Changes In Blood Glucose Research Articles

EFFECT OF INHALED CORTICOSTEROID ON BLOOD GLUCOSE AND HBA1C LEVELS IN PATIENTS OF ASTHMA AGED 3-12 YRS

INTRODUCTION: Asthma is a major health concern globally. Asthma, the common chronic disease in children creates not only a myriad of physical, emotional and social problems for the child and the family but also a nancial burden on the family. Though many drugs are available for treatment of asthma, steroid therapy remains the mainstay of treatment and control of recurrent attacks and long-term outcome. The safest and most effective choice for this is inhaled corticosteroids. Adverse effects following prolonged use of systemic corticosteroids are well established on carbohydrate metabolism. Patients on moderate to severe doses of Inhaled corticosteroid (ICS) may have similar effects on carbohydrate metabolism when used for prolonged period. HbA1c levels indicate blood glucose levels concentration in the preceding 8-12 weeks. There is denite evidence of raised Plasma glucose levels with the use of ICS but very scanty literature studying the levels of HbA following use of ICS is available specially in pediatric age group.Some studies do not show signicant rise in plasma 1c glucose or HbA1c The present study was planned to see if there is any change in blood glucose and HbA1c in patients who were on prolonged use of ICS i.e. more than 4 months of moderate to high dose 200 µg to 800 µg and more of inhaled corticosteroid per day were included. RESULT : Correlation between HbA1c levels and duration of Budesonide used.It is seen that cases using budesonide for upto 6 months and upto 600 µmg per day and for less than 6 month had mean HbA1c levels of 5.24+0.80% and those using more than 600µgm per day and for more than 6 month had mean HbA1c level of 5.611+.38%. It is seen that as the dose and duration increase HbA1c level also increase. The difference was not statistically signicant.

Individual differences in sensory and expectation driven interoceptive processes: a novel paradigm with implications for alexithymia, disordered eating and obesity

Those with disordered eating and/or obesity often express difficulties in sensing or interpreting what is happening in the body (interoception). However, research is hindered by conceptual confusion, concerns surrounding domain specificity, and an inability to distinguish sensory (bottom-up) and expectation driven (top-down) interoceptive processes. A paradigm was therefore developed from an active inference perspective. Novel indices were computed and examined in those with alexithymia: a personality associated with interoceptive deficits and disordered eating. The paradigm successfully identified individuals driven by sensations rather than expectations: alexithymia was characterized by attenuated prior precision (a larger divergence between pre-prandial and post-prandial satiety, and low expectation confidence), and increased prediction error (a higher correlation between changes in hunger and blood glucose, and greater rebound hunger after a sensory incongruent drink). In addition, those with a higher BMI were less confident and had a larger anticipated satiety divergence. These findings demonstrate the need to move beyond existing paradigms such as the Satiety Quotient and Heartbeat Counting Task which may have limited our understanding of eating behaviour.

178 Relationships Between Sow Blood Glucose Levels on Day of Farrowing and Sow and Litter Parameters

Abstract Low blood glucose levels at the start of farrowing have been associated with increased farrowing duration and stillbirth rate. This study evaluated changes in sow blood glucose (BG) on the day of farrowing and investigated relationships between sow and litter parameters and BG. The study was carried out over 12 h from 0600h (time of last feeding) on the day sows were induced to farrow (d 115 of gestation) as a cross-sectional survey using 42 sows/gilts of which 32 farrowed. Blood samples (1.2 μL) were collected from an ear vein of each sow every 2 h from 0600 h; glucose was measured using a glucometer (Accuchek Aviva; Roche Diabetes Care, Inc., Indianapolis, IN). Sow parameters recorded included parity, body condition score (BCS: 1 = extremely thin to 5 = extremely fat), number of piglets born, total litter birth weight, and farrowing duration. Linear relationships between sow parameters and BG were developed using PROC REG of SAS. Sows that farrowed had similar (P > 0.05) BG to those that did not (84.4 vs. 86.8 mg/dL; SEM 1.76). Regression relationships between sow parameters and BG were generally weak (adjusted R2 ≤ 0.20). There was no effect (P > 0.05) of time after feeding, time after start of farrowing, or time interval between piglet births on BG. Average BG levels increased linearly (P < 0.05) with sow BCS (7.6 mg/dL/BCS; SE 2.63) but decreased linearly (P < 0.05) with sow parity (-2.5 mg/dL/litter; SE 0.96), litter size (-0.8 mg/dL/piglet; SE 0.28), litter weight (-0.06 mg/dL/kg; SE 0.26), and farrowing duration (-1.8 mg/dL/h; SE 0.82). In contrast to previous research, changes in BG from last feed to start of farrowing (which ranged from 0 to 9 h) and relationship with other sow and litter parameters were relatively limited.

