Baseline Fasting Blood Glucose Levels Research Articles

Glycemic indicators and mental health symptoms: results from the greater Beirut area cardiovascular cohort.

Depression and anxiety present high and complex comorbidity with diabetes. One proposed explanation is that glycemic dysregulations and diabetes-related processes can influence mental health risk. We examined the associations of concurrent and prior glycemic indicators (Hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) levels) with depression and anxiety symptoms in a community-based sample of middle-aged Lebanese adults. Data come from the Greater Beirut Area Cardiovascular Cohort (GBACC), with baseline and 5-year assessments of sociodemographic, lifestyle, and biological factors (n=198). Depression (Patient Health Questionnaire-9) and anxiety (General Anxiety Disorder-7) symptoms were assessed at follow-up. We investigated associations between glycemic indicators and continuous mental health scores using first linear and then piecewise regression models. Adjusted piecewise regression models showed different associations with mental outcomes across glycemic indicators in the diabetic/clinical compared to the non-diabetic range: Among participants with <126 mg/dl baseline FBG, higher FBG levels in this range were significantly associated with lower depressive (beta=-0.12, 95%CI= [-0.207, -0.032]) and anxiety symptoms (beta=-0.099, 95%CI= [-0.186, -0.012]). In contrast, among participants with baseline FBG levels ≥126 mg/dl, higher FBG levels were significantly associated with higher anxiety symptoms (beta=0.055; 95%CI= 0.008, 0.102). Higher baseline FBG levels in the ≥126 mg/dl range showed a not statistically significant trend for higher depressive symptoms. Although not significant, baseline HbA1c levels showed similar patterns with negative associations with mental health symptoms in the <6.5% range. Results show that FBG levels were associated with poorer mental health symptoms only in the clinical/diabetic range, and not in the normal range. Associations were observed with baseline glycemic indicators, highlighting potentially early and prolonged associations with mental health. Findings highlight the importance of clinical changes in glycemic indicators for mental health and motivate further research into the transition toward adverse associations between diabetes and mental health.

The Effect of Healthy Boba Pearl Drink on Post-Prandial Glucose

This study was a randomized controlled trial using a repeated experimental design with a pre-test and a post-test control group. The study subjects were women of childbearing age, aged 20‒30 years, with no diagnosed chronic diseases and with baseline fasting blood glucose levels less than 125 mg/dL. Participants were randomly assigned to treatment and control groups. The treatment group received 350 mL of healthy boba drink, while the control group received 350 mL of commercial boba drink. The healthy boba drink was made by mixing 67 mL of fresh milk, 133 mL of soy milk, 1 g of stevia sweetener, 100 g of red dragon fruit, and 40 g of healthy boba pearls. It contained 215 kcal of energy, 8.82 g of protein, 8.90 g of fat, 30.78 g of carbohydrate, and 1,808 g of fiber. Each group had an initial fasting blood glucose levels measurement before the intervention, and postprandial glucose levels were measured at the end of the intervention (one time of intervention). The collected data were analyzed univariately to analyze the effect of treatment on postprandial glucose using the independent t-test. The result indicated that the subjects in the treatment group and 96.2% of the subjects in the control group had fasting glucose levels less than 126 mg/dL. Both participants in the control and treatment groups had postprandial glucose levels less than 200 mg/dL. The mean glucose level was 89.49 mg/dL in the treatment group and 92.57 mg/dL in the control group. The study results showed that the treatment group that consumed the healthy boba drink had a lower average postprandial glucose level than the control group. The statistical test results showed that there was a significant effect of healthy boba drink consumption on postprandial glucose levels in the treatment group (p&lt;0.000). It is concluded that the healthy boba drink intervention had a significant effect (p&lt;0.000) on lowering blood glucose by 5.82 mg/dL after the initial treatment. The results of this study are a major first step for future work to develop a healthier boba drink.

The Impact of Genetic Polymorphisms on the Anti-Hyperglycemic Effect of Dapagliflozin.

The influence of genetic variants on the glucose-lowering effects of dapagliflozin remains unclear. This study aims to investigate the impact of polymorphisms in solute carrier family 5 member 2 (SLC5A2), uridine diphosphate glucuronosyltransferase 1A9 (UGT1A9), solute carrier family 2 member 2 (SLC2A2) and member 4 (SLC2A4) on the anti-hyperglycemic effect of dapagliflozin in patients with type-2 diabetes mellitus (T2DM). A total of 141 patients with T2DM were included in this prospective cohort study. Twenty-nine single nucleotide polymorphisms (SNPs) were selected and genotyped using the Sequenom MassArray platform or Sanger sequencing. Glycated hemoglobin (HbA1c) and fasting blood glucose (FBG) levels were compared before and after the treatment with dapagliflozin. Among the 29 SNPs selected, 27 were successfully analyzed. After three months of dapagliflozin treatment, FBG levels were significantly reduced (8.00 mmol/L (5.45-10.71) mmol/L vs 6.40 mmol/L (5.45-9.20) mmol/L, p = 0.003) in patients with T2DM. However, there was no significant change in HbA1c levels (8.10% (6.88-10.00)% vs 8.10% (6.83-10.00)%, p = 0.452). Analysis of covariance showed that patients with the minor allele homozygote or heterozygote of rs12471030 (CT/TT), rs12988520 (AC/CC) or rs2602381 (TC/CC) had higher FBG levels compared to those with the major allele homozygote (p = 0.014, p = 0.024, and p = 0.044, respectively). After adjusting for baseline FBG level, age, gender, body mass index, use of insulin and use of metformin, three SNPs-rs12471030, rs12988520 and rs2602381-were associated with the anti-hyperglycemic effect of dapagliflozin. However, using a stringent significance threshold (p < 0.002 with Bonferroni correction), none of these selected SNPs were significantly associated with FBG and HbA1c levels after dapagliflozin treatment. After adjusting for confounding variables, polymorphisms in SLC5A2, UGT1A9, SLC2A2 and SLC2A4 genes were not associated with the anti-hyperglycemic effect of dapagliflozin in the Chinese population. ChiCTR2200059645.

Evaluation of insulin resistance in rheumatoid arthritis in Eastern India

Background: Increase in insulin resistance predisposes to cardiovascular disease. Studies from various parts of world show increase prevalence of IR in rheumatoid arthritis (RA) but there is little data from India. Aims and Objectives: To evaluate the prevalence of IR in RA and after 6 months of treatment with disease-modifying antirheumatic drugs. Materials and Methods: This hospital-based longitudinal observational study was done between July 2018 and June 2019 in the Division of Rheumatology, Department of General Medicine, S.S. Hospital, BHU, in treatment-naive RA patients with age ≥18 years. Exclusion criteria were known diabetes, preexisting dyslipidemias, or any other chronic illness. Detailed history and examination were done. Fasting glucose and fasting insulin were done to calculate the homeostatic model for assessment of IR (HOMA IR). Results: The most common age group in our study was 31–40 years (38%). The mean age of onset of disease was 39.5 years. Female-to-male ratio was 5.25:1. The mean duration of illness was 3 years with baseline mean disease activity score (DAS) 28 score 6.2698 ± 1.07437. Baseline mean cholesterol level, triglyceride, high-density lipoprotein, low-density lipoprotein, and very low-density lipoprotein were 169.40 ± 33.802 mg/dL, 164.42 ± 91.585 mg/dL, 47.66 ± 11.825 mg/dL, 99.88 ± 27.059 mg/dL, and 34.42 ± 19.186 mg/dL, respectively. Baseline fasting blood glucose levels, fasting insulin levels, and HOMA IR were 99.40 ± 20.761 mg/dL, 11.84770 ± 4.351550 m IU/L,and 2.905 ± 1.2272, respectively. After treatment of 6 months, lipid profile, fasting insulin, and HOMA IR improved significantly. However, there was no significant correlation found between IR and disease activity before and after treatment. Conclusion: The patients of RA are at higher risk of IR and dyslipidemia and early diagnosis with the initiation of treatment for RA can reverse the IR in RA patients.

Comparative effects of rosuvastatin and atorvastatin on the risk of new-onset diabetes mellitus in patients with acute coronary syndrome receiving percutaneous coronary intervention: a retrospective cohort study

Abstract Background Statins are frequently prescribed to reduce cardiovascular morbidity and mortality by lowering low-density lipoprotein cholesterol levels. However, the use of statins leads to an increased incidence of new-onset type 2 diabetes mellitus (NODM). Our study aims to compare the effect of rosuvastatin versus atorvastatin on NODM in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) within 18 months of follow-up. Methods A retrospective cohort study was conducted on patients with ACS who underwent PCI and were treated with rosuvastatin or atorvastatin between June 2012 and June 2017. The survival functions between the 2 groups were estimated using the Kaplan-Meier method and compared using the log-rank test with NODM as the endpoint. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk factors of NODM. Results In total, 220 patients received rosuvastatin and 168 atorvastatin. The cumulative incidence of NODM in the rosuvastatin group was lower but did not reach statistical significance, compared with that in the atorvastatin group (7.27% vs. 12.50%, respectively; log-rank P = 0.08). Using Cox proportional hazards models, baseline fasting blood glucose level was associated with a statistically significant increase in the risk of NODM (HR: 4.56; 95% CI: 2.83–7.36; P &lt; 0.01). Conclusion Long-term use of moderate rosuvastatin had a similar incidence of NODM compared with atorvastatin in patients with ACS receiving PCI.

A Comparison of the Blood Glucose, Growth Hormone, and Cortisol Responses to Two Doses of Insulin (0.15 U/kg vs. 0.10 U/kg) in the Insulin Tolerance Test: A Single-Centre Audit of 174 Cases.

Objective The insulin tolerance test (ITT) is the gold standard endocrine test used to assess the integrity of the growth hormone (GH) and cortisol axes. The ITT has potential risks, and severe hypoglycaemia may necessitate intravenous glucose rescue. There is no clear consensus as to the optimal insulin dose for the ITT. Therefore, we sought to compare the standard dose (0.15 U/kg) and a low-dose ITT (0.1 U/kg). Design Single-centre audit of ITT data (2012–2021). Patients and Measurements. Patients who underwent an ITT to assess possible GH deficiency/adrenal insufficiency were included. Glucose, GH, and cortisol were measured at baseline and 30, 45, 60, 90, and 120 minutes following I.V. insulin bolus (0.15 U/kg or 0.10 U/kg). Results Of the ITTs performed, only 3/177 (1.7%) did not achieve adequate hypoglycaemia (≤2.2 mmol/L) with a single insulin dose. In total, 174 patients (43.5 ± 12.1 yrs, mean ± standard deviation) were included for analysis (0.15 U/kg: n = 113, 0.10 U/kg: n = 61). All 174 subjects had adequate hypoglycaemia regardless of baseline fasting blood glucose level or insulin dose. Neither nadir glucose nor glucose delta (i.e., baseline minus nadir) differed between insulin doses. Trends in both cortisol and GH responses over time were similar between groups, and a greater proportion of patients receiving the standard dose had an adequate cortisol response (77/106 (72.6%) vs. 32/60 (53.3%), p=0.01). The rates of glucose rescue did not differ in a subset of 79 patients, with on-demand glucose rescue in 4/35 (11%) for the standard dose and 2/44 (5%) for the low dose (p=0.25). Conclusions Our results suggest that the low-dose ITT produces comparable glucose, cortisol, and GH responses to the higher dose. Given the risks associated with hypoglycaemia, the low dose appears to be preferable to the standard dose ITT in most circumstances.

A J-Shaped Curve Relationship Between Baseline Fasting Blood Glucose and 1-Year Stroke Recurrence in Non-diabetic Patients With Acute Cerebral Infarction in Xi'an, China: A Multicenter Observational Cohort Study.

BackgroundThe relationship between baseline fasting blood glucose (FBG) levels and 1-year stroke recurrence in non-diabetic patients with acute cerebral infarction (ACI) is unclear. We aimed to clarify this relationship in non-diabetic patients with ACI.MethodsBaseline FBG levels and related information of the patients were collected at admission and the events of stroke recurrence were followed up 1, 3, 6, and 12 months after the patients were discharged. Baseline FBG levels were analyzed as continuous variables and quartiles (Q1–Q4). Multivariate Cox regression models and a two-piecewise linear regression model were used to investigate the relationship and determine the threshold effect between baseline FBG levels and 1-year stroke recurrence in non-diabetic patients with ACI.ResultsOverall, 1,634 non-diabetic patients with ACI were enrolled. After adjusting for potential confounding factors, the hazard is 2.24-fold higher in Q4 than those in Q2, being considered the reference in non-diabetic patients with ACI [hazard ratio (HR) = 2.24, 95%CI: 1.08–4.65, P = 0.031]. Plotting hazard ratios over baseline FBG levels suggested a J-shaped relationship for 1-year stroke recurrence. Further analysis revealed that the nadir value of baseline FBG levels is 4.6 mmol/L. The relationship was more significant in patients with atrial fibrillation than in those without (P for interaction = 0.009).ConclusionLower and higher baseline FBG levels may lead to an increased risk of 1-year stroke recurrence in non-diabetic patients with ACI as shown by a J-shaped curve with a nadir value of 4.6 mmol/L.

Effect of fasting blood glucose on risk of new\u2010onset hypertension in rural Chinese population: a 15-year follow-up cohort

BackgroundThe purpose of this study was to examine the correlation between fasting blood glucose and new-onset hypertension and examine any synergistically effect modification with multiple risk factors.MethodsWe conducted post-hoc analyses of repeated-measures data in the original Dongzhi osteoporosis cohort study. In total, 3985 participants without hypertension aged 25–64 years were included in the current analyses. Generalized estimating equation models were used to assess the relationship between fasting blood glucose and risk of new-onset hypertension after adjusting for pertinent covariates and autocorrelations among siblings.Results393 men (19.4%) and 398 women (20.3%) without hypertension at the baseline developed hypertension by the end of the study period. Compared to lower baseline fasting blood glucose levels (Q1–Q3: < 5.74 mmol/L; clinical cut points: < 5.6 mmol/L), higher baseline fasting blood glucose levels (Q4: ≥ 5.74 mmol/L; clinical cut points: ≥ 5.6 mmol/L and < 7.0 mmol/L) increased the risk of new-onset hypertension significantly [(OR: 1.54, 95% CI 1.19–1.98, P < 0.001); (OR: 1.38, 95% CI 1.09–1.75, P = 0.008)] in women. Additionally, a stronger significant association was found in women with elevated fasting blood glucose on risk of new-onset of hypertension with higher total cholesterol (≥ 5.2 mmol/L) [(OR: 2.76; 95% CI: (1.54, 4.96), P < 0.001)]. However, no association was found between fasting blood glucose and risk of new-onset hypertension in men.ConclusionsHigh fasting blood glucose may be significantly associated with risk of new-onset hypertension in Chinese women, especially in women with higher total cholesterol. Further randomized studies are needed to confirm our findings.

Effects of Fasting Blood Glucose on the Progression of Arterial Stiffness in Nondiabetic Population

Abstract Background To investigate the relationship between baseline fasting blood glucose levels and the progression of arterial stiffness in nondiabetic population. Methods In this research, the individuals participated in the Kailuan research cohort and completed 2 tests of brachial–ankle pulse wave velocity (baPWV) from 2010 to 2018 and were not diabetic at the first baPWV testing were included. A multiple linear regression was applied to analyze the impact of baseline fasting blood glucose levels on baPWV and its progress during the follow-up. Results A total of 16,875 with 10,453 male (61.94%) subjects met the inclusion criteria. The average age at baseline (the first baPWV measurement) was (45.9 ± 13.0) years old and the average baPWV was (1,439.0 ± 309.3) cm/s. During the follow-up (the second baPWV measurement), the average age was (49.6 ± 13.3) years old, and the average baPWV was (1,494.6 ± 334.3) cm/s. The baPWV progression in the observed subjects was (55.7 ± 233.4) cm/s. After adjusted for other confounding factors, multiple linear regression analysis found that there was a positive correlation between the baseline fasting blood glucose levels and the follow-up baPWV. With every 1 mmol/l baseline fasting blood glucose increase, the follow-up baPWV increased 16.89 cm/s. With every 1 mmol/l fasting blood glucose level increase, the progress of baPWV increased by 3.70 cm/s. Conclusions Fasting blood glucose levels in nondiabetics affect arterial stiffness during follow-up. Elevated fasting blood glucose levels during the follow-up period are a risk factor that may increase the progression of arterial stiffness.

Predictors of blood glucose change and vascular complication of type 2 diabetes mellitus patients in Felege Hiwot Referral Hospital, North West Ethiopia

Vascular complication results in serious physical damages which may lead to the death of Type 2 diabetes mellitus patients. Studying the determinant factors of changes in blood glucose level and duration of time to the development of vascular complications helps to save the lives of citizens. A retrospective cohort study was conducted among type 2 diabetes mellitus (T2DM) patients enrolled between December 2011 and December 2012 at Felege Hiwot Referral Hospital. A total of 159 T2DM patients were included in the study. Joint modelling of longitudinal and survival analysis was employed to identify predictors of Blood Glucose Change and Vascular Complication of Type 2 Diabetes Mellitus Patients. The prevalence of vascular complication in Type 2 diabetes patients was 23.3%. Half of these patients developed an avascular complication after 24 months from the onset of the follow-up. The significant predictors of shorter time to development of vascular complication were positive proteinuria (adjusted hazard ratio (AHR) = 1.62, CI: 1.08–2.41), increase in the level of serum creatinine (AHR = 4.12, CI: 1.94–8.74), cholesterol ≥ 200 mg/dl (AHR = 1.54, CI: 1.01–2.35), and log (fasting blood glucose) (AHR = 1.453, CI: 1.004–2.104). The predictors of progression of fasting blood glucose were duration of treatment (CL: − 0.015, − 0.0001), hypertension (CL: 0.018, 0.098), baseline fasting blood glucose level 126–139 and 140-199 mg/dl (CI: − 0.40, − 0.31) and (CI: − 0.24, − 0.17), respectively. Male T2DM patients, patients with more visits to the hospital and patients who required one oral agent had a relatively lower progression of blood sugar level. Type 2 diabetes mellitus patients having higher cholesterol level, positive proteinuria, higher fasting blood sugar and a lesser number of hospital visits had a higher risk of developing a complication.

Evaluation of the effects of intraarticular glucocorticoid injections on blood glucose levels in diabetes mellitus and nondiabetes mellitus patients with adhesive capsulitis of the shoulder.

The aim of this study was to assess the effect of intraarticular glucocorticoid injections on blood glucose levels in diabetes mellitus (DM) and non-DM patients with adhesive capsulitis of the shoulder and investigate the risk factors for hyperglycemia. The study included 40 DM and 38 non-DM patients. The DM status, HbA1c levels, baseline fasting blood glucose (FBG) level, and post-injection 1-, 7-, 15-, and 21-day FBG levels were evaluated retrospectively. The FBG levels were significantly higher 1 and 7 day after the glucocorticoid injection as compared with the baseline levels (P = 0.001 and <0.001, respectively). The increase was greatest in DM patients and then returned to baseline levels 15-day post-injection. In terms of the mean difference in post-injection and baseline FBG levels, the increase on day 1 was statistically significantly greater in the DM group as compared with that in the non-DM group (P = 0.01). Linear regression model showed that only the baseline FBG level predicted the glucose level 1-day post-treatment (β = 0.839, P < 0.01). Intraarticular glucocorticoid injections can safely be administered as a treatment for adhesive capsulitis of the shoulder in patients with well-controlled DM. Baseline FBG levels may predict peak blood glucose levels in patients with well-controlled DM. We recommend that DM patients with adhesive capsulitis should undergo frequent monitoring of blood glucose in the 2 week following intraarticular glucocorticoid injection treatment.

Effect of treatment with direct antiviral agents (DAAs) on glycemic control in patients with type 2 diabetes mellitus & hepatitis C virus genotype 4

Background and aimsIt is widely recognized that chronic hepatitis C is a metabolic disease that is strongly associated with type 2 diabetes mellitus (T2DM) and insulin resistance (IR). The evidence behind the effect of Direct Anti-Viral Agents (DAAs) therapy on T2DM is conflicting. The aim of the present study was to evaluate the effect of treatment with DAAs on glycemic control in patients with type-2 diabetes mellitus and chronic hepatitis C virus genotype 4. MethodsThis study was a prospective study that conducted on 100 patients with chronic hepatitis C and Type-2 diabetes mellitus, selected from Kafr El-Sheikh Liver Research Center treated with Direct Anti-Viral Agents (DAAs) during the period from September 1, 2017 to last of August 2018. All patients in the study were subjected to the following: Full history taking stressing on the age, gender, previous treatment; clinical examination and laboratory investigations. HBA1C was assessed before and after DAAs treatment. ResultsIn the present study, there was a significant decrease of baseline fasting blood glucose levels after treatment when compared with before treatment. Also, there was a significant decrease of 2 h post prandial blood glucose after treatment when compared with before treatment. There was significant decrease of HBA1c levels after treatment when compared with before treatment. ConclusionsDAAs treatment significantly improved the fasting blood glucose and help better glycemic control. This study augments the importance and the benefits of new Direct Anti-Viral Agents interferon free regimens in diabetic HCV infected patients.

Sitagliptin Add-on to Metformin Therapy: The Efficacy of Dual Therapy on Glycemic Control in Type 2 Diabetes

Objectives: Sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, is an effective and well tolerated incretin-based therapy when used in addition to metformin therapy. We aimed to evaluate the 52-week results of adding sitagliptin to metformin monotherapy on HbA1c, fasting blood glucose (FBG) and body weight (BW). Materials and Methods: The study included 44 patients who were treated with sitagliptin and continued to sitagliptin for 12 months while receiving metformin monotherapy. Age, sex, weight, body mass index,FBG, HbA1c, urea, creatinine, total cholesterol, triglyceride, LDL, HDL, alanine aminotransferase and aspartate aminotrensferase parameters were evaluated. Results: The mean age of the 44 patients included in the study was 58.5 ± 8.9 years. Initially, BWand BMI were80.36 ± 11.72 kg and 31.14 ± 5.16 kg / m 2 ; respectively. The initial HbA1c level was 7.5 ± 0.64%. The rates of HbA1cdecline according to the initial level were 0.82%, 0.86% and 0.9% at 3th, 6th and 12th months; respectively. There were statistically significant results when the baseline HbA1c level was compared to 3th, 6th and 12th months’ HbA1c levels. FBG level decreased 23.65 mg /dl, 26.07 mg / dl and 23.55 mg / dl at 3th, 6th and 12th months; respectively. There were also statistically significant results when the baseline FBG level was compared to 3th, 6th and 12th months’ FBG levels. It was observed that the decline in the FBG continued steadily during 12 months. Conclusion: Addition of sitagliptin to treatment is an effective and well tolerated option in patients with type 2 diabetes who are not able to achieve adequate glycemic control despite metformin monotherapy (especially HbA1c level 7-8%).

A retrospective study on the impact of statins on blood glucose levels in Lebanese controlled type two diabetic patients

Objective: The American Food and Drug Administration have warned about a possible association between statins and the development of new-onset diabetes. Lebanese studies lack sufficient data about this correlation. This study was conducted to evaluate the clinical implication of statins on blood glucose levels among diabetic Lebanese hospitalized patients. Methods: A four-month retrospective observational study was conducted from February till May 2017. It included 131 type II diabetic patients stabilized on statins for a minimum of one year. In addition to statin type, strength, and duration, fasting blood glucose (FBG), glycosylated hemoglobin (Hba1c), body mass index (BMI), and lipid profiles were recorded. Results: The mean baseline FBG levels before the initiation of statins and post-statin intake were 115.25 mg/dL and 175.81 mg/dL for atorvastatin 10mg, 110.63 mg/dL and 183.16 mg/dL for atorvastatin 20mg, 119.25 mg/dL and 189.11mg/dl for atorvastatin 40mg, 123.21mg/dL and 202.05mg/dL for rosuvastatin 10mg, 114.53 mg/dL and 169.50 mg/dL for rosuvastatin 20mg, and 118.56 mg/dL and 174.64mg/dL for simvastatin 20mg. The association between statins at different doses and mean FBG levels was statistically significant (p<0.05). The mean baseline glycosylated hemoglobin before statin prescription was 5.63% and significantly increased to 7.5% three months after statin intake (p-value of 0.03). Conclusion: In view of the evidence, it is difficult to refute that an association exists between statin use and elevated blood glucose levels. Patients on statins should carefully monitor their glucose levels to assess the risk and benefit of statin use.

New-Onset Diabetes Mellitus in Patients with Idiopathic Membranous Nephropathy Undergoing Tacrolimus and Low-Dose Corticosteroid Therapy

Background: Idiopathic membranous nephropathy (IMN) is the most common cause of nephrotic syndrome in adults. Although various studies have demonstrated the efficacy of tacrolimus combined with corticosteroids for treating IMN, both tacrolimus and corticosteroids have been shown to be diabetogenic, particularly following organ transplantation. Furthermore, the frequency and risk factors for new-onset diabetes mellitus (NODM) in IMN patients treated with tacrolimus plus low-dose corticosteroids remain unclear. Objectives: To evaluate the incidence of NODM in IMN patients undergoing tacrolimus plus low-dose corticosteroid therapy and to confirm the risk factors for NODM development. Methods: This retrospective study recruited 72 eligible patients with biopsy-proven IMN from our center, between September 2013 and June 2018. All subjects were treated with tacrolimus plus low-dose corticosteroids for a minimum of 3 months. The primary outcome was NODM development during the follow-up period. The secondary outcome was complete or partial remission. Patients were divided into 2 groups: patients with NODM (NODM group) and those without NODM (No-NODM group). Demographic and clinical data at baseline and follow-up were assessed. Results: During follow-up, 31 of the 72 patients developed NODM (43.0%). The median time to occurrence was 3 months after treatment initiation. NODM patients were significantly older (median age 59 vs. 40 years) than No-NODM patients. Baseline fasting blood glucose levels were slightly higher in the NODM group; however, the difference was not significant (p = 0.07). Older age was an independent risk factor for NODM (OR 1.73 and 95% CI 1.20–2.47, p = 0.003). Overall kidney remission rates were 80.6%. There was no significant difference in remission rate between groups. There was a significant difference in development of pulmonary infection, which occurred in 7 NODM patients and only in 1 No-NODM patient (p = 0.018). IMN reoccurred in 5 NODM patients but only 1 No-NODM patient. Conclusions: Tacrolimus plus low-dose corticosteroid therapy was an efficient treatment for IMN; however, it was accompanied by increased NODM morbidity, which should be considered serious, due to the increased risk of life-threatening complications. Increasing age was a major risk factor for NODM in IMN patients treated with tacrolimus plus low-dose corticosteroid therapy.

Sociodemographic and clinical correlates of key outcomes from a Mobile Insulin Titration Intervention (MITI) for medically underserved patients

BackgroundInsulin titration is typically done face-to-face with a clinician; however, this can be a burden for patients due to logistical issues associated with in-person clinical care. The Mobile Insulin Titration Intervention (MITI) used basic cell phone technology including text messages and phone calls to help patients with diabetes find their optimal basal insulin dose (OID). ObjectiveTo evaluate sociodemographic and clinical correlates of reaching OID, text message response rate, and days needed to reach OID. MethodsPrimary care providers referred patients to MITI and nurses delivered the program. Three multivariable regression models quantified relationships between various correlates and primary outcomes. ResultsThe sample included 113 patients from 2 ambulatory clinics, with a mean age of 50 years (SD = 10), 45% female, 79% Hispanic, 43% unemployed, and 46% uninsured. In regression models, baseline fasting blood glucose (FBG) was negatively associated with odds of reaching OID and 100% text responses, and positively associated with days to reach OID, p < .05). ConclusionsPatients with higher baseline FBG levels were less successful across outcomes and may need additional supports in future mHealth diabetes programs. Practical ImplicationsBasic cell phone technology can be used to adjust patients’ insulin remotely, thereby reducing logistical barriers to care.

