Blood Glucose Values Research Articles

5180 Atypical Presentation of Type 2 Diabetes Mellitus in a 72Year Old Caucasian Male with Hemoglobin J-Baltimore Variant: A Case Report

Abstract Disclosure: C. Muojieje: None. M. Luzuriaga: None. Objective: This case report discusses the unusual manifestation of Type 2 Diabetes Mellitus (T2DM) in a 72-year-old Caucasian male possessing a rare Hemoglobin variant, Hemoglobin J-Baltimore. It emphasizes the importance of recognizing how hemoglobin variants can impact HbA1c measurements. Alternative markers, such as fructosamine and HbA1c measurement using turbidimetric inhibition immunoassay (TINIA), are discussed as potential tools for a more precise assessment of glycemic control. Furthermore, it accentuates the effectiveness of tailored treatment strategies in such cases. Methods: A 72-year-old Caucasian male with a history of T2DM was referred to an endocrinology clinic due to substantial discordance between the blood glucose (BG) values when self-monitoring and HbA1c. The patient was diagnosed with T2DM a decade ago due to fasting hyperglycemia. His HbA1c levels had remained within normal range. He exhibited signs of diabetic nephropathy with moderately increased albuminuria. He was never prescribed an oral hypoglycemic agent. He reported polyuria, weight loss, and fatigue, prompting him to monitor his BG at home twice daily, revealing readings > 200 mg/dl. HbA1c measurement using high-performance liquid chromatography (HPLC) was 4.8%. His fasting plasma glucose was 190 mg/dl, and fructosamine levels were 292 umol/L (205 - 285 umol/L). An HbA1c level via TINIA was 6.4%. Hemoglobin electrophoresis unveiled the presence of Hemoglobin J-Baltimore. We started metformin, resulting in an improvement in HbA1c from 6.4% to 5.8%. Fructosamine levels improved from 292 umol/L to 210 umol/L. Fasting blood glucose remained > 150 mg/dl. Dulaglutide was introduced. Follow-up analysis showed an improvement in FBS to < 120 mg/dl. HbA1c remained unchanged at 5.9%. Conclusion: The significance of hemoglobin variants, exemplified by Hemoglobin J-Baltimore, cannot be overstated in the context of patients with T2DM, especially within populations where these variants are uncommon. This case underscores the need for a nuanced approach to glycemic control assessment in such individuals. The utilization of alternative markers, such as HbA1c values obtained through TINIA, emerges as a valuable strategy. The role of continuous glucose monitoring (CGM) is crucial, providing real-time and comprehensive data, which enhances the quality of care and contributes to more tailored and effective treatment strategies. Presentation: 6/1/2024

6938 An Unusual Case of New-onset autoimmune insulin dependent Diabetes Mellitus Complicating Gestational Diabetes Mellitus in A Pregnant Female Diagnosed Early Postpartum - The Enigma of Autoimmunity and Diabetes During Pregnancy

Abstract Disclosure: R. Abdelmasih: None. W. Pan: None. Introduction: Gestation diabetes is the most common metabolic disorder in pregnancy affecting 25% of pregnancies. T1DM accounts for 0.2-0.5% of all pregnancies in the United States yearly. New-onset autoimmune insulin-dependent diabetes mellitus during pregnancy is very uncommon and it might be overlooked. Diabetes-related autoantibodies have been studied in women with GDM with prevalence of 0-10%. There is controversial data regarding the clinical significance of checking diabetes antibodies in pregnancy. Case Presentation: A 22-year-old G1P1 female with history of Hashimoto hypothyroidism presented during early second trimester for evaluation of GDM with serum glucose of 300s mg/dl in a random blood sample with multiple subsequent high values, hemoglobin A1C of 9.4% (prepartum value was 5.3%). Patient was started on insulin during pregnancy. Pregnancy was complicated with cesarian section and macrosomia. 1 week postpartum, A1c was 5.4%, Insulin was discontinued, and patient was continued on Metformin. 2 months Postpartum, patient presented with persistent high blood glucose values of 300-400 mg/dl with no signs of DKA. Glipizide and Glargine 15 units daily were added though patient continued to have hyperglycemia. Laboratory workup were remarkable for high blood glucose of 342 mg/dl, low C peptide of 0.6 ng/dl, and positive glutamic acid decarboxylase antibodies (GAD Ab) 38.8 U/ml. oral antidiabetics were discontinued and prandial insulin was added. Discussion: GDM is a risk factor for DMII after pregnancy given high insulin resistance postpartum, Data regarding new-onset DMI and diabetes autoimmunity during pregnancy is lacking. About 0-10% of women with gestational diabetes develop DM autoantibodies. GAD Ab exhibits the highest sensitivity of 63% for type 1 diabetes prediction compared to Islet cell antibodies (48%), and tyrosine phosphatase-related islet antigen 2 (34%). Pathophysiology of autoimmune DM during pregnancy is not quite understood; It is thought that when autoimmune tendency is present, GDM causes β-cells to deteriorate due to excessive insulin production in setting of insulin resistance, and the burden of third-trimester gestation may cause the insulin deficiency to be expressed sooner than non-pregnant female. So far, Literature about the predictive value or specific clinical features of checking diabetes autoantibodies is discordant and inconclusive. It is suggested to screen for autoantibodies only when array of clinical hallmarks suggestive of an autoimmune DM form of GDM present as young age, low BMI, need for insulin therapy early in pregnancy, presence of ketones, concurrent other autoimmune conditions (e.g., thyroiditis). This case is to shed light on autoimmunity in pregnancy. More data is needed with longer follow-up to better identify women at risk, their characteristics, indications for autoantibodies testing, follow and prognosis. Presentation: 6/2/2024

Analysis of the Clinical Efficacy of Glimepiride Combined with Insulin in the Treatment of Elderly Diabetes

Objective: To explore the clinical efficacy and incidence of hypoglycemia in the treatment of elderly diabetes with glimepiride combined with insulin. Methods: A total of 100 patients diagnosed with diabetes in Qinghai Red Cross Hospital from January 2018 to January 2019 were selected and divided into an observation group and a control group according to the order of their visits, with 50 patients in each group. The observation group was treated with glimepiride combined with insulin, while the control group was treated with insulin alone. The blood sugar indicators, including glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and 2-hour postprandial blood glucose (2h PBG), were compared between the two groups. Additionally, the incidence of hypoglycemia was compared, and the causes of hypoglycemia were analyzed and summarized, proposing corresponding countermeasures. Results: The glycated hemoglobin value of the observation group was lower than that of the control group, and the statistical analysis showed a significant difference (t = 3.54, P < 0.05). The fasting blood glucose value in the observation group was lower than that in the control group, with statistically significant differences (t = 4.08, P < 0.05). The 2-hour postprandial blood glucose value in the observation group was also lower than that in the control group, with a significant difference (t = 3.82, P < 0.05). The incidence of hypoglycemia in the observation group was 10%, while it was 56% in the control group, with a statistically significant difference between the two groups (χ2 = 5.813, P < 0.05). Conclusion: The efficacy of glimepiride combined with insulin in the treatment of elderly diabetes is significantly higher than that of insulin alone, with a lower incidence of hypoglycemia.

The Oldest of Old Male C57B/6J Mice Are Protected from Sarcopenic Obesity: The Possible Role of Skeletal Muscle Protein Kinase B Expression

The impact of aging on body composition and glucose metabolism is not well established in C57BL/6J mice, despite being a common pre-clinical model for aging and metabolic research. The purpose of this study was to examine the effect of advancing age on body composition, in vivo glucose metabolism, and skeletal muscle AKT expression in young (Y: 4 months old, n = 7), old (O: 17–18 months old, n = 10), and very old (VO: 26–27 month old, n = 9) male C57BL/6J mice. Body composition analysis, assessed by nuclear magnetic resonance, demonstrated O mice had a significantly greater fat mass and body fat percentage when compared to Y and VO mice. Furthermore, VO mice had a significantly greater lean body mass than both O and Y mice. We also found that the VO mice had greater AKT protein levels in skeletal muscle compared to O mice, an observation that explains a portion of the increased lean body mass in VO mice. During glucose tolerance (GT) testing, blood glucose values were significantly lower in the VO mice when compared to the Y and O mice. No age-related differences were observed in insulin tolerance (IT). We also assessed the glucose response to AMPK activation by 5-aminoimidazole-4-carboxamide-1-β-D-ribofuranoside (AICAR). The change in blood glucose following AICAR administration was significantly reduced in VO mice compared to Y and AG mice. Our findings indicate that lean body mass and AKT2 protein expression in muscle are significantly increased in VO mice compared to O mice. The increase in AKT2 likely plays a role in the greater lean body mass observed in the oldest of old mice. Finally, despite the increased GT, VO mice appear to be resistant to AMPK-mediated glucose uptake.

Major cardiovascular and neurological events among diabetic patients with severe hypoglycaemia at a tertiary care hospital in Bangladesh

Background: Cardiovascular disease (CVD) is a major cause of death and disability among people with diabetes mellitus (DM). Hypoglycemia is a potential risk factor to augment life threatening CVD. This study intended to find out impact of severe hypoglycemia in adverse cardiovascular and neurological events among patients with DM. Methods: This cross-sectional study was conducted among diabetic patients with severe hypoglycemia (plasma glucose <70 mg/dl or 3.9 mmol/l) admitted in BIRDEM General Hospital from March 2014 to April 2015. Patients were categorized into two groups depending on blood glucose values (group A <2.8 and group B e”2.8) for analytical purpose. Major cardiac events including acute myocardial infarction (MI), non ST elevated MI or arrhythmia were observed along with neurological outcome including acute stroke, hypoglycemic encephalopathy and convulsion by both relevant clinical examinations and investigations as appropriate. Data were collected at discharge or death if any. Results: Among the 311 patients, 62% were in the age group of 51 to 60 years with mean age 49.02 years. Mean duration of DM was 8.5 (±5.4) years and in 85.5% cases HbA1c was e”7%. Majority was on insulin (79.41%); predominantly on premixed (33.5%) and self mixed (35.7%) regime. Meal related factors (p <0.001) e.g., delayed or missed meal, insulin related factors (p<0.001) e.g., miscalculation, overdosing were significant predisposing factors for developing hypoglycemia. Multivariate analysis revealed frequency of hypoglycemia was more in diabetic nephropathy (p<0.01), chronic liver disease (p=0.01), gastroparesis (p=0.01), cognitive impairment (p<0.001), established CVD (p=0.02) and adrenal insufficiency (p<0.01). Nocturnal hypoglycemia (33.80% ) and hypoglycemic unawareness (44.23%) was also observed among the participants. Cardiovascular events were found in 98 (31.55%) individuals which included any form of arrhythmia (p=0.02), non ST elevated MI (p=0.08) and ST elevated MI (p<0.008). Among the neurological events (n=67, 21.54%), hypoglycemic encephalopathy (p<0.02) and acute stroke (p=0.01) were significant. Seizure happened in 15 individuals (p=0.53). Nine patients died (death rate 2.89%). Predominant cause of death was acute MI (6, 66%) and hypoglycemic encephalopathy (3, 33.33%). Conclusion: The major finding of this study suggest that severe hypoglycemia is strongly associated with fatal cardiovascular and neurological events including MI, acute stroke and hypoglycemic encephalopathy in diabetic patients predominantly treated with insulin. Mortality was found in 2.89% participants. Co morbidities including renal disease, liver disease, gastroparesis, cognitive impairment increased the vulnerability of developing severe hypoglycemia. In most of the cases, lifestyle factors are the precipitating causes of hypoglycemia, which are readily recognizable and easily modifiable. Therefore, appropriate diabetic education and periodic reevaluation of patient’s knowledge, attitude and practice towards hypoglycemia is of utmost importance to prevent this common but life-threatening complication. BIRDEM Med J 2024; 14(3): 118-123

Amylase intrapancreatic infusion delays insulin release during an intravenous glucose tolerance test, proof of acini-islet-acinar interactions.

The possible existence of an acini-islet-acinar (AIA) reflex, involving mutual amylase and insulin interactions, was investigated in the current acute experiment on pigs. To confirm the existence of an AIA reflex and justify the placement of the exocrine and endocrine pancreatic components within the same organ. The study was performed on six pigs under general anesthesia. An intravenous glucose tolerance test was performed, with a bolus infusion of 50% glucose to the jugular vein, while amylase (5000 U/kg) or vehicle intrapancreatic infusions were administered via the pancreaticoduodenalis cranialis artery during 30 min with a 1 mL/min flow rate. The amylase infusion to pancreatic arterial circulation inhibited and delayed the insulin release peak which is usually associated with the highest value of blood glucose and is typically observed at 15 min after glucose infusion, for > 1 h. The intrapancreatic infusion of the vehicle (saline) did not have any effect on the time frame of insulin release. Infusion of 1% bovine serum albumin changed the insulin release curve dramatically and prolonged the high range of insulin secretion, far beyond the glucose peak. Intrapancreatic arterial infusion of amylase interrupted the integrated glucose-insulin interactions. This confirms an AIA reflex and justifies placement of the exocrine and endocrine pancreatic components within the same organ.

Effect of Infection on the Incidence of Hyperglycemic Hemichorea: A Case-Series.

To explore the effect of infection on hyperglycemic hemichorea. The clinical data of 11 patients with hyperglycemic hemichorea admitted to the Affiliated People' s Hospital of Xinxiang Medical College and the Second People's Hospital of Xinxiang were retrospectively analyzed, including gender, age, clinical symptoms, imaging features, blood glucose, glycated hemoglobin, infection indicators, and treatment conditions. Eleven patients had acute or sub-acute onset, including 9 females and 2 males, with an average age of 74.55 years. Nine patients presented with unilateral limb involuntary movement and 2 patients presented with bilateral limb involuntary movement. Imaging findings of 9 patients showed abnormalities in the basal ganglia region. Random blood glucose levels were all elevated at admission, with an average blood glucose value of 26.20 mmol/l. Urine ketone bodies were positive in 2 patients, inflammatory indexes were elevated in 7 patients, symptoms of hypoglycemic treatment and anti-infection treatment in 10 patients disappeared, and symptoms of 1 patient disappeared after improved microcirculation treatment. The disease tends to occur in middle-aged and elderly women, and the blood glucose may fluctuate significantly during the onset. Infection may lead to the occurrence and development of the disease. Active control of blood sugar, inflammation and improvement of brain metabolism can effectively control symptoms and prevent recurrence.

Performance of a Novel Continuous Glucose Monitoring Device in People With Diabetes.

In this multicenter study, performance of a novel continuous glucose monitoring (CGM) system was evaluated. Adult participants with diabetes were included in the study. They each wore three sensors of the CGM system on the upper arms for up to 14 days. During four in-clinic visits, frequent comparison measurements with capillary blood glucose (BG) samples were performed. The primary endpoint was the 20/20 agreement rate (AR): the percentage of CGM readings within ±20 mg/dL (at BG values <100 mg/dL) or ±20% (at BG values ≥100 mg/dL) of the comparator. Further evaluations included mean absolute relative difference (MARD) and 20/20 AR in different BG ranges and across the wear time. Data from 48 participants and 139 sensors were analyzed. During in-clinic sessions the 20/20 AR was 90.5% and the MARD was 9.2%. For BG ranges <70, 70-180, and >180 mg/dL, 20/20 AR was 94.3%, 89.0%, and 92.5%, respectively. At the beginning, middle, and end of sensor wear time, 20/20 AR was 92.8%, 91.5%, and 85.9%, respectively. The 14-day survival probability was 82.4%. Pain and bleeding after sensor insertion were within the expected range. Based on the study outcome, the use of the device is regarded as safe. The system showed a good performance compared to capillary BG measurements. This level of accuracy could be shown over the entire measurement range, especially in the low glycemic range, and the whole wear time of the sensors. The results of this study are supporting a non-adjunctive use of the device.

Development of ZnFe(PBA)@Mo3C2Tx Nanohybrid based Non‐Enzymatic Sensor for the Detection of Glucose in Human Sweat

AbstractZnFe (PBA)@Mo3C2Tx is prepared by in‐situ sonication method using ZnFe Prussian blue analogue infused with Mo3C2Tx (MXene) to use as a non‐enzymatic glucose sensor owing to its low cost and biocompatibility. The synthesized ZnFe (PBA)@Mo3C2Tx is characterized for its physical and chemical characterization by XRD, Raman, XPS, EDAX, and FESEM analyses, revealing a functionalized multiple‐layered structure with a cubic nano‐hybrid arrangement. This sensor has undergone electroanalytical investigation, including cyclic voltammetry and chronoamperometry analysis. The electrochemical performance of ZnFe(PBA)@Mo3C2Tx exhibits an excellent analytical performance with a sensitivity of 818.285 μA mM−1 cm−2 and the limit of detection (LOD) of 1.6 μM (S/N=3). The analysis of glucose in human sweat samples, compared with their corresponding blood glucose values, yield a relative standard deviation (RSD) of 2.98 %.

A new classification method for gestational diabetes mellitus: a study on the relationship between abnormal blood glucose values at different time points in oral glucose tolerance test and adverse maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus

BackgroundGestational diabetes mellitus (GDM) can lead to various adverse pregnancy outcomes for both mothers and infants, including gestational hypertension, premature rupture of membranes, preterm birth, macrosomia, large for gestational age (LGA) infants, and neonatal hypoglycemia. Previous studies have mainly focused on the overall risk of GDM for adverse maternal and neonatal outcomes, but there has been limited research specifically investigating the relationship between different patterns of abnormal oral glucose tolerance test (OGTT) results and adverse maternal and neonatal outcomes. ObjectiveThe study aimed to analyze the maternal and neonatal outcomes among GDM women with different OGTT patterns and to explore a new classification method capable of stratifying GDM into high-risk (GDM-HR) and low-risk subtypes based on OGTT results. Study DesignWe conducted a retrospective cohort study at the Women's Hospital, School of Medicine, Zhejiang University, spanning from November 1, 2015, to April 30, 2018. During the study period, a total of 3268 cases of GDM were enrolled. Based on the results of the OGTT, these GDM cases were classified into 7 subtypes, and the composition ratio of each subtype and their maternal and neonatal outcomes were analyzed. Innovatively, we proposed to categorize GDM-HR (characterized by elevated fasting blood glucose [FBG] levels, including T0, T0+1, T0+2, and T0+1+2) and low-risk GDM (GDM-LR, without elevated FBG, including T1, T2, and T1+2) and compared the maternal and neonatal outcomes between the two subtypes. Results(1) In this cohort of 3268 GDM cases, the composition ratios of the 7 GDM subtypes were as follows: T0 (7.9%, n=260), T1 (24.2%, n=791), T2 (27.4%, n=897), T0+1 (5.4%, n=175), T0+2 (1.7%, n=56), T1+2 (26.2%, n=855), and T0+1+2 (7.2%, n=234). (2) GDM subtypes with elevated FBG levels (GDM-HR) exhibit more severe adverse prognostic outcomes compared to those without elevated FBG levels (GDM-LR). (3) Multiple logistic regression analysis revealed that compared to the GDM-LR group, the GDM-HR group showed increased fetal birth weight (by approximately 150 grams), and had higher rates of cesarean section (adjusted odds ratio [aOR]: 1.45, 95% confidence interval [CI]: 1.19–1.76), hypertensive disorders of pregnancy (aOR: 1.78, 95% CI: 1.35–2.35), preterm birth (aOR: 1.59, 95% CI: 1.17–2.16), macrosomia (aOR: 2.66, 95% CI: 2.07–3.43), LGA infants (aOR: 2.46, 95% CI: 2.05–2.97), and neonatal hypoglycemia (aOR: 2.00, 95% CI: 1.37–2.91). Partial correlation analysis shows a positive correlation between fetal birth weight and FBG levels, with r=0.222, P<.001. Multiple linear regression indicates that for every 1 mmol/L increase in FBG, the fetal weight is estimated to increase by approximately 188 grams. ConclusionThe composition ratio of GDM subtypes with elevated FBG (GDM-HR) is relatively low within GDM cases, yet it presents with a higher risk of adverse outcomes compared to subtypes without elevated FBG (GDM-LR), warranting increased attention from obstetricians. Applying this new classification method in clinical practice enables better differentiation and individualized management of GDM.

Evaluation of risk factors for long-term atrial fibrillation development in patients undergoing typical atrial flutter ablation: amulticenter pilot study.

Atrial flutter (AFL) and atrial fibrillation (AF) are the most commonly detected supraventricular arrhythmias and share similar pathophysiological mechanisms. After the successful ablation of AFL, AF frequently occurs in the long-term follow-up. As emphasized in some studies, certain mechanisms seem to predispose to the development of AF in AFL patients, and approximately 20% of these patients have accompanying AFL. We aimed to analyze independent risk factors that predict the development of AF in patients who underwent typical AFL ablation. This was a multicenter, cross-sectional, and retrospective study. Atotal of 442 patients who underwent typical AFL ablation at three different centers between January1, 2018 and January1, 2022 were included retrospectively. After the ablation procedure the patients were divided into those who developed AF and those who did not. The patients were followed up for an average of 12(4-20) months. In the post-procedural period, atrial arrhythmias were investigated with 24‑h Holter and ECG at 1month, 6months, and 12months and then at 6‑month intervals thereafter. Overall, AF developed in 206 (46.6%) patients in the long-term follow-up. Age, hypertension (HT), obstructive sleep apnea syndrome (OSAS), previous cerebrovascular accident (CVA), left atrium anteroposterior diameter, severe mitral regurgitation, hemoglobin, blood glucose, and HbA1c values were found to be significant in univariable analysis. According to multivariable analysis, HT (p = 0.014; HR: 1.483 [1.084-2.030]), OSAS (p = 0.008; HR: 1.520 [1.117-2.068]) and previous CVA (p = 0.038; HR: 1.749 [1.031-2.968]) were independently associated with the development of AF in AFL patients who underwent ablation procedure. In the present study, we found that HT, OSAS, and previous CVA were independently correlated with the development of AF in the long-term follow-up of patients who underwent typical AFL ablation. We consider that AFL patients with such risk factors should be followed up closely following cavotricuspid isthmus ablation for the development of AF.

The Effect of Nursing Counseling on Treatment Compliance: Acute Coronary Syndrome and Diabetes Mellitus.

The comorbidity of acute coronary syndrome and diabetes affects patient prognoses. Therefore, it is important to manage these diseases simultaneously. In this study, the effect of nursing counseling on treatment compliance was investigated in patients who had received surgical treatment for acute coronary syndrome and had been recently diagnosed with diabetes. A quasi-experimental design with pretest-posttest control group was used. The study sample consisted of 60 patients (intervention group = 30, control group = 30). The data were collected using a patient information form, the Patient Learning Needs Scale, and the Scale for Patient Compliance with Type 2 Diabetes Mellitus Treatment. This study was conducted in compliance with the Transparent Reporting of Evaluations with Nonrandomized Designs checklist. The intervention group earned significantly higher posttest scores on the Patient Learning Needs total scale and subscales than the control group. Moreover, intervention group compliance with treatment was higher than that of the control group. Furthermore, although significant improvements were found in the average posttest body mass index, fasting blood glucose, HbA1c, total cholesterol, triglyceride, and low-density lipoprotein cholesterol values of the control group, the between-group differences in these values were not significant. It is important for nurses to provide counseling services that align with the learning needs of their patients. Also, nursing counseling units should be created and staffed by both specialist nurses and nurse trainers working in healthcare institutions.

The sodium correction factor for dogs undergoing treatment for a hyperglycemic crisis is a 1.6-mEq/L decrease in sodium per 100-mg/dL increase in glucose.

To determine the sodium correction factor for clinical use in hyperglycemic diabetic dogs. Retrospective analysis of 76 hospitalization episodes from 67 different dogs presenting to the University of Georgia Veterinary Teaching Hospital between January 1, 2015, and January 1, 2023. For each hospitalization episode, paired blood sodium and glucose concentration measurements were recorded from the time of presentation until glucose concentration was ≤ 201 mg/dL. Therapies administered, primary diagnosis, and concurrent diseases were also recorded for each episode. A linear mixed model was used to determine the sodium correction factor per 100-mg/dL increase in glucose. Piecewise linear mixed models were also constructed for blood glucose measurements ≤ 400 mg/dL and > 400 mg/dL to explore potential correction factor differences between low and high glucose concentrations. A sodium correction factor of a 1.6-mEq/L (95% CI, 1.3 to 1.9 mEq/L) decrease in sodium concentration per 100-mg/dL increase in blood glucose concentration was calculated. Differences in the correction factor between conditions of low and high glucose concentrations could not be determined due to a small sample size of blood glucose values > 400 mg/dL. Most dogs received similar treatments throughout the study period, including balanced isotonic crystalloids (97% [74/76]), electrolyte supplementation (84% [64/76]), and regular insulin (97% [74/76]). Almost all patients (93% [71/76]) had 1 or more concurrent diseases. A sodium correction factor of 1.6 mEq/L (decrease in sodium per 100-mg/dL increase in glucose) is recommended for clinical use in hyperglycemic diabetic dogs.

The Effect of Carbonhydrate Mouth Rinse on the Endurance Performance in Football Players

The presence of carbohydrates (CHO) in the mouth can enhance performance by stimulating the reward center of the brain. Mouth rinsing with CHO does not cause a potential side effect of gastrointestinal discomfort associated with CHO consumption. Numerous studies have demonstrated that using a carbohydrate solution via mouth rinsing can improve performance in endurance sports. However, research on football is limited, and the effectiveness of this approach in football is uncertain. This placebo-controlled and double-blind study was conducted to evaluate the impact of rinsing the mouth with a 15% CHO solution on endurance performance among football players. Twenty healthy male football players, aged between 20 and 25, participated in the study. Endurance performance was indirectly measured using the results of the Yo-Yo intermittent recovery (IR) test. Blood glucose and lactate levels of the football players were measured before and after the Yo-Yo IR test. They were given either a placebo or a 15% carbohydrate solution to rinse their mouths three times, including before warming up, before the Yo-Yo IR test, and in the middle of the test. There was no significant difference found in the levels of blood lactate, blood glucose, and VO2max values between the two groups (p&amp;gt; 0.05). The study concluded that rinsing the mouth with a 15% CHO solution had no significant impact on the endurance performance of football players.

Assessment of glycemic index of the unripe green papaya in mice

Papaya (Carica papaya L.) is a rich-nutrition fruit include vitamins (A, B and C), carbohydrates, proteins, alkaloids, proteolytic enzymes, and benzyl isothiocyanate. Papaya contains papain, which helps strengthen the constitution of diabetes patients. Its water-soluble fiber can stabilize blood sugar levels, reducing the risk of complications. Papaya has benefits such as lowering blood lipids and softening blood vessels due to the fruit acids it contains, which is advantageous for patients with diabetes complicated by hypertension, arteriosclerosis, and dyslipidemia. Additionally, the proteolytic enzymes in papaya are beneficial for the digestive system. Unripe green bananas have been found to contain a significant amount of resistant starch, giving them potential as a low glycemic index (GI) food. Therefore, the aim of this study was to determine the effects of unripe green papaya on blood glucose regulation. The blood glucose values were measured in C57BL/6 mice before and within 120 minutes after consuming 50 mg of glucose and the grated unripe green papaya containing 50 mg of starch was conducted to calculate the incremental area under the curve (IAUC) for blood glucose changes post-consumption of glucose and the grated unripe green papaya. The results showed that the average IAUC for the grated unripe green papaya was 11,176.67, while the average IAUC for glucose was 7,666.25. According to the GI calculation formula, GI of the grated unripe green papaya was determined to be 146. Therefore, based on the results of this study, these results will be used as the basis for the development of related blood glucose regulation products of the unripe green papaya (Carica papaya L.) in the future.

Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

Social determinants of health (SDOH) have been associated with diabetes risk; however, their association with cardiovascular disease (CVD) events in individuals with diabetes is poorly described. We hypothesized that a greater number of SDOH among individuals with diabetes would be associated with a higher risk of CVD events. The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is a national, biracial cohort of 30,239 individuals ≥45 years old recruited in 2003-2007. We included 6,322 participants with diabetes at baseline, defined as healthcare professional diagnosis, diabetes medication use, or blood glucose values. Seven SDOH that were individually associated with CVD events were included (P<0.20). The outcome was CVD events, a composite of expert-adjudicated myocardial infarction, stroke, or cardiovascular death. We estimated Cox proportional hazard models to examine associations between number of SDOH (0, 1, 2, ≥3) and CVD events. In an age and sex adjusted model, the presence of multiple SDOH significantly increased the risk of any CVD event (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.26 to 1.74 for two SDOH; HR, 1.68; 95% CI, 1.43 to 1.96 for ≥3 SDOH). This finding was attenuated but remained statistically significant in a fully adjusted model (HR, 1.19; 95% CI, 1.01 to 1.40 for two SDOH; HR, 1.27; 95% CI, 1.07 to 1.50 for ≥3 SDOH). Having multiple SDOH was independently associated with an increased risk of CVD events, a finding driven by cardiovascular death. Identifying individuals with diabetes who have multiple SDOH may be helpful for detecting those at higher risk of experiencing or dying from CVD events.

Cut-off value of glycated hemoglobin A1c for detecting diabetic retinopathy in the Chinese population.

Glycated hemoglobin A1c (HbA1c) is considered the most suitable for diabetes mellitus diagnosis due to its accuracy and convenience. However, the effect of HbA1c on diabetic retinopathy (DR) in the Han and Korean populations in Jilin, China, remains inconclusive. To determine the best cut-off of HbA1c for diagnosing DR among the Chinese. This cross-sectional study included 1933 participants from the Yanbian area of Jilin Province, China. Trained investigators employed a questionnaire-based survey, physical examination, laboratory tests, and fundus photography for the investigation. The best cut-off value for HbA1c was established via the receiver operating characteristic curve. The factors associated with HbA1c-associated risk factors were determined via linear regression. The analysis included 887 eligible Chinese Han and Korean participants, 591 of whom were assigned randomly to the training set and 296 to the validation set. The prevalence of DR was 3.27% in the total population. HbA1c of 6.2% was the best cut-off value in the training set, while it was 5.9% in the validation set. In both Chinese Han and Korean populations, an HbA1c level of 6.2% was the best cut-off value. The optimal cut-off values of fasting blood glucose (FBG) ≥ 7 mmol/L and < 7 mmol/L were 8.1% and 6.2% respectively in Han populations, while those in Korean populations were 6.9% and 5.3%, respectively. Age, body mass index, and FBG were determined as the risk factors impacting HbA1c levels. HbA1c may serve as a useful diagnostic indicator for DR. An HbA1c level of 6.2% may be an appropriate cut-off value for DR detection in the Chinese population.

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.

Linalool exerts antioxidant activity in a rat model of diabetes by increasing catalase activity without antihyperglycemic effect.

Diabetes mellitus (DM) is a prevalent metabolic disorder often accompanied by oxidative stress, which contributes to various diabetic complications. Investigating the antioxidant activity of linalool (LIN) is crucial as it may offer a natural therapeutic approach to mitigate oxidative damage in DM. The aim of the present study was to investigate the antioxidant activity of LIN in a DM rat model. A total of 40 male Wistar albino rats (age, 8 weeks; weight, 250-300 g) were used. CONTROL and DM groups were administered physiological saline solution by oral gavage for 21 days. In rats in the DM + LIN and LIN groups, 100 mg/kg LIN was administered intragastrically after streptozotocin injection (n=10 per group). In the first (48 h after STZ injection), second (1 week later), third (2 weeks later), and fourth (3 weeks later) blood glucose measurements, a statistically significant increase was found in the blood glucose values of the DM and DM + LIN groups compared with those of the CONTROL group. During the 21-day experimental period, there was no reduction in blood glucose levels of the DM + LIN group. Consequently, no discernible anti-hyperglycemic effect of LIN was observed. Catalase enzyme activity, superoxide dismutase (SOD) enzyme activity, malondialdehyde (MDA) levels and glutathione (GSH) levels were measured spectrophotometrically. All assays were conducted according to the protocols provided in the respective kits. The results were analyzed to assess the oxidative status and antioxidant capacity in the experimental groups. Catalase (CAT) activity was decreased in the DM group compared with that in the CONTROL group in both the serum and liver. However, LIN administration restored CAT activity in the DM + LIN group to the level of the CONTROL group. In the liver, the DM + LIN-treated group showed a notable reduction in malondialdehyde (MDA) levels compared with those in the DM group. In conclusion, the present results suggest that the antioxidant properties of LIN may have a regulatory effect on the oxidative status in diabetes-affected systems, potentially offering therapeutic benefits in managing oxidative stress associated with diabetes.

Early blood glucose screening in asymptomatic high-risk neonates.

Detecting and treating severe hypoglycemia promptly after birth is crucial due to its association with adverse long-term neurodevelopmental outcomes. However, limited data are available on the optimal timing of glucose screening in asymptomatic high-risk neonates prone to hypoglycemia. Risk factors associated with asymptomatic high-risk neonates include late prematurity≥35 and <37weeks gestation (LPT), small-for-gestational-age (SGA), large-for-gestational-age (LGA), and infant-of-a-diabetic mother (IDM). This study aims to determine the incidence and the impact of individual risk factors on early hypoglycemia (defined as blood glucose≤25 mg/dL in the initial hour after birth) in asymptomatic high-risk neonates. All asymptomatic high-risk neonates ≥35weeks gestation underwent early blood glucose screening within thefirst hour after birth (n=1,690). A 2-year retrospective analysis was conducted to assess the incidence of early neonatal hypoglycemia in this cohort and its association withhypoglycemia risk factors. Out of the 9,919 births, 1,690 neonates (17 %) had risk factors for neonatal hypoglycemia, prompting screening within the first hour after birth. Incidence rates for blood glucose≤25 mg/dL and≤15 mg/dL were 3.1 and 0.89 %, respectively. Of concern, approximately 0.5 % of all asymptomatic at-risk neonates had a blood glucose value of≤10 mg/dL. LPT and LGA were the risk factors significantly associated with early neonatal hypoglycemia. Asymptomatic high-risk neonates, particularly LPT and LGA neonates, may develop early severe neonatal hypoglycemia identified by blood glucose screening in the first hour of life. Additional investigation is necessary to establish protocols for screening and managing asymptomatic high-risk neonates.