Blood Glucose Variability Research Articles

Impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris at 6 months follow-up

BackgroundWe explored the impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris (SAP) at 6months follow-up. MethodsFrom May 2015 to April 2016, a total of 746 patients with SAP were divided to high glycemic variability group (H group) (n=261) and low glycemic variability group (L group) (n=485). The primary end point was incidence of periprocedural myocardial infarction and MACE at 6months follow-up. ResultsThe occurrence of periprocedural myocardial infarction occurred in 18.8% of patients in H group and in 12.4% in L group (P=0.03). The incidence of MACE at 6months follow-up was 9.6% in H group and 4.5% in L group (P=0.01). Multivariable analysis suggested that high glycemic variability conferred a 53% risk increment of 6months follow-up MACE (odds ratio 2.13, 95% confidence interval 1.85–5.38; P=0.01). ConclusionsThe trial shows that higher blood glucose variability was correlated with higher incidence of periprocedural myocardial infarction and MACE at 6months follow-up.

Continuous glucose monitoring reveals hypoglycemia risk in elderly patients with type 2 diabetes mellitus.

Aims/IntroductionThe incidence of type 2 diabetes is higher in elderly patients, in whom this disease is associated with dementia, falling, stroke and death. We utilized a continuous glucose monitoring device to analyze the relationship between hypoglycemia and diabetes treatments to identify risk factors for hypoglycemia (defined as a blood glucose level <70 mg/dL).Materials and MethodsWe classified 170 patients aged ≥65 years with type 2 diabetes who were receiving steady‐state medication (29 of whom were inpatients) into hypoglycemic and non‐hypoglycemic groups, and compared their glycosylated hemoglobin levels, treatment types, continuous glucose monitoring data and other parameters. We carried out univariate analyses to identify variables associated with hypoglycemia risk, followed by multivariate analyses of drug class and other factors. The accuracy of the continuous glucose monitoring data was confirmed by calibration.ResultsHypoglycemia risk was higher in the patients using insulin (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.16–4.08, P = 0.015), and lower in patients who were being treated with dipeptidyl peptidase‐4 inhibitors (OR 0.47, 95% CI: 0.25–0.89, P = 0.019). Patients with lower variability in blood glucose had a significantly lower hypoglycemia risk (OR 0.87, 95% CI: 0.83–0.91, P < 0.0001), and those with a lower average blood glucose level had a significantly higher risk (OR 1.09, 95% CI: 1.06–1.12, P < 0.0001).ConclusionsIn patients aged ≥65 years with type 2 diabetes, higher glucose variability and lower average glucose levels indicate a greater hypoglycemia risk. It is therefore necessary to ensure comprehensive blood glucose control in such patients to prevent hypoglycemia.

A needle-type glucose biosensor based on PANI nanofibers and PU/E-PU membrane for long-term invasive continuous monitoring

A minimally invasive glucose biosensor capable of continuous monitoring of subcutaneous glucose has been developed in this study. This sensor was prepared using electropolymerized conductive polymer polyaniline (PANI) nanofibers as an enzyme immobilization material and polyurethane (PU)/epoxy-enhanced polyurethane (E-PU) bilayer coating as a protective membrane. The sensor showed almost the same sensitivity (63nA/mM) and linearity (0–20mM with the correlation coefficient r2 of 0.9997) in both PBS and bovine serum tests. When stored in 37°C bovine serum, the sensor's sensitivity gradually increased about 30% of the initial value within the first 13 days and then remained stable for the rest of the study period of 53 days. In vivo implantation experiments using mice models showed real-time response to the variation of blood glucose with an average signal delay of about 8min. Continuous monitoring showed that the sensor response increased for the first 12 days and then entered a stable period for 14 days. The sensor's baseline (530±10nA) and the total response to 1ml 50% dextrose injection were almost the same (267±15nA) in the stable period. The in vivo stable performances indicated that the sensor could be used as an implantable device for long-term invasive monitoring of blood glucose.

Glucose variability aggravates cardiac fibrosis by altering AKT signalling path.

To study the effect of blood glucose variability on cardiac fibrosis and its mechanism in a model of diabetic cardiomyopathy. A total of 45 Sprague Dawley rats were randomly divided into three groups: control, control diabetes mellitus and fluctuated blood glucose groups. Fluctuated blood glucose was induced by daily subcutaneous insulin and intraperitoneal glucose injections at different time points. Blood lipids and glycosylated haemoglobin A1c were assessed. Super oxide dismutase activity and malondialdehyde level in rat heart homogenates were determined by assay kit. Structural cardiac tissue changes were observed by haematoxylin and eosin staining and Masson's trichrome staining. Collagen type 3, fibronectin, phosphorylated Ser/Thr protein kinase, phosphorylated glycogen synthase kinase-3 beta, glycogen synthase kinase-3 beta, nuclear factor kappa-light-chain-enhancer of activated B cells, cleaved-cysteinyl aspartate-specific proteinase-3 (caspase-3) and tumour necrosis factor-α levels were determined by western blot. Compared with the control group, cardiac fibrosis and oxidative stress in heart tissue were aggravated in diabetic rats, which were more pronounced in glucose variability rats. However, the expression levels of AKT and glycogen synthase kinase-3 beta were not significantly different in three groups, but the expression levels of phosphorylated Ser/Thr protein kinase and phosphorylated glycogen synthase kinase-3 beta were significantly decreased in the control diabetes mellitus and fluctuated blood glucose groups compared to control group, and levels in the fluctuated blood glucose group were significantly less than in the control diabetes mellitus group. In addition, the expression levels of nuclear factor kappa B and caspase-3 in both the control diabetes mellitus and fluctuated blood glucose groups were higher than in the control group, with the highest levels measured in the fluctuated blood glucose group. Blood glucose variability can aggravate heart tissue fibrosis, possibly involving oxidative stress by inhibiting AKT signalling path.

Glucose Variability Measures as Predictors of Oral Feeding Intolerance in Acute Pancreatitis: A Prospective Pilot Study.

Oral feeding intolerance (OFI) is a common complication in patients with acute pancreatitis (AP). Variations in blood glucose are associated with impaired gastrointestinal function but, to date, measures of glucose variability have not been investigated to predict OFI in patients with AP. To investigate the usefulness of several glucose variability measures in predicting the occurrence of OFI early in the course of AP. In this prospective cohort study, six measures of glucose variability were calculated prior to the occurrence of OFI. Multivariate binary logistic regression analyses were conducted, and the diagnostic performance and accuracy of glucose variability measures were assessed. Of the 95 prospectively enrolled patients, 21 (22%) developed OFI. After adjusting for confounders, admission blood glucose concentration and mean blood glucose concentration were significantly associated with OFI [odds ratio 1.49 (95% confidence interval 1.01-2.20) and odds ratio 1.67 (95% confidence interval 1.07-2.61), respectively]. Both admission blood glucose and mean blood glucose had an area under the curve of 0.83 and positive likelihood ratios of 6.45 and 10.19, respectively. Blood glucose concentration before refeeding, standard deviation of blood glucose concentration, coefficient of variation, and mean amplitude of glycemic excursions were not significantly associated with OFI. In-hospital blood glucose concentrations are associated with subsequent development of OFI in patients with AP. In particular, admission blood glucose and mean blood glucose could be useful predictors of OFI in this setting.

Effectiveness of acarbose in treating elderly patients with diabetes with postprandial hypotension

Postprandial hypotension (PPH) is a common condition that occurs primarily in elderly patients with type 2 diabetes mellitus (T2DM). This study aimed to assess the effectiveness of acarbose for PPH;...

Can Peripartum Plasma Profiles of Steroid Hormones, Metabolites and Minerals Predict Postpartum Fertility in Buffaloes?

The plasma profile of various hormonal, biochemical and mineral constituents was studied in 32 buffaloes under nutritional management of transition period for 2 months before to 2 months postpartum. The buffaloes that expressed estrus and conceived within 120 days postpartum, irrespective of nutrient treatment or control groups, were classified as fertile (n=15) and rests as infertile (n=17) buffaloes. The variations in blood glucose and plasma profile of progesterone, estradiol, protein, cholesterol, triglycerides, Ca, P, Mg and trace minerals (Zn, Fe, Cu, Co, Mn), if any, on day 60, 30, 15 prepartum, on the day of calving, and on day 15, 30, 45 and 60 postpartum in postpartum conceiving and non-conceiving buffaloes were examined. There was no significant effect of fertile-infertile groups on plasma P4 and E2 profile on any day, except on day 45 postpartum, where E2 was (p less than 0.05) higher in fertile than infertile group (31.47±2.37 vs. 24.29±1.76 pg/ml), indicating early onset of follicular activity with ovulatory estrus in postpartum fertile group. The blood glucose and plasma protein profile also did not vary significantly at any of the intervals between two groups. Further, no significant difference in plasma cholesterol or triglyceride concentrations was found between conceived and non-conceived buffaloes at any of the intervals pre- or postpartum, except that the pooled mean cholesterol level was higher (P less than 0.05) in non-conceived than conceived buffaloes. The plasma concentrations of calcium, inorganic phosphorus and magnesium also did not reveal significant variation between fertile and infertile buffaloes at any of the intervals, though the magnesium value was higher in conceived than non-conceived buffaloes. Similarly, no significant difference was seen in the levels of plasma trace minerals, viz., Zn, Fe, Mn, Cu or Co between fertile and infertile buffaloes at any of the intervals studied. These nonsignificant variations noted between fertile and infertile buffaloes in blood profile could perhaps be due to masking effect of nutritional supplementation as the control group was also optimally managed by the farmers; hence the animals were pooled irrespective of groups for this comparison.

Cutpoints for screening blood glucose concentrations in healthy senior cats.

Objectives The objectives of this study were to determine the reference interval for screening blood glucose in senior cats, to apply this to a population of obese senior cats, to compare screening and fasting blood glucose, to assess whether screening blood glucose is predicted by breed, body weight, body condition score (BCS), behaviour score, fasting blood glucose and/or recent carbohydrate intake and to assess its robustness to changes in methodology. Methods The study included a total of 120 clinically healthy client-owned cats aged 8 years and older of varying breeds and BCSs. Blood glucose was measured at the beginning of the consultation from an ear/paw sample using a portable glucose meter calibrated for cats, and again after physical examination from a jugular sample. Fasting blood glucose was measured after overnight hospitalisation and fasting for 18-24 h. Results The reference interval upper limit for screening blood glucose was 189 mg/dl (10.5 mmol/l). Mean screening blood glucose was greater than mean fasting glucose. Breed, body weight, BCS, behaviour score, fasting blood glucose concentration and amount of carbohydrate consumed 2-24 h before sampling collectively explained only a small proportion of the variability in screening blood glucose. Conclusions and relevance Screening blood glucose measurement represents a simple test, and cats with values from 117-189 mg/dl (6.5-10.5 mmol/l) should be retested several hours later. Cats with initial screening blood glucose >189 mg/dl (10.5 mmol/l), or a second screening blood glucose >116 mg/dl (6.4 mmol/l) several hours after the first, should have fasting glucose and glucose tolerance measured after overnight hospitalisation.

Achieving effective glycaemic control using an insulin micro-pump.

For those with type 1 diabetes mellitus (T1DM), a deranged blood glucose level can cause hypo/hyperglycaemic episodes and in the long term contribute to microvascular disease. Such outcomes can effect concordance with insulin management regimens and affect the patient's quality of life. A variety of insulin delivery methods are available, including continuous subcutaneous insulin infusion (CSII) via either a tethered or patch pump. Pumps have the potential to improve delivery, monitoring and adjustment of insulin regimens, thus freeing patient's time and affording more control of their disease. This article reports how a new patch pump, has helped a cohort of patients to improve blood glucose variability levels and thus quality of life.

Abstract WP17: Association of Blood Glucose and Clinical Outcome After Mechanical Thrombectomy for Acute Ischemic Stroke

Background: Elevated blood glucose (BG) levels at admission following acute ischemic stroke (AIS) have been associated with adverse clinical outcomes in thrombolytic and non-thrombolytic treated patients. This association has been inconsistent and has not been studied after mechanical thrombectomy (MT). The current study looks at multiple BG parameters and their association with outcome following MT in AIS. Methods: AIS patients undergoing MT with a retrievable stent between 2012 and 2016 at two stroke centers were studied. Favorable clinical outcome was defined as having a modified Rankin Scale score (mRS) of 0-2 at three months. Admission BG, maximum BG during the hospital stay, and serial measurements every 4-6 hours in the first 24 hours were recorded. The following demographic and clinical data was also collected: age, sex, baseline NIHSS score, onset-to-reperfusion times, HgA1c, and stroke mechanism. Results: Seventy-nine patients were identified (mean age 69, 49% male, SEM= 1.56); thirty-three patients had a favorable clinical outcome at three months and 46 had unfavorable outcomes. In univariate analysis, BG variability (standard deviation of BG, SD) in the first 24 hours following admission and maximum BG during hospital stay was associated with unfavorable outcomes (Table 1). The association between admission BG and favorable outcome was not statistically significant. In multivariate logistic regression analysis the SD of BG (OR= 1.08, 95% CI= 1.02-1.13, P= .005) had the highest predictive value for favorable outcome. Conclusions: Greater BG variability is associated with worse clinical outcome in patients with AIS undergoing MT. Using SD and/or serial measurements of BG appear better than single BG measurements at predicting clinical outcome in this population.

Impact of a Paper-Based Dynamic Insulin Infusion Protocol on Glycemic Variability, Time in Target, and Hypoglycemic Risk: A Stepped Wedge Trial in Medical Intensive Care Unit Patients.

Stress-induced hyperglycemia is a common feature of intensive care unit (ICU) patients. Besides mean blood glucose (BG) level, glucose variability and hypoglycemia have been highlighted as independent predictors of ICU and hospital mortality. Recent ICU recommendations suggest using insulin infusion protocols that can minimize glucose variability and hypoglycemic risk. Our aim was to assess the efficacy, safety, and acceptance by nurses of a paper-based simple dynamic insulin protocol compared with those by nurses of a paper-based static protocol. This is a 1 year stepped-wedge study that compared a static sliding scale protocol (SP - static protocol) with a validated dynamic paper-based intravenous insulin infusion protocol (DP - dynamic protocol) in medical ICU patients of a single university hospital. Patients with stress-induced hyperglycemia >9.9 mmol/L and ≥48 h intravenous insulin infusion were included in this trial. One hundred thirty-one patients were included and received continuous intravenous insulin infusion managed with SP (n = 65) or DP (n = 66). Glucose variability was significantly higher in the SP group than in the DP group (mean average glucose excursion index: 0.90 [0.00-1.91] mmol/L vs. 0.00 [0.00-0.90] mmol/L, respectively; P = 0.001). The percentage of time spent in the target range (7.7-9.9 mmol/L) was lower in the SP group than in the DP group (42.5% [28.8%-54.2%] vs. 47.5% [36.6%-57.1%]; P = 0.037). Low BG (<4.4 mmol/L) and hypoglycemia (<3.3 mmol/L) were more frequent in the SP group than in the DP group. According to a satisfaction survey, this protocol was well accepted by nurses. Our simple and feasible paper-based, dynamic insulin infusion protocol reduced glycemic variability and hypoglycemic risk in a medical ICU.

Effects of G6pc2 deletion on body weight and cholesterol in mice.

Genome-wide association study (GWAS) data have linked the G6PC2 gene to variations in fasting blood glucose (FBG). G6PC2 encodes an islet-specific glucose-6-phosphatase catalytic subunit that forms a substrate cycle with the beta cell glucose sensor glucokinase. This cycle modulates the glucose sensitivity of insulin secretion and hence FBG. GWAS data have not linked G6PC2 to variations in body weight but we previously reported that female C57BL/6J G6pc2-knockout (KO) mice were lighter than wild-type littermates on both a chow and high-fat diet. The purpose of this study was to compare the effects of G6pc2 deletion on FBG and body weight in both chow-fed and high-fat-fed mice on two other genetic backgrounds. FBG was reduced in G6pc2 KO mice largely independent of gender, genetic background or diet. In contrast, the effect of G6pc2 deletion on body weight was markedly influenced by these variables. Deletion of G6pc2 conferred a marked protection against diet-induced obesity in male mixed genetic background mice, whereas in 129SvEv mice deletion of G6pc2 had no effect on body weight. G6pc2 deletion also reduced plasma cholesterol levels in a manner dependent on gender, genetic background and diet. An association between G6PC2 and plasma cholesterol was also observed in humans through electronic health record-derived phenotype analyses. These observations suggest that the action of G6PC2 on FBG is largely independent of the influences of environment, modifier genes or epigenetic events, whereas the action of G6PC2 on body weight and cholesterol are influenced by unknown variables.

Association of In-Hospital Mortality and Dysglycemia in Septic Patients.

BackgroundThe associations between dysglycemia and mortality in septic patients with and without diabetes are yet to be confirmed. Our aim was to analyze the association of diabetes and sepsis mortality, and to examine how dysglycemia (hyperglycemia, hypoglycemia and glucose variability) affects in-hospital mortality of patients with suspected sepsis in emergency department (ED) and intensive care units.MethodsClinically suspected septic patients admitted to ED were included, and stratified into subgroups according to in-hospital mortality and the presence of diabetes. We analyzed patients’ demographics, comorbidities, clinical and laboratory parameters, admission glucose levels and severity of sepsis. Odds ratio of mortality was assessed after adjusting for possible confounders. The correlations of admission glucose and CoV (blood glucose coefficients of variation) and mortality in diabetes and non-diabetes were also tested.ResultsDiabetes was present in 58.3% of the patients. Diabetic patients were older, more likely to have end-stage renal disease and undergoing hemodialysis, but had fewer malignancies, less sepsis severity (lower Mortality in Emergency Department Sepsis Score), less steroid usage in emergency department, and lower in-hospital mortality rate (aOR:0.83, 95% CI 0.65–0.99, p = 0.044). Hyperglycemia at admission (glucose≥200 mg/dL) was associated with higher risks of in-hospital mortality among the non-diabetes patients (OR:1.83 vs. diabetes, 95% CI 1.20–2.80, p = 0.005) with the same elevated glucose levels at admission. In addition, CoV>30% resulted in higher risk of death as well (aOR:1.88 vs. CoV between 10 and 30, 95%CI 1.24–2.86 p = 0.003).ConclusionsThis study indicates that while diabetes mellitus seems to be a protective factor in sepsis patients, hyper- or hypoglycemia status on admission, and increased blood glucose variation during hospital stays, were independently associated with increased odds ratio of mortality.

Association between glycemic variability and major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome during 30-day follow-up

BackgroundWe explored the association between glycemic variability and major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS) during 30-day follow-up. MethodsFrom May 2013 to April 2015, a total of 864 patients with ACS were divided to high glycemic variability group (H group) (n=285) and low glycemic variability group (L group) (n=579). The primary end point was a 30-day incidence of MACCE. Secondary end points were the incidence of atrial fibrillation (AF) during hospitalization and length of hospital stay. ResultsThe primary end point occurred in 15.2% of patients in H group and in 9.7% in L group (p=0.03). The incidence of AF during hospitalization was 14.5% in H group and 8.9% in L group (p=0.02). Compared with the L group, the H group extended the length of hospital stay. Multivariable analysis suggested that high glycemic variability conferred a 57% risk increment of 30-day MACCE (odds ratio 1.97, 95% confidence interval 1.32–6.86; p=0.02). ConclusionThe trial shows that higher blood glucose variability was correlated with higher incidence of MACCE, AF and longer length of stay.

Blood Glucose Variability and Outcomes in Critically III Children

Objectives:To find the incidence of hyperglycemia (blood glucose [BG] ≥150 mg/dl), hypoglycemia (BG ≤60 mg/dl), and variability (presence of hypoglycemia and hyperglycemia) in critically ill children in the 1st week of Intensive Care Unit (ICU) stay and their association with mortality, length of ICU stay, and organ dysfunction.Materials and Methods:The design was a retrospective observational cohort study. Consecutive children ≤18 years of age admitted from March 2003 to April 2012 in a combined adult and pediatric closed ICU. Relevant data were collected from chart review and hospital database.Results:Out of 258 patients included, isolated hyperglycemia was seen in 139 (53.9%) and was unrelated to mortality and morbidity. Isolated variability in BG was noted in 76 (29.5%) patients and hypoglycemia was seen in 9 (3.5%) patients. BG variability was independently associated with multiorgan dysfunction syndrome on multivariate analysis (adjusted odds ratio [OR]: 7.1; 95% confidence interval [CI]: 1.6–31.1). Those with BG variability had longer ICU stay (11 days vs. 4 days, on log-rank test, P = 0.001). Insulin use was associated with the occurrence of variability (adjusted OR: 3.6; 95% CI: 1.8–7.0).Conclusion:Glucose disorders were frequently observed in critically ill children. BG variability was associated with multiorgan dysfunction and increased ICU stay.

Comparison of Two Protocols in the Management of Glucocorticoid-induced Hyperglycemia among Hospitalized Patients.

Context:There is limited literature focusing on the management of glucocorticoid-induced hyperglycemia (GCIH).Aims:The primary objective was to compare the mean blood glucose between the experimental group (new protocol) and the control group (standard protocol) in the management of GCIH. The secondary objective was to compare other parameters of glycemic efficacy, variability, and safety parameters.Methods:This was a randomized, open-labeled, parallel arm trial. Adult patients who were given glucocorticoid (minimum dose equivalent to prednisolone 10 mg) in the past 24 h and had 2 h postmeal plasma glucose ≥200 mg/dl were included in the study. Patients randomized to control group received standard basal-bolus insulin. In the experimental group, a “correctional insulin” matching the glycemic profile of the glucocorticoid administered was provided with or without “background” basal-bolus insulin. The parameters of glycemic efficacy, variability, and safety were compared. P < 0.05 was considered statistically significant.Results:Data of 67 patients included in the study were analyzed, of which 33 patients were in the experimental group and 34 patients in the control group. The mean blood glucose in the experimental and the control group was 170.32 ± 33.46 mg/dl and 221.05 ± 49.72, respectively (P = 0.0001). The parameters for glycemic variability were all significantly lower in patients in the experimental group. The hypoglycemia event rate was low in both the groups.Conclusion:When compared to the standard basal-bolus insulin protocol, the new protocol showed lower mean blood glucose and lower glycemic variability.

Application of dynamic glucose monitoring in the diagnosis and differential diagnosis of hypoglycemia

Objective To analyze the characteristics of dynamic blood glucose in hypoglycemia patients with different causes and explore the application value of dynamic glucose monitoring system (DGMS) in the diagnosis and differential diagnosis of hypoglycemia. Methods We used DGMS to monitor the blood glucose levels of 20 hypoglycemia patients for 3-6 days, including 6 cases of insulinoma, 7 cases of reactive hypoglycemia, 2 cases of autoimmune hypoglycemia, 3 cases of islet cell hyperplasia, 1 case of drug-induced hypoglycemia, 1 case of congenital hyperinsulinism. The blood glucose profiles of hypoglycemia patients with different causes were compared. Results The average monitoring duration was (88.9±10.8)hours. 38-936 points of hypoglycemia were detected in these patients with hypoglycemia. The average blood glucose of patients of each cause, in the order from low to high, were: congenital hyperinsulinism [(2.97±0.59)mmol/L], islet cell hyperplasia [(4.83±1.32)mmol/L], insulinoma [(4.87±1.37)mmol/L], drug-induced hypoglycemia [(5.98±0.8)mmol/L], reactive hypoglycemia [(6.38±1.99)mmol/L], and autoimmune hypoglycemia [(7.63±2.67)mmol/L]. The constituent ratio of hypoglycemia from low to high were: autoimmune hypoglycemia and drug-induced hypoglycemia (0%), reactive hypoglycemia [0.5% (0.0%, 1.6%), insulinoma [9.0% (5.2%, 16.3%), islet cell hyperplasia [9.5% (1.1%, 14.2%), congenital hyperinsulinism (58.5%). In terms of the blood glucose profiles in day and night, the night blood glucose levels were lower than those in daytime in insulinoma [(5.16±1.37)mmol/L vs. (4.44±1.24)mmol/L], reactive hypoglycemia [(6.93±2.19)mmol/L vs. (5.57±1.25)mmol/L], autoimmune hypoglycemia [(8.08±2.79)mmol/L vs. (6.95±2.31)mmol/L], islet cell hyperplasia [(5.23±1.31)mmol/L vs. (4.11±1.00)mmol/L] and congenital hyperinsulinism [(3.06±0.57)mmol/L vs. (2.83±0.59)mmol/L] (all P<0.05); while the daytime blood glucose level was lower than that at night in drug-induced hypoglycemia [(5.90±0.81)mmol/L vs. (6.11±0.77)mmol/L, P<0.05]. 62.2% and 78.9% of the hypoglycemia episodes happened at night in patients with insulinoma and islet cell hyperplasia, and 43.2% at night in patients with congenital hyperinsulinism. The highest standard deviation of blood glucose (2.67 mmol/L), largest amplitude of glycemic excursions (9.2 mmol/L)and coefficient of variation (35%) were found in patients with autoimmune hypoglycemia. The largest range of blood glucose (20.4 mmol/L) was found in patients with reactive hypoglycemia. The day-night differences in coefficient of variation (31.6% vs. 22.4%) and range of blood glucose (20.4 mmol/L vs. 6.8 mmol/L) were most prominent in patients with reactive hypoglycemia. Conclusion The dynamic monitoring of blood glucose and the analysis of the parameters such as average blood glucose, blood glucose profiles and variability of blood glucose may be helpful for the diagnosis of hypoglycemia and differential diagnosis of causes of hypoglycemia. Key words: Hypoglycemia; Insulinoma; Dynamic glucose monitoring system; Continuous glucose monitoring system; Reactive hypoglycemia; Differential diagnosis

Effect evaluation of quality control circle on the health promotion of diabetic patient

Objective To investigate the effect of quality control circle on the health promotion of diabetic patient. Methods Diabetes activity group of quality control circle was organized to have continuous disease control management on diabetic patients. Self-care capability, blood glucose, blood fat and body mass index variation of patients before and after the management were analyzed and controlled. Results After QCC management, the self-care capability of patients was significantly improved before admission to hospital(P<0.01). After being controlled by QCC activity group, 6 months after discharge from hospital, the fasting blood glucose, blood glucose 2 hours after dinner and blood fat declined dramatically, and the average body mass index also relieved significant, which was significantly different from it before admission to hospital (P<0.01). Conclusion Continuous and effective service conducted by quality control circle activity to diabetic patients can not only reach self-management, but also an effective way to cure diabetes and control complications, which is worth popularizing. Key words: Diabetic patients; Quality control circle; Self-care ability; Blood glucose control

First Libyan experience with insulin pump therapy: Impact on glycemic control and patients satisfaction

Background: The mainstay of contemporary management of type 1 diabetes mellitus (T1DM) is “physiological insulin replacement”. Regimens based on multiple daily injections (MDI) of insulin improve glycemic control and increase the frequency of hypoglycemia. Insulin pump therapy also improves glycemic control, and reduces the within-day and between-day glycemic variability that is seen with insulin injections. Objectives: We aimed to evaluate out first experience with insulin pump therapy by 1) assessing the glycemic control on insulin pump therapy compared to MDI based therapy and 2) to learn the attitude of patients and families towards the use of insulin pump. Patients and Methods: A prospective observational study involving 37 patients who used insulin pump between March &amp; November 2013. Patients were selected according to certain criteria set up by treating physician. Data collected included demographic, clinical and biochemical data before, during and after insulin pump therapy use. Severe hypoglycemia requiring hospital management and diabetic ketoacidosis (DKA) were documented. Health-related quality of life, diabetes knowledge and patient's attitude towards pump therapy were captured before and after pump use. Outcome measures: Change HbA1c, occurrence of severe hypoglycemia and DKA. Change of body mass index (BMI) and difference in score results of health quality questionnaire. Results: 51.4% were males; mean age was 15 years (86.5% of them were between 2 and 22 years. About 94.4% had diabetes for a mean of 6.9 (range 1-14) years. The indications of insulin pump were high HbA1c (29.7%), wide variation of blood glucose (10.8%), severe hypoglycemia and/or hypoglycemic unawareness (18.9%), recurrent DKA (5.4%) and other indications (8.1%). However, 27.0% had a good metabolic control but multiple daily injections (MDI) was reportedly “compromising” their quality of life. The mean HbA1c level decreased from 9.1% to 7.4% (P = 0.001). The mean BMI increased from 21.2 to 22.0 kg/m2 (P=0.026) independent of age (r = 0.180, P = 0.295). Two episodes of DKA in one patient who had severe contact dermatitis at the site of cannula &amp; sensor and one severe hypoglycemia, which required hospital admission due to unmatched carbohydrate intake to insulin dose due to incorrect carbohydrate counting. The health quality questionnaire scores revealed an improvement from 34.2 to 46.7 (P = 0.001). Conclusions: Our first experience with insulin pump therapy was positive in terms of achieving and maintaining good glycemic control in most of patients, it for more contact between patients and health providers and created better opportunities for diabetes education and support.

Hypoglycemia Prevention in Hospital Patients: A Quality Improvement Project to Prevent Severe and Recurrent Hypoglycemia.

Hypoglycemia, defined as a blood glucose level <70 mg/dL (3.9 mmol/L), occurs frequently in hospitalized patients. Both inpatient and outpatient trials have shown that the risk of hypoglycemia limits the achievement of blood glucose control (1–7). In addition to causing distress for patients, severe hypoglycemia is associated with cardiac arrhythmias, cardiac ischemia, seizures, brain damage, and death (3,4,8–12). After a hypoglycemic event, the likelihood of further episodes of low blood glucose is increased (2,9,12,13). Glycemic variability is also independently associated with risk of mortality (5–9,12,14,15) and can be an unintended consequence of reactive treatment of hypoglycemia. If dextrose is given only in response to low blood glucose levels, but the precipitating factor for hypoglycemia persists, a cycle of recurrent low glucose levels alternating with higher post-treatment levels occurs. Fortunately, this pattern represents a modifiable risk, as illustrated in Figure 1 (14). FIGURE 1. Recurrent hypoglycemia: treatment versus prevention. Initially hypoglycemia was treated reactively, with at least five recurrences of low blood glucose and high glycemic variability. With initiation of proactive IV dextrose, further hypoglycemia was prevented, and glycemic variability was reduced. Recent advances in health care quality and patient safety call for a change from reactive to preventive care. When this concept is applied to hypoglycemia management, it is evident that the unevaluated assumption that reactive treatment of hypoglycemia is sufficient often underlies facility routines. Avoiding circumstances that are frequently associated with low blood glucose levels is at the core of optimal glycemic management in the inpatient setting. Recent studies show that “safe and effective glucose control” (15) can be facilitated and hypoglycemia can be prevented through tactics such as appropriate monitoring, ensuring adequate caloric intake, coordinating the …