A Phase 2 Evaluation of a Novel Co-Formulation of Pramlintide and Regular Insulin to Improve Postprandial Glycemic Control in Adults with Type 1 Diabetes (T1D)

Objective: Pramlintide co-administration, used in conjunction with prandial insulin, has substantial clinical benefits to improve post-prandial glucose excursions, glycemic variability (GV) and time in range (TIR), but is associated with an increased injection burden that adversely affects adherence and persistence. A novel, fixed-ratio co-formulation of pramlintide and regular insulin (XP-3924) was evaluated in a phase 2 single injection study measuring XP-3924 pharmacokinetics (PK), glucose pharmacodynamics (PD), and its effects upon overall glycemic control. Methods: This was a Phase 2 randomized, open-label, active comparator-controlled, three-period cross-over study, which enrolled 18 adults with T1D to compare the PK and PD, glycemic affects and safety and tolerability of a single dose of XP-3924, to co-administration of regular insulin (Humulin® R) and pramlintide (Symlin®), and to an injection of regular insulin (RI) alone. Subjects were randomly allocated to a sequence of three treatments: XP-3924 (with 50% insulin reduction based their insulin to carbohydrate ratio), RI, or co-administration (RI with 50% insulin reduction plus a comparable pramlintide dose, co-administered as separate injections). The study drugs were administered subcutaneously 30 minutes before a 75-gram oral glucose challenge and glucose levels were monitored for 6 hours. Results: XP-3924 treatment resulted in a 62.3% reduction of hyperglycemia (blood glucose AUC0-3 hr >180 mg/dL) after the glucose challenge when compared to RI (p<0.001), and exhibited comparable postprandial glycemic control to that of the co-administration. After the oral glucose challenge, the mean absolute change in blood glucose and was less in XP-3924 when compared to both co-administration and to RI (197.7±70.74 mg/dL, 230.5±162.39 mg/dL, 254.2±195.21 mg/dL, respectively), as well as GV as defined by the comparison of the intrasubject coefficient of variation of plasma glucose readings across study treatments (53.3%, 62.1%, 71.0%, respectively). The PK of Pramlintide in XP-3924 when compared to co-administration, exhibited longer median Tmax [40.5 (range 21.0–150.0) minutes versus 10.0 (range 10.0–24.0) minutes, respectively], and comparable AUC0-360. The incidence and severity of treatment emergent adverse events (e.g., injection site reactions, minimal nausea and vomiting) was comparable across all treatment arms with no drug-related serious adverse events. Conclusion: XP-3924 was well tolerated and significantly improved post-prandial glucose excursions and glycemic variability compared to regular insulin. XP-3924 also exhibited a favorable PK and PD profile and may be a viable alternative to insulin and pramlintide co-administration to improve treatment adherence and overall glycemic control, especially after meals, addressing an unmet need in the clinical care of people with type 1 diabetes.

A Single Virtual Consult Reduces Severe Hyperglycemia in Patients Admitted with COVID19 Infection

