Average Glucose Research Articles

Association of Continuous Glucose Monitoring Metrics With Pregnancy Outcomes in Patients With Preexisting Diabetes.

Continuous glucose monitoring (CGM) improves maternal glycemic control and neonatal outcomes in type 1 diabetes pregnancies compared with self-monitoring of blood glucose. However, CGM targets for pregnancy are based on expert opinion. We aimed to evaluate the association between CGM metrics and perinatal outcomes and identify evidence-based targets to reduce morbidity. This was a retrospective cohort study of pregnant patients with type 1 or 2 diabetes who used real-time CGM and delivered at a U.S. tertiary center (2018-2021). Multiple gestations, fetal anomalies, and early pregnancy loss were excluded. Exposures included time in range (TIR; 65-140 mg/dL), time above range (TAR), time below range (TBR), glucose variability, average glucose, and glucose management indicator. The primary outcome was a composite of fetal or neonatal mortality, large or small for gestational age at birth, neonatal intensive care unit admission, hypoglycemia, shoulder dystocia or birth trauma, and hyperbilirubinemia. Logistic regression estimated the association between CGM metrics and outcomes, and optimal TIR was calculated. Of 117 patients, 16 (13.7%) used CGM before pregnancy and 68 (58.1%) had type 1 diabetes. Overall, 98 patients (83.8%) developed the composite neonatal outcome. All CGM metrics, except TBR, were associated with neonatal morbidity. For each 5 percentage-point increase in TIR, there was 28% reduced odds of neonatal morbidity (odds ratio 0.72, 95% CI 0.58-0.89). The statistically optimal TIR was 66-71%. Nearly all CGM metrics were associated with adverse neonatal morbidity and mortality and may aid management of preexisting diabetes in pregnancy. Our findings support the American Diabetes Association recommendation of 70% TIR.

Vascular neovascularization and post-traumatic stress intervention of perforator flap obstruction in diabetic patients

BackgroundDiabetic patients often suffer from neovascularization during branch flap repair, and the process of formation of these neo-vessels and post-traumatic stress intervention have not been adequately studied.Subjects and MethodsFifty diabetic patients were selected for this study and divided into an experimental group and a control group. The experimental group received post-traumatic stress intervention treatment, while the control group received conventional treatment. Choke vessels were counted and observed by collecting tissue samples from the study subjects using histological methods.ResultsData analysis software SPSS 23.0 was used for statistical analysis of data. A significant reduction in the number of Choke vessels was observed in the experimental group as compared to the control group (the mean number of Choke vessels was 10.2 in the experimental group and 17.8 in the control group, P<0.05). In addition, the blood glucose level of the experimental group was significantly decreased (the average blood glucose level of the experimental group was 8.6 mmol/L and the average blood glucose level of the control group was 11.4 mmol/L, P<0.01).ConclusionsPost-traumatic stress intervention can significantly reduce the number of Choke vessels and thus improve the results of perforator flap repair. It provides useful guidance for the surgical treatment of diabetic patients and provides an important theoretical basis for clinical practice.AcknowledgementThe research is supported by: the Hainan Provincial Natural Science Foundation of China (No. 821RC1064).

The Effect of the Timing of Banana Intake on Postprandial Glucose Spike: Randomized Parallel-Group Comparison Study

Objective: To elucidate the effects of the timing of banana intake on postprandial glucose spike and glucose metabolism. Methods: This randomized parallel-group comparison study was designed to randomize 54 adults aged 41- 60 years into three groups. The first group consumed 120 g of banana at breakfast daily for 2 weeks, the second group consumed 120 g of banana after dinner daily for 2 weeks, and the third consumed no banana or banana-containing food for 2 weeks. The participants in each group wore a continuous glucose monitor on their arms for 2 weeks to measure their blood glucose trend. Body composition and serum biomarkers were evaluated before and after intervention. Results: There were 16 participants in the banana-at-breakfast group, 16 in the banana-after-dinner group, and 15 in the control group. We defined a postprandial blood glucose increase of >140 mg/dL as a “glucose spike.” When comparing the glucose spike incidence ratio (incidence of glucose spikes divided by number of times measured), the point estimate of the incidence ratio of banana-at-breakfast group at dinner compared with breakfast was 1.55 (point estimate. 95% confidence interval: 1.09- 2.20), that of banana-after dinner group 1.83 (point estimate. 95% confidence interval: 1.28-2.61), and control group 2.03 (point estimate. 95% confidence interval: 1.36-3.04). In addition, the banana-afterdinner and control groups showed a higher incidence ratio, compared with the banana-at-breakfast group. Glycoalbumin decreased significantly in the banana-at- breakfast group compared with the other groups. Conclusions: The results showed that glucose spikes were less generated when consuming bananas at breakfast than when consuming them after dinner or not consuming them at all. The level of glycoalbumin, an index for average blood glucose, was lower in the banana-at-breakfast group than in the banana-after-dinner and control groups within 2 weeks. Clinical Trial Registry: UMIN 000050025

Effect of Progressive Muscle Relaxation Techniques on Blood Glucose Levels in Elderly With Type 2 Diabetes Mellitus

Introduction: The International Diabetes Federation revealed that Indonesia is currently ranked sixth worldwide for deaths from diabetes in 2021. In addition to pharmacological therapy, managing type 2 diabetes mellitus can use non-pharmacological therapies, such as progressive muscle relaxation therapy. This study aimed to analyze the effect of progressive muscle relaxation therapy on blood glucose levels in older people with type 2 diabetes mellitus. Method: This study used a quantitative method with a quasi-experimental approach, pre-test, and post-test with a control group. Sampling technique random sampling of 70 elderly. Instruments: observation sheet of blood glucose levels and PMR SOP. Data analysis using the T-Test. Results: The average blood glucose level before the intervention was 211.7 mg/dl and 183.74 mg/dl after the intervention. In the intervention group, there was an effect with p-value = 0.036 (p-value <0.05). Post-intervention and post-control, there was no difference with a value of 0.074 (p> 0.05), meaning there is no difference. Conclusions: Progressive muscle relaxation affects blood glucose levels in the elderly with type 2 diabetes mellitus at the elderly Posyandu, Singosari Village.

Workplace health promotion: results of a combined multidisciplinary intervention over a long period - preliminary results.

Obesity is a multifactorial disease that is one of the major public health problems. It is the result of the interaction between behavioral, social and endocrine-metabolic components. Already in the 80s, it was highlighted by the World Health Organization (WHO) that the workplace is an ideal setting for introducing health promotion programs. The aim of the present study was to implement a health promotion program among healthcare workers (HCWs) operating in an Emergency Hospital in Southern Italy, combining diet, sports activity and motivational support over a 24-month period. Participants were HCWs operating in an Emergency Hospital in Southern Italy. The inclusion criteria were as follows: overweight or obesity, i.e., body mass index (BMI) >25 kg/m2, or waist circumference >102 cm (males), >88 cm (females); dyslipidemia without pharmacological treatment, i.e., total cholesterol >220 mg/dL, or high-density lipoprotein (HDL) cholesterol <35 mg/dL, or low-density lipoprotein cholesterol (LDL) >130 mg/dL, or triglycerides >200 mg/dL; fasting glucose levels >120 mg/dl and/or reduced tolerance to glucose or diabetes mellitus, without pharmacological treatment was determined through HbA1c. The analysis was conducted on 36 participants. Follow-up was performed after twelve (T12) and twenty-four months (T24). The average systolic blood pressure (SBP) and diastolic blood pressure (DBP) values decreased during the time period. The average BMI of both male and female HCWs was significantly reduced from T0 to T12 and from T0 to T24. The triglyceride levels gradually decreased, but not significantly, from T0 to T24. The average blood glucose values decreased from T0 to T12 and from T12 to T24. The number of subjects who started to perform physical activity increased significantly between T0 and T12 and between T0 and T24. The findings have led to a significant change in HCWs' lifestyles and body perceptions, as well as their ability to work.

Preparation of patients with type 2 diabetes mellitus for elective percutaneous coronary intervention

Aim. To assess the quality of preparation of patients with type 2 diabetes mellitus for elective percutaneous coronary intervention, which is aimed to achieving the target values of the modifiable cardiovascular risk factors.Materials and Methods. We retrospectively analysed 100 electronic medical records of patients with type 2 diabetes mellitus who were admitted for elective percutaneous coronary intervention at Research Institute for Complex Issues of Cardiovascular Diseases from 2021 to 2022. We analysed clinicopathological data, the data from clinical laboratory tests, and pharmacological anamnesis.Results. The average age was 65.19 ± 8.69 years, and the proportion of women was 59%. Smoking history and obesity were reported in 22% and 55% of patients, respectively, with average body mass index of 30.38 [27.66; 34.87] kg/m2. All patients suffered from arterial hypertension, 55% had past medical history of myocardial infarction, and 15% had atrial fibrillation. The duration of type 2 diabetes mellitus was 10 [3; 12] years. Target blood pressure at the admission was achieved in 40% patients. Average total cholesterol and blood glucose were 4.15 [3.50; 5.10] mmol/L and 7.85 [6.15; 11.00] mmol/L, respectively. Beta blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and statics were received by 90%, 89%, and 97% of patients. Maximum statin dose was registered in 27% patients, combined therapy (statin + ezetimibe) was documented in 4% patients. 14% of patients did not take hypoglycemic drugs. Oral hypoglycemic agents were received in 65% (in most cases biguanides and sulphonylureas, in 7% patients they were combined with insulin). Sodium-dependent glucose cotransporter (SGLT2) inhibitors have been taken by 19% of patients.Conclusion. Patients with type 2 diabetes mellitus recommended for elective percutaneous coronary intervention typically suffer from arterial hypertension and frequently had increased body mass index, total cholesterol, and blood glucose. The prevalence of using antihypertensive drugs, oral hypoglycemic agents, and lipid-lowering drugs should be increased.

PENGARUH AIR REBUSAN DAUN SEMANGGI AIR (Marsilea crenata) TERHADAP PENURUNAN KADAR GLUKOSA DARAH MENCIT (Mus musculus) HIPERGLIKEMIA

Hyperglycemia is a marker of diabetes mellitus which is generally caused by damaged pancreatic ? cells which interferes with insulin secretion, causing the amount of blood glucose in the body to be uncontrolled. Marsilea crenata is known to contain several phytochemical compounds such as phenolics, flavonoids and steroids which have a positive effect on treating metabolic disorders. This study aims to determine the effect of Marsilea crenata cooking water on blood glucose levels in Mus musculus. The method used to check blood glucose levels is the POCT method. The results obtained in this study indicate that there is a difference in the average blood glucose examination in the treatment group and the control group. The average blood glucose before treatment was found to be 186.1 mg/dl, while measurements at the 4th and 7th hours after therapy with Marsilea crenata boiled water showed results of 166 mg/dl and 155.2 mg/dl. Statistical tests indicated that there was a significant difference or the effect of giving Marsilea crenata boiled water on decreasing blood glucose levels. Keywords : Marsilea crenata, Mus musculus, Blood glucose level, Hyperglycemia

The Impact of Chronic Heart Failure Treatment on Glycemic Variability in Patients without Diabetes Mellitus

Background. According to statistics, about 26 million people worldwide suffer from heart failure (HF). Currently, sodium-glucose cotransporter 2 inhibitors are widely prescribed for treatment of HF with reduced left ventricular ejec-tion fraction (LVEF) throughout the world. Therefore, prescribing drugs that have anti-hypoglycemic effect in patients without diabetes mellitus still raises some concerns, considering the possible risk of developing hypoglycemia.&#x0D; The aim. To assess the effect of dapagliflozin on glycemic variability in treatment of HF with reduced LVEF in patients without diabetes mellitus.&#x0D; Materials and methods. The study was conducted at the premises of the Department of Cardiometabolic Diseases of the Ukrainian Children’s Cardiac Center. Twenty-three patients with HF with reduced LVEF of various etiologies without diabetes mellitus were evaluated. The variability of glycemia in the study group was assessed using continuous glucose monitoring. For this, the MiniMed iPro2 continuous glucose monitoring system (Medtronic, USA) was used.&#x0D; The sensor was inserted on day 1 and removed on day 7. Average value of glycemia during the day, time in range (TIR) and time below range (TBR) were calculated on the basis of data about the level of glucose in the intercellular fluid obtained for 6 days of monitoring. Dapagliflozin 10 mg once a day was prescribed to all the patients included in the study for the treatment of HF with reduced LVEF. The average follow-up period was 7 months.&#x0D; Results. The examined patients were divided according to clinical and laboratory characteristics. Assessment of daily variability of glycemia during 6 days of observation using continuous glucose monitoring in patients on dapagliflozin revealed average blood glucose level from 4.4 mmol/L (minimum value) to 6.0 mmol/L (maximum value). These results indicate minimal risk of hypoglycemia and safety of using dapagliflozin in case of HF with reduced LVEF without concomi-tant type 2 diabetes mellitus. TIR and TBR indicators were also evaluated in patients with and without prediabetes. The obtained data allows to assert the same safety of taking dapagliflozin in both these groups, due to the fact that time of glycemia &lt;3.9 mmol/l does not exceed the indicator of 5%.&#x0D; Conclusion. The use of dapagliflozin as part of complex therapy of HF with reduced LVEF does not elevate the risk of developing hypoglycemia in patients without diabetes mellitus.

Augmented Glycemic Gap is a Marker for Predicting the Early Neurological Outcomes in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Background and Purpose: Glycemic Gap (GG) as an index reflecting the acute fluctuation of glycemia, has been proved to be associated with poor functional outcomes in Acute Ischemic Stroke (AIS) patients. However, it predictive value on post-thrombolysis Early Neurological Outcomes (ENOs) are still controversial. This study aimed to use GG to evaluate the influence of pretreatment relative glucose changes on post-thrombolysis ENOs, and we further explored the predictive value of GG in different glycemic control status. Methods: Early Neurological Deterioration (END) was defined as a National Institutes of Health Stroke Scale Score (NIHSS) =4, Early Neurological Improvement (ENI) was defined as a =4-point decrease in NIHSS score or a complete resolution of neurological deficits, between the time of admission and 24 hours after intravenous recombinant tissue-type plasminogen activator (IV-rtPA). GG was calculated as Admission Blood Glucose level (ABG)- estimated average blood glucose level (eAG), eAG could be derived from HbAlc according to the equation eAG=28.7*HbAlc-46.7 Results: Increased GG was significantly associated with post-thrombolysis END and poor functional outcome at discharge (OR, 1.982; 95% CI, 1.213-3.238; P=0.006) (OR, 2.079; 95% CI, 1.305-3.312; P=0.002). Its predictive value on END was more pronounce in diabetic patients (OR, 2.434; 95% CI, 1.079-5.491; P=0.032), after dichotomizing glycemic control status, its significance was only maintained in diabetic patients with good previous glucose control (OR, 6.946; 95% CI, 1.217-39.636; P=0.029). Conclusion: An evaluated GG was associated with high risk of post-thrombolysis END and poor functional outcome at discharge in AIS patients, and the previous glucose control should be considered when predicting ENOs.

A-027 The Clinical Indications of Low or Non-reportable HbA1c Results

Abstract Background Hemoglobin A1c (HbA1c) is the major non-enzymatic glycation product of hemoglobin A (HbA) and usually measured as a percentage of total hemoglobin. It is widely used in the screening, diagnosis, and monitoring of diabetes because HbA1c correlates with the average blood glucose level over the past 8–12 weeks in patients with a normal RBC lifespan. However, many factors can cause inaccurate HbA1c measurements or invalidate this correlation. While a high HbA1c raises the concern of inadequate glycemic control, a low or non-reportable HbA1c may also indicate diverse clinical conditions or technical issues. This study analyzes the pathophysiological conditions and technical limits leading to a low or non-reportable HbA1c value and discusses the use of other lab values in HbA1c result interpretation. Methods HbA1c was measured by cation exchange HPLC (Tosoh G8, v5.24F). 37 cases with a low or non-reportable HbA1c (&amp;lt;4.0%) from January 1, 2022 to November 30, 2022 were reviewed. The relevant diagnoses, medical history, medications, and recent (±1 week from the HbA1c test) lab results (CBC, blood glucose, fructosamine, haptoglobin, LDH) were examined to identify the causes of low HbA1c values. The causes were grouped by pathological mechanisms or technical issues to calculate the frequency, and the association with other lab values was also explored. Results Low or non-reportable HbA1c cases accounted for 0.1% of total HbA1c tests (37/42 771), and about 30% (11/37) had been diagnosed with diabetes by the end of the review period. From the chart, 41% (15/37) cases had elevated blood glucose (&amp;gt;109 mg/dL), 73% (27/37) were anemic (Hb &amp;lt; 13.0 or 11.7 g/dL for male or female), and 46% (17/37) showed a high MCV (&amp;gt;96 fL). Among those cases, a minor portion was caused by method-specific technical issues (8%, 3/37) or unknown reasons (5%, 2/37). The majority (86%, 32/37) was attributed to the following mechanisms: intravascular hemolysis (51%, 19/37), hepatosplenic RBC destruction (27%, 10/37), and increased erythropoiesis (8%, 3/37). For those cases with intravascular hemolysis (51%), the causes were categorized as inherited RBC disorders (19%, 7/37, including hemoglobinopathy and G6PD deficiency), acquired hemolytic diseases (19%, 7/37, including autoimmune hemolytic anemia), and adverse effects of medications (13%, 5/37, including dapsone and hydroxychloroquine). For those cases with hepatosplenic RBC destruction (27%), most of them were caused by cirrhosis (19%, 7/37). In addition, increased erythropoiesis (8%) was observed in patients with recent hemorrhage or EPO treatment. Some hemoglobin variants like homozygous HbE resulted in non-reportable HbA1c (8%), which represented a technical limit of the HPLC method. Conclusion Although low or non-reportable HbA1c cases are rare (0.1%), a significant portion (30%) of them are diabetic patients, and their HbA1c results can be misleading. The majority of low HbA1c cases (86%) are associated with clinical conditions causing a shortened RBC lifespan, and the most common causes include inherited RBC diseases (19%), cirrhosis (19%), medication adverse effects (14%), and autoimmune diseases (11%). Because increased RBC destruction and compensatory erythropoiesis are the underlying mechanisms, hemoglobin, MCV, and markers assessing hemolytic anemia (haptoglobin, LDH, reticulocyte%) can aid in HbA1c interpretation.

A-070 A fully automated HbA1c Assay on the DxC 500 AU Clinical Chemistry Analyser

Abstract Background Diabetes mellitus is a condition characterized by hyperglycemia resulting from the body’s inability to use blood glucose for energy. In Type-1 diabetes, the pancreas no longer makes insulin and blood glucose cannot enter the cells to be used for energy. In Type-2 diabetes, the pancreas does not make enough insulin or the body is unable to use insulin correctly. According to the World Health Organization (WHO), 422 million adults were living with diabetes globally in 2014 with an estimated 1.6 million deaths directly associated with diabetes annually. HbA1c is the major species of glycohemoglobin in human blood. HbA1c formation occurs through a non-enzymatic reaction, called glycation, which occurs between glucose and the n-terminal valine of the hemoglobin â-chain of HbA. A Schiff base intermediate product is formed, which rearranges to form a stable ketoamine in an irreversible reaction. The rate of glycation is proportional to the glucose concentration in the bloodstream and is an accurate reflection of average blood glucose over a period of eight to twelve weeks. HbA1c testing is recommended for the diagnosis of diabetes by the International Expert Committee (IEC), the American Diabetes Association (ADA), and the WHO, who recommended a diagnostic threshold of = 6.5% ( = 48 mmoL/moL) HbA1c and a range for pre-diabetes of 5.7%–6.4% (39–46 mmoL/moL) HbA1c. Methods The HbA1c Advanced assay on the DxC 500 AU* utilizes automatic sample pre-treatment, has batch and random access capability. No manual pre-treatment of the whole blood sample or additional washing steps are required. Firstly the red blood cells are hemolyzed automatically, total hemoglobin and glycated hemoglobin are then measured colorimetrically and immunoturbidimetrically respectively. Results Precision studies were conducted according to CLSI EP15-A3. Commercial controls and four native K2 EDTA whole blood samples ranging from 5.1% to 12.0% HbA1c, were run twice daily, over twenty days using three lots of reagent on three DxC500AU Clinical Chemistry analyzers at a single site. Repeatability ranged from 0.86% to 1.44% CV and Total Precision ranged from 1.55% to 2.43% CV. Linearity studies were conducted according to CLSI EP06-A, and verified an analytical measuring range of 4.0%–15.0% (NGSP) and 20–140 mmol/mol (IFCC). Method comparison and bias estimation was evaluated using CLSI EP09-A3. K2 EDTA patient samples (n = 150) across the analytical range were run vs a Secondary Reference method and yielded a slope of 1.031, intercept −0.147% HbA1c, correlation coefficient R = 0.997 for Weighted Deming regression, and slope 1.000 and intercept 0.06% HbA1c for Passing Bablok regression. Interference studies carried out demonstrated no significant interference from common endogenous interferences, a large panel of drugs, common Hb variants (HbC, HbD, HbE, HbA2 and HbS) and cross reactants (HbA0, HbA1a+b, acetylated hemoglobin, carbamylated hemoglobin, glycated hemoglobin, glycated albumin and labile HbA1c). Conclusion The HbA1c Advanced assay on the DxC 500 AU is a precise and accurate assay, requiring no manual pretreatment and can be used for monitoring and diagnosing diabetes. *Pending clearance by the United States Food and Drug Administration and achievement of CE compliance. Not currently available for in vitro diagnostic use.

Lifetide biofeedback intervention in type 2 diabetic patients: a pilot observation

To evaluate the therapeutic efficacy of lifetide biofeedback intervention in patients with type 2 diabetes mellitus (T2DM). We analyzed the changes in average blood glucose, estimated glycosylated hemoglobin (HbA1c), fasting blood glucose and HbA1c levels in 5 patients with T2DM undergoing lifetide biofeedback intervention without the use of hypoglycemic drugs. A transient blood glucose monitoring system was used for drug withdrawal management during the intervention. Compared with those before the intervention, the average blood glucose and fasting blood glucose and HbA1c levels showed no significant changes after the intervention without using hypoglycemic drugs (P>0.05), but the estimated HbA1c was significantly decreased after the intervention (P<0.05). Two patients achieved complete remission, two showed partial remission, and one had substantially improved blood glucose levels. One patient showed a marked increase in extremity temperature after the intervention (P<0.05). Another patient had a significantly increased heart rate variability index (P<0.05) without obvious changes in heart rate after the intervention (P>0.05). By reestablishing the balance in autonomic nervous system regulation and enhancing peripheral microcirculation, lifetide biofeedback intervention helps to maintain stable blood glucose levels, achieve disease remission, and reduce the occurrence of complications in T2DM patients after discontinuation of hypoglycemic drugs without changing their lifestyles.

The effect of Cocoa Fruits (Theobroma cacao L.) extracts on serum blood glucose levels in white rats (Rattusnovergicus)

Checking blood glucose levels supports healthy lifestyle and pattern changes to avoid foods that contain high glucose, which can increase blood glucose levels. This study aims to analyze the administration of cocoa pod extract (Theobroma cacao L.) to describe serum blood glucose levels in white rats (Rattusnovergicus). This study used an RCT (randomized controlled trial) design involving five groups of cocoa pod extract samples through an evaporation process using a rotary vacuum evaporator after going through the maceration process for 3 x 24 hours divided into three concentrations of 50 mg/Kg body wt, 100 mg/Kg body wt, 150 mg/Kg body wt. Furthermore, serum blood glucose levels will be measured on the 3rd, 7th, and 14th day after administration of metformin and waste extract of cocoa pod shell (Theobroma cacao L.). Analysis of the research data used a paired t-test. The results showed that the average fasting blood glucose levels of K1 rats (Mus musculus) to the average fasting glucose levels in K2, K3, K4, and K5, respectively, were as follows: 0.037 (p &lt;0.05); 0.000 (p &lt; 0.05); 0.028 (p &lt; 0.05); and 0.015 (p &lt;0.05). This shows that the average fasting blood glucose level is significantly different (p &lt;0.05). The average fasting blood glucose levels of K2 (metformin group) to the average glucose levels in K3 (extract group 50 mg/kg body wt), K4 (extract group 100 mg/kg body wt), and K5 (extract group 150 mg/kg body wt) respectively are as follows: 0.157 (p &gt; 0.05); 1.000 (p &gt; 0.05); and 0.995 (p &gt; 0.05). This shows that the average blood glucose levels between K2, K3, K4, and K5 did not differ significantly (p &lt;0.05) after measuring cocoa pod extract for two days. Based on the results of data analysis from this experimental study, it can be concluded that there is an effect of giving cocoa pod extract (Theobroma cacao L.) on fasting blood glucose levels of mice (Mus musculus) with type 2 diabetes mellitus hypercholesterolemia model. Keywords: Diabetes mellitus; Cacao; Blood Glucose; Rats

Evaluation of Basal Plus Versus Sliding Scale Insulin Therapy on Glucose Variability in Critically Ill Patients Without Preexisting Diabetes.

There is limited evidence evaluating the impact of insulin treatment strategies on glucose variability in critically ill patients without preexisting diabetes. Compare basal plus insulin (BPI) and sliding scale insulin (SSI) impact on glycemic control outcomes in critically ill patients without preexisting diabetes experiencing hyperglycemia. This multicenter, retrospective review analyzed critically ill patients with hyperglycemia who received either BPI or SSI. Patients with a hemoglobin A1C >6.5% during the admission of interest or in the previous 3 months, or a diagnosis of diabetes at the time of discharge were excluded. The primary outcome was glucose variability during the intensive care unit (ICU) admission. Secondary outcomes included hypoglycemia frequency, frequency of goal glucose levels, mortality, and length of stay. The analysis included 228 patients (39 in BPI, 189 in SSI). Average glucose variability was higher in the BPI group compared with the SSI group (85.8 mg/dL ± 33.1 vs 70.2 mg/dL ± 30.7; P = 0.009), which remained when controlling for baseline confounding (-12.1 [5.6], 95% CI -23.2 to -0.99; P = 0.033). Hypoglycemia incidence was similar between groups. BPI patients had a lower incidence of glucose values within goal range than SSI patients (P = 0.046). There was no difference in length of stay or hospital mortality. The use of SSI compared with a BPI regimen may result in reduced glycemic variability in critically ill patients without preexisting diabetes. Future prospective studies, with a larger sample size, are warranted to confirm our exploratory findings and characterize clinically significant benefits.

Clinical evaluation of a decision support system for glucose infusion in hypoglycaemic clamp experiments.

To provide a preliminary evaluation of the accuracy and safety of Gluclas decision support system suggestions in a hypoglycaemic clamp study. This analysis was performed using data from 32 participants (four groups with different glucose-insulin regulation: post Roux-en-Y gastric bypass with and without postprandial hypoglycaemia syndrome, postsleeve gastrectomy and non-operated controls) undergoing Gluclas-assisted hypoglycaemic clamps (target: 2.5 mmol/L for 20 minutes at 150 minutes after oral glucose ingestion). Gluclas provided glucose infusion rate suggestions upon manual entry of blood glucose values (every 5 minutes), which were either followed or overruled by investigators after critical review. Accuracy and safety were evaluated by mean absolute error (MAE), mean absolute percentage error (MAPE), average glucose level, coefficient of variation (CV) and minimal glucose level during the 20-minute hypoglycaemic period. Investigators accepted 84% of suggestions, with a mean deviation of 30.33 mg/min. During the hypoglycaemic period, the MAE was 0.16 (0.12-0.24) (median [interquartile range]) mmol/L and the MAPE was 6.12% (4.80%-9.29%). CV was 4.90% (3.58%-7.27%), with 5% considered the threshold for sufficient quality. The minimal glucose level was 2.40 (2.30-2.50) mmol/L. Gluclas achieved sufficiently high accuracy with minimal safety risks in a population with differences in glucose-insulin dynamics, underscoring its applicability to various patient groups.

To Correlate our Proprietary Metabolic Score with Clinical Biomarkers of Metabolic Health: Metabolic Insights from Glucose Variability, Time in Range and Average Glucose Scores

To Correlate our Proprietary Metabolic Score with Clinical Biomarkers of Metabolic Health: Metabolic Insights from Glucose Variability, Time in Range and Average Glucose Scores

Corn stem fiber fractionation by acid hydrolysis

Fractionation was carried out by hydrolyzing corn stalk powder with 0.3 M HCl. The hydrolysis process was carried out with 3 variations of acid volume with 3 replications in each variation. This hydrolysis will be carried out at a temperature of 100 – 120°C for ± 60 minutes. The glucose level before hydrolysis was 9.7%. The average glucose levels produced after hydrolysis in each volume treatment were 8.56% at a volume of 600 ml, 8.4% at a volume of 650 ml, and 7.92% at a volume of 700 ml.

The association between obesity indicators and metabolic risk factors in type-2 diabetic patients

Rationale and objectivesObesity, accumulation of adipose tissue, is a global disease that can lead to cardiovascular and metabolic complications. The aim of this study was to investigate the relationship between obesity indicators and metabolic risk factors in type 2 diabetes mellitus (T2DM) patients. Materials and methodsA total of 337 T2DM subjects were included in our study. The metabolic risk factors including diabetes duration, fast plasma glucose (FPG), height, weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), estimated average glucose (eAG), glycated hemoglobin (HbA1c), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c), triglyceride (TG), blood urea nitrogen (BUN), serum creatinine (Scr), free fatty acid (FFA), uric acid (UA), cystatin c (cysc), albumin (Alb), urinary albumin creatinine ratio (UACR) were recorded. The obesity indicators included body surface area (BSA), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), para-perirenal fat thickness (PRFT), total abdominal fat (TAF), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT). The association between obesity indicators and metabolic risk factors was investigated by univariate and multivariate analysis. ResultsHDL-c was independently associated with WHR and PRFT (β = −0.126 vs. −0.214, both p < 0.05). TG and Scr were both independently associated with PRFT (β = 0.173 vs. 0.218, both p < 0.01, respectively). UA was independently associated with BSA (β = 0.172, p < 0.01) and PRFT (β = 0.151, p < 0.01). cysc, Alb and UACR were independently associated with WC (β = 0.274 vs. 0.204 vs. 0.182, all p < 0.01). ConclusionIn T2DM patients, obesity indicators were significantly associated with metabolic risk factors.

The effects of Mediterranean diets with low or high glycemic index on plasma glucose and insulin profiles are different in adult men and women: Data from MEDGI-Carb randomized clinical trial

Recent evidence suggests that the ability to regulate glucose and insulin homeostasis is different in men and women. Against this background, it has been hypothesized that the impact on daily plasma glucose and insulin profiles of the glycemic index (GI) of the habitual diet may differ according to sex. The aim of this study is to evaluate whether 8-h average plasma glucose and insulin profiles during a low- or a high-GI diet in individuals at high risk of developing type 2 diabetes are influenced by sex. We conducted a randomized, controlled, parallel group dietary intervention, comparing high-versus low-GI diets in a multi-national (Italy, Sweden, and the United States) sample of 156 adults at risk for type 2 diabetes. For 12 weeks, 82 vs 74 participants consumed either a low-GI or high-GI Mediterranean diet, respectively. The two experimental diets contained the same quantity of available carbohydrate (270g/d) and fiber (35g/d) and the same foods and beverages, except for the major sources of starch that was specific to the low-GI and high-GI groups (pasta, brown rice, flatbread, all bran, and wheat bread plus rye and seeds, vs jasmine rice, potato, couscous, wholegrain bread, and rusks). At baseline and after the intervention plasma glucose and insulin profiles were evaluated for 8h in the two intervention groups - separately for men and women - with both breakfast and lunch resembling food choices of the assigned diet. One hundred fifty-six adults (82 women, 74 men) with at least two traits of the metabolic syndrome completed the intervention. In women, the high-GI induced significantly higher (23%, p<0.05) 8-h average plasma glucose concentrations in comparison to the low-GI dietalready on the first day of the intervention; the difference increased up to 37% (p<0.05) after 12 weeks of diet. Conversely, there were no significant differences between the two diets in men. These results were confirmed by the two-way analysis of variance showing a statistically significant interaction between the effects of sex and diet on the glucose profile after breakfast and lunch (F=7.887, p=0.006). The results of our intervention show that women, compared to men, are more sensitive to the metabolic effects of the dietary GI. This has a strong clinical and scientific relevance and, if confirmed in further studies, it might have important implications for dietary strategies for diabetes and cardiovascular disease prevention in the context of personalized nutrition. Clinicaltrials.gov n. NCT03410719.

The sGC Activator Runcaciguat Has Kidney Protective Effects and Prevents a Decline of Kidney Function in ZSF1 Rats.

Chronic kidney disease (CKD) progression is associated with persisting oxidative stress, which impairs the NO-sGC-cGMP signaling cascade through the formation of oxidized and heme-free apo-sGC that cannot be activated by NO. Runcaciguat (BAY 1101042) is a novel, potent, and selective sGC activator that binds and activates oxidized and heme-free sGC and thereby restores NO-sGC-cGMP signaling under oxidative stress. Therefore, runcaciguat might represent a very effective treatment option for CKD/DKD. The potential kidney-protective effects of runcaciguat were investigated in ZSF1 rats as a model of CKD/DKD, characterized by hypertension, hyperglycemia, obesity, and insulin resistance. ZSF1 rats were treated daily orally for up to 12 weeks with runcaciguat (1, 3, 10 mg/kg/bid) or placebo. The study endpoints were proteinuria, kidney histopathology, plasma, urinary biomarkers of kidney damage, and gene expression profiling to gain information about relevant pathways affected by runcaciguat. Furthermore, oxidative stress was compared in the ZSF1 rat kidney with kidney samples from DKD patients. Within the duration of the 12-week treatment study, kidney function was significantly decreased in obese ZSF1 rats, indicated by a 20-fold increase in proteinuria, compared to lean ZSF1 rats. Runcaciguat dose-dependently and significantly attenuated the development of proteinuria in ZSF1 rats with reduced uPCR at the end of the study by -19%, -54%, and -70% at 1, 3, and 10 mg/kg/bid, respectively, compared to placebo treatment. Additionally, average blood glucose levels measured as HbA1C, triglycerides, and cholesterol were increased by five times, twenty times, and four times, respectively, in obese ZSF1 compared to lean rats. In obese ZSF1 rats, runcaciguat reduced HbA1c levels by -8%, -34%, and -76%, triglycerides by -42%, -55%, and -71%, and cholesterol by -16%, -17%, and -34%, at 1, 3, and 10 mg/kg/bid, respectively, compared to placebo. Concomitantly, runcaciguat also reduced kidney weights, morphological kidney damage, and urinary and plasma biomarkers of kidney damage. Beneficial effects were accompanied by changes in gene expression that indicate reduced fibrosis and inflammation and suggest improved endothelial stabilization. In summary, the sGC activator runcaciguat significantly prevented a decline in kidney function in a DKD rat model that mimics common comorbidities and conditions of oxidative stress of CKD patients. Thus, runcaciguat represents a promising treatment option for CKD patients, which is in line with recent phase 2 clinical study data, where runcaciguat showed promising efficacy in CKD patients (NCT04507061).