Blood Glucose Values Research Articles

Is there a Relation between Depression and Anxiety to Clinical Characteristics among Patients with T2D in Greece?

Diabetes is a chronic disease that may be related to various periods of an individual's life. The aim of the present study is the investigation of the existence of depression and anxiety among patients suffering from type 2 diabetes as well as the factors that influence these variables (depression and anxiety). The Hospital Anxiety and Depression Scale (HADS) for mental health assessment was used in the context of the collection of the research data. The study involved 100 patients (42 men and 58 women) with an average age of 63.72 ± 9.84 years of life. The results showed that there was a positive correlation between HbA1c value and anxiety as well as HADS questionnaire total score, and a positive correlation between blood glucose value and anxiety as well as HADS questionnaire total score. Both depression and anxiety of these patients are influenced by different clinical factors.

Influence of sphingolipid enzymes on blood glucose levels, development of diabetes, and involvement of pericytes.

Sulfatide is a chaperone for insulin manufacturing in beta cells. Here we explore whether the blood glucose values normally could be associated with this sphingolipid and especially two of its building enzymes CERS2 and CERS6. Both T1D and T2D have low blood sulfatide levels, and insulin resistance on beta cells at clinical diagnosis. Furthermore, we examined islet pericytes for sulfatide, and beta-cell receptors for GLP-1, both of which are related to the insulin production. We examined mRNA levels in islets from the DiViD and nPOD studies, performed genetic association analyses, and histologically investigated pericytes in the islets for sulfatide. Polymorphisms of the gene encoding the CERS6 enzyme responsible for synthesising dihydroceramide, a precursor to sulfatide, are associated with random blood glucose values in non-diabetic persons. This fits well with our finding of sulfatide in pericytes in the islets, which regulates the capillary blood flow in the islets of Langerhans, which is important for oxygen supply to insulin production. In the islets of newly diagnosed T1D patients, we observed low levels of GLP-1 receptors; this may explain the insulin resistance in their beta cells and their low insulin production. In T2D patients, we identified associated polymorphisms in both CERS2 and CERS6. Here, we describe several polymorphisms in sulfatide enzymes related to blood glucose levels and HbA1c in non-diabetic individuals. Islet pericytes from such persons contain sulfatide. Furthermore, low insulin secretion in newly diagnosed T1D may be explained by beta-cell insulin resistance due to low levels of GLP-1 receptors.

Metabolic control level and glucose variability in adolescents with type 1 diabetes during low and high-intensity exercise.

The main purpose of this study was to characterize the determinants of metabolic changes in young type 1 diabetes (T1DM) and to determine glycemic variability during low and high-intensity exercise. 20 young male T1DM patients were divided into two subgroups characterized by levels of glycated hemoglobin (HbA1c): HbA1c<7.3% (better HbA1c subgroup, n=10) and with levels HbA1c>7.3% (worse HbA1c subgroup, n=10). All participants performed a maximal oxygen uptake test and two efforts of various intensities (45 minutes of aerobic exercise and 30 minutes of mixed aerobic-anaerobic intensity exercise). Continuous glucose monitors (CGM) were used to control the glucose concentration. Changes in biomarkers describing the metabolic response were similar in both groups. A comparison of applied efforts exhibited that maximal capacity effort resulted in the highest values of blood glucose (BG) at the end (150.9-160.6 mg/dl) and 1 hour after the exercise (140.2-161.3 mg/dl). BG concentration before, during, 1 hour, and 24 hours after each exercise was insignificantly higher in the worse Hb1Ac group. HbA1c levels are insufficient to confirm whether the applied effort is performed in acceptable glycemic values. The CGM monitors allow for precise control of BG variations and accurate planning of physical activity by adjusting the insulin and carbohydrate consumption dose.

Use of FreeStyle Libre for continuous glucose monitoring in adult horses.

To evaluate the feasibility of using the FreeStyle Libre (a continuous glucose monitoring system [CGMS]) for instantaneous continuous monitoring of interstitial glucose in adult horses and examine the applicability and accuracy of this system in horses submitted to combined glucose-insulin test (CGIT). Laboratory measurements and continuous glucose monitoring system (CGMS) readings were analyzed using a 2 × 2 factorial statistical model with repeated measures over time. This analysis assessed the effects of the test (factor 1), group (factor 2), and their interactions (test × group, test × time, and group × time). Pearson's correlation analysis was applied to blood glucose values. Mean comparisons were conducted using the t-test, and agreement between techniques was assessed via the Bland-Altman method, with a 95% confidence interval. Field study on private horse farms in association with a veterinary school. Ten healthy stallions were assigned to one of two groups based on their body condition scores (BCS). Group 1 (G1, n= 5) consisted of nonobese horses with a BCS of 5 or 6, while Group 2 (G2, n= 5) consisted of obese horses with a BCS of 7 or higher. A CGMS sensor was attached to the dorsolateral aspect of the proximal one third of each horse's neck. Laboratory blood glucose measurements and CGMS interstitial glucose readings were compared at different time points for up to 7days after sensor fixation. Obese horses were also submitted to CGIT on Day 4. A comparative analysis of glucose measurements obtained in G1 and G2 horses using the CGMS and enzymatic methods revealed significant group×time interactions (P<0.001) and time effects (P<0.001). No interactions were detected between group (P=0.45), test (P=0.62), group and test (P=0.28), or time and test (P=0.92). In G1 and G2, tests were significantly correlated (r=0.84 and P=0.00) at all time points (T0-T5). Agreement between the glucose values obtained using different methods was excellent despite a small time delay in CGMS detection of rapid changes in blood glucose. It was concluded that the CGMS can be used for indirect assessment of glycemic status (ie, based on interstitial glucose measurements) in nonobese and obese adult horses submitted to CGIT.

Impact of coexisting type 2 diabetes mellitus on the urinary microbiota of kidney stone patients.

Type 2 diabetes mellitus (T2DM) commonly complicates kidney stone disease (KSD). Our objective is to investigate the variations in the urinary microbiota between individuals with KSD alone and those with KSD plus T2DM. This exploration could have implications for disease diagnosis and treatment strategies. During lithotripsy, a ureterscope was employed, and 1 mL of urine was collected from the renal pelvis after bladder disinfection. Sequencing targeting the V3-V4 hypervariable region was performed using the 16S rRNA and Illumina Novaseq platform. The Shannon index showed a significant decrease in the KSD plus T2DM group compared to the KSD-only group (false discovery rate = 0.041). Principal Coordinate Analysis (PCoA) demonstrated a distinct bacterial community in the KSD plus T2DM group compared to the KSD-only group (false discovery rate = 0.027). The abundance of Sphingomonas, Corynebacterium, and Lactobacillus was significantly higher in the KSD plus T2DM group than in the KSD-only group (false discovery rate < 0.05). Furthermore, Enhydrobacter, Chryseobacterium, and Allobaculum were positively correlated with fasting blood glucose and HbA1c values (P < 0.05). The urinary microbiota in the renal pelvis exhibits differences between patients with KSD plus T2DM and those with KSD alone. Further studies employing animal models are necessary to validate these distinctions, potentially paving the way for therapeutic developments based on the urinary microbiota.

Nasal Glucagon Reverses Insulin-induced Hypoglycemia With Less Rebound Hyperglycemia: Pooled Analysis of Clinical Trials.

Rebound hyperglycemia may occur following glucagon treatment for severe hypoglycemia. We assessed rebound hyperglycemia occurrence after nasal glucagon (NG) or injectable glucagon (IG) administration in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). This was a pooled analysis of 3 multicenter, randomized, open-label studies (NCT03339453, NCT03421379, NCT01994746) in patients ≥18 years with T1D or T2D with induced hypoglycemia. Proportions of patients achieving treatment success [blood glucose (BG) increase to ≥70 mg/dL or increase of ≥20 mg/dL from nadir within 15 and 30 minutes]; BG ≥70 mg/dL within 15 minutes; in-range BG (70-180 mg/dL) 1 to 2 and 1 to 4 hours postdose; and BG >180 mg/dL 1 to 2 and 1 to 4 hours postdose were compared. Incremental area under curve (iAUC) of BG >180 mg/dL and area under curve (AUC) of observed BG values postdose were analyzed. Safety was assessed in all studies. Higher proportions of patients had in-range BG with NG vs IG (1-2 hours: P = .0047; 1-4 hours: P = .0034). Lower proportions of patients had at least 1 BG value >180 mg/dL with NG vs IG (1-2 hours: P = .0034; 1-4 hours: P = .0068). iAUC and AUC were lower with NG vs IG (P = .025 and P < .0001). As expected, similar proportions of patients receiving NG or IG achieved treatment success at 15 and 30 minutes (97-100%). Most patients had BG ≥70 mg/dL within 15 minutes (93-96%). The safety profile was consistent with previous studies. This study demonstrated lower rebound hyperglycemia risk after NG treatment compared with IG. NCT03421379, NCT03339453, NCT01994746.

Biochemical profile of patients in ketosis-prone diabetes state in Côte d’Ivoire

: Diabetes keto-acidosis is the most serious hyperglycemic emergency in patients with diabetes. DKA has long been considered a key clinical feature of T1D. In this study, we assessed biochemical disorders focused on lipid and renal parameters in KPD.: We carried out a case-controls study for one year, encompassing 200 participants in total. Patients were outpatients newly diagnosed diabetics attending for the first time hospitals, controls were no-ketosis participants. Blood samples were taken, after 10 to 12 hours of fasting from the day before, in different tubes for each intended analyses according to instructor’s recommendation. The increased mean value of fasting blood glucose together with HbA1c are corrolated with ketonuria. As regard to cardio-metabolic risk, ketosis-prone patients were at greater risk than no-ketosis controls The mean AIP value was higher in KPD women than in men, with no significant statistical correlation. Uremia and creatininemia, two kidney parameters commonly prescribed to explore glomerular filtration, were correlated with some social indicators. The mean values of these both parameters increased significantly with age in KPD group. Creatinine increased significantly with age in patients, in line with glomerular filtration rate (GFR). The older the participants, the higher the mean values of these parameters. : These biochemical parameters, high atherogenic index and lower glomerular filtration rate, documented in our study, must be sought out when inaugural ketosis is suspected for improving the clinical prognosis of patients in the initial step of management.

A50 PRODUCTION OF A PANCREATIC AND INTESTINAL HEPATOCYTE NUCLEAR FACTOR 4A DOUBLE KNOCKOUT MOUSE MODEL TO UNRAVEL NEW MECHANISMS CONTROLLING METABOLISM

Abstract Background Hepatocyte nuclear factor (HNF) 4A is a transcription factor mainly found within endodermal organs, including the intestine and pancreas. HNF4A controls the expression of genes associated with glucose transit, glycolytic enzymes, lipid and drug metabolism, and incretin production from intestinal enteroendocrine cells. Mutations within this are linked to various diseases, including maturity-onset diabetes of the young and increased risk of Type 2 diabetes mellitus. However, it remains unclear whether intestinal and pancreatic HNF4A is functionally involved in glucose metabolism. This could be partly due to the lack of suitable experimental model that allow recreating phenotypes associated with hnf4a lost in two key organs involved in controlling body glucose levels. Aims To generate a conditionally mutant mouse line that does not express HNF4A in the intestine or the pancreas and to investigate how glucose metabolism is affected in these mice. Methods Conditional deletion in each organ was achieved by mating VillinCre or InsCreER with Hnf4αloxP/loxP C57BL/6 mice, respectively. The mutant mouse line was then generated by crossing mice Hnf4αloxP/loxP+VillinCre and Hnf4αloxP/loxP+InsCreER. PCR was performed to confirm all genotypes. Male and female mice around 2-3 months were distributed in four groups, including controls, Hnf4α-deleted intestine only, Hnf4α-deleted pancreas only, and Hnf4α-deleted in both organs. HNF4A expression was measured by qPCR, immunoblot and immunofluorescence. Glucose metabolism tests, including oral glucose tolerance (2g/kg) and insulin tolerance (0.75 International Units/kg) were performed. The blood glucose levels were measured after overnight fasting at 15, 30, 60, and 120 min. Results The body weight of four groups of mice remained comparable over experimental time. HNF4A expression was not detected from double mutant mice’s gut epithelial or pancreatic β cells. The oral glucose challenge showed a difference among the group of experimental mice as compared to the control group. After 15 min, blood glucose values of double mutant mice remained higher than control mice, for which glucose clearance was less efficient in the mutants. Insulin tolerance tests demonstrated that double mutant mice behave differently than control mice, suggesting a defect in insulin response. Conclusions These promising preliminary results allow us to obtain and characterize a novel murine model to study glucose metabolic syndrome that could be related to hnf4a gene deletion in both the gut and pancreas. Further studies are needed to establish a mechanism by which the HNF4A transcription factor could interplay between the intestine and the pancreas during whole-body glucose metabolism. Funding Agencies CIHRBourses d’excellence de l'Université de Sherbrooke

Neonatal Birth Weight With Daily Compared With Every-Other-Day Glucose Monitoring in Gestational Diabetes Mellitus: A Randomized Controlled Trial.

To assess whether universal use of every-other-day glucose monitoring in patients with gestational diabetes mellitus (GDM) resulted in similar birth weights and medication use and was preferred by the patient compared with traditional daily glucose monitoring. This was a noninferiority randomized controlled trial conducted at a single New York City hospital between April 2021 and May 2022. Patients with singleton pregnancies who were diagnosed with GDM after 20 weeks of gestation and had a minimum of 7 days of previous daily blood glucose testing were randomly assigned to test blood glucose values daily or every other day. The primary outcome was neonatal birth weight. We calculated a total sample size of 196 participants needed for noninferiority to be tested, assuming the mean birth weight in the every-other-day group, compared with the daily group, was no higher than the predefined noninferiority margin of 200 g (80% power and one-sided alpha of 0.05). Postrandomization characteristics, including blood glucose values and medication initiation and timing, were recorded. Satisfaction with treatment group was assessed using the validated Oxford Maternity Diabetes Treatment Satisfaction Questionnaire. A total of 197 patients were randomized: 98 in the daily group and 99 in the every-other-day group. Baseline characteristics were similar between groups. The mean neonatal birth weight was similar between groups (mean±SD 3,090±418 g among newborns in the daily group compared with 3,181±482 g among newborns in the every-other-day group). For the primary outcome, the every-other-day group was found to be noninferior to the daily group with an upper confidence limit for the mean difference in mean birth weight of 197 g, which was below the noninferiority margin of 200 g ( P =.046). Postrandomization, there were no significant differences in the number of patients who required medication, the gestational age at which medication was started, or the type of medication used. Average fasting and postprandial glucose values were similar between groups. There was an increase in adherence to treatment group in those randomized to every-other-day blood sugars, but no difference in patient satisfaction. In patients with GDM, testing blood glucose values every other day was as effective as testing daily, without apparent effects on birth weight, medication initiation, or glucose control. Reduced frequency of blood glucose monitoring might help decrease the emotional, physical, and financial burden experienced by patients with GDM. ClinicalTrials.gov , NCT04857073.

Prevalence of metabolic syndrome and its association with rapid weight loss among former elite combat sports athletes in Serbia.

In terms of the potential influence of rapid weight loss (RWL) on the metabolic health of former combat sports athletes (CSA), the scientific literature is quite scarce. Therefore, the objective of the presented research was to determine the differences in metabolic syndrome (MetS) parameters and the prevalence of MetS between former athletes who performed RWL and athletes who did not. The sample of the presented study comprised 150 participants from Serbia, equally divided into two groups: 75 former athletes who had practiced combat sports and 75 ex-athletes of various other sports who did not practice RWL during their careers. The following parameters related to the MetS were evaluated: waist circumference, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure, fasting glucose, and triglycerides. The oral glucose tolerance test (OGTT) was used to assess the participant's body response to sugar. The RWL group had significantly higher both systolic (p < 0.001) and diastolic blood pressure (p < 0.001) compared to the group of athletes who did not practice weight reduction during their careers. Additionally, a tendency toward statistically significant differences between groups was recorded in the variable triglycerides (p = 0.069). Regarding OGTT, increased values of fasting blood glucose at the final measurement were revealed only in the RWL group (p = 0.003). The prevalence of MetS was substantially higher in CSA than in the control group (39.5% vs. 16.2%, respectively p = 0.002). This study suggests that former elite CSA who used RWL during their sports career are susceptible to negative metabolic alterations at the end of their competitive period.

Glycemic Management in Insulin-Naive Patients in the Inpatient Setting.

The ideal inpatient insulin regimen efficiently attains the target blood glucose range, effectively treats hyperglycemia, and minimizes the risk of hypoglycemia. The objective of this study was to compare glycemic targets achieved by using correctional monotherapy (CM) and basal-bolus therapy (BBT) in insulin-naive patients in the inpatient setting to determine optimal blood glucose management for these patients. This was a retrospective observational cohort study of 792 patients with diabetes not on home insulin therapy who were admitted to an academic hospital over a 5.5-month period. The percentages of hyperglycemic and hypoglycemic values in each group were compared. Among the 3,112 measured blood glucose values obtained from 792 patients within the first 24 hours of insulin administration, 28.5% were hyperglycemic in the BBT group compared with 23.5% in the CM group. When adjusted for covariates, there was a 23% decrease in hyperglycemia in the BBT group (incidence rate ratio = 0.77, 95% CI 0.64-0.95, P = 0.006). Increases in A1C and admission blood glucose, as well as decreases in admission creatinine and inpatient steroid use, were independently associated with higher rates of hyperglycemia, adjusted for all other covariates. There was no significant difference between the groups in the rate of hypoglycemia in the first 24 hours, which was 1.9% in the BBT group and 1.4% in the CM group (P = 0.301). Utilizing BBT in insulin-naive patients admitted to the hospital within the first 24 hours of insulin administration results in lower rates of hyperglycemia without higher rates of hypoglycemia when compared with CM.

Make your choice: Angiography or periodical health examination?

Periodical health examination is one of the important factors influencing a healthy lifestyle. Patients undergoing routine physical examination in primary care are included in the scope of preventive medical services, which is the most basic principle of primary care. Identifying the risk factors enables individuals to adopt healthier lifestyle practices. In our study, we examined the correlation between patients undergoing coronary angiography for suspected coronary stenosis and the extent of primary care services they had received in their medical history, along with the severity of stenosis observed during the angiography. Patients were interviewed using a pre-structured questionnaire to gather information about their past utilization of primary healthcare services related to coronary matters and their cardiovascular (CV) risk profile as documented in their medical history. The necessary standard tests for angiography procedures were retrieved from patient records. The SYNTAX score, a tool that aids in the objective assessment of the severity of coronary artery disease (CAD), was computed and documented. This score was then compared with the history of primary care utilization. The patients' utilization of services from the Primary Healthcare Center (PHC) was evaluated using a scoring system, with an average score of 29.27 ± 11.27 out of 100 points (minimum: 20; maximum: 60). The average SCORE Türkiye indicating the 10-year risk of CV events for all patients was calculated as 14.31% ± 8.65% (high-very high risk), while the average SYNTAX score was 15.20 ± 9.97. There was a positive and significant correlation found between fasting blood glucose and creatinine values with both SYNTAX score and SCORE Türkiye (respectively; R = 0.238, P = .013; R = 0.289, P = .002). Factors such as smoking and metabolic syndrome were associated with CAD severity. It important to highlight that individual recommended for angiography had a notably lower utilization of healthcare services from the PHC based on their medical histories. This circumstance has resulted in individuals who do not undergo CV event screenings at PHCs having higher SYNTAX scores, indicating more severe CAD that necessitates angiography. Conducting regular periodical health examinations at PHCs can help mitigate these statistics.

Reliability and accuracy of bedside capillary blood glucose measurement by glucometers compared to venous blood glucose in critically ill patients: A facility based cross-sectional study

BackgroundThe traditional reference standard, venous blood glucose requires venipuncture and laboratories usually return the test results after 60 minutes. Our aim was to determine the agreement accuracy of glucose (capillary) levels obtained by POC glucometers with glucose (venous) values by standard laboratory method (glucose-oxidase) and to assess whether and to what extent the glucometers perform uniformly well across the entire range of blood glucose values. MethodsWe compared the diagnostic accuracy of two- point of care glucometers with laboratory venous glucose, the reference standard using Bland- Altman plots and Clark error grid method to analyse the results. ResultsThis study included a total of 110 patients (38[34%] women; mean age 52.1 years (SD, 17.3); range 14 to 85 years. Fourteen patients (12%) were known to have diabetes. The mean glucose value (glucometer 1) was 152.9 mg/dL (SD 83.1); range= 48 to 501 mg/dL; that by glucometer 2 was 152.2 mg/dL (SD 76.2); range= 30 to 458 mg/dL and by the laboratory was 148.6 mg/dL (SD 81.5); range= 52 to 480 mg/dL. Of the 110 subjects, 2(2%) had blood glucose below 70 mg/dL; 85(77%) between 70 and 180 mg/ dL and 23(21%) had blood glucose exceeding 180 mg/dL. The Bland- Altman plot showed a bias of 4 mg% (95%CI -9.8 to +1.1); and the limits of agreement were -63 and +54 mg%. The area under the receiver operating characteristic curve for the two glucometers was 0.92 and 0.93 respectively. ConclusionsPoint of care glucose, measured by glucometers was in agreement with the venous glucose estimation. Both glucometers were equally accurate and performed uniformly well across the wide range of blood glucose values.

Association of High Sensitivity C-reactive Protein with Type II Diabetic Retinopathy

Objective: The objective of this study is to find out the association of diabetic retinopathy with serum homocysteine and high sensitivity (hs) CRP levels.&#x0D; Methods: The research was conducted out at the Army Medical College's Department of Physiology and Centre for Research in Experimental and Applied Medicine (CREAM), Rawalpindi, in partnership with the Armed Forces Institute of Ophthalmology, Rawalpindi for a tenure of 12 months. Ninety subjects, were included in the study, thirty in each group: controls, diabetic subjects, and the patients suffering from diabetic retinopathy (DR).&#x0D; Results: Healthy controls, diabetic subjects, and patients with DR were found to have mean Fasting Blood Glucose (FBG) values of 5.51 0.34 (mmol/l), 8.11 0.67 (mmol/l), and 8.73 0.90 (mmol/l), respectively (p=0.001). The mean HbA1c level in normal subjects was noted as 5.08 ± 0.27 in healthy controls as compared to 7.70 + 0.89 (mmol/l)) in diabetic subjects and 9.02 + 1.76 (mmol/l) in patients with DR (p=0.001 by ANOVA). &#x0D; In normal subjects, the mean hs CRP levels were noted to be 3.74 + 1.97 (mg/l) in healthy controls as compared to 15.32 + 2.93 (mg/l) in diabetic subjects and 26.71 + 4.88 (mg/l) in patients with diabetic retinopathy (p=0.001 by ANOVA).&#x0D; Conclusion: During the study, it was found that elevated levels of these inflammatory biomarkers can accurately predict the onset of diabetic retinopathy and that hs CRP levels are strongly related with the development of diabetic retinopathy. Monitoring these inflammatory signs in the serum can therefore help prevent diabetic microangiopathic consequences, including DR.

Comparison of Point Accuracy Between Two Widely Used Continuous Glucose Monitoring Systems.

Safe and effective self-management of glucose levels requires immediate access to accurate data. We assessed the point accuracy of the Dexcom G7 Continuous Glucose Monitoring System (Dexcom, Inc., San Diego, CA, USA) and FreeStyle Libre 3 (Abbott Diabetes Care, Alameda, CA, USA) sensors in a head-to-head comparison. Multicenter, single-arm, prospective, nonsignificant risk evaluation enrolled adults (≥ 18 years) with diagnosed type 1 diabetes (T1D) or type 2 diabetes (T2D). Accuracy was assessed by comparing sensor data to laboratory reference values Yellow Springs Instrument [YSI] and capillary blood glucose values. Outcome measures were differences in mean absolute relative difference (MARD), number and percentage of matched glucose pairs within ±20 mg/dL/±20 of reference values within glucose ranges: < 54, 54 to 69, 70 to 180, 181 to 250, > 250 mg/dL, and combined. Data from 55 adults were included in the analysis. Analysis showed significantly lower MARD with the FreeStyle Libre 3 sensor vs the Dexcom G7 sensor (8.9% vs 13.6%, respectively, P < .0001) with a higher percentage of glucose values within ±20 mg/dL/±20 of reference (91.4% vs 78.6%). The MARD values for both continuous glucose monitoring (CGM) sensors were similar during the first 12 hours; however, the FreeStyle Libre 3 MARD was notably lower than the Dexcom G7 MARD during the next 12 hours (10.0% vs 15.1%, respectively, P < .0001) and throughout the study period. The FreeStyle Libre 3 sensor was more accurate than the Dexcom G7 sensor in all metrics evaluated throughout the study period. This is the first head-to-head study to our knowledge that compares the flagship products currently in widespread use of the two largest CGM manufacturers.

A Minimized Measurement Scheme for Predicting HbA1c Using Discrete Self-Monitoring Blood Glucose Data Within 4 Weeks for People with Type 2 Diabetes.

Objective: To establish an accurate and robust calculation model for predicting hemoglobin A1c (HbA1c) for people with type 2 diabetes (T2D) by using the fewest discrete blood glucose values according to an irregular data set and propose an appropriate cost-effective and scientific scheme for routine blood glucose monitoring. Methods: By using two data sets obtained from 2017 to 2022, which involved 2432 people with T2D, ∼420,000 irregular blood glucose values, and 10,000 HbA1c values, multiple blood glucose monitoring schemes were designed and compared to find the optimal one. The data were structured and then fitted using a regularized extreme learning machine, and the results were evaluated on the basis of indicators such as mean absolute error (MAE), root mean square error, and the relevance analysis (R) value; the optimal scheme for routine blood glucose monitoring was determined by combining the accuracy and the cost and was compared with previous studies in terms of accuracy and stability. Results: Data fitting results for the chosen scheme: R = 0.8029 (P < 0.001), MAE = 0.3181% (95% confidence interval, 0.2666-0.3695%). Within the last 4 weeks before the prediction of HbA1c, a minimum of only seven fasting and seven postprandial blood glucose values are needed, of which are one fasting and one postprandial blood glucose values per 4 days. Compared with previous studies, the prediction model shows better accuracy and stability (P < 0.05), especially under the great glucose fluctuation group. Conclusion: A minimized calculation model for accurately and robustly predicting HbA1c using discrete self-monitoring of blood glucose data within 4 weeks for people with T2D has been established and provides a new reference for the design of a scheme for blood glucose monitoring. The diabetes care clinic of Peking University First Hospital (Registration Number: ChiCTR2300068139).

Intuitive eating was associated with anxiety, depression, pregnancy weight and blood glucose in women with gestational diabetes mellitus: a prospective longitudinal study.

Outside of pregnancy, intuitive eating (IE) is associated with lower body weight, blood glucose, and higher positive mood. However, little was known about the relationship between IE and anxiety-depression in the GDM population. Thus, this study aimed to investigate the association of IE with anxiety and depression, pregnancy weight and pregnancy blood glucose in the first and second GDM visit. Data from 310 pregnant women with GDM from the Fujian Maternal and Child Health Hospital Trial (Approval Number: 2020Y9133) were analyzed. IE was assessed using the Intuitive Eating Scale-2 subscales of Eating for Physiological Reasons rather than Emotional Reasons (EPR), Relying on Hunger and Satiety Cues (RHSC) and Body-Food Choice Consistency (B-FCC). Observations included weight, body mass index (BMI), fasting plasma glucose (FPG) and 2-h postprandial blood glucose; the Hospital Anxiety and Depression Scale (HADS) was used to assess the level of anxiety and depression in pregnant women with GDM. Linear regression analysis was used to assess the correlation between IE and anxiety, depression, pregnancy blood glucose and weight. The cross-sectional analysis showed that the EPR eating behavior was negatively correlated with anxiety and depression, and the B-FCC eating behavior was negatively correlated with depression at both the first and second GDM visit; in addition, the B-FCC eating behavior was associated with lower BMI in the third trimester (all p < 0.05). In longitudinal analyses, the EPR eating behavior in the first visit for GDM predicted lower levels of anxiety and depression in the second GDM visit, whereas the RHSC eating behavior in the first visit for GDM was associated with lower FPG in the second GDM visit (all p < 0.01). These results suggest that practicing intuitive eating may be beneficial and that higher intuitive eating adherence can lead to lower levels of anxiety and depression and more ideal gestational weight and blood glucose values.

Improvement of blood glucose control and reduction of hypoglycemia, body weight, and C-reactive protein in type 1 diabetic patients treated with intensive insulin therapy with insulin analogs

Background/Aim. Good metabolic control can delay the onset and progression of chronic complications of diabetes mellitus (DM). Intensified insulin therapy (IIT) is the cornerstone of good metabolic control in the treatment of type 1 DM (T1DM) while avoiding hypoglycemia and body weight (BW) gain in those patients. The aim of the study was to assess the effects of IIT with insulin analogs (aspart and glargine) in T1DM patients. Methods. This prospective clinical study included 49 patients with at least one year of T1DM duration, who were on IIT with human insulin at that moment. They commenced therapy with insulin aspart for three months, followed by insulin glargine for another three months. An analysis of blood glucose (BG) control (glycated hemoglobin ? HbA1c, mean BG, fasting BG, postprandial BG, and glycemic variability) and analysis of BW, hypoglycemia, and C-reactive protein (CRP) levels were performed. Results. The HbA1c level decreased slightly (non-significantly) after three months of insulin aspart therapy (from 9.28% to 8.83%) and decreased significantly after the aspart/glargine combination (to 8.08%; p &lt; 0.001). After the first three months with aspart therapy, a significant reduction in postprandial BG was noted after all three main meals. The mean postprandial rise of BG was significantly reduced. The variability of daily BG was significantly reduced (standard deviation of BG fell from 2.28 mmol/L to 1.90 mmol/L; p &lt; 0.05). The mean BG value in the profiles decreased (from 9.11 mmol/L to 8.31 mmol/L; p &lt; 0.05). All BG values in the profiles after six months were statistically significantly lower compared to the initial values, as well as the mean BG (6.88 mmol/L; p &lt; 0.001) and the variability of daily BG (1.49 mmol/L; p &lt; 0.01). Our results showed a significant reduction in the number of hypoglycemias after three months, especially after the introduction of insulin glargine therapy (significant reduction in the number of symptomatic, asymptomatic, and nocturnal hypoglycemias). The results showed a discrete but significant reduction in BW and a significant reduction in CRP levels (from 3.43 mg/L to 2.25 mg/L; p &lt; 0.001). Conclusion. Treatment of patients with T1DM with insulin analogs (insulin aspart and insulin glargine) in IIT leads to improved BG control with a reduction in the number of hypoglycemia, BW, and CRP levels.

Obesity and heart failure with preserved ejection fraction.

Aim: To perform an overall assessment of heart failure with preserved ejection fraction (HFpEF) adults with central obesity. Materials and Methods: We enrolled HFpEF patients with central obesity (n =73, mean age 52.4 ± 6.3 years) and without obesity (n =70, mean age 51.9 ± 7.1 years) and compared with an age-matched healthy subjects who had not suffered from HF (n = 69, mean age 52.3 ± 7.5 years). Physical examination, routine laboratory tests such as fasting blood glucose, fasting insulin, insulin resistance (HOMA) index, serum lipids, haemoglobin, creatinine, ALT, AST, uric acide, hs CRP, TSH, N-terminal proB-type natriuretic peptide (NT-proBNP) and standard transthoracic echocardiogram (2D and Doppler) examinations were performed and assessed. Results: The average values of diastolic blood pressure (DBP), glucose and lipid profiles, uric acide, hs CRP were found to be significantly higher among obese patients with HFpEF than non-obese. Despite more severe symptoms and signs of HF, obese patients with HFpEF had lower NT-proBNP values than non-obese patients with HFpEF (129±36.8 pg/ml, 134±32.5 pg/ml vs 131±30.4 pg/ml, 139±33.8 pg/ml respectively; p < 0.05). However, it was found that patients with high central (visceral) adiposity have more pronounced obesity-related LV diastolic dysfunction, lower E/e' ratio, lower mitral annular lateral e' velocity, an increased LV diastolic dimension and LV mass index. Compared with non-obese HFpEF and control subjects, obese patients displayed greater right ventricular dilatation (base, 35±3.13 mm, 36±4.7 mm vs 33±2.8 mm, 34±3.2 mm and 29±5.3 mm, 30±3.9 mm; length, 74±5 mm, 76±8 mm vs 67±4 mm, 69±6 mm and 60±3 mm, 61±5 mm respectively; p < 0.05), more right ventricular dysfunction (TAPSE 16±2 mm, 15±3 mm vs 17±2 mm, 17±1 mm and 19±2 mm, 20±3 mm respectively; p < 0.05). Conclusions: Obese patients with HFpEF have higher diastolic BP, atherogenic dyslipidemia, insulin resistance index values and greater systemic inflammatory biomarkers, despite lower NT-proBNP values, which increase the risk of cardiovascular events in future. Echocardiography examination revealed not only significant LV diastolic dysfunction, but also displayed greater RV dilatation and dysfunction.

Enhanced blood glucose levels prediction with a smartwatch.

Ensuring stable blood glucose (BG) levels within the norm is crucial for potential long-term health complications prevention when managing a chronic disease like Type 1 diabetes (T1D), as well as body weight. Therefore, accurately forecasting blood sugar levels holds significant importance for clinicians and specific users, such as type one diabetic patients. In recent years, Continuous Glucose Monitoring (CGM) devices have been developed and are now in use. However, the ability to forecast future blood glucose values is essential for better management. Previous studies proposed the use of food intake documentation in order to enhance the forecasting accuracy. Unfortunately, these methods require the participants to manually record their daily activities such as food intake, drink and exercise, which creates somewhat inaccurate data, and is hard to maintain along time. To reduce the burden on participants and improve the accuracy of BG level predictions, as well as optimize training and prediction times, this study proposes a framework that continuously tracks participants' movements using a smartwatch. The framework analyzes sensor data and allows users to document their activities. We developed a model incorporating BG data, smartwatch sensor data, and user-documented activities. This model was applied to a dataset we collected from a dozen participants. Our study's results indicate that documented activities did not enhance BG level predictions. However, using smartwatch sensors, such as heart rate and step detector data, in addition to blood glucose measurements from the last sixty minutes, significantly improved the predictions.