Diabetes and hyperglycemia are risk factors for morbidity and mortality in hospitalized patients with COVID19. Subspecialty consultative resources to help front-line clinicians treat these conditions is often limited. We implemented a “Virtual Hyperglycemia Surveillance Service (VHSS)” to guide glucose management in COVID19 patients admitted to our 1541-bed academic medical center.From April 22 to June 9, 2020, hospitalized adult patients with COVID19 and 2 or more blood glucose (BG) values greater than 250 mg/dl over 24-h were identified using a daily BG report. The VHSS reviewed BGs and treatment plans, then made recommendations for future glycemic management via a one-time note, visible to all providers. Some patients with re-admission or persistently elevated BG after 1 week received a second VHSS note. We compared BGs from 24-h pre- and 72-h post-intervention starting at 6AM on the day following VHSS review. We also evaluated for hypoglycemia, insulin infusion use and use of formal diabetes consults. A subgroup analysis was performed on patients in the intensive care unit (ICU). At the end of the intervention, we identified a retrospective control cohort admitted to the same hospital from March 21 to April 21, 2020 who met the inclusion criteria for a VHSS assessment.The VHSS group consisted of 100 patients with 126 individual VHSS encounters, and the control group comprised 50 patients. Baseline characteristics in the VHSS and control groups, respectively, were: mean age 62.5 vs 62.1 years, % male 58 vs 56, mean weight 91.4 vs 93.4 kg, BMI 31.8 vs 33.0 kg/m2, and HbA1c 9.1 vs 8.8 %. There were fewer patients in the ICU in the VHSS than control group (44% vs 66%). In the VHSS group, mean BG pre- vs. post-intervention was 260.3 ±21.7 and 227.4 ±25.3 mg/dl (p<0.001). In the control group, mean BG pre-and post- the day they met assessment criteria was 264.8 ± 6.5 mg/dl and 250.6 ± 8.6 mg/dl (p=0.18). There was no difference in the use of insulin infusions or diabetes consults between the two groups. More hypoglycemia (BG<70 mg/dl) occurred in the VHSS than control group (8.3% vs 0%, p=0.04). Within the VHSS group, the average change in BG was significantly greater in ICU than non-ICU patients (-51.8 ±8.7 vs -19.6 ±5.0 mg/dl, p<0.01) and the reduction in the % of BG over 250 mg/dl was also significantly greater in the ICU (-32.2% vs -16.8%, p=0.02).Implementation of a single virtual consult for severely hyperglycemic hospitalized COVID19 patients was associated with rapidly reduced BG concentrations, especially in the ICU. The mean reduction in BG with VHSS intervention was more than 2-fold greater than that observed in our control group. Glucose control remained suboptimal, however, suggesting the need for subsequent input from this specialty service.

New Insight into the Vagus Nerve Regulation of Glucose Homeostasis: A Role for Afferent Signaling and Skeletal Muscle Glucose Uptake

The autonomic nervous system (ANS) participates in maintaining glucose homeostasis, in part through vagus nerve signals between the liver and brain stem. However, the role of afferent and efferent vagus nerve signaling in the regulation of glucose homeostasis is unknown. Here we observed electrical stimulation of the cervical vagus nerve significantly reduced blood glucose levels from the baseline level in wildtype, fasted mice as compared with sham stimulated controls (change in blood glucose; sham stimulation vs. stimulated, -14.14 mg/dL ± 13.44 mg/dL vs. -27.14 mg/dL ± 18.54 mg/dL, p = 0.0218). Animals subjected to chemical ablation of the vagus nerve (vagotomy) proximal to the stimulating electrodes failed to respond to the glucose lowering effects of vagus nerve stimulation (change in blood glucose; proximal vagotomy vs. no vagotomy, -6.750 mg/dL ± 14.05 mg/dL vs. -25.22 mg/dL ± 19.14 mg/dL, p = 0.0243). This indicates that afferent vagus nerve signaling can decrease glucose levels. We also observed vagus nerve stimulation failed to mediate significant changes in circulating levels of insulin, glucagon, leptin, or GLP-1. Skeletal muscle glucose uptake is mediated by GLUT4 transporters, a major mechanism for maintaining glucose. To investigate whether skeletal muscle glucose uptake via GLUT4 is required for the glucose lowering effect of vagus nerve stimulation, we generated transgenic mice that lacked the GLUT4 transporter selectively in skeletal muscle. Vagus nerve stimulation resulted in decreases in circulating glucose levels in littermate controls, but not in animals with the GLUT4 transporter knocked out in the skeletal muscle (change in blood glucose; littermate controls vs. GLUT4 KO, -59.63 mg/dL ± 28.37 mg/dL vs. -36.67 mg/dL ± 15.63 mg/dL). Next, to test effects of vagus nerve stimulation in hyperglycemic conditions, obese ob/ob mice with baseline glucose greater than 250 mg/dL were subjected to vagus nerve stimulation. A significant decrease in blood glucose levels from baseline is observed in ob/ob mice as compared to sham stimulated controls (change in blood glucose; stimulated vs. sham stimulated, -84.72 mg/dL ± 27.41 mg/dL vs. -10.65 mg/dL ± 14.05 mg/dL, p = 0.003). Together these findings indicate afferent vagus nerve activity increases glucose uptake in skeletal muscle and lowers serum glucose.

