Blood Glucose In Group Research Articles

Evaluating Hospital Revisit Risk in Patients Discharged from the Emergency Department with Blood Glucose of 300 mg/dL (16.7 mmol/L) or Greater

Background: In the emergency department (ED), hyperglycemia may be overlooked due to non-diabetes mellitus (DM) primary diagnoses. We compared the risk of all-cause hospital revisits within 30 days after ED discharge in DM patients with normal blood glucose (BG), moderate hyperglycemia, and severe hyperglycemia. Methods: This was a retrospective cohort study of patients 18 years and older discharged from a tertiary care ED between 1 January and 31 March 2018. The severe hyperglycemia group had BG levels of 300 mg/dL (16.7 mmol/L) or greater. The moderate hyperglycemia group had a history of DM, all BG levels less than 300 mg/dL (16.7 mmol/L), and at least one BG level of 180 mg/dL (10 mmol/L) or greater. The normal BG group had a history of DM and BG less than 180 mg/dL (10 mmol/L). Results: Of 302 patients who met criteria, 118 had severe hyperglycemia, 67 had moderate hyperglycemia, and 117 had normal BG. No significant difference between the severe hyperglycemia, moderate hyperglycemia, and normal BG groups was found in 30-day all-cause hospital revisits (19.5% vs. 10.4% vs. 15.4%, respectively, p = 0.25). Patients with a past medical history (PMH) of atherosclerotic cardiovascular disease (ASCVD) or any ED visit in the year preceding the index visit each had an increased risk of a hospital revisit within 30 days (p = 0.025) after covariate adjustment; the adjusted risk of a 30-day hospital revisit among those with a PMH of ASCVD was 2.68 times greater than the risk among those without a history of ASCVD (95% CI: 1.59 to 4.53), and the adjusted RR of a 30-day revisit among those who had an ED visit in the prior year was 1.92 times greater than those without an ED visit in the prior year (95% CI: 1.10 to 3.35). Conclusions: The results suggest no significant association between hyperglycemia in the ED and 30-day hospital revisits. In any patient with DM with a history of ASCVD or any ED visit in the previous year, there may be an increased risk of revisits.

Abstract 4120918: Prevalence Of Prediabetes According To Sleep Apnea Status

Aim: The association between obstructive sleep apnea and prediabetes using STOP-Bang questionnaire is unknown. We aimed to investigate prevalence of prediabetes among people according to sleep apnea status. Methods: This cross-sectional study included 10131 Korean adults without diabetes with information of STOP-Bang score were identified from the dataset of the Korea National Health and Nutrition Examination Survey 2019-2021. Prediabetes was categorized into three subsets: fasting blood glucose only (fasting blood glucose 100-125 mg/dL, HbA1c <5.7%), HbA1c only group (fasting blood glucose <100mg/dL, HbA1c 5.7-6.4%) and both fasting blood glucose and HbA1c group (fasting blood glucose 100-125mg/dL, HbA1c 5.7-6.4%). We used multivariable logistic regression to see the odds ratio and 95% confidence intervals for prediabetes. Results: There were 3828 subjects who reported STOP-Bang score of ≥3, which shows increased risk of OSA. Multivariable-adjusted odds ratio (95% confidence interval) for prediabetes meeting both fasting blood glucose and HbA1c comparing STOP-Bang score of ≥3 with <3 was 1.06 (1.01-1.12). In further evaluation of separate gender groups, statistically significant results were seen in women. The multivariable adjusted result correlated with that of the total population. (odds ratio 1.20, 95% confidence interval 1.10-1.30) This was more prominently seen in postmenopausal women. (odds ratio 1.21, 95% confidence interval 1.11-1.32) Conclusion: In Korean general population, the odds of the risk of obstructive sleep apnea was significant in prediabetes group meeting both fasting blood glucose and HbA1c, especially in postmenopausal women.

Sustained Reduction of Subclinical Inflammation in the years after Breastfeeding.

Lactation is associated with lower future risk of cardiovascular disease in women but the mechanism(s) underlying this relationship remain unclear. We sought to characterize the relationship between duration of exclusive breastfeeding and cardiovascular risk factors over the first 5-years postpartum. In this prospective cohort study, 328 women underwent serial cardiometabolic characterization (anthropometry, blood pressure, lipids, fasting glucose, adiponectin, C-reactive protein (CRP)) at 1-year, 3-years, and 5-years postpartum. Cardiovascular risk factors in 3 groups defined by duration of exclusive breastfeeding, as follows: <3 months (n=107), 3-6 months (n=101), and ≥6 months (n=120). The prevalence of metabolic syndrome did not differ between the groups at 3-years but, by 5-years postpartum, was higher in women who had exclusively breastfed <3 months than in those who did so for 3-6 and ≥6 months, respectively (14.0% vs 6.9% vs 4.2%; p=0.02). However, after adjustment for covariates (including BMI), there were no significant differences between groups in blood pressure, glucose, LDL cholesterol, HDL cholesterol, triglycerides or adiponectin. Indeed, the only cardiovascular risk factor difference that persisted after covariate adjustment was that women who had exclusively breastfed <3 months had higher CRP at both 3-years (p=0.04) and 5-years (p=0.01). Moreover, generalized estimating equation analyses with adjustment for covariates (including time-dependent BMI) showed that CRP remained higher over time in these women, as compared to their peers, from 1-year to 3-years to 5-years postpartum (p=0.03). Sustained reduction of subclinical inflammation may contribute to the cardioprotective effect of lactation in women.

Comprehensive biomarker analysis of metabolomics in different syndromes in traditional Chinese medical for prediabetes mellitus

BackgroundPrediabetes mellitus (PreDM) is a high-risk state for developing type 2 diabetes mellitus (T2DM) and often goes undiagnosed, which is closely associated with obesity and characterized by insulin resistance that urgently needs to be treated.PurposeTo obtain a better understanding of the biological processes associated with both "spleen-dampness" syndrome individuals and those with dysglycaemic control at its earliest stages, we performed a detailed metabolomic analysis of individuals with various early impairments in glycaemic control, the results can facilitate clinicians’ decision making and benefit individuals at risk.MethodsAccording to the diagnostic criteria of TCM patterns and PreDM, patients were divided into 4 groups with 20 cases, patients with syndrome of spleen deficiency with dampness encumbrance and PreDM (PDMPXSK group), patients with syndrome of dampness-heat in the spleen and PreDM (PDMSRYP group), patients with syndrome of spleen deficiency with dampness encumbrance and normal blood glucose (NDMPXSK group), and patients with syndrome of dampness-heat in the spleen and normal blood glucose (NDMSRYP group). Plasma samples from patients were collected for clinical index assessment and untargeted metabolomics using liquid chromatography-mass spectrometry.ResultsAmong patients with the syndrome of spleen deficiency with dampness encumbrance (PXSK), those with PreDM (PDMPXSK group) had elevated levels of 2-hour post-load blood glucose (2-h PG), glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol (HDL-C), and systolic blood pressure (SBP) than those in the normal blood glucose group (NDMPXSK group, P < 0.01). Among patients with the syndrome of dampness-heat in the spleen (SRYP), the levels of body mass index (BMI), fasting blood glucose (FBG), 2-h PG, HbA1c, and fasting insulin (FINS) were higher in the PreDM group (PDMSRYP group) than those in the normal blood glucose group (NDMSRYP group, P < 0.05). In both TCM syndromes, the plasma metabolomic profiles of PreDM patients were mainly discriminatory from the normal blood glucose controls of the same syndrome in the levels of lipid species, with the PXSK syndrome showing a more pronounced and broader spectrum of alterations than the SRYP syndrome. Changes associated with PreDM common to both syndromes included elevations in the levels of 27 metabolites which were mainly lipid species encompassing glycerophospholipids (GPs), diglycerides (DGs) and triglycerides (TGs), cholesterol and derivatives, and decreases in 5 metabolites consisting 1 DG, 1 TG, 2 N,N-dimethyl phosphatidylethanolamine (PE-NMe2) and iminoacetic acid. Correlation analysis identified significant positive correlations of 3α,7α,12α,25-Tetrahydroxy-5β-cholestane-24-one with more than one glycaemia-related indicators, whereas DG (20:4/20:5) and PC (20:3/14:0) were positively and PC (18:1/14:0) was inversely correlated with more than one lipid profile-related indicators. Based on the value of correlation coefficient, the top three correlative pairs were TG with PC (18:1/14:0) (r = − 0.528), TG with TG (14:0/22:4/22:5) (r = 0.521) and FINS with PE-NMe (15:0/22:4) (r = 0.52).ConclusionOur results revealed PreDM patients with different TCM syndromes were characterized by different clinical profiles. Common metabolite markers associated with PreDM shared by the two TCM syndromes were mainly lipid species encompassing GP, GL, cholesterol and derivatives. Our findings were in line with the current view that altered lipid metabolism is a conserved and early event of dysglycaemia. Our study also implied the possible involvement of perturbed bile acid homeostasis and dysregulated PE methylation during development of dysglycaemia.

Reduced Blood Glucose Levels in Diabetic Patients After Using a Combination of Progressive Muscle Relaxation (Pro-Mure) and Slow Deep Breathing Exercises (SD-Bex)

Background: One of the causes of diabetes mellitus is a person's lifestyle, namely their level of physical inactivity. So, to avoid complications, persons with diabetes mellitus require both pharmaceutical and non-pharmacological treatments to lower blood glucose values. Finding out if people with diabetes mellitus might reduce their blood glucose levels by combining a technique that involved slow deep breathing and progressive muscular relaxation was the primary goal of the research. Methods: This study is quasi-experimental because it uses a control group design with pre- and post-tests. The number of respondents is 34, and the method of sampling is purposive sampling. Twenty to twenty-five minutes of a combination of progressive muscle relaxation (Pro-Mure) and slow deep breathing exercises (SD-Bex) were administered to the experimental group, while the control group received the usual course of intervention. Values of blood glucose levels were the dependent variable. With a p-value of less than 0.05, the study used the Wilcoxon Signed Rank Test to compare outcomes before and after treatment and the Mann-Whitney test to compare the experimental group to the control group. Results: We found that the intervention group's blood glucose value was 0.001 and the control group's was 0.025. A p-value of 0.001 was found on the value of blood glucose levels between the experimental group and the control group as a result of the study utilising the Mann-Whitney test. Conclusion: Those suffering from diabetes mellitus can find relief from their symptoms by combining the techniques of Progressive Muscle Relaxation with Slow Deep Breathing. Additionally, the method is simple to apply.

Associations of insulin sensitivity and immune inflammatory responses with child blood lead (Pb) and PM2.5 exposure at an e-waste recycling area during the COVID-19 lockdown.

Fine particular matter (PM2.5) and lead (Pb) exposure can induce insulin resistance, elevating the likelihood of diabetes onset. Nonetheless, the underlying mechanism remains ambiguous. Consequently, we assessed the association of PM2.5 and Pb exposure with insulin resistance and inflammation biomarkers in children. A total of 235 children aged 3-7years in a kindergarten in e-waste recycling areas were enrolled before and during the Corona Virus Disease 2019 (COVID-19) lockdown. Daily PM2.5 data was collected and used to calculate the individual PM2.5 daily exposure dose (DED-PM2.5). Concentrations of whole blood Pb, fasting blood glucose, serum insulin, and high mobility group box 1 (HMGB1) in serum were measured. Compared with that before COVID-19, the COVID-19 lockdown group had lower DED-PM2.5 and blood Pb, higher serum HMGB1, and lower blood glucose and homeostasis model assessment of insulin resistance (HOMA-IR) index. Decreased DED-PM2.5 and blood Pb levels were linked to decreased levels of fasting blood glucose and increased serum HMGB1 in all children. Increased serum HMGB1 levels were linked to reduced levels of blood glucose and HOMA-IR. Due to the implementation of COVID-19 prevention and control measures, e-waste dismantling activities and exposure levels of PM2.5 and Pb declined, which probably reduced the association of PM2.5 and Pb on insulin sensitivity and diabetes risk, but a high level of risk of chronic low-grade inflammation remained. Our findings add new evidence for the associations among PM2.5 and Pb exposure, systemic inflammation and insulin resistance, which could be a possible explanation for diabetes related to environmental exposure.

#993 The molecular effects of SGLT2i (Empagliflozin) on α-Klotho and Nephrin/Podocin proteins in type II diabetic mice model

Abstract Background and Aims Type 2 diabetes mellitus (T2DM), especially hyperglycemia, is associated with increased glucose cell toxicity and oxidative stress that can lead to irreversible damage in the kidney such as diabetic nephropathy (DN). DN is one of the most common microvascular complications of diabetes and is the leading cause of end-stage renal disease (ESRD) and replacement therapy. Several works in the setting of early experimental diabetic nephropathy using the recent anti-diabetic drugs such as sodium-glucose transporter type 2 inhibitors in the prevention, development or amelioration of renal injury. The exact mechanisms, by which these drugs ameliorate glomerular injury from hyperglycemia, had not been clarified well. Klotho and Podocin-Nephrin proteins are an important proteins involved in the tubule-glomerular injury. The Klotho is a circulating anti-ageing hormone with anti-oxidative and anti-inflammatory properties with vascular protective effects in animal studies. Podocin &amp; Nephrin are important component of the glomerular foot-process membrane, the slit-diaphragm. Recently, several experimental reports showed decreased α-Klotho, Nephrin and Podocin expression in different models of diabetic nephropathy. Method We used BTBR mouse strain with the ob/ob leptin-deficiency mutation, which develops T2DM with hyperglycemia and DN; C57/BL mice were the control (CON). EMPA was administrated to T2DM mice (T2DM+EMPA) via drinking water for 12 weeks. Blood parameters were measured repeatedly, and at sacrifice, mice kidneys were harvested for histological and biochemical analyses. We evaluated renal glomerular structure of Nephrin, Podocin and α-Klotho proteins expression. Results EMPA treatment reduced T2DM blood glucose vs C57 group (P &amp;lt; 0:01), and increase urine glucose in EMPA+DM group (P &amp;lt; 0:001) EMPA vs. C57BL/6 and DM). Histological analyses in kidney sections, revealed decreased α-Klotho expression in glomeruli of DM mice vs Control mice (15.95 ± 0.64 vs 36 ± 2.42, (P &amp;lt; 0:01), and restored back in DM+ EMPA mice vs control mice (27.64 ± 0.94 vs 15.95 ± 0.64, P &amp;lt; 0:01). Podocin expression in glomeruli: control mice 31.3 ± 3.7 VS DM mice 21.26 ± 1.22 and DM + EMPA mice 28.22 ± 0.50 VS DM mice 21.26 ± 1.22 Conclusion Hyperglycemia (DM type II) reduces Podocin-Nephrin and α-Klotho proteins expression in the glomeruli kidney and upregulated by EMPA treatment. SGLT2i (EMPA) treatment in DM patients can significantly reduce progression of DN and onset of ESRD probably through its effect on α-Klotho/Podocin-Nephrin proteins.

Antidiabetic Activity of Isolated Compounds of Crinum solapurense Leaves Extract in Albino Wistar Rats

Background: The leaves extracts of Crinum solapurense are examined for in-vivo antidiabetic pharmacological action. Methods: Plant material including different multi-component mixes has a large number of bioactive chemicals. Therefore, it is crucial to separate and determine these compounds which have active phytoconstituents are responsible for the pharmacological action. The extracts for action in-vivo antidiabetic investigation from the leaves extract of Crinum solapurense are the subject of the current research project. From the leaves, ethanolic extracts of the medicinal plant Crinum solapurense, two alkaloid compounds—gulonic acid &amp; shikimic acid—were identified. The alkaloids found in the phytoconstituents of Crinum solapurense leaves may be the cause of their pharmacological action. Results: In the DNSA inhibition assay method the IC50 value was observed to be 5.31 &amp; 11.17 μg/ml for shikimic acid &amp; gulonic acid correspondingly. In the Iodine-Starch Technique the IC50 value was observed to be 9.91 &amp; 12.70 μg/ml for shikimic acid &amp; gulonic acid correspondingly. In the In-vivo animal study of Gulonic acid in the group that was not given any treatment, diabetic rats displayed considerable weight loss at the end of the trial (p ˂0.001). When dexamethasone was administered, the diabetic group's blood glucose levels significantly increased in comparison to the control group (p is equal to 0.01). Two parameters were improved in a dosage-dependent way when mice were given glibenclamide or gulonic acid at a dose of 50.00 or 100.00 milligrams per kilogram body weight. Diabetes led to a substantial rise in HbA1c (p˂0.05) in the group of diabetics who were not receiving treatment. Conclusion: Based on the in-vivo animal study it was concluded that the leaves extracts of Crinum solapurense show significant effects of antidiabetic pharmacological action in diabetes induced animals.

The association between blood glucose levels on arrival at the hospital and patient outcomes after out-of-hospital cardiac arrest: A multicenter cohort study

BackgroundThis study aimed to investigate the association between blood glucose levels on arrival at the hospital and 1-month survival and favorable neurological outcomes in patients with OHCA using a large Japanese dataset. MethodsThis study was a secondary analysis of data from the JAAM-OHCA Registry. Adult (≥18 years) patients with witnessed OHCA transported to emergency departments and registered in the database from June 2014 to December 2019 were included in the study. The primary and secondary endpoints were 1-month survival and 1-month favorable neurological outcomes (Glasgow-Pittsburgh Cerebral Performance Category score 1 or 2), respectively. Patients were categorized into the following four groups based on blood glucose levels on arrival at the hospital: <80 mg/dL, 80–179 mg/dL, 180–299 mg/dL, and ≥300 mg/dL. ResultsThis study included 11,387 patients. Survival rates were 1.3%, 3.1%, 7.0%, and 5.7% in the <80 mg/dL, 80–179 mg/dL, 180–299 mg/dL, and ≥ 300 mg/dL blood glucose groups, respectively. The rates of favorable neurological outcomes in each group were 0.4%, 1.5%, 3.3%, and 2.5%, respectively. Multivariable analysis showed that 180–299 mg/dL glucose was significantly associated with 1-month survival and favorable neurological outcomes compared with 80–179 mg/dL glucose (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.34–2.31; p < 0.001 and OR, 1.52; 95 % Cl, 1.02–2.25; p = 0.035, respectively). In this study, blood glucose levels with the best outcomes likely ranged from 200 to 250 mg/dL based on the cubic spline regression model. ConclusionsBlood glucose level of 180–299 mg/dL on arrival at the hospital was significantly associated with 1-month survival and favorable neurological outcomes compared to blood glucose level of 80–179 mg/dL in patients with OHCA.

Effect of Ethanol Extract of Sala (Cynometra ramiflora Linn.) leaves for reducing Blood Glucose Levels in Male Wistar Rats Induced by Alloxan

Diabetes is a chronic illness brought on by either insufficient insulin production by the pancreas or inefficient insulin utilisation by the body. There is currently no proven diabetes treatment. The development of current therapies is solely focused on preserving and enhancing patients' quality of life. In addition to utilising oral hypoglycemic medications or insulin injections to control blood sugar, several medicinal plants have also undergone pharmacological testing and can be used experimentally. There were 5groups, namely negative control group (0.5% Na CMC), positive control (glibenclamide 0.9mg/kg), ethanol extract of Sala leaves at doses of 250, 500, and 1000mg/kgBW. Each group was induced by alloxan 150mg/kg intraperitoneal body weight before fasting blood glucose levels 200mg/dL. Each group's blood glucose levels were taken and checked as pre alloxan, post alloxan, 7 and 10 days after treatment. The results showed that the ethanol extract of Sala leaves with doses of 250, 500, and 1000mg/kg for 7 and 10 days after treatment showed glucose-lowering activity (p&lt;0.05) on all alloxan induction. The ethanolic extract of the leaves of the Sala plant (Cynometra ramiflora Linn.) with doses of 250, 500, and 1000mg/kgBW for 7 and 10 days showed significant glucose-lowering activity (p&lt;0 0.05) in alloxan-induced mice.

Fibrinogen-to-Albumin Ratio and Glucose Metabolic States in Patients With Coronary Heart Disease.

This study investigated the relationship between fibrinogen-to-albumin ratio (FAR) and glucose metabolic state in patients with coronary heart disease (CHD). A total of 52,062 patients were enrolled in this study. Patients were classified according to FAR tertiles (T1: FAR < 0.0073; T2: 0.0073 ≤ FAR ≤ 0.0886; T3: FAR ≥ 0.0887). Patients were also classified into the normal glucose regulation (NGR) and elevated blood glucose (EBG) groups. The relationship between FAR and EBG was analyzed using logistic regression, and the association was evaluated according to sex and age. Among the participants, 32,471 (62.4%) had EBG, which was positively associated with FAR (odds ratio [OR], 1.19; 95% confidence interval [CI] 1.15-1.23). The OR of the FAR for EBG in males was higher than that in females (1.25; 95% CI 1.18-1.33 vs 1.15; 95% CI 1.10-1.20). Moreover, the OR of FAR for EBG was greater in patients aged 60 or younger (OR: 1.25; 95% CI 1.18-1.33) than in the elderly patients (over 60 years of age) (OR: 1.15; 95% CI 1.10-1.20). The results indicated a significant relationship between FAR and EBG and this association was higher in males and middle-aged patients.

Glucose fluctuations aggravated the late sodium current induced ventricular arrhythmias via the activation of ROS/CaMKII pathway

BackgroundRecent evidence revealed that glucose fluctuation might be more likely to cause arrhythmia than persistent hyperglycemia, whereas its mechanisms were elusive. We aimed to investigate the effect of glucose fluctuation on the occurrence of ventricular arrhythmia and its mechanism. MethodsStreptozotocin (STZ) induced diabetic rats were randomized to five groups: the controlled blood glucose (C-STZ) group, uncontrolled blood glucose (U-STZ) group, fluctuated blood glucose (GF-STZ) group, and GF-STZ rats with 100 mg/kg Tempol (GF-STZ + Tempol) group or with 5 mg/kg KN93 (GF-STZ + KN93) group. Six weeks later, the susceptibility of ventricular arrhythmias and the electrophysiological dysfunctions of ventricular myocytes were evaluated using electrocardiogram and patch-clamp technique, respectively. The levels of reactive oxygen species (ROS) and oxidized CaMKII (ox-CaMKII) were determined by fluorescence assay and Western blot, respectively. Neonatal rat cardiomyocytes and H9C2 cells in vitro were used to explore the underlying mechanisms. ResultsThe induction rate of ventricular arrhythmias was 10%, 55%, and 90% in C-STZ group, U-STZ group, and GF-STZ group, respectively (P < 0.05). The electrophysiological dysfunctions of ventricular myocytes, including action potential duration at repolarization of 90% (APD90), APD90 short-term variability (APD90-STV), late sodium current (INa-L), early after depolarization (EAD) and delayed after depolarizations (DAD), as well as the levels of ROS and ox-CaMKII, were significantly increased in GF-STZ group. In vivo and ex vivo, inhibition of ROS or ox-CaMKII reversed these effects. Inhibition of INa-L also significantly alleviated the electrophysiological dysfunctions. In vitro, inhibition of ROS increase could significantly decrease the ox-CaMKII activation induced by glucose fluctuations. ConclusionsGlucose fluctuations aggravated the INa-L induced ventricular arrhythmias though the activation of ROS/CaMKII pathway.

Research on the Effect of Humanistic Nursing Care on Elderly Type 2 Diabetes Mellitus Patients

Objective: To explore and analyze the effect of humanistic nursing care on elderly type 2 diabetes patients. Methods: 100 elderly patients with type 2 diabetes who were treated in our hospital from May 2021–May 2023 were selected for this study. The patients were divided into an experimental group and a reference group by flipping a coin, with 50 cases in each group. The experimental group received humanistic nursing care, while the reference group received routine nursing care. The blood glucose level, compliance and nursing satisfaction were compared between the two groups. Results: Before the intervention, there was no statistically significant difference between the groups in pre-meal blood glucose, blood glucose 2 hours after eating, and glycosylated hemoglobin (P &gt; 0.05). After the intervention, pre-meal blood glucose, blood glucose 2 hours after eating, and glycosylated hemoglobin in the humanities group were significantly better than those in the reference group (P &lt; 0.05). Besides, before the intervention, there was no statistically significant difference in compliance with diet, medication, examination, and exercise between the groups (P &gt; 0.05). After the intervention, the compliance with diet, medication, examination, and exercise in the experimental group was significantly better than that of the reference group (P &lt; 0.05). The patients in the experimental group were significantly more satisfied with the nursing care received than the reference group (P &lt; 0.05). Conclusion: Humanistic nursing care can reduce blood sugar in elderly patients with type 2 diabetes, strengthen treatment compliance, and improve satisfaction.

864-P: Effects on Glycemic Control by Combination Therapy of Gliclazide-Metformin and Insulin in Type 2 Diabetes Mellitus Patients

Background: Diabetes mellitus is most common non-communicable diseases. Purpose of this study was to observe the effects on glycemic control by combination therapy of gliclazide-metformin and insulin in type 2 diabetes mellitus patients according to baseline HbA1c, fasting blood glucose (FBG) and blood glucose 2 hours after breakfast. Methods: An observational study was conducted at Endocrinology Outpatient Department of Dhaka Medical College Hospital, Dhaka and Outpatient Department of Ibrahim General Hospital, Mirpur, Dhaka over a period of one year (July 2018 to June 2019). Total 110 type 2 diabetic patients were selected purposively. The patients were divided into two groups. In group I, 55 patients treated with gliclazide (80mg) and metformin (500mg) combination therapy twice daily for consecutive 12 weeks and in group II, 55 patients treated with Insulin (premixed 30/70) twice daily for consecutive 12 weeks. Results: After 12 weeks of treatment HbA1c level reduced from (mean ± SD) 8.94 ± 0.91 to 7.82 ± 1.86 in group I and 10.07 ± 1.28 to 7.90 ± 1.01in group II. FBG level reduced from 10.05 ± 1.57 to 7.96 ± 1.62 in group I and 11.61 ± 2.62 to 7.60 ± 1.23 in group II. Blood glucose 2 hours ABF level reduced from 14.00 ± 2.04 to10.99 ± 1.41 in group I and 16.70 ± 3.61to 10.71 ± 1.52 in group II. In group I, 36.4% patients achieved HbA1c target level, 40% patients achieved FBG target level and 25.5% patients achieved blood glucose 2 hrs ABF target level. In group II, 29.1% patients achieved HbA1c target level, 56.4% patients achieved FBG target level and 29.1% patients achieved blood glucose 2 hrs ABF target level Conclusion: This study showed improvement in the overall glycemic control (HbA1c, FBG and blood sugar 2hours ABF) during the study period. Both groups of drugs are effective in controlling blood glucose but individual group has unique beneficial effect. Key words: Type 2 diabetes mellitus, Glycemic control, Glicazide-Metformin Disclosure M.Saifuddin: None.

The Combined Effects of Aspartame and Acesulfame-K Blends on Appetite: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Aspartame (Asp) and acesulfame-K (Ace-K) are nonnutritive sweeteners (NNSs) commonly used in combination to replace added sugars in reduced- or low-calorie foods and beverages. Despite Asp/Ace-K blends having negligible calories, their effects on appetite have not been reviewed systematically. We therefore undertook a systematic review and meta-analysis of the metabolic effects of Asp/Ace-K blends on energy intake (EI), subjective appetite scores, blood glucose, and the incretin hormones glucose-dependent insulinotropic peptide and glucagon-like peptide. MEDLINE, Web of Science, and Cochrane CENTRAL databases (Embase, PubMed, and CINAHL) were searched (May 2021) for randomized controlled trials (RCTs). Human RCTs using Asp/Ace-K blends compared with sugar and water controls were included, whereas isolated cell and animal studies were excluded. An overall 4829 publications were identified and 8 studies, including 274 participants, were retrieved for review. The Asp/Ace-K group's EI was significantly reduced compared with sugar [mean difference (MD): -196.56kcal/meal; 95% CI: -332.01, -61.11kcal/meal; P=0.004] and water (MD: -213.42kcal/meal; 95% CI: -345.4, -81.44kcal/meal; P=0.002). Meta-analysis of subjective appetite scores and incretins could not be undertaken due to inconsistencies in data reporting and insufficient data, respectively, but of the 4 studies identified, no differences were observed between Asp/Ace-K blends and controls. The Asp/Ace-K group's blood glucose was nonsignificantly reduced compared with sugar (MD: -1.48mmol/L; 95% CI: -3.26, 0.3mmol/L; P=0.1) and water (MD: -0.08mmol/L; 95% CI: -0.62, 0.47mmol/L; P=0.78). Lower EI in participants who were predominantly healthy and assigned to Asp/Ace-K blends could not be reliably attributed to changes in subjective appetite scores. Blood glucose and incretins were also generally not affected by Asp/Ace-K blends when compared with controls. Additional short- and long-term RCTs using NNSs and sugars at dietarily relevant levels are needed. This trial was registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42017061015).

A Chinese medical nutrition therapy diet accompanied by intermittent energy restriction alleviates type 2 diabetes by enhancing pancreatic islet function and regulating gut microbiota composition

Medicine food homologous (MFH) plants and wholegrains have gained increasing attention for prevention and treatment of type 2 diabetes (T2D). Substantial evidence supports the effectiveness of intermittent energy restriction (IER) in T2D management. However, there are few studies that report intermittent use of a low-calorie pre-prepared food including MFH plants and wholegrains in T2D. The aim of this study was to investigate the effects of Chinese Medical Nutrition Therapy (CMNT), a MFH plants and wholegrains diet accompanied by IER, on glycemic control and potential mechanism. Ten-week-old diabetic db/db mice were randomly divided into CMNT group (feeding low-calorie mouse CMNT diet in day 1–4 and ad libitum regular chow for up to 7 days per cycle) and control group (ad libitum access to regular chow). The results showed that CMNT reduced fasting blood glucose, improved glucose tolerance with higher insulin secretion, attenuated macrophage infiltration, promoted β-cell proliferation of pancreatic islets, and increased diabetes-improving microbiota (Bacteroides, Rikenellaceae_RC9_gut_group and Coprococcus_1) in db/db mice. Additionally, we performed a pilot study evaluating CMNT in thirty-nine T2D patients without obesity. Participants with T2D randomly assigned to two groups: CMNT group (receiving a consecutive 5-day low-calorie human CMNT diet with 10 days of habitual eating per cycle for 90 days) and control group (continuing on a normal diet). We observed an improvement in glycemic control in CMNT group with significant reduction in HbA1c, fasting glucose, 2 h postprandial blood glucose but control group were not affected. After CMNT intervention, the abundance of the phylum Bacteroidetes, and genus Bacteroides, Parabacteroides and Roseburia were significantly higher than baseline in T2D patient, which were closely associated with glycemic control. These findings suggested that CMNT is a promising nutritional intervention approach in diabetes management.

Modification effect of changes in cardiometabolic traits in association between kidney stones and cardiovascular events.

BackgroundsWhether longitudinal changes in metabolic status influence the effect of kidney stones on cardiovascular disease (CVD) remains unclarified. We investigated the modification effect of status changes in metabolic syndrome (MetS) in the association of kidney stones with risk of incident CVD events.MethodsWe performed a prospective association and interaction study in a nationwide cohort including 129,172 participants aged ≥ 40 years without CVDs at baseline and followed up for an average of 3.8 years. Kidney stones information was collected by using a questionnaire and validated by medical records. The repeated biochemical measurements were performed to ascertain the metabolic status at both baseline and follow-up.Results4,017 incident total CVDs, 1,413 coronary heart diseases (CHDs) and 2,682 strokes were documented and ascertained during follow-up. Kidney stones presence was significantly associated with 44%, 70% and 31% higher risk of CVDs, CHDs and stroke, respectively. The stratified analysis showed significant associations were found in the incident and sustained MetS patients, while no significant associations were found in the non-MetS at both baseline and follow-up subjects or the MetS remission ones, especially in women. For the change status of each single component of the MetS, though the trends were not always the same, the associations with CVD were consistently significant in those with sustained metabolic disorders, except for the sustained high blood glucose group, while the associations were consistently significant in those with incident metabolic disorders except for the incident blood pressure group. We also found a significant association of kidney stone and CVD or CHD risk in the remain normal glucose or triglycerides groups; while the associations were consistently significant in those with incident metabolic disorders except for the incident blood pressure group. We also found a significant association of kidney stone and CVD or CHD risk in the remain normal glucose or triglycerides groups.ConclusionsA history of kidney stones in women with newly developed MetS or long-standing MetS associated with increased risk of CVD. The mechanisms link kidney stones and CVD risk in the metabolic and non-metabolic pathways were warranted for further studies.

The study of bone mineral density measured by quantitative computed tomography in middle-aged and elderly men with abnormal glucose metabolism

BackgroundTo investigate the value of quantitative computed tomography (QCT) measurement of bone mineral density (BMD) in middle-aged and elderly men with abnormal blood glucose.MethodsTotal 138 men aged above 50 years old with routine physical examination were involved in the study. All participants were evaluated with serological index, BMD by QCT and dual energy X-ray absorptiometry (DXA). Statistical analysis was conducted by χ2 test and regression model.ResultsAll individuals were divided into normal blood glucose (NBG) group and abnormal blood glucose (ABG) group. Compared with NBG group, BMD detected by QCT was obviously lower in ABG group (P < 0.05). More cases with low bone mass or osteoporosis were detected by QCT measurement than DXA (χ2 = 56.618, P = 0.000), which were consistent in both NBG and ABG groups (χ2 was 33.564 and 23.250, P = 0.000). No significant difference of detection rates was found in both subgroups neither by QCT nor DXA measurement (χ2 = 4.204, P = 0.122). Regression analysis revealed that ABG was negatively associated with BMD assessed by QCT (β = -0.217, P < 0.05), which did not show statistical difference after adjusting for age.ConclusionIn middle-aged and elderly male patients with NBG or ABG, QCT manifests higher detection rates of low bone mass and osteoporosis than DXA. ABG is negatively correlated with BMD measured by QCT, which is affected by age.

Effectiveness of Multidisciplinary Nursing Based on Fever, Blood Sugar, and Swallowing Function Management in Patients with Acute Stroke.

Purpose The aim of this study was to assess the effectiveness of multidisciplinary nursing based on fever, blood sugar, and swallowing function management in patients with acute stroke (AS). Methods A total of 200 AS patients who were treated in our hospital from January 2016 to January 2020 were recruited and randomized at a ratio of 1 : 1 into a control group and a study group. The control group received standardized early rehabilitation nursing, and the study group received multidisciplinary nursing based on fever, blood sugar, and swallowing function management plus standardized early rehabilitation nursing. The patients were also assigned different blood glucose levels upon admission to a high blood glucose group or a normal blood glucose group. The clinical endpoint is clinical efficacy. Results Multidisciplinary nursing resulted in better clinical outcomes and treatment efficiency in the patients in the study group versus standardized early rehabilitation nursing. When compared with the control group, the patients in the study group showed lower National Institute of Health Stroke Scale (NIHSS) scores, higher Barthel Index (BI) scores, lower fasting blood glucose levels and body temperature 24 hours after admission, a lower incidence of swallowing dysfunction and aspiration pneumonia 30 days after nursing, and lower C-reactive Protein (CRP) levels 7 days after nursing. The NIHSS scores of the high blood glucose group were significantly higher than those of the normal blood glucose group. Conclusion Multidisciplinary nursing based on fever, blood sugar, and swallowing function management for patients with AS improves the clinical outcome and treatment efficiency, restores the swallowing function and blood glucose level, and ameliorates the long-term prognosis of patients.

Effect of exercise in obese diabetic patients with chronic kidney disease

IntroductionObesity is the most dangerous risk factor for kidney disease if it is coupled with diabetes mellitus and hypertension, and it has a direct impact on chronic kidney disease progression to end-stage renal disease. The present study was to document the effect of 3 months of aerobic exercises vs. resistance exercises in obese patients with diabetes and chronic kidney disease.MethodsOverall, 84 patients (36 males and 48 females) who met the inclusion criteria were randomly assigned to 2 groups. Group 1 received aerobic exercises 3 times/week for 3 months, and group 2 was treated with resistance exercises 3 times/week for 3 months.ResultsAt baseline, no significant difference was found between the groups in body mass index, waist circumference, waist-to-hip ratio, blood pressure, heart rate, or blood glucose. The difference in exercise performance between the 2 groups prior to treatment was not significant, but after 3 months of treatment, there was a significant increase in exercise performance and improvement in the parameters of body mass index, waist circumference, waist-to-hip ratio, blood pressure, heart rate, and blood glucose within group 1 and group 2, with no significant difference between the 2 groups.ConclusionsAerobic exercise is effective in decreasing obesity and increasing physical performance in obese diabetic chronic kidney disease patients. Resistance exercises alone can also decrease obesity and increase physical performance. So, both types of exercises can be used in the treatment of obesity.