes Mellitus. J Diabetes Sci Technol 2018; 12:1184-1191. [PMID: 29893144 PMCID: PMC6232729 DOI: 10.1177/1932296818776993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Few studies have evaluated continuous glucose monitoring (CGM) in older patients with type 2 diabetes mellitus (T2DM) not using injectable therapy. CGM is useful for investigating hypoglycemia and glycemic variability, which is associated with complications in T2DM. METHODS A CGM substudy of Individualized treatMent aPproach for oldER patIents in a randomized trial in type 2 diabetes Mellitus (IMPERIUM)) was conducted. Patients were vulnerable (moderately ill and/or frail) older (≥65 years) individuals with suboptimally controlled T2DM. Strategy A comprised glucose-dependent therapies (n = 26) with a nonsulfonylurea oral antihyperglycemic medication (OAM) and a glucagon-like peptide-1 receptor agonist as the first injectable. Strategy B comprised non-glucose-dependent therapies (n = 21) with sulfonylurea as the preferred OAM and insulin glargine as the first injectable. Primary endpoints were duration and percentage of time spent with blood glucose (BG) ≤70 mg/dL over 24 hours at week 24. RESULTS Duration and percentage of time spent with hypoglycemia at ≤70 mg/dL were similar for Strategy A and Strategy B; glycemic control improved similarly in both arms (LSM change in HbA1c at week 24; A = -1.2%, B = -1.4%). Duration and percentage time spent with euglycemia and hyperglycemia were also similar in both arms. However, Strategy A was associated with lower within-day (21.1 ± 1.2 vs 25.1 ± 1.4, P = .046) and between-day (5.4 ± 1.0 vs 9.1 ± 1.3, P = .038) BG variability (coefficient of variance [LSM ± SE]) at week 24. CONCLUSIONS This CGM substudy in older patients with T2DM showed lower within- and between-day BG variability with glucose-dependent therapies but similar HbA1c reductions and hypoglycemia duration with glucose-independent strategies.
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Affiliation(s)
- Richard E. Pratley
- Florida Hospital and Sanford Burnham
Prebys Translational Research Institute, Orlando, FL, USA
- Richard E. Pratley, MD, Florida Hospital
Translational Research Institute, 301 Princeton Ave, Orlando, FL 32804, USA.
| | - Julio Rosenstock
- Dallas Diabetes and Endocrine Center at
Medical City, Dallas, TX, USA
| | | | - Alan Sinclair
- Foundation for Diabetes Research in
Older People, Diabetes Frail Limited, Worcestershire, UK
| | | | | | | | - Ran Duan
- Lilly USA, LLC, Indianapolis, IN,
USA
| | - Andreas Festa
- Eli Lilly & Company, Vienna,
Austria
- 1st Medical Department, LK Stockerau,
Niederösterreich, Austria
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Su Q, Liu J, Li P, Qian L, Yang W. Relative Contribution of Fasting and Postprandial Blood Glucose in Overall Glycemic Control: Post Hoc Analysis of a Phase IV Randomized Trial. Diabetes Ther 2018; 9:987-999. [PMID: 29574635 PMCID: PMC5984909 DOI: 10.1007/s13300-018-0403-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Few prospective clinical trials have investigated the role of fasting blood glucose (FBG) and/or postprandial glucose (PPG) in assessing overall glycemic control by using different insulin regimens. In the present post hoc analysis, we assessed the contribution of FBG and/or PPG in overall glycemic control in Chinese patients under insulin treatment. METHODS CLASSIFY is a phase IV, randomized, open-label, 26-week, parallel-arm, treat-to-target, multinational, controlled study in patients with type 2 diabetes mellitus to compare the efficacy and safety of insulin lispro mix 25 (LM25) and insulin lispro mix 50 (LM50) as starter insulins. Insulin was titrated with an aim to target pre-meal blood glucose (BG) levels at > 3.9 and ≤ 6.1 mmol/L before breakfast and dinner. The primary outcome assessed was the change in HbA1c from baseline. RESULTS Chinese patients contributed 38.7% (N = 156) of the total population. The majority of patients were male (52.6%). The mean (SD) body mass index was 24.54 (3.04) kg/m2 and mean (SD) HbA1c was 8.54 (1.10) % at baseline. At week 26, LM50 showed a significantly greater reduction from baseline in HbA1c (- 2.03% vs - 1.55%, P < 0.001), average daily BG (- 3.21 vs - 2.34 mmol/L, P < 0.001), average post-meal BG (- 3.58 vs - 2.39 mmol/L, P < 0.001), and average prandial BG excursion (- 1.01 vs - 0.22 mmol/L, P = 0.006) than the LM25 group. The reductions in average pre-meal BG (- 2.59 vs - 2.28 mmol/L, P = 0.137) were not significantly different between the groups. The proportion of patients achieving HbA1c targets (< 7% or ≤ 6.5%) without nocturnal hypoglycemia or weight gain was greater (P < 0.05) with LM50 compared with LM25. CONCLUSION LM50 achieved better overall glycemic control than LM25 as a starter insulin in Chinese patients, which may be due to greater improvement in PPG levels. TRIAL REGISTRATION Clinicaltrials.gov identification number: NCT01773473. FUNDING Eli Lilly and Company, Shanghai, China.
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Affiliation(s)
- Qing Su
- Department of Endocrinology and Metabolism, Xin Hua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Endocrinology and Metabolism, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Pengfei Li
- Medical Department, Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Lei Qian
- Medical Department, Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
- Medical Science Department, Shanghai Haihe Pharmaceutical Co. Ltd, Shanghai, China
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
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Fatati G, Di Donato A, Grandone I, Menicocci P, Mirri E, Prosperini G, Scardapane M, Rossi MC, Palazzi M. Impact of Insulin Degludec in Hospitalized Patients With and Without Type 2 Diabetes Requiring Parenteral/Enteral Nutrition: An Observational Study. Adv Ther 2018; 35:809-816. [PMID: 29777522 DOI: 10.1007/s12325-018-0709-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Hyperglycemia in inpatients is a major problem, especially when nutritional support is required. This study aims to assess the impact of treatment with insulin degludec (IDeg) on mean blood glucose (BG) and glycemic variability in noncritical hospitalized patients with and without type 2 diabetes (T2DM) receiving enteral and/or parenteral nutrition (EN, PN). METHODS Mean BG and glycemic variability from admission up to 7 days of hospitalization were evaluated in consecutive cases with and without T2DM. Percentage of coefficient of variation (CV) for glucose was used to express glycemic variability. RESULTS Overall, 26 patients (13 with and 13 without T2DM) were admitted to the hospital for any cause. Subjects were 65.4% men and they were mainly elderly (mean age 66.3 ± 13.4 years). PN was administered in 88.5% of patients and EN in 19.2%. At admission, mean HbA1c level was 5.9 ± 0.7% in patients without diabetes and 9.1 ± 2.5% in patients with T2DM. During hospitalization, mean daily BG levels changed from 151 ± 47.3 mg/dl (day 1) to 157 ± 66.7 mg/dl (day 7) in patients without diabetes and from 210 ± 66.5 mg/dl to 192 ± 48.6 mg/dl in patients with T2DM. CV decreased from 14% (day 1) to 11% (day 7) in patients without diabetes and from 20% (day 1) to 9% (day 7) in patients with T2DM. No symptomatic or severe hypoglycemia occurred. CONCLUSIONS Despite the small sample size and the lack of control group, this study represents the first proof-of-concept that IDeg in hospitalized patients with or without T2DM who require nutritional support has the potential to maintain stable levels of BG and reduce glycemic variability. FUNDING Novo Nordisk S.p.A. grant.
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Affiliation(s)
- Giuseppe Fatati
- Unit of Diabetology, Dietology and Clinical Nutrition, S. Maria Hospital, Terni, Italy
| | - Agnese Di Donato
- Unit of Diabetology, Dietology and Clinical Nutrition, S. Maria Hospital, Terni, Italy
| | - Ilenia Grandone
- Unit of Diabetology, Dietology and Clinical Nutrition, S. Maria Hospital, Terni, Italy
| | - Pina Menicocci
- Unit of Diabetology, Dietology and Clinical Nutrition, S. Maria Hospital, Terni, Italy
| | - Eva Mirri
- Unit of Diabetology, Dietology and Clinical Nutrition, S. Maria Hospital, Terni, Italy
| | - Giuseppe Prosperini
- CORESEARCH-Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Marco Scardapane
- CORESEARCH-Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Maria Chiara Rossi
- CORESEARCH-Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
| | - Mariangela Palazzi
- Unit of Diabetology, Dietology and Clinical Nutrition, S. Maria Hospital, Terni, Italy
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Sayed A, Alyafei F, De Sanctis V, Soliman A, Elgamal M. Translating the HbA1c assay into estimated average glucose values in children and adolescents with type 1 diabetes mellitus. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:22-26. [PMID: 30049928 DOI: 10.23750/abm.v89is4.7357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The A1c assay, expressed as the percent of hemoglobin that is glycated, measures chronic glycemia and is widely used to judge the adequacy of diabetes treatment and adjust therapy. Day-to-day management is guided by self-monitoring of capillary glucose concentrations (milligrams per decilitre or millimoles per litter) as well as by using continuous glucose monitoring systems (CGMS). We found a mathematical relationship between A1c and average glucose (AG) levels measured by CGMS over 5 days and determined the correlation between the variable CGMS parameters and HbA1c in 50 children with type 1 diabetes mellitus (DM-1) on MDI therapy. RESEARCH DESIGN AND METHODS A total of 50 diabetic children randomly selected from a cohort of children with DM-1 were included in the analyses. A1c levels obtained at the end of 3 months and measured in a central laboratory were compared with the AG levels during the previous 5 days recorded by CGMS. AG was calculated by combining weighted results from 5 days of continuous glucose monitoring performed before measuring HbA1c, with 3-5 point daily self-monitoring of capillary (fingerstick) glucose. RESULTS Linear regression analysis between the A1c and AG values provided the tightest correlations HbA1c=0.0494 MG- 2E-14, R2=0.90, P<0.0001), allowing calculation of an estimated average glucose (eAG) for A1c values. CONCLUSIONS Our study showed a linear relationship between HbA1C and AG values measured by CGMS for 5 days before HbA1c measurement. The AG can be easily calculated using a formula derived from linear regression analysis of HbA1c data obtained in our diabetic children.
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Affiliation(s)
- Ahmed Sayed
- Department of Pediatrics, Hamad Medical Center, Doha, Qatar.
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Limited benefit of haemoglobin glycation index as risk factor for cardiovascular disease in type 2 diabetes patients. DIABETES & METABOLISM 2018; 45:254-260. [PMID: 29784563 DOI: 10.1016/j.diabet.2018.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/05/2018] [Accepted: 04/18/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND The haemoglobin glycation index (HGI) has been proposed as a marker of interindividual differences in haemoglobin glycosylation. Previous studies have shown a relationship between high HGI and risk of cardiovascular disease (CVD) in patients with diabetes. However, no studies have investigated the role of previous CVD in this association. METHODS The study cohort comprised patients with type 2 diabetes mellitus (T2DM; n=1910) included in the Second Manifestations of Arterial Disease (SMART) study. The relationship between either HGI or HbA1c and a composite of cardiovascular events as the primary outcome, and mortality, cardiovascular mortality, myocardial infarction and stroke as secondary outcomes, was investigated using Cox proportional-hazards models. Similar analyses were performed after stratification according to previous CVD. RESULTS A 1-unit higher HGI was associated with a 29% greater risk of a composite of cardiovascular events (HR: 1.29, 95% CI: 1.06-1.57) in patients without previous CVD, whereas no such relationship was seen in patients with previous CVD (HR: 0.96, 95% CI: 0.86-1.08). The direction and magnitude of the hazard ratios (HRs) of HGI and HbA1c in relation to outcomes were similar. Additional adjustment for HbA1c in the association between HGI and outcomes lowered the HRs. CONCLUSION Similar to HbA1c, higher HGI is related to higher risk of cardiovascular events in patients with T2DM without CVD. As HbA1c has proved to be a comparable risk factor, and obtaining and interpreting the HGI is complicated, any additional benefit of applying the HGI in clinical settings is likely to be limited.
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Sayed A, Alyafei F, De Sanctis V, Soliman A, Elgamal M. Translating the HbA1c assay into estimated average glucose values in children and adolescents with type 1 diabetes mellitus. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89. [PMID: 30049928 PMCID: PMC6179094 DOI: 10.23750/abm.v89i5.7357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The A1c assay, expressed as the percent of hemoglobin that is glycated, measures chronic glycemia and is widely used to judge the adequacy of diabetes treatment and adjust therapy. Day-to-day management is guided by self-monitoring of capillary glucose concentrations (milligrams per decilitre or millimoles per litter) as well as by using continuous glucose monitoring systems (CGMS). We found a mathematical relationship between A1c and average glucose (AG) levels measured by CGMS over 5 days and determined the correlation between the variable CGMS parameters and HbA1c in 50 children with type 1 diabetes mellitus (DM-1) on MDI therapy. RESEARCH DESIGN AND METHODS A total of 50 diabetic children randomly selected from a cohort of children with DM-1 were included in the analyses. A1c levels obtained at the end of 3 months and measured in a central laboratory were compared with the AG levels during the previous 5 days recorded by CGMS. AG was calculated by combining weighted results from 5 days of continuous glucose monitoring performed before measuring HbA1c, with 3-5 point daily self-monitoring of capillary (fingerstick) glucose. RESULTS Linear regression analysis between the A1c and AG values provided the tightest correlations HbA1c=0.0494 MG- 2E-14, R2=0.90, P<0.0001), allowing calculation of an estimated average glucose (eAG) for A1c values. CONCLUSIONS Our study showed a linear relationship between HbA1C and AG values measured by CGMS for 5 days before HbA1c measurement. The AG can be easily calculated using a formula derived from linear regression analysis of HbA1c data obtained in our diabetic children.
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Affiliation(s)
- Ahmed Sayed
- Department of Pediatrics, Hamad Medical Center, Doha, Qatar
| | - Fawzia Alyafei
- Department of Pediatrics, Hamad Medical Center, Doha, Qatar
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Ashraf Soliman
- Department of Pediatrics, Hamad Medical Center, Doha, Qatar,Correspondence: Ashraf Soliman MD PhD FRCP Department of Pediatrics, Hamad General Hospital PO Box 3050, Doha, Qatar Tel. 0097455983874 E-mail:
| | - Mona Elgamal
- Department of Pediatrics, Hamad Medical Center, Doha, Qatar
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Abstract
Glycemic fluctuations, characterized by short-term oscillations in plasma glucose, are important when managing type 2 diabetes (T2D) and may be considered a target of glucose-lowering therapies. Continuous glucose monitoring (CGM) has been used to evaluate the effects of different treatments on glycemic fluctuations. This review examines approaches to and the importance of minimizing glycemic fluctuations among patients with T2D. Measures of HbA1c, fructosamine, and glycated albumin reflect a long-term average of plasma glucose, and are therefore unable to provide an accurate measure of short-term glycemic oscillations. CGM provides accurate monitoring of real-time glucose fluctuations and has been used to investigate the effects of lifestyle and treatment on daily glycemic control. Dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists have demonstrated significant improvements in measures such as the mean amplitude of glucose excursions and standard deviation of CGM. Case studies of two patients with T2D utilizing CGM are also included in this review, which demonstrated that CGM was a useful tool for diagnosing unrecognized hypoglycemia and hyperglycemia in situations in which it was impractical to check fingerstick concentrations. Altogether, the evidence suggests that glycemic fluctuations are a potential target to consider when managing T2D. CGM allows for the real-time evaluation of glycemic fluctuations and may assist in the development of an individualized treatment plan to adequately control short-term oscillations in blood glucose levels.
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Affiliation(s)
- Paresh Dandona
- Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo , Buffalo, New York, USA
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Sertbas Y, Ozdemir A, Sertbas M, Dayan A, Sancak S, Uyan C. The Effect of Glucose Variability on QTc Duration and Dispersion in Patients with Type 2 Diabetes Mellitus. Pak J Med Sci 2017; 33:22-26. [PMID: 28367166 PMCID: PMC5368313 DOI: 10.12669/pjms.331.11440] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: Glycemic variability (GV) is a new term with the episodes of hyper and hypoglycemia in diabetic patients. Both prolonged QT interval and QTd are potential risk factors for malignant ventricular arrhythmias affecting the mortality of different groups of patients including diabetes mellitus. In this study, we aimed to evaluate if the glucose variability increasing the QTc interval and QTc dispersion in type 2 diabetes mellitus. Methods: We included 275 consecutive patients with type 2 diabetes. We quantified the GV with standard deviation (SD) and coefficient of variation (CV) from 7 point glucose measures. We investigated the relationship of GV parameters with QT parameters. Results: The prevalence of prolonged QTc duration was 21%, no patients have prolonged QTc dispersion (> 80 ms). SD of the patients with prolonged QTc duration was significantly higher than the others (45.14 ±24.45 vs. 37.78 ±9.03 p<0.05). There was also a significant relationship between SD and QTc dispersion (r: 0.164; p: 0.007). There were no relationship between the QT parameters and microvascular diabetic complications. SD and HbA1c levels were significantly higher on the patients having peripheral neuropathy (p<0.005). Conclusion: The result of this study demonstratess that increased glycemic variability is associated with prolonged QTc duration and QTc dispersion. It is important to focus on targeting optimal glycemic control with GV as an additional goal point along with the traditional following parameters such as fasting-postprandial blood glucose and HbA1c.
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Affiliation(s)
- Yasar Sertbas
- Yasar Sertbas, MD. Doctor, Department of Internal Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Ali Ozdemir
- Ali Ozdemir, MD. Associate Professor, Department of Internal Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Meltem Sertbas
- Meltem Sertbas, MD. Doctor, Department of Internal Medicine, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Akin Dayan
- Akin Dayan, MD, Doctor, Department of Family Medicine, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Seda Sancak
- Seda Sancak, MD. Associate Professor, Department of Endocrinology, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Cihangir Uyan
- Cihangir Uyan, MD. Professor, Department of Cardiology, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
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44
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Hanefeld M, Raccah D, Monnier L. Individualized, patient-centered use of lixisenatide for the treatment of type 2 diabetes mellitus. Expert Opin Drug Metab Toxicol 2016; 13:311-321. [PMID: 27776453 DOI: 10.1080/17425255.2017.1251579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease associated with hyperglycemia, which can lead to serious vascular complications. Current treatment guidelines place particular emphasis on personalization of therapy. Within this guidance, the use of various second-line therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), is recommended under certain circumstances. Areas covered: Factors influencing glucose homeostasis, including gastric emptying and the associated cardiovascular (CV) risk when homeostasis is not maintained, are reviewed. Physiology relating to the mechanism of action of GLP-1 RAs is summarized, with a particular focus on lixisenatide. In addition, an overview of efficacy and safety data for lixisenatide is presented and the CV effects of GLP-1 RAs are examined. Finally, the rationale and clinical data supporting the combination of lixisenatide and basal insulin are explored. Expert opinion: GLP-1 analogs meet a need for better glycemic control, with the added benefits of reduced hypoglycemic risk and body weight. The combination of a short-acting GLP-1 RA, such as lixisenatide, with a basal insulin, exploits the complementary effects of both of these therapies and seems well suited for the treatment of T2DM. However, further studies are needed to establish the associated CV risks and/or benefits of GLP-1 RAs.
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Affiliation(s)
- Markolf Hanefeld
- a Centre for Clinical Studies , GWT-TUD GmbH , Dresden , Germany
| | - Denis Raccah
- b Department of Diabetology , University Hospital Sainte-Marguerite , Marseille , France
| | - Louis Monnier
- c Laboratory of Human Nutrition and Atherosclerosis, Institute of Clinical Research , University of Montpellier I , Montpellier , France
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Rai S, Hulse A, Kumar P. Feasibility and acceptability of ambulatory glucose profile in children with Type 1 diabetes mellitus: A pilot study. Indian J Endocrinol Metab 2016; 20:790-794. [PMID: 27867881 PMCID: PMC5105562 DOI: 10.4103/2230-8210.192894] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Insulin administration and self-monitoring of blood glucose (SMBG) are pillars in the management of diabetes in children. Introduction of continuous glucose monitoring (CGM) has made it possible to understand the glycemic profiles which are not picked up by SMBG. Recent advent of flash glucose monitoring with inbuilt software to obtain ambulatory glucose profile (AGP) has emerged as a novel method to study glycemic patterns in adults with Type I diabetes. However, the use of AGP in children is yet to be explored. METHODS AGP was used in 46 children with Type 1 diabetes mellitus. Feasibility was measured regarding data and sensor failure. Acceptability was measured using a questionnaire. RESULTS Forty-six children (22 girls and 24 boys) with a mean age of 10.07 years and mean diabetes duration of 3.4 years were included in the study. In this cohort, for 30 (65.21%) subjects, the sensor remained in situ for a complete duration of 14 days. Except for minor discomfort, AGP was well accepted by most of the children and their parents. CONCLUSION AGP is a feasible option for monitoring glycemic status in children with diabetes with a high rate of acceptance.
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Affiliation(s)
- Sushma Rai
- Department of Pediatrics, PESIMSR, Kuppam, Andhra Pradesh, India
- Department of Diabetes and Endocrinology, Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
| | - Anjana Hulse
- Department of Diabetes and Endocrinology, Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
| | - Prasanna Kumar
- Department of Diabetes and Endocrinology, Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
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46
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Schein A, Correa A, Casali KR, Schaan BD. Are glucose levels, glucose variability and autonomic control influenced by inspiratory muscle exercise in patients with type 2 diabetes? Study protocol for a randomized controlled trial. Trials 2016; 17:38. [PMID: 26790405 PMCID: PMC4719684 DOI: 10.1186/s13063-016-1156-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/05/2016] [Indexed: 01/27/2023] Open
Abstract
Background Physical exercise reduces glucose levels and glucose variability in patients with type 2 diabetes. Acute inspiratory muscle exercise has been shown to reduce these parameters in a small group of patients with type 2 diabetes, but these results have yet to be confirmed in a well-designed study. The aim of this study is to investigate the effect of acute inspiratory muscle exercise on glucose levels, glucose variability, and cardiovascular autonomic function in patients with type 2 diabetes. Methods/design This study will use a randomized clinical trial crossover design. A total of 14 subjects will be recruited and randomly allocated to two groups to perform acute inspiratory muscle loading at 2 % of maximal inspiratory pressure (PImax, placebo load) or 60 % of PImax (experimental load). Discussion Inspiratory muscle training could be a novel exercise modality to be used to decrease glucose levels and glucose variability. Trial registration ClinicalTrials.gov NCT02292810.
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Affiliation(s)
- Aso Schein
- Exercise Pathophysiology Research Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Aps Correa
- Exercise Pathophysiology Research Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. .,Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia.
| | - Karina Rabello Casali
- Institute of Science and Technology, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Beatriz D Schaan
- Exercise Pathophysiology Research Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. .,Graduate Program in Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. .,Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
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47
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Solanki JD, Basida SD, Mehta HB, Panjwani SJ, Gadhavi BP, Patel P. Impact of disease control and co-existing risk factors on heart rate variability in Gujarati type 2 diabetics: An observational study. J Family Med Prim Care 2016; 5:393-398. [PMID: 27843848 PMCID: PMC5084568 DOI: 10.4103/2249-4863.192323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a proven threat of cardiac dysautonomia with paucity of studies from India. Poor disease control makes it further worse with co-existence of hypertension in majority. Heart rate variability (HRV) is a validated noninvasive tool to assess cardiac autonomic status. Aim: We studied HRV parameters of type 2 diabetics looking for effects of disease control and other co-existing risk factors. Materials and Methods: Ninety-eight hypertensive and forty normotensive under–treatment, Gujarati type 2 diabetics were evaluated for disease control and risk stratification. Five minutes resting, HRV was measured by Variowin HR, software-based instrument, using standard protocols to record time domain, frequency domain, and Poincare plot HRV parameters. They were compared between subgroups for the difference with P < 0.05 defining statistical significance. Results: All HRV parameters were reduced in type 2 diabetics, having mean age 56 years, mean duration 6 years with poor glycemic but comparatively better pressure control. HRV parameters were significantly not different in good compared to poor glycemics or in subjects with optimum pressure control than those without it. Results did not differ significantly, by the presence of individual cardiovascular risk factor in diabetics except resting heart rate. Conclusion: Our findings of HRV suggest that type 2 diabetics with poor glycemic control do not have a significant difference of cardiac dysautonomia by pressure control, glycemic control, and absence of risk cardiovascular factor. It suggests diabetes as a major cause for cardiac dysautonomia, residual risk despite treatment and need for HRV screening, strict glycemic control, and further studies.
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Affiliation(s)
| | | | - Hemant B Mehta
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Sunil J Panjwani
- Department of Medicine, Government Medical College, Bhavnagar, Gujarat, India
| | - Bhakti P Gadhavi
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Pathik Patel
- Student, Government Medical College, Bhavnagar, Gujarat, India
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48
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Abstract
Chronic hyperglycemia is the primary risk factor for the development of complications in diabetes mellitus (DM); however, it is believed that frequent or large glucose fluctuations may independently contribute to diabetes-related complications. Postprandial spikes in blood glucose, as well as hypoglycemic events, are blamed for increased cardiovascular events in DM. Glycemic variability (GV) includes both of these events; hence, minimizing GV can prevent future cardiovascular events. Correcting GV emerges as a target to be pursued in clinical practice to safely reduce the mean blood glucose and to determine its direct effects on vascular complications in diabetes. Modern diabetes management modalities, including glucagon-related peptide-1-based therapy, newer insulins, modern insulin pumps and bariatric surgery, significantly reduce GV. However, defining GV remains a challenge primarily due to the difficulty of measuring it and the lack of consensus regarding the optimal approach for its management. The purpose of this manuscript was not only to review the most recent evidence on GV but also to help readers better understand the available measurement options and how the various definitions relate differently to the development of diabetic complications.
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Affiliation(s)
- Sunghwan Suh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Koziol J, Johnson K, Brenner K, Fortmann A, Morrisey R, Philis-Tsimikas A. Novel approach to inpatient glucometric monitoring and variability in a community hospital setting. J Diabetes Sci Technol 2015; 9:246-56. [PMID: 25539653 PMCID: PMC4604585 DOI: 10.1177/1932296814564992] [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] [Indexed: 01/08/2023]
Abstract
Hyperglycemia and glucose variability in the hospital environment are associated with higher rates of complications, longer lengths of stay, and mortality. Standardized metrics are needed to assess the efficacy and safety of glucose management interventions. Glucometric data were collected from 2024 inpatients in a San Diego hospital between 2009 and 2011. As a complementary measure of glucose control, individual patient excursion rates were calculated using counts of distinct excursions from normal to critical glucose ranges >180 or <70 mg/dL. Prediction models for excursion rates were devised, based on patient demographic and clinical characteristics. Patients were predominantly male (51.2%), Caucasian (86.0%), and elderly (median age 72 years). Obesity was prevalent: 32% were overweight and 33% were obese. Median length of hospitalization was 5.0 days (range, 0.8-139.4 days). Unadjusted rate of excursions >180 mg/dL was 0.456 per 24 hours. The proportion of zero excursions decreased as severity of illness decreased, but was unrelated to age. Excursion rates were slightly smaller for major and extreme severity of illness compared to mild or moderate illness severity. Excursion rates did not vary in a monotone fashion with age, although the general pattern reflected a reduction in excursion rates from the first age quartile (19 to 59) through the last age quartile (83 to 100). Using the Akaike information criterion, zero-inflated negative binomial models were identified as appropriate for analyzing glucose excursion rates. Systematic approaches to glucose reporting and management in the hospital environment offer "windows of opportunity" to improve diabetes care.
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Buckley JP, Mellor DD, Morris M, Joseph F. Standing-based office work shows encouraging signs of attenuating post-prandial glycaemic excursion. Occup Environ Med 2013; 71:109-11. [PMID: 24297826 DOI: 10.1136/oemed-2013-101823] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The main aim of this study was to compare two days of continuous monitored capillary blood glucose (CGM) responses to sitting and standing in normally desk-based workers. DESIGN, SETTING AND PARTICIPANTS This open repeated-measures study took place in a real office environment, during normal working hours and subsequent CGM overnight measures in 10 participants aged 21-61 years (8 female). MAIN OUTCOMES Postprandial (lunch) measures of: CGM, accelerometer movement counts (MC) heart rate, energy expenditure (EE) and overnight CGM following one afternoon of normal sitting work compared with one afternoon of the same work performed at a standing desk. RESULTS Area-under-the-curve analysis revealed an attenuated blood glucose excursion by 43% (p=0.022) following 185 min of standing (143, 95% CI 5.09 to 281.46 mmol/L min) compared to sitting work (326; 95% CI 228 to 425 mmol/L min). Compared to sitting, EE during an afternoon of standing work was 174 kcals greater (0.83 kcals/min; p=0.028). The accelerometer MC showed no differences between the afternoons of seated versus standing work; reported differences were thus a function of the standing work and not from additional physical movements around the office. CONCLUSIONS This is the first known 'office-based' study to provide CGM measures that add some of the needed mechanistic information to the existing evidence-base on why avoiding sedentary behaviour at work could lead to a reduced risk of cardiometabolic diseases.
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Affiliation(s)
- John P Buckley
- Department of Clinical Sciences and Nutrition, The University of Chester, Chester, Cheshire, UK
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