Changes In Blood Glucose Levels Research Articles

Effects of Adrenaline Containing Local Anesthesia on Blood Pressure and Blood Glucose Levels Undergoing Tooth Extractions – A Comparative Study

Exodontia, the most common dental procedure for damaged or decayed teeth, often utilizes local anesthesia with vasoconstrictors like adrenaline. Although effective, adrenaline can impact blood glucose levels and hemodynamic parameters, particularly in hypertensive and diabetic patients. Objectives: To compare changes in blood pressure and blood glucose levels among healthy, hypertensive and diabetic patients undergoing tooth extraction with adrenaline-containing local anesthesia. Methods: A total of 177 participants were split equally into three groups: healthy, hypertensive and diabetic. Prior to and twenty minutes’ post-injection, blood pressure, and blood glucose levels were measured while a local anesthetic containing 2% lignocaine HCL with 1: 100,000 adrenaline was administered. Sample paired t test and one-way ANOVA were employed in the analysis. Results: Among hypertensive patients, random blood glucose significantly decreased post-procedure (p=0.001), while systolic blood pressure significantly increased (p<0.001) and diastolic blood pressure significantly decreased (p=0.021). Diabetic patients showed a non-significant decrease in glucose levels (p=0.209) but a significant increase in both systolic (p<0.001) and diastolic blood pressure (p=0.002). Healthy patients experienced a significant increase in systolic blood pressure (p=0.015) but no significant changes in glucose levels (p=0.873) or diastolic pressure (p=0.301). Conclusions: Adrenaline in local anesthesia significantly increases systolic blood pressure in all patient groups, with pronounced effects in hypertensive and diabetic patients. Changes in blood glucose were significant only in hypertensive patients, while changes in diabetic patients were non-significant. These findings highlight the need for careful monitoring and personalized management strategies in dental procedures to minimize potential adverse effects and ensure patient safety.

Impact of hospital-community diabetes management intervention in Central Region, Ghana: A retrospective study

ObjectiveEffective diabetes management remains suboptimal in low-resourced countries including Ghana. We determined the effectiveness of hospital-community link diabetes management intervention on glycaemic control and other outcomes. MethodsA retrospective study design, using secondary data from the Ghana-Netherlands for Health Foundation diabetes programme. The z-test was used for proportions, to compare parameters between baseline (2017) and endpoint (2022). The Friedman test was used to assess changes in blood glucose levels, and the multivariable Logistic regression to identify factors associated with blood glucose control. ResultsAnalyses of 251 clinical records showed decline in median blood glucose levels across six years from 8.8 mmol/L (7.2–12.9) in 2017 to 6.5 mmol/L (5.7–7.2) (p = 0.001) in 2022, recording 43 % increase in patients attaining glycaemic control in 2022 (p = 0.001). The Friedman test showed significant reduction in glucose levels (χ2 = 319.2, p = 0.001), with an effect size of 0.25 using the Kendall test. The logistic regression analyses revealed that patients on metformin and Glibenclamide combination were more likely to achieve glycaemic control than those on metformin monotherapy (adjusted OR = 7.30, 95 % CI 2.31–23.01, p = 0.001). ConclusionThe intervention achieved significant reduction in blood glucose levels. Patients with diabetes benefit from the hospital-community link diabetes management intervention regarding glycaemic control.

The Influence of Emodin Succinyl Ethyl Ester on Non-alcoholic Steatohepatitis Induced by a Diet High in Fructose, Cholesterol, and Fat in Mice.

Nonalcoholic steatohepatitis (NASH) is a subtype of nonalcoholic fatty liver disease (NAFLD) characterized by hepatic steatosis and evidence of hepatocyte injury (ballooning) and inflammation, with or without liver fibrosis. In this study, after 12 weeks of induction, the mice were treated with emodin succinyl ethyl ester (ESEE) for four weeks at doses of 10/30/90 mg/kg/d. The blood analysis of experimental endpoints showed that ESEE exhibited significant therapeutic effects on the progression of disorders of glycolipid metabolism and the induced liver injury in the model animals. Histopathological diagnosis of the liver and total triglyceride measurements revealed that ESEE had a significant therapeutic effect on the histopathological features of nonalcoholic fatty liver disease/hepatitis, such as cellular steatosis and activation of intrahepatic inflammation. Additionally, ESEE was able to improve hepatocyte fat deposition, steatosis, and the course of intrahepatic inflammatory activity. Furthermore, it showed some inhibitory effect on liver fibrosis in the model animals. In summary, this study confirms the therapeutic effects of ESEE on the NAFLD/NASH model in C57BL/6J mice induced by a high-fat, high cholesterol, and fructose diet. These effects were observed through improvements in liver function, inhibition of fibrosis, and inflammatory responses. Changes in blood glucose levels, blood lipid metabolism, liver histopathological staining, liver fibrosis staining, and related pathological scores further supported the therapeutic effects of ESEE. Therefore, this study has important implications for the exploration of novel drugs for nonalcoholic fatty liver disease.

Low blood glucose and fatigue accumulation at peak hours of occupational trauma in secondary industry workers

Objectives. The incidence of occupational traumatic injuries caused by human error has been reported to occur at 11:00 and 8–9 h after commencing work. Impaired attention is closely related to the incidence of these accidents. Therefore, this study aimed to clarify the changes in blood glucose, fatigue and stress response hormone levels over time among workers in a secondary industry. Methods. The blood glucose and subjective fatigue levels of 26 male secondary-industry workers were measured on workdays. In addition, the cortisol and dehydroepiandrosterone levels in saliva were measured on one workday and one holiday. Results. Blood glucose levels at 11:00 and 17:30 on the workday were significantly lower than those at 09:30. Moreover, hypoglycemia was observed in some participants. A significant increase in subjective fatigue levels was observed during the workday. However, no significant differences in salivary cortisol levels were observed between the workday and the holiday at any time point. Conclusions. Blood glucose levels decreased and subjective fatigue levels increased at the time points that occupational accidents were reported to occur most frequently during work. These factors may contribute to human errors due to impaired attentional function.

Association between pathologic complete response and biochemical indicators after neoadjuvant therapy for HER2-positive breast cancer

PurposeThis study investigated the changes in the fasting blood glucose (FBG), fasting triglyceride (FTG), and fasting total cholesterol (FTC) levels during neoadjuvant therapy (NAT) for human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) and the association with pathologic complete response (pCR).MethodsRelevant data from Sichuan Cancer Hospital from June 2019 to June 2022 were collected and analyzed, and FBG, FTG, and FTC were divided into baseline, change, and process groups, which were grouped to analyze the changes after receiving NAT and the association with pCR.Results In the estrogen receptor (ER)-negative subgroup, patients with low levels of FTG in the process group were more likely to achieve pCR compared to high levels, and in the progesterone receptor (PR)-negative subgroup, patients with lower FTG compared to higher FTG after receiving NAT was more likely to achieve pCR.ConclusionsPatients with HER2-positive BC undergoing NAT develop varying degrees of abnormalities (elevated or decreased) in FBG, FTG, and FTC; moreover, the status of FTG levels during NAT may predict pCR in ER-negative or PR-negative HER2-positive BC.Early monitoring and timely intervention for FTG abnormalities may enable this subset of patients to increase the likelihood of obtaining a pCR along with management of abnormal markers.

Impact of the State of Emergency Declaration for Severe Acute Respiratory Syndrome Coronavirus-2 Pandemic Suppression on Individuals with Type 1 Diabetes Mellitus.

Objective To examine the impact of lifestyle changes caused by the first emergency declaration issued in 2020 on glycemic control and body weight changes in Japanese individuals with type 1 diabetes mellitus. Methods This study included Japanese individuals with type 1 diabetes mellitus who visited Tokyo Women's Medical University Hospital between January 2019 and September 2020 (n=278). Seasonal changes in glycated hemoglobin (HbA1c) levels and the body mass index (BMI) were compared. A self-administered questionnaire regarding changes in treatment, diet, exercise, sleep, and telecommuting was used to assess lifestyle changes. Results Although HbA1c levels decreased from winter to summer in 2019 and 2020, the annual change was slightly but significantly greater in 2020 than in 2019. Seasonal changes in the BMI between 2019 and 2020 were also significantly different. An increase in the daily insulin dose, overall blood glucose level, diurnal change in blood glucose level, and food intake were significantly associated with increased HbA1c levels. Furthermore, HbA1c levels decreased with increasing moderate physical activity and sleep duration. The change in the BMI increased with increasing insulin dose, overall high blood glucose levels, and food intake. However, an increase in moderate physical activity was associated with a decrease in the BMI. HbA1c levels were significantly lower after the first emergency declaration in individuals with type 1 diabetes mellitus than that before the emergency declaration, even after accounting for seasonal variations. Conclusion Decreased HbA1c levels were associated with a decreased food intake, increased moderate exercise, and increased sleep duration during the state of emergency. The BMI remained relatively unchanged.

A Non-Toxic Binuclear Vanadium(IV) Complex as Insulin Adjuvant Improves the Glycemic Control in Streptozotocin-Induced Diabetic Rats.

Diabetes mellitus (DM) complications are a burden to health care systems due to the associated consequences of poor glycemic control and the side effects of insulin therapy. Recently. adjuvant therapies, such as vanadium compounds, have gained attention due to their potential to improve glucose homeostasis in patients with diabetes. In order to determine the anti-diabetic and antioxidant effects of the oxidovanadium(IV) complex (Et3NH)2[{VO(OH}2)(ox)2(µ-ox)] or Vox2), rats with streptozotocin (STZ)-induced diabetes were treated with 30 and 100 mg/kg of Vox2, orally administered for 12 days. Vox2 at 100 mg/kg in association with insulin caused a 3.4 times decrease in blood glucose in STZ rats (424 mg/dL), reaching concentrations similar to those in the normoglycemic animals (126 mg/dL). Compared to insulin alone, the association with Vox2 caused an additional decrease in blood glucose of 39% and 65% at 30 and 100 mg/kg, respectively, and an increased pancreatic GSH levels 2.5 times. Vox2 alone did not cause gastrointestinal discomfort, diarrhea, and hepatic or renal toxicity and was not associated with changes in blood glucose level, lipid profile, or kidney or liver function. Our results highlight the potential of Vox2 in association with insulin in treating diabetes.

Immediate Impact of Switching from Dipeptidyl Peptidase4 (DPP4) Inhibitors to Low-Dose (0.3mg) Liraglutide on Glucose Profiles: A Retrospective Observational Study.

As treatment agents for diabetes, liraglutide is a long-acting glucagon-like peptide1 receptor agonist, and dipeptidyl peptidase4 (DPP4) inhibitors are widely used because of their safety and tolerability. Regular treatment with liraglutide has been reported to significantly reduce blood glucose levels, but the impact of low-dose (0.3mg) liraglutide on blood glucose levels immediately after treatment switching from a DPP4 inhibitor remains unknown. We conducted a single-arm, retrospective, observational study in 55 inpatients with type2 diabetes (T2D) to investigate the changes (Δ) in their blood glucose levels at six time points (6-point) from the day before (day-1) to the day after (day1) by switching the antidiabetic treatment from a DPP4 inhibitor to liraglutide 0.3mg (low-dose liraglutide) once daily. We also attempted to identify factors associated with the blood glucose-lowering effects of liraglutide. The median values of the changes in fasting, preprandial, and postprandial blood glucose levels and the fluctuations in the blood glucose levels expressed as the standard deviation of the 6-point blood glucose levels were significantly lower on day1 than on day-1 (P < 0.05, P < 0.0001, P < 0.0001, P < 0.01, respectively); there were no cases of severe hypoglycemia. The Δblood glucose levels were not associated with the baseline serum hemoglobin A1c values or with any markers of the insulin secreting capacity. There were no associations between the previously used blood glucose-lowering drug and the Δblood glucose levels. Switching from a DPP4 inhibitor to low-dose (0.3mg) liraglutide once daily significantly reduced the blood glucose levels and excursions of the blood glucose levels even from the very day after the treatment switch, with no serious adverse events.

Noninvasive Blood Glucose Monitoring Using Spatiotemporal ECG and PPG Feature Fusion and Weight-Based Choquet Integral Multimodel Approach.

change of blood glucose (BG) level stimulates the autonomic nervous system leading to variation in both human's electrocardiogram (ECG) and photoplethysmogram (PPG). In this article, we aimed to construct a novel multimodal framework based on ECG and PPG signal fusion to establish a universal BG monitoring model. This is proposed as a spatiotemporal decision fusion strategy that uses weight-based Choquet integral for BG monitoring. Specifically, the multimodal framework performs three-level fusion. First, ECG and PPG signals are collected and coupled into different pools. Second, the temporal statistical features and spatial morphological features in the ECG and PPG signals are extracted through numerical analysis and residual networks, respectively. Furthermore, the suitable temporal statistical features are determined with three feature selection techniques, and the spatial morphological features are compressed by deep neural networks (DNNs). Lastly, weight-based Choquet integral multimodel fusion is integrated for coupling different BG monitoring algorithms based on the temporal statistical features and spatial morphological features. To verify the feasibility of the model, a total of 103 days of ECG and PPG signals encompassing 21 participants were collected in this article. The BG levels of participants ranged between 2.2 and 21.8 mmol/L. The results obtained show that the proposed model has excellent BG monitoring performance with a root-mean-square error (RMSE) of 1.49 mmol/L, mean absolute relative difference (MARD) of 13.42%, and Zone A + B of 99.49% in tenfold cross-validation. Therefore, we conclude that the proposed fusion approach for BG monitoring has potentials in practical applications of diabetes management.

Changes in Biochemical Components of Obesity in Wistar Rats Fed Mentha Piperita-Supplemented High-Fat Diet

The research is designed to assess changes in biochemical components of obesity in Wistar rats fed peppermint-supplemented high-fat diet. Twenty (20) female Wistar rats of about 117.88±10.82g were divided into four (4) groups of five (5) rats each and randomly assigned to the formulated diets. The groups had similar average weights. Groups A and B were fed standard diet and High-fat diet respectively, while groups C and D were respectively fed 4% peppermint-supplemented standard diet and 4% peppermint-supplemented high-fat diet. The changes in weight and blood glucose level were monitored on weekly basis. At the end of six (6) weeks of the experiment, organ to body weight ratio, serum insulin level and HOMA-IR were determined. Markers of hepatic functions (transaminases, total bilirubin, albumin, globulin, conjugated bilirubin and total protein), markers of renal functions (electrolyte concentrations, urea and creatinine), serum activities of antioxidant enzymes (catalase, glutathione peroxidase, reduced glutathione and superoxide dismutase) and serum concentrations of malondialdehyde (MDA) were also determined. No significant (p≤0.05) differences were observed among the groups in weight gain, organ to body weight ratio, blood glucose levels, activities of antioxidant enzymes and serum MDA concentrations. The group fed 4% peppermint-supplemented high-fat diet had significantly (p≤0.05) higher activities of ALT, AST, total cholesterol and low-density lipoprotein cholesterol but significantly (p≤0.05) lower high-density lipoprotein cholesterol when compared with the group fed standard diet or high-fat diet. Serum creatinine and bicarbonate were significantly (p≤0.05) lower in the group fed 4% peppermint-supplemented high-fat diet compared with the group fed the standard diet. It is therefore concluded that including peppermint leaf powder in the diet for a period of 6 weeks may not have a significant impact on the body weight, organ development and glucose utilisation. However, it is important to note that consumption of high-fat diet supplemented with peppermint might lead to dyslipidemia, liver and kidney dysfunctions without altering oxidative balance in Wistar rats.

Effect of denosumab on glucose metabolism in postmenopausal osteoporotic women with prediabetes: a study protocol for a 12-month multicenter, open-label, randomized controlled trial

BackgroundParticipants with prediabetes are at a high risk of developing type 2 diabetes (T2D). Recent studies have suggested that blocking the receptor activator of nuclear factor-κB ligand (RANKL) may improve glucose metabolism and delay the development of T2D. However, the effect of denosumab, a fully human monoclonal antibody that inhibits RANKL, on glycemic parameters in the prediabetes population is uncertain. We aim to examine the effect of denosumab on glucose metabolism in postmenopausal women with osteoporosis and prediabetes.MethodsThis is a 12-month multicenter, open-label, randomized controlled trial involving postmenopausal women who have been diagnosed with both osteoporosis and prediabetes. Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density T score of ≤ − 2.5, as measured by dual-energy X-ray absorptiometry (DXA). Prediabetes is defined as (i) a fasting plasma glucose level of 100–125 mg/dL, (ii) a 2-hour plasma glucose level of 140–199 mg/dL, or (iii) a glycosylated hemoglobin A1c (HbA1c) level of 5.7–6.4%. A total of 346 eligible subjects will be randomly assigned in a 1:1 ratio to receive either subcutaneous denosumab 60 mg every 6 months or oral alendronate 70 mg every week for 12 months. The primary outcome is the change in HbA1c levels from baseline to 12 months. Secondary outcomes include changes in fasting and 2-hour blood glucose levels, serum insulin levels, C-peptide levels, and insulin sensitivity from baseline to 12 months, and the incidence of T2D at the end of the study. Follow-up visits will be scheduled at 3, 6, 9, and 12 months.DiscussionThis study aims to provide evidence on the efficacy of denosumab on glucose metabolism in postmenopausal women with osteoporosis and prediabetes. The results derived from this clinical trial may provide insight into the potential of denosumab in preventing T2D in high-risk populations.Trial registrationThis study had been registered in the Chinese Clinical Trials Registry. Registration number: ChiCTR2300070789 on April 23, 2023. https://www.chictr.org.cn.

Aerobic Exercise Training Under Normobaric Hypoxic Conditions to Improve Glucose and Lipid Metabolism in Overweight and Obese Individuals: A Systematic Review and Meta-Analysis.

Guo, Hai, Linjie Cheng, Dilihumaier Duolikun, and Qiaoling Yao. Aerobic exercise training under normobaric hypoxic conditions to improve glucose and lipid metabolism in overweight and obese individuals: a systematic review and meta-analysis. High Alt Med Biol. 24:312-320, 2023. Background: Obesity is a critical public health issue around the world, reaching epidemic proportions in some countries. However, only a few studies have examined the effects of hypoxic training on metabolic parameters in an obese population. This systematic review and meta-analysis aimed to determine the effects of aerobic exercise training under normobaric hypoxic conditions versus normoxic training in improving glucose and lipid metabolism in obese individuals. Methods: A systematic search of PubMed, EMBASE, Web of Science, and Wan Fang databases (up to August 2021) was performed to identify randomized controlled trials (RCTs) of overweight or obese human subjects eligible for inclusion. Main study endpoints were changes in body mass index (BMI), waist/hip (W/H) ratio, leptin, blood glucose and insulin levels, as well as blood lipids between hypoxic and normoxic conditioning. Results: Fourteen RCTs with a total of 413 subjects qualified for inclusion. Pooled analyses revealed that BMI (d = 0.38), W/H ratio (d = 0), blood glucose (d = 0.01), and triglyceride (d = -2.27) were not significantly different between aerobic exercise training under hypoxic and normoxic conditions. However, significant differences were found in heart rate at rest (d = -4.50) between aerobic exercise training under hypoxic versus normoxic conditions. Conclusions: In conclusion, no significant benefits were noted in aerobic exercise training under hypoxic conditions over normoxic conditions in overweight or obese individuals. However, the maximum training heart rate mm was significantly higher under hypoxic conditions than under normoxic conditions. Future studies with larger samples controlling for exercise-related parameters, and addressing the potential modifying effects of level of hypoxia, sex, or age on the role of hypoxic exercise training are warranted. PROSPERO registration number: CRD42020221680.

Analisis Drug Related Problems dan Pengaruhnya terhadap Pengendalian Glukosa Darah pada Pasien Covid-19 dengan Komorbiditas Diabetes Melitus Tipe 2

This study aims to anayze the effect of drug related problems (DRPs) on glycemic control in COVID-19 patients with comorbid diabetes mellitus type 2. This research is a cross-sectiona study using retrospective data obtained from secondary data from the medica records of Covid-19 patients. with type 2 diabetes mellitus. The research location was at Jati Padang Hospita. The sample consisted of 76 medica records with total sampling method. Data collected using PCNE V9.00 were then tested using the Wilcoxon test comparing initia GDS in hospita with GDS at the end of patient discharge, the Chisquare test which correlated changes in GDS with patient clinica outcomes and the Spearman test which linked changes in GDS with DRPs, characteristics of Covid-19 patients with diabetes mellitus predominant age 46-55 years (30.3%), predominant sex mae (51.3%), length of stay 6-10 days (64.5%), profile of drug use that is often used antivira, antibiotics, vitamins and supplements, symptomatic and antidiabetic (100%). The most common comorbidities were hypertension (60.4%), the incidence of DRPs (92.1%), the most common fina GDS was hyperglycemia (≥ 200 mg/dL) (65.8%). 58 patients were discharged with a negative sample (76.3%). The results of the Wilcoxon test on blood glucose showed differences in blood glucose at the beginning and at the end. The results of the Chi-square test between changes in blood glucose and the patient's clinica outcome (p&gt;0.05) showed that there was no significant relationship between changes in blood glucose levels and the patient's clinica outcome. Spearmen's correlation test results (p&gt;0.05) showed a significant relationship between DRPs and changes in patient's blood glucose. The correlation between the incidence of DRPS and blood glucose (0.169) shows a weak relationship. It can be interpreted that DRPs do not realy affect changes in blood glucose in patients at Jati Padang Hospital.&#x0D; &#x0D;

The Role of Sodium and Glucose in the Prognosis of Patients with Aneurysmal Subarachnoid Hemorrhage: A Literature Review of New Evidence

AbstractThe present study aims to review the influence of glycemia and natremia on the propensity to develop complications, worse prognosis, and mortality risk in patients with aneurysmal subarachnoid hemorrhage (aSAH). This is an integrative literature review guided by the guiding question: “Do changes in blood glucose levels or plasma sodium concentration influence in-hospital morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage?”. The search for articles was performed on the PubMed platform, limiting the selection to works published in English in the period from 2017 to 2022. The results found demonstrate that the role of sodium ions in changes in the prognosis of patients is complex, with hypernatremia being the main factor described to worse outcomes. In contrast, the part of hyponatremia is controversial and may not have prognostic value, and serum sodium concentration is increasingly an important item to be evaluated in patients with aSAH. As for glucose, the variability of this substrate, both hyperglycemia and hypoglycemia, may be correlated with in-hospital and long-term mortality in patients with aSAH. Thus, the present study concludes that changes in blood glucose values and plasma sodium concentration influence the in-hospital morbidity and mortality of patients with aSAH. However, it is emphasized that the analysis of the independent influence of each of the related predictors must be done with caution due to the heterogeneity of the results found.

Hypoglycemic activity of Syzygium cumini (L.) Skeels seed extracts: an approach to in vitro, in vivo, and in silico studies

This research is carried out to explore the hypoglycemic activity of Syzygium cumini seed extracts by in vitro, in vivo, and in silico methods. For in vitro studies the α-amylase and α-glucosidase enzyme inhibition assays were employed. For in vivo studies 30 alloxan induced Wistar rats were used. They were orally administered with glibenclamide and low/high dose of the extracts and were monitored regularly for the change in blood glucose levels for about 28 days. The in silico molecular docking was conducted to evaluate the binding interaction of 1,2,3-Benzenetriol with human pancreatic α-amylase and α-glucosidase. It was found that all the extracts were able to inhibit the α-amylase and α-glucosidase enzymes. Among which the acetone extract showed greater inhibition with 72.52 ± 0.51% and 63.02 ± 0.73% for both the enzymes, respectively. There was significant (p < 0.05) reduction in blood glucose levels in the rats administered with glibenclamide and extracts. In silico docking results revealed that the compound 1,2,3-Benzenetriol exhibited the highest binding affinity for human pancreatic α-amylase with binding energy −7.7 kcal/mol. Thus suggesting the utilization of S. cumini seeds in the management of diabetes mellitus. Communicated by Ramaswamy H. Sarma

FRI636 Sleep Architecture In Diabetic Patients With Sleep Apnea On Metformin

Abstract Disclosure: M. Varma: None. M. Eghbali: None. D. Hung: None. A. Sahai: None. Background: Metformin, commonly used medication to treat Type II Diabetes Mellitus (DM) improves insulin sensitivity, reduces glucose production in liver and absorption by intestines. Type II DM patients often have higher BMI with increased incidence of sleep apnea. Metformin consuming patients sometimes report insomnia. Blood glucose levels affect sleep duration; therefore Metformin-related changes in blood glucose levels may affect sleep. Metformin prescriptions grew from 40 million in 2004 to 90 million in 2020. This has improved long term vascular complications outcomes in diabetics. Coincidentally the number of patients using sleeping aids has increased. Melatonin sales have doubled since 2004, approximating 821 million USD in sales in 2020. With diabetes and Metformin each causing significant changes in sleep, we aimed to examine sleep architecture in known diabetic patients on Metformin presenting with excessive daytime sleepiness and fatigue. Hypothesis: We hypothesize that Metformin affects sleep and influences sleep architecture in diabetic patients. Methods: Sleep architecture in 29 Type II DM patients taking Metformin, with symptoms of excessive daytime sleepiness, snoring, and fatigue was examined. Patients underwent overnight polysomnography which included six channel EEG, Electrooculogram, Electromyogram EKG, and pulse oximetry, respiratory and flow monitoring in a sleep lab. Sleep staging done using AASM guidelines. Data on age, gender, BMI, medications and sleep stages N1, N2, N3 and REM was collected. Data analyzed and shown as mean + SD, t test p&amp;lt;0.05 significant. Results: All patients had OSA diagnoses per AASM guidelines. The average age of patients with DM and OSA on Metformin therapy was 63 years, average BMI was 36. AASM stage distribution was N1 2.69 % + 0.02, N2 59.31% + 0.15, N3 12.22 % + 0.09, (Normal 25%) with 5.71% +0.06 REM sleep (normal 25%). All stages of sleep were reduced with significant reduction in deep sleep (N3) and REM sleep. Conclusion: Diabetic patients on Metformin had alterations in sleep architecture with significantly reduced restorative phases of deep and REM sleep. Sleep apnea reduces N3 and REM sleep, but diabetic pts had a more significant decrease. Although Metformin improves long term outcomes in diabetes associated complications, it alters sleep patterns. Altered sleep patterns further modify insulin release and over prolonged periods worsen glycemic control. Often patients on Metformin need additional medication like insulin for metabolic control. In part the progression of insulin resistance can be from altered sleep. Better understanding the effects of Metformin on sleep is needed to prevent long-term deteriorating effects on sleep while maintaining effective metabolic control. Presentation: Friday, June 16, 2023

SAT175 Noninsulinoma Pancreatogenous Hypoglycemia Syndrome As A Complication Of Nissen Fundoplication

Abstract Disclosure: R. Rinn: None. S. Lacount: None. J. Muuse: None. Hypoglycemia is a common condition that is typically diagnosed with Whipple’s Triad (hypoglycemic symptoms, low blood glucose, resolution of symptoms with treatment). It is important to recognize and treat early as it has the potential for lethal outcomes. Dumping syndrome is a rare presentation after Nissen’s fundoplication and predominantly reported in children. Here we present a case of an adult with persistent postprandial hypoglycemia after Nissen Fundoplication. A 79-year-old male with a recent Nissen’s fundoplication presented with repeated episodes of extreme fatigue and diaphoresis after eating. Other complaints included weakness and significant weight loss. Finger stick glucose on multiple checks were found to be in 40s. He was hospitalized and underwent extensive workup with Endocrinology and Gastroenterology. Important labs revealed elevated insulin 10.2, C-peptide level at 7.3 and pro-insulin at 27.7, negative insulin antibodies, a normal Insulin like growth factor (IGF-1) at 74, Beta-hydroxybutyrate level 0.1, and a negative screen for sulfonylureas. He was discharged home on a low carbohydrate diet but continued having repeated Whipple’s triad positive hypoglycemic episodes. In terms of imaging, CT of the abdomen did not reveal a mass, other localization studies were deferred since the episodes were mostly post-prandial concerning for NIPHS than insulinoma. For management, he had minimal response to octreotide and verapamil. His symptoms are currently being managed on acarbose and diazoxide with dietary modifications consisting of high protein and limited complex carbohydrates. Postprandial hypoglycemia as a complication of Nissen’s fundoplication is thought to be secondary to dumping syndrome (DS). DS is divided into two stages- early/osmotic stage and late/ hypoglycemic stage. Both types are caused by a large amount of gastric contents emptying into the duodenum, resulting in vasomotor symptoms from changes in blood pressure, pulse and glucose levels, as well as gastrointestinal symptoms. Glucagon like peptide-1 is responsible for the second phase and the levels are directly related to gastric emptying and inversely related to plasma glucose concentration. Accelerated gastric emptying causes increased GLP-1 levels leading to exaggerated insulin response resulting in rebound severe hypoglycemia. It is important to realize that diet plays an important role in symptom management. After Nissen’s fundoplication, a decrease occurs in the storage capacity of the fundus and gastric distensibility, which causes increased gastric motility with rapid emptying. Dietary modifications include reduction of carbohydrate intake and supplementation of dietary fibers with meals greatly help relieve symptoms associated with dumping syndrome in addition to drug therapy. Presentation: Saturday, June 17, 2023

Effect on Hemoglobin A1c (HbA1c) and Body Weight After Discontinuation of Tirzepatide, a Novel Glucose-Dependent Insulinotropic Peptide (GIP) and Glucagon-Like Peptide-1 (GLP-1) Receptor Agonist: A Single-Center Case Series Study.