A Pharmacokinetic Study of High‐Dose Intravenous Vitamin C in Healthy Volunteers and Oncological Patients

Purpose : High-dose intravenous vitamin C (IVC) is used in a variety of disorders and clinical trials (e.g. cancer, sepsis, burn, infection, fatigue, chelation). However, reliable pharmacokinetic (PK) data is limited and misinformation exists in clinical applications of vitamin C. Here we conducted a study in healthy volunteers and cancer patients to detail the PK of escalating doses of IVC from 1 to 100 g. Methods : A single-site standard PK study was conducted in 12 healthy volunteers and 12 cancer patients. Healthy subjects received a single-dose IVC infusion at 1, 5, 10, 25, 50, or 75 g, while the 100 g was administered as 4-dose infusions separated by 1-week; oncology subjects received 25, 50, 75, or 100 g of IVC with 4-dose infusions at each dose level separated by 1-week. Blood and urine samples were collected pre-infusion and at various time points within 24 hours post-infusion. Complete blood counts, blood chemistry, metabolic parameters were measured. Urine oxalate, urate, and ascorbate were also detected. Pharmacokinetic parameters were computed using noncompartmental methods. Adverse events were monitored during the study. Results : In healthy subjects, ascorbate maximum plasma concentration (Cmax) and the area under the concentration-time curve over 24 hours (AUC0-24) increased proportionally with the IVC doses. Half-life (t1/2) of ascorbate was stable on these doses (1.8 ± 0.3 h). No saturation of clearance was observed. When receiving 100 g of IVC, oncology patients had significantly lower Cmax than healthy participants (oncology: 151 ± 42 mg/dL vs. healthy: 578 ± 58 mg/dL) and AUC0-24 (oncology: 942 ± 225 hr*mg/dL vs. healthy: 2499 ± 55 hr*mg/dL), but a longer half-life (oncology: 5.4 ± 2.6 hours vs. healthy: 1.8 ± 0.3 hours). Consequently, the 24-h total ascorbate excretion in urine was significantly lower in oncology subjects than healthy subjects at 100 g (oncology: 38.6 ± 10.0 g vs. healthy: 107.4 ± 1.9 g). No adverse events were observed except for Grade 1 chills in one oncology participant at 100 g. MTD was not reached. There were no significant changes in blood glucose or ECG tracings in all participants. The blood calcium decreased immediately after patients received the IVC at the high dose levels (75 and 100 g), but the change was temporary and likely related to osmolarity of the infuscate. IVC had no significant effect on blood counts or indicators of liver and kidney functions including ALT, AST, albumin-to-creatinine ratio and urea nitrogen. Conclusion : Intravenously administered ascorbate resulted in systemic pharmacological concentrations with Cmax linearly correlated with the dose. Disease conditions such as cancer may change the Cmax and t1/2, presumably because of tissue utilization. Ascorbate was exclusively excreted through urine. High does up to 100 g/infusion did not change blood counts or major blood chemistry, nor kidney or liver functions. This study is the first to report pharmacokinetics of escalating doses of IVC from 1 to 100 g with sampling over 24-hours in both healthy and oncology subjects. The data could be used to clarify existing misinformation and to guide future clinical trials.

Effect of high-intensity interval training on cardiometabolic risk factors in childhood obesity: a meta-analysis

This systematic review with meta-analysis aimed to quantify the effectiveness of high-intensity interval training (HIIT) on the cardiometabolic health of obese children and adolescents. Relevant articles were sourced from PubMed, Embase, the Web of Science, EBSCO, the Cochrane Library and China National Knowledge Infrastructure (CNKI). Randomized controlled trials were included if they employed participants aged 7-19 years. Outcomes included fasting glucose (FG), fasting insulin (FI), homeostasis model assessment-insulin resistance (HOMA-IR), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triacylglycerol (TG), total cholesterol (TC), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at baseline and postintervention and compared with those in the control group. Data analysis and synthesis were completed by Revman 5.3 software and Stata 12.0 software (StataCorp LLC., College Station, TX, USA). Eight trials involving 379 participