Abnormal Blood Glucose Research Articles

Correlations of glucose metabolism, insulin resistance and inflammatory factors with symptom score of patients with benign prostatic hyperplasia.

To investigate the effects of glucose metabolism, insulin resistance, and inflammatory factors on International Prostatic Symptom Score (IPSS) of patients with benign prostatic hyperplasia (BPH), to explore their correlations and evaluate the clinical significance. 90 patients with BPH were selected and divided into normal blood glucose group and abnormal blood glucose group. The changes of indexes related to prostate function, prostate volume (PV), prostate-specific antigen (PSA), and IPSS in two groups were evaluated. The fasting blood glucose (FBS), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR) index and inflammatory factors interleukin-8 (IL-8) and cyclooxygenase 2 (COX-2) levels in expressed prostatic secretion (EPS) were compared. The correlations of glucose metabolism, insulin resistance and inflammatory factors with IPSS were analyzed by Logistic regression. The changes of these indexes after treatment of BPH were observed. The FBS, FINS, HOMA-IR, and inflammatory factors IL-8 and COX-2 levels were significantly different between high IPSS group and low IPSS group of patients with BPH. Moreover, the PV and PSA were higher in high IPSS group than those in low IPSS group. The FBS, FINS and inflammatory factors IL-8 and COX-2 levels were positively correlated with IPSS (p<0.05). All the indexes above of BPH patients were decreased after treatment. The FBS, FINS, and inflammatory factors IL-8 and COX-2 levels are closely correlated with IPSS, which can reflect the severity and prognosis of BPH. It can effectively postpone the progression of BPH by lowering blood glucose, improving insulin resistance, and controlling the expressions of inflammatory factors in serum through a healthy lifestyle and clinical comprehensive treatment.

Dipstick urine analysis screening among asymptomatic dogs of k9 units

The study was designed to determine the abnormal urine components such as red blood corpuscles, protein, bilirubin, nitrites, specific gravity, glucose, hydrogen ion, ketones, urobilinogen and leukocyte abnormality in k9 dogs urine.The present study was carried out on 135 asymptomatic dogs (65 males and 70 females) with age (2 – 8 years) in Al-Najaf governorate between February 2016 and April 2016. At morning, urine specimens were collected from dogs and tested via method of dipstick. Mass urinary screening is a suitable tool to detect dogs with asymptomatic progressive renal diseases, however the urinalysis can deliver to us information not merely about the kidneys and bladder, but also the liver, pancreas, and other organs, as well as, helping to make a diagnosis, in addition to determining a prognosis (a prediction of the consequence of the disease) and response to treatment. Results showed that 46 (34%) dogs were with urinary abnormalities, hematuria was the most frequent abnormality showed 28(60.9%), nitrituria 10(21.7%), proteinuria 4(8.7%), bilirubinuria in 2(4.3%) and decreased specific gravity 2(4.3%) respectively, pH (0%), glucose (0%), ketones (0%), urobilinogen (0%) and leukocyte (0%).

Macro and Micro-Vascular Complications and their Risk Factors in Diabetes Mellitus Patients of Southern Punjab, Pakistan

Background: Diabetes is defined as syndrome and is accompanied by number of micro and macro-vascular complications. The burden is quite high in developing countries so the main aim of this study is to evaluate complications in diabetes patients of Pakistan. Methods: A cross-sectional descriptive study was undertaken from December 2015 to March 2016 using a paper based questionnaire. Patients were selected from the 3 private clinics and 3 hospitals employing the systematic sampling technique and anthropometric readings were taken for each individual. The complications were measured by the standards measuring procedures. The demographics were elaborated by the descriptive statistics and the binary logistic regression model was used to analyze the factors associated with the complications by using SPSS version 18. Results: Mean age± SD of the respondent’s was 48.8±14.6 year. One hundred and thirty (43.5%) were females, 270 (90.3%) were married, 103 (34.5%) were rural resident, 189 (63.2%). Sixty five (21.7%) patients accompany Cardiovascular disease (CVD), 51 (17.0%) had diabetic nephropathy, 96 (32.1) had diabetic neuropathy and 124 (41.5%) had diabetic retinopathy. Age (AOR=2.477 95%CI=1.085, 5.654, p=0.031) and abnormal blood glucose level (AOR=1.872 95%CI=1.005, 3.487, p=0.048) is the significantly affecting factors of CVD. Body mass index was the strongest independent predictor for diabetic nephropathy (AOR=0.233 95%CI=0.067, 0.806, p=0.021) and diabetic retinopathy (AOR=3.558 95%CI=1.884, 6.719 p=0.00). Conclusion: The complications seem to be high among the diabetic patients with high frequency of the risk factors accompanying them. Imparting appropriate knowledge and preventing strategies will prove to be of immense benefits in reducing the co-morbidities. Key words: Micro-Vascular complications, Macro-Vascular complications, Diatbetes, Pakistan.

Proportion of Abnormal Glucose Values and Perinatal Outcome [13J

INTRODUCTION: Practical targets for glycemic control are unclear. This study examines associations between different proportions of abnormal self-monitored blood glucose (SMBG) values and adverse perinatal outcomes. METHODS: We conducted a retrospective cohort study of women undergoing SMBG between 1/1/2011-12/31/2016. Four weeks of SMBG values initiated before 32 weeks with at least 50% of expected values present were required. Women with type 1 diabetes or major congenital anomalies were excluded. The primary outcome was a composite of stillbirth, neonatal death, cesarean for arrest, shoulder dystocia, birth injury, new hypertensive disorder, birth weight &gt;90% (LGA), or treatment for neonatal hypoglycemia. The primary exposure was the total percent abnormal SMBG values, examined by degree of abnormality: &lt;25% (tight), &lt;33% (moderate), or &lt;50% (loose) abnormal. RESULTS: 120 women met inclusion criteria of whom 47.9% had gestational diabetes (GDM) and 52.1% had type 2 diabetes. Overall, 29.4% had tight control, 37.0% had moderate control, and 33.6% had loose control. Women with tight control were less likely to experience the primary outcome (34.3% vs 69.4%, RR 0.49, 95%CI 0.31-0.80), LGA infants (14.3% vs 34.5%, RR 0.41, 95% CI 0.17-0.98), or neonatal hypoglycemia (11.4% vs 34.1%, RR 0.34, 95%CI 0.13-0.88) than women without tight control. After adjusting for age, parity, and diabetes type, both moderate and tight control were associated with a reduced odds for the primary outcome, however loose control was not. CONCLUSION: Keeping SMBG to less than 33% abnormal is associated with a reduced risk of adverse perinatal outcomes. These data may help clinicians set targets for glycemic control.

The association of gestational diabetes mellitus with fetal birth weight

AimsGestational diabetes mellitus (GDM) and different time-point glucose levels might have different effects on fetal birth weight. The aim of this study was to further evaluate the associations of GDM and different time-point blood glucose levels with fetal birth weight in a prospective cohort study. MethodsThis prospective cohort study was conducted in Zhoushan Maternal and Child Health Hospital, Zhejiang, from August 2011 to May 2015. 1232 pairs of singleton, full-term newborns and their mothers without other pregnant and perinatal complications were selected as participants. ResultsOf the 1232 women, 234 had GDM. GDM was positively associated with birth weight (β = 99.5 g, P = 0.0002), gestational age-specific Z-score of birth weight (β = 0.23, P = 0.0003), and an increased risk of large for gestational age (LGA; OR = 1.79, 95%CI: 1.11–2.89) and macrosomia (OR = 2.13, 95%CI: 1.34–3.40). Compared with abnormal fasting plasma glucose (FPG) during the second trimester, abnormal postload glucose in oral glucose tolerance test had significantly higher birth weight and gestational age-specific Z-score of birth weight, and an increased risk of macrosomia. Abnormal FPG and abnormal postload glucose had significantly joint effect on birth weight (β = 161.4 g, P = 0.0192), gestational age-specific Z-score of birth weight (β = 0.42, P = 0.0121) and risk of macrosomia (OR = 3.24, 95%CI: 1.21–8.67) and LGA (OR = 5.73, 95%CI: 2.20–14.90). Compared with abnormal blood glucose during the first trimester, GDM had significantly higher birth weight and gestational age-specific Z-score of birth weight. Abnormal blood glucose during the first trimester and GDM had significantly joint effect on birth weight (β = 125.8 g, P = 0.0010), gestational age-specific Z-score of birth weight (β = 0.30, P = 0.0013) and risk of macrosomia (OR = 2.34, 95%CI: 1.28–4.30) and LGA (OR = 2.53, 95%CI: 1.37–4.67). However, we did not find blood glucose during the first trimester independently associated with birth weight. ConclusionsGDM was significantly associated with higher birth weight and an increased risk of LGA and macrosomia. Fetal growth was mostly influenced by postload glucose levels, rather than FBG. Moreover, different time-point blood glucose levels had significantly joint effects on birth weight and risk of LGA and macrosomia.

Informational value of percent body fat with body mass index for the risk of abnormal blood glucose: a nationally representative cross-sectional study

ObjectiveTo examine the value of percent body fat (%BF) with body mass index (BMI) to assess the risk of abnormal blood glucose (ABG) among US adults who are normal weight...

Can we stratify the risk for insulin need in women diagnosed early with gestational diabetes by fasting blood glucose?

Objective: The objective of this study is to evaluate risk factors and propose a model for the prediction of insulin requirement during the treatment of early-diagnosed gestational diabetes mellitus (GDM).Research design and methods: Retrospective cohort analysis of all pregnant women who were diagnosed with GDM by abnormal fasting blood glucose at the first prenatal visit. According to the requirement for insulin therapy to achieve good glycemic control (insulin or diet group), women were compared regarding clinical and laboratory variables. The performance of these variables in predicting insulin need for GDM treatment was identified by a logistic regression model, and a nomogram was created based on the model to facilitate clinical interpretation.Results: In total, 408 women were included for analysis. Among them, 135 (33%) needed insulin therapy. In the logistic regression model, maternal age, prepregnancy body mass index, fasting blood glucose (FBG) value, prior GDM, and family history of diabetes were significant independent variables for the prediction of insulin need.Conclusions: The need for insulin therapy in women with early diagnosis of GDM can be predicted by a logistic regression model, which can be converted to a clinically usable nomogram that could help to properly address follow-up strategies for GDM treatment in regions where health resources are limited.

To find number of patients admitted in PICU with hypoglycemia, hyperglycemia and variable blood glucose and to correlate its effect with the outcome

To find number of patients admitted in PICU with hypoglycemia, hyperglycemia and variable blood glucose and to correlate its effect with the outcome

Unsupervised Classification based Analysis of the Temporal Pattern of Insulin Sensitivity and Modelling Noise of Patient Groups under Tight Glycemic Control

Abstract Background: Glycaemic control (GC) of critical care patients with abnormal blood glucose (BG) level can reduce mortality and improve clinical outcomes. Model based GC protocol allows personalised and effective control of BG level of the patients. As a part of the protocol the patient’s state is predicted by a stochastic model. Improving accuracy of patient state prediction would enable to develop more effective model-based GC algorithms. Methods: The temporal behaviour of the metabolic system of intensive care patients under glycaemic control was analysed and three patient cohorts from three geographically distant hospitals were compared with each other. The three hospitals used the same glycaemic control protocol, but provided different treatment environment. The patients, based on the time function of their state changes - described by the insulin sensitivity parameter (SI(t)) - were classified and the distribution of the patients from different cohorts were examined. Results: In the study no major differences were found in the distribution of the geographically distinct patient cohorts. As the SI value describes the metabolic state of the patient this result suggests that the temporal pattern of the metabolic state changes is similar in each patient cohorts. The patient state descriptor parameter (SI) is identified by using a physiological model. The accuracy of the model and the temporal changes in the accuracy are also analysed by a similar classification methodology than the one used for patient state change classification. The classified time function was the modelling noise identified by a stochastic model. The patients from different hospitals were distributed evenly between the resulted classes, thus modelling accuracy is found to be similar in the three patient cohorts. These results confirms previous studies, however in the previous studies mainly statistical comparison were made rather than the comparison of the temporal pattern of the state descriptor parameters. The correlation between the patient state and the modelling accuracy based classification is also analysed by comparing the classes resulted in by the above described two studies. As high portion of the patients are classified into the same classes by the two classification study we can state that the temporal pattern of the state change correlates with the temporal pattern of the modelling error.

983: Rate of Hyperglycemia and Adverse Outcomes among Gestational Diabetics

The diagnosis of gestational diabetes (GDM) typically entails blood glucose (BG) monitoring 4 times daily: fasting (F) and three postprandial (PP) values. The ideal threshold at when therapy should be initiated or modified is uncertain, with some suggesting when > 33% of values are above pre-specified thresholds and others, when > 50% are abnormal. The aim of this study was to determine if there exists a threshold in the percentage of abnormal BG values at any of the 4 scheduled testing timeframes that is associated with adverse perinatal outcomes. This was a secondary analysis of a randomized controlled trial at 5 tertiary centers evaluating the frequency of BG testing among GDM patients. BG values were defined as abnormal if: F were ≥ 95 mg/dl or if 2-hr PP values were ≥ 120 mg/dl. Composite neonatal morbidity (CNM) included any one of the following: Shoulder dystocia, large-for-gestational age (birthweight >90th% for GA), NICU admission, neonatal hypoglycemia or hyperbilirubinemia. Composite maternal morbidity (CMM) was the presence of either pre-eclampsia or indicated delivery for uncontrolled BG values. Patients with missing data for any of these outcomes were excluded. A receiver operating characteristics (ROC) analysis was used for each time point to determine if the percentage of abnormal BG was associated with CNM or CMM. Of the 293 women randomized, 282 (96%) were eligible for analysis. The rate of CNM was 35%, and of CMM, 18%. On average, women had 32 BG values for evaluation for fasting and 2hr PP. Baseline maternal characteristics were similar among women with and without CNM. Almost three-quarter of the patients did not require medical treatment. The proportion of chorioamnionitis (0.5% vs. 5%, p=0.02) and preterm labor (3.3% vs. 18%, p<0.01) were higher among women with CNM. The mean percentage of abnormal values at all each of the 4 testing timeframes was similar between both groups (Table). There was no difference in proportion of patients with ≥50% abnormal values throughout pregnancy. Area under the ROC curves demonstrated that the percentages of abnormal BG value was poor at identifying CNM or CMM (Figure). Among women with GDM, the percentage rate of abnormal BG values was poor predictor of composite maternal or neonatal morbidity; concurrently identifying an optimal threshold was not feasible.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

EVALUATION OF PREDICTIVE FACTORS OF DEVELOPMENT OF TYPE 2 DIABETES MELLITUS (T2DM) IN PATIENTS WITH GESTATIONAL DIABETES MELLITUS (GDM)

Abstract Introduction: Several groups have been considered as the population at risk for diabetes, one of which is women with a history of gestational diabetes. Women with gestational diabetes are likely to develop type 2 diabetes mellitus (T2DM) and cardiovascular disease. Given the great importance of controlling risk factors for T2DM following gestational diabetes, it was decided to conduct a study to investigate predictive factors of the development of T2DM in patients with gestational diabetes mellitus (GDM). Methods: This cross-sectional study had been conducted on pregnant women with gestational diabetes in 2015. All pregnant women underwent screening for gestational diabetes at the first visit. At six to 12 weeks after parturition, they were put under oral glucose tolerance test (OGTT) again. Follow-up was done in all cases where there was an abnormality in diagnostic test or symptoms of hyperglycemia, glycosuria, and abnormal weight gain. All blood samples were centrifuged, and plasma samples obtained were transferred to measure glucose. Chi-square test was used for data analysis with IBM SPSS 21.0 statistical software. P-value less than 0.05 was considered as the significance level. Results: A total of approximately 185 patients were included in this study with a mean age of 27.7 ± 4.8 years. Among 185 patients who were followed-up for six to 12 weeks after parturition, 10% of patients were with type 2 diabetes after pregnancy. In addition, 10% of postpartum patients have had impaired glucose tolerance test (IGT), but diabetes was not found. Also, 30.27% (n = 56) of the patients have had impaired fasting glucose (IFG). Finally, about 44.32% (n = 82) of the patients had abnormal blood glucose test (AGT). After analyzing the data, it was found that, of 185 patients, two patients had a BMI less than 20, three people with a BMI between 20–24.9, seven patients with a BMI between 25–29.9, and three patients with BMI between 30–40 had diabetes, according to GTT test. Risk factors such as cholesterol, history of hyperthyroidism, history of hypothyroidism, polycystic ovarian syndrome, obesity, acanthosis nigricans, and family history of diabetes had no significant relationship with development of diabetes after pregnancy (p>0.05). Conclusion: About 10% of patients after parturition clearly had diabetes, according to the tests carried out. Our study showed that BMI and FBS play a significant role in predicting the development of diabetes, but factors such as history of miscarriage, stillbirth, macrosomia, death without cause and medical records such as hypertension, obesity, hyperthyroidism, and hypothyroidism have not played a significant role in this prediction.

Insulin resistance, blood glucose and inflammatory cytokine levels are risk factors for cardiovascular events in diabetic patients complicated with coronary heart disease.

This study was designed to investigate the relation of insulin resistance, blood glucose and inflammatory cytokines with cardiovascular events in diabetic patients complicated with coronary heart disease (CHD). A total of 120 patients with diabetes mellitus type 2 (T2DM) complicated with CHD admitted to Jinan Central Hospital from January 2015 to March 2016 were enrolled in this study. There were 60 cases complicated with cardiovascular events and 60 had no history of cardiovascular events; there were 40 cases with abnormal blood glucose, 40 with insulin resistance and 40 with elevated inflammatory cytokines. Changes in the levels of blood glucose, fasting serum insulin and inflammatory cytokines as well as changes in the homeostasis model assessment of insulin resistance indexes (HOMA-IR) were recorded and compared among groups of patients. Besides, changes in the Global Registry of Acute Coronary Events (GRACE) risk score and the incidence rate of cardiovascular events were also detected and multivariate logistic regression analysis was conducted so as to identify relevant risk factors. Our results showed the fasting blood glucose and the 2 h postprandial blood glucose levels in the non-cardiovascular event group were lower than those in the cardiovascular event group (P<0.05). However, levels of fasting serum insulin and HOMA-IR in the non-cardiovascular event group were significantly higher than those in the cardiovascular event group (P<0.05). Additionally, levels of tumor necrosis factor-α (TNF-α), interleukin-6 and C-reactive protein in the non-cardiovascular event group were significantly lower than those in the cardiovascular event group (P<0.05). Moreover, GRACE risk scores in patients with elevated inflammatory cytokines were higher than those in patients with insulin resistance and those in patients with blood glucose abnormalities (P<0.05). The incidence rate of cardiovascular events in patients with blood glucose abnormalities was lower than that in patients with insulin resistance and that in patients with elevated inflammatory cytokines. There was a positive correlation between TNF-α and HOMA-IR (P<0.05), and between HOMA-IR and the GRACE risk score (P<0.05). Blood glucose abnormalities, insulin resistance and inflammatory cytokines were all independent risk factors for cardiovascular events. Based on our findings, stronger inflammatory responses in patients with T2DM complicated with CHD lead to higher incidence rates of cardiovascular events. Besides that, elevated blood glucose and insulin resistance levels are also independent risk factors for cardiovascular events.

Dysmetabolic iron overload syndrome (DIOS)

Dysmetabolic iron overload syndrome (DIOS) corresponds to mild increase in both liver and body iron stores associated with various components of metabolic syndrome in the absence of any identifiable cause of iron excess. It is characterized by hyperferritinemia with normal or moderately increased transferrin saturation, one or several metabolic abnormalities (increased body mass index with android distribution of fat, elevated blood pressure, dyslipidaemia, abnormal glucose metabolism, steatohepatitis), and mild hepatic iron excess at magnetic resonance imaging or liver biopsy. Alteration of iron metabolism in DIOS likely results from a multifactorial and dynamic process triggered by an excessively rich diet, facilitated by environmental and genetic cofactors and implying a cross-talk between the liver and visceral adipose tissue. Phlebotomy therapy cannot be currently considered as a valuable option in DIOS patients. Sustained modification of diet and life-style habits remains the first therapeutic intervention in these patients together with drug control of increased blood pressure, abnormal blood glucose and dyslipidaemia when necessary.

8 A Scoring System for Detecting Left Ventricular Diastolic Dysfunction in Hypertensive Patients

Introduction: Hypertension is the most common condition seen in primary care and a risk factor for diastolic dysfunction. Diastolic dysfunction occurred before heart failure in hypertensive patients with preserved ejection fraction, therefore early diagnosis of diastolic dysfunction is very important. Several factors have been known to be associated with left ventricular diastolic dysfunction and a new scoring system could be generated from those factors. Methods: A cross sectional study was conducted in Tarakan General District Hospital North Kalimantan with hypertensive subjects on October 2016. Patients characteristics, all factors related to left ventricular diastolic dysfunction, and echocardiographic data were collected and analysed. Results: There were 132 total samples in this study, and left ventricular diastolic dysfunction was found in 40.2% samples. From logistic regression analysis, age ≥55 years old (p = 0.006), poor blood pressure control (p < 0.001), left ventricular hypertrophy (p = 0.003), and abnormal fasting blood glucose (p = 0.001) were found to have a significant relation with left ventricular diastolic dysfunction and became a final model variables of scoring system. Left ventricular diastolic dysfunction scoring system could be generated form those variables final models. Calibration and internal validation tests for this scoring system showed good results. Conclusion: A scoring system can be generated to detect left ventricular diastolic dysfunction in hypertensive patients.

Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care.

Aboriginal and Torres Strait Islander Australians experience a greater burden of disease compared to non-Indigenous Australians. Around one-fifth of the health disparity is caused by cardiovascular disease (CVD). Despite the importance of absolute cardiovascular risk assessment (CVRA) as a screening and early intervention tool, few studies have reported its use within the Australian Indigenous primary health care (PHC) sector. This study utilizes data from a large-scale quality improvement program to examine variation in documented CVRA as a primary prevention strategy for individuals without prior CVD across four Australian jurisdictions. We also examine the proportion with elevated risk and follow-up actions recorded. We undertook cross-sectional analysis of 2,052 client records from 97 PHC centers to assess CVRA in Indigenous adults aged ≥20 years with no recorded chronic disease diagnosis (2012-2014). Multilevel regression was used to quantify the variation in CVRA attributable to health center and client level factors. The main outcome measure was the proportion of eligible adults who had CVRA recorded. Secondary outcomes were the proportion of clients with elevated risk that had follow-up actions recorded. Approximately 23% (n = 478) of eligible clients had documented CVRA. Almost all assessments (99%) were conducted in the Northern Territory. Within this jurisdiction, there was wide variation between centers in the proportion of clients with documented CVRA (median 38%; range 0-86%). Regression analysis showed health center factors accounted for 48% of the variation. Centers with integrated clinical decision support systems were more likely to document CVRA (OR 21.1; 95% CI 5.4-82.4; p < 0.001). Eleven percent (n = 53) of clients were found with moderate/high CVD risk, of whom almost one-third were under 35 years (n = 16). Documentation of follow-up varied with respect to the targeted risk factor. Fewer than 30% with abnormal blood lipid or glucose levels had follow-up management plans recorded. There was wide variation in CVRA between jurisdictions and between PHC centers. Learnings from successful interventions to educate and support centers in CVRA provision should be shared with stakeholders more widely. Where risk has been identified, further improvement in follow-up management is required to prevent CVD onset and reduce future burden in Australia's Indigenous population.

Pioglitazone-induced bone loss in diabetic rats and its amelioration by berberine: A portrait of molecular crosstalk

Diabetes mellitus and osteoporosis both are high prevalence disorders, especially in the elderly population. Pioglitazone, a PPAR-γ agonist associated with bone loss and risk of fracture in type 2 diabetes mellitus patients. In this study, ameliorative effect of berberine against pioglitazone-induced bone loss in diabetic rats and possible mechanisms has been explored. Diabetes was induced in male Wistar albino rats by streptozotocin (65 mg/kg, i.v.) after 15min of nicotinamide (230mg/kg, i.p.) administration. Diabetic rats were treated orally with pioglitazone (10mg/kg) and berberine (100mg/kg) alone and in combination of both for 12 weeks. Femur of each rat was isolated and evaluated for the bone micro-architecture, BMD, histology and mRNA expression of PPAR-γ, AMPK, and bone turnover markers (RANKL, OPG, Runx2, and osteocalcin). Urinary calcium and serum TRAP was also measured. Treatment of pioglitazone and berberine alone and in combination significantly ameliorate abnormal blood glucose, serum insulin, and HbA1c levels in streptozotocin-induced diabetic rats. Pioglitazone treatment significantly increased urinary calcium, serum TRAP, mRNA expression of RANKL, PPAR-γ as well as significantly decreased Runx2, OPG, osteocalcin and AMPK levels in diabetic rats. Pioglitazone administration also shows detrimental effect on femur epiphysis micro-architecture, BMD and histology. Whereas, berberine treatment alone and in combination with pioglitazone remarkably ameliorates the abnormal urinary calcium, mRNA expression of AMPK, bone turnover markers, femur epiphysis micro-architecture, histology and also increases BMD in diabetic rats. In conclusion, berberine shows protective effect against pioglitazone-induced bone loss in diabetic rats possibly through AMPK activation pathway.

Random blood glucose screening at a public health station encouraged high risk subjects to make lifestyle changes.

Screening and early diagnosis of prediabetes and diabetes can prevent or delay disease onset and complications. To that end, a free public health station was established in a large, government medical centre. This study evaluated the long-term outcomes of abnormal random blood glucose results among patients with no history of diabetes or prediabetes. The Diabetes Unit supervised a public dysglycaemia and hypertension screening station. Participants with blood glucose >140mg/dL and no history of diabetes or prediabetes were contacted by telephone for follow-up. Among screened subjects, 868 (average age 57.5±12years) had a random blood glucose level >140mg/dL and 341 (39.3%) responded to the telephone survey. Of these, 313 (91.8%) subsequently had fasting blood glucose measured at their health maintenance organisation (HMO), of which 101 (32.3%) were abnormal. A total of 173 (51%) respondents initiated interventions: 59 (17.3%) antidiabetic treatment; 145 (42.5%) sugar-restricted diet; and 96 (28.2%) a physical activity programme. Of patients with abnormal fasting blood glucose, 17 (14.5%) reported having had this result previously compared with 9 (4.2%) with normal fasting glucose (P=.001). Among respondents, 216 (63.3%) stated the screening was effective and 273 (80.1%) would recommend it. The station was effective in promoting additional screening among high-risk age groups and encourages subjects to make lifestyle changes. Operating the screening station is simple and effective; therefore it may serve as a complementary step in promoting community healthcare.

Genetic risk of prediabetes and diabetes development in chronic myeloid leukemia patients treated with nilotinib

Impaired fasting glucose and type 2 diabetes represent adverse events in patients with chronic myeloid leukemia (CML) treated with the second generation tyrosine kinase inhibitor nilotinib. An unweighted genetic risk score (uGRS) for the prediction of insulin resistance, consisting of 10 multiple single-nucleotide polymorphisms, has been proposed. We evaluated uGRS predictivity in 61 CML patients treated with nilotinib. Patients were genotyped for IRS1, GRB14, ARL15, PPARG, PEPD, ANKRD55/MAP3K1, PDGFC, LYPLAL1, RSPO3, and FAM13A1 genes. The uGRS was based on the sum of the risk alleles within the set of selected single-nucleotide polymorphisms. Molecular response (MR)3.0 and MR4.0 were achieved in 90% and 79% of patients, respectively. Before treatment, none of the patients had abnormal blood glucose. During treatment and subsequent follow-up at 80.2 months (range: 1-298), seven patients (11.5%) had developed diabetes that required oral treatment, a median of 14 months (range: 3-98) after starting nilotinib treatment. Twelve patients (19.7%) had developed prediabetes. Prediabetes/diabetes-free survival was significantly higher in patients with a uGRS <10 than in those with higher scores (100% vs. 22.8 ± 12.4%, p <0.001). Each increment of one unit in the uGRS caused a 42% increase in the prediabetes/diabetes risk (hazard ratio = 1.42, confidence interval: 1.04-1.94, p = 0.026). The presence of more than 10 allelic variants associated with insulin secretion, processing, sensitivity, and clearance is predictive of prediabetes/diabetes development in CML patients treated with nilotinib. In clinical practice, uGRS could help tailor the best tyrosine kinase inhibitor therapy.

Use of a Connected Glucose Meter and Certified Diabetes Educator Coaching to Decrease the Likelihood of Abnormal Blood Glucose Excursions: The Livongo for Diabetes Program.

BackgroundThe Livongo for Diabetes Program offers members (1) a cellular technology-enabled, two-way messaging device that measures blood glucose (BG), centrally stores the glucose data, and delivers messages back to the individual in real time; (2) unlimited BG test strips; and (3) access to a diabetes coaching team for questions, goal setting, and automated support for abnormal glucose excursions. The program is sponsored by at-risk self-insured employers, health plans and provider organizations where it is free to members with diabetes or it is available directly to the person with diabetes where they cover the cost.ObjectiveThe objective of our study was to evaluate BG data from 4544 individuals with diabetes who were enrolled in the Livongo program from October 2014 through December 2015.MethodsMembers used the Livongo glucose meter to measure their BG levels an average of 1.8 times per day. We estimated the probability of having a day with a BG reading outside of the normal range (70-180 mg/dL, or 3.9-10.0 mmol/L) in months 2 to 12 compared with month 1 of the program, using individual fixed effects to control for individual characteristics.ResultsLivongo members experienced an average 18.4% decrease in the likelihood of having a day with hypoglycemia (BG <70 mg/dL) and an average 16.4% decrease in hyperglycemia (BG >180 mg/dL) in months 2-12 compared with month 1 as the baseline. The biggest impact was seen on hyperglycemia for nonusers of insulin. We do not know all of the contributing factors such as medication or other treatment changes during the study period.ConclusionsThese findings suggest that access to a connected glucose meter and certified diabetes educator coaching is associated with a decrease in the likelihood of abnormal glucose excursions, which can lead to diabetes-related health care savings.

Prevalence and outcome of abnormal blood glucose concentration in critically ill children admitted to Pediatric Emergency Unit at Sohag University Hospital, Egypt

Aims:To determine the frequency and outcome of blood glucose abnormalities, in critically ill children requiring admission to pediatric emergency unit in Sohag University Hospital. Methods:Prospective observational study, conducted on critically ill children admitted to emergency unit of Sohag University Hospital. Cases were recruited during the study period from September 2015 to April 2016. Results: The prevalence of hypoglycaemiarepresenting 6% of all cases. Multivariate analysis of clinical variables associated with hypoglycemia showed thatlast meal >12 hours ago, and tachypnea are independent indicators of hypoglycaemia.Hyperglycemia was detected in 15.4 % of all cases. Patients with abnormal blood glucose measurements had mean length of hospital stay (LOS) 7.7± 10.02 days, compared to patients with normal blood glucose measurements 8.1± 8.07 days.PICU admission was found to be more in patients with abnormal blood glucose measurements (23.1%) compared to patients with normal blood glucose measurements (3.4%).Most of patients who had normal blood glucose measurements were discharged well (77.4%), whereas (55.6%) of patients who were observed to have hypoglycemia died, and (25.5%) of patients who were observed to have hyperglycemia died. Conclusions:Abnormal glucose concentrations are common in critically ill children. Where facilities for blood glucose estimation exist, blood glucose should be measured in all children sick enough to warrant admission, particularly those severely ill or malnourished children and who bear the brunt of mortality.