Introduction The purpose of this study was to examine changes in blood glucose levels and body weight after discontinuation of tirzepatide, a novel long-acting dual glucose-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1 RA). Methods Nine subjects (five males, four females, age 54.3±5.4 years, body mass index 33.5±3.3 kg/m2) participating with type 2 diabetes in the SURPASS J-mono study were included. Subjects were randomized to tirzepatide 5 mg, 10 mg, 15 mg, or a dulaglutide 0.75 mg group. Fifty-two weeks after randomization, study drug administration was discontinued. To investigate progress after the end of administration, changes in hemoglobin A1c (HbA1c) and body weight were further examined two, four, and six months after discontinuation of the study drug. Results After fifty-two weeks, all tirzepatide groups had improved HbA1c and body weight compared with the dulaglutide group. At two, four, and six months after the end of study drug administration, re-elevation of HbA1c was observed in all groups. Furthermore, in the tirzepatide groups, dose-dependent weight regain was observed from an early stage. Conclusions Compared to dulaglutide, tirzepatide exhibited excellent blood-glucose-improving and weight-reducing effects. However, exacerbation of blood glucose and rebound of weight gain occurred relatively early after administration was ended. For type 2 diabetes patients who need weight loss and are prescribed tirzepatide, these findings suggest a necessity for continuous prescription or careful follow-up when stopping.

203.2: Changes in portal pressure, blood glucose, and blood pressure levels during islet infusion in pediatric patients: Close monitoring for every five minutes during islet auto-transplantation

203.2: Changes in portal pressure, blood glucose, and blood pressure levels during islet infusion in pediatric patients: Close monitoring for every five minutes during islet auto-transplantation

Effect of sitagliptin combined with Yiqi yangyin huoxue decoction on clinical efficacy and hemorheology in early diabetic nephropathy.

Early diabetic nephropathy (DN) is a complication of diabetes mellitus. It mainly affects kidney microvessels and glomerular function, and its timely and effective treatment is critical for early DN. However, the effects of treatments comprising simple Western medicine are not optimal. With the promotion and implementation of integrated Chinese and western medicine treatments, remarkable results have been achieved for many diseases. To this end, we explored the clinical efficacy of integrated traditional Chinese and western medicines for the treatment of early DN. To investigate the effect of sitagliptin tablets combined with Yiqi yangyin huoxue decoction on clinical efficacy and hemorheology in patients with early DN. Through a retrospective analysis, 123 patients with early DN were admitted to the endocrinology clinic of the Changzhou NO. 7 People's Hospital from January 2021 to October 2022 and were selected as study subjects. After rigorous screening, 100 patients with early DN were enrolled. The control group (CG, n = 50) and the observation group (OG, n = 50) were divided according to the treatment method. The CG were treated with sitagliptin, and the OG were treated with sitagliptin plus the Yiqi yangyin huoxue decoction. Both groups were treated for 3 mo. For both groups, the baseline data and clinical efficacy were compared, and changes in blood glucose levels, lipid levels, renal function, and hematological indicators before (T0) and after (T1) treatment were assessed. The total effective rate for the OG was 94.00% and that of the CG was 80.00% (P < 0.05). After treatment (T1), the levels of fasting blood glucose, 2 h postprandial glucose, total cholesterol, triacylglycerol, and low-density lipoprotein cholesterol in OG patients were obviously lower than those in the CG (P < 0.05), and cystatin C, homocysteine, urinary microalbumin, and blood creatinine values in OG patients were also obviously lower than those in the CG (P < 0.05); erythrocyte deposition, plasma viscosity, whole blood high shear viscosity, and whole blood low shear viscosity were markedly lower in OG patients than in the CG (P < 0.05). Sitagliptin combined with Yiqi yangyin huoxue decoction has a remarkable effect when used to treat patients with early DN. Further, it is helpful in improving hemorheological indices and controlling disease progression.