Hemoglobin glycation index predicts cardiovascular disease in people with type 2 diabetes mellitus: A 10-year longitudinal cohort study

Background and aimsPrevious studies have suggested that the hemoglobin glycation index (HGI) can be used as a predictor of diabetes-related complications. We examined the prognostic significance of a high HGI for cardiovascular disease (CVD) in an ongoing hospital-based cohort. MethodsFrom March 2003 to December 2004, 1302 consecutive patients with type 2 diabetes and without a prior history of CVD were enrolled. CVD was defined as the occurrence of coronary artery disease or ischemic stroke. The HGI was calculated as the measured glycated hemoglobin (HbA1c) minus predicted HbA1c. Predicted HbA1c were calculated for 1302 participants by inserting fasting blood glucose (FBG) into the equation, Predicted HbA1c level = 0.02106 × FBG [mg/dL] + 4.973. Cox proportional hazards models were used to identify the associations between the HGI and CVD after adjusting for confounding variables. ResultsDuring 11.1 years of follow-up, 225 participants (17.2%) were newly diagnosed with CVD. The baseline HGI was significantly higher in subjects with incident CVD than in those without CVD, although the baseline FBG levels did not differ according to the occurrence of CVD. Compared with patients without CVD, those with CVD were older, had a longer duration of diabetes and hypertension, and used more insulin at baseline. A Cox hazard regression analysis revealed that the development of CVD was significantly associated with baseline HGI (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.31–2.87; p < 0.001, comparing the highest and lowest quartiles of HGI). This relationship was unchanged after additional adjustment for baseline HbA1c level (HR, 1.74; 95% CI, 1.08–2.81). The HRs of HbA1c in relation to outcomes were similar to or lower than those seen for HGI. After adjustment for HGI, the effect of the highest HbA1c on incident CVD disappeared. ConclusionsHigh HGI was independently associated with incident CVD in patients with type 2 diabetes. Patients with high HGI at baseline had a higher inherent risk for CVD.

Association of mean platelet volume with incident type 2 diabetes mellitus risk: the Dongfeng\u2013Tongji cohort study

BackgroundMost of prior studies to demonstrate the association between mean platelet volume (MPV) and type 2 diabetes mellitus (T2DM) risk were cross-sectional design with inconsistent results. In the present prospective cohort study, we aimed to explore the relationship between MPV and incident T2DM risk among a middle-aged and older Chinese population.MethodsThis prospective study included 14,009 individuals derived from the Dongfeng–Tongji cohort which was launched in 2008. A total of 997 incident T2DM patients were diagnosed during the mean 4.51 years of follow-up period. MPV levels were divided into quartiles. The adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) of incident T2DM was estimated by Cox proportional hazard models.ResultsCompared with study participants with MPV < 7.49 fL, the HRs of T2DM incidence were 1.39 (95% CI 1.11–1.75), 1.14 (0.90–1.44), and 1.39 (95% CI 1.07–1.81) in study participants with 7.49 ≤ MPV < 8.43 fL, 8.43 fL ≤ MPV < 9.69 fL and MPV ≥ 9.69 fL, respectively. This positive association was more pronounced after exclusion of the newly diagnosed incident cases during the first 2 years follow-up. Further adjustment for baseline fasting blood glucose level (FBG) did not materially alter the positive association. The positive association was particularly evident among females, non-current smokers and study participants with FBG level less than 5.6 mmol/L at baseline.ConclusionHigher levels of MPV were independently associated with increased incident risk of T2DM in a middle-aged and older Chinese population.

Improvements in Diabetic Patients’ Outcomes in a Clinical Decision Support System

Background: There is considerable interest worldwide in prevention and control of diabetes using health information technology systems. Although previous studies have acknowledged improvements of blood pressure control in a clinical decision support system (CDSS), little is known about whether it could contribute to diabetic patients‘ outcomes. Objectives: To compare diabetic patients‘ outcomes six months before and after the introduction of a CDSS. Methods: We considered patients with diabetes in a general hospital and ten clinics that embedded a CDSS within an electronic health record in April 2011, and tracked their medical records from October 2010 to March 2012 (split at April 2011; pre- and post-period). The CDSS mainly had two main functions: (1) to visually highlight abnormal laboratory values on longitudinal inspection data; and (2) to provide a list of patients with severe diabetes. Primary outcome measures included glycated hemoglobin (HbA1c), fasting blood glucose, low-density lipoprotein cholesterol (LDL-C), and glomerular filtration rate (eGFR). The values were averaged for each patient and compared between preand post-period using the Wilcoxon signed-rank test. Results: A total number of 3,678 blood test results from 705 patients were analyzed. The mean HbA1c levels (and standard deviation) among severe cases (baseline HbA1c ≥ 8.4%) were significantly improved over the study period, from 9.49 ± 1.13% to 8.73 ± 1.23% (p < 0.001). In contrast, the moderate group (baseline HbA1c < 8.4%) deteriorated, from 7.61 ± 0.40% to 7.70 ± 0.65%. In terms of fasting blood glucose levels, the severe group (baseline fasting blood glucose level ≥ 160 mg/dl) improved significantly (p < 0.001). On the contrary, the moderate group (baseline fasting blood glucose level < 160 mg/dl) deteriorated significantly (p < 0.001). The patients’ outcomes were improved with the CDSS. Conclusion: Improvements of patients‘ outcomes were observed, indicating the potential effectiveness of the CDSS. Visually emphasizing abnormal laboratory values and displaying severe patients may be effective for disease control of diabetes patients.

Association between Helicobacter pylori infection and risk of new-onset diabetes: a community-based, prospective cohort study

BackgroundHelicobacter pylori infection affects about 50% of the population worldwide. Results from previous studies, most of which were cross-sectional, on the association between H pylori infection and diabetes were inconsistent. We aimed to examine the association between H pylori infection and the risk of new-onset diabetes. MethodsIn this prospective cohort study, we recruited participants aged 45–74 years without diabetes from the Chinese Multi-provincial Cohort Study—Beijing Project, a community-based cohort study. H pylori serostatus (with seropositivity defined as anti-H pylori antibodies ≥10 U/mL, measured by latex-enhanced turbidimetric immunoassay), and diabetes status (with diabetes identified by self-report, fasting blood glucose concentration ≥7 mmol/L, or self-reported use of glucose-lowering drugs) were recorded at baseline, in 2007, and in 2012. We used multivariable logistic regression models to estimate the independent association between H pylori infection and diabetes risk. Ethics approval was granted by the ethics committee of Beijing An Zhen Hospital, Capital Medical University, and all participants provided written informed consent. FindingsOf 1671 participants (686 [41%] men; mean age 56·6 years [SD 7·8]), 966 (58%) were positive for H pylori infection at baseline. Between 2002 and 2012, 206 (12%) incident diabetes cases were recorded. After adjustment for other well known or potential risk factors of diabetes (including age, BMI, HDL, triglyceride, lipid-lowering therapy, smoking, hypertension, C-reactive protein, baseline fasting blood glucose level, and education level), H pylori infection was associated with a reduced risk of new-onset diabetes at 10 years (odds ratio 0·70, 95% CI 0·50–0·99) and at 5 years (0·82, 0·53–1·26 in 2002–07; 0·51, 0·30–0·87 in 2007–12). When participants with high fasting blood glucose (≥6·1 mmol/L) at baseline were excluded, H pylori infection was still associated with a reduced risk of new-onset diabetes (0·73, 0·51–1·03 in 2002–12; 0·83, 0·52–1·31 in 2002–07, 0·45, 0·22–0·93 in 2007–12). Of 1408 participants with anti-H pylori antibody measurements in both 2002 and 2007, 746 (53%) were persistently seropositive. Compared with participants who were persistently seronegative, those who were persistently seropositive had lower risk of new-onset diabetes at 5 years (0·50, 0·29–0·86). Of 725 participants who had anti-H pylori antibody measurements at all three timepoints (2002, 2007, and 2012), those who were persistently seropositive had a reduced risk of diabetes (0·70, 0·41–1·21). InterpretationH pylori infection is associated with a lower risk of new-onset diabetes in Chinese adults aged 45–74 years. The extrapolation of these results and the underlying mechanism for observed association need further investigation. FundingParticipants recruitment and data collection were supported by Beijing Municipal Science & Technology Commission (953850700), the National Science & Technology Pillar Program during the Eleventh Five-Year Plan Period (2006BAI01A01 and 2006BAI01A02), and the National Science & Technology Pillar Program during the Twelfth Five-Year Plan Period (2011BAI09B01). Study design, data analysis and interpretation, and other pertinent aspects of the study were funded by the National Natural Science Foundation of China (81170266, 81070226, and 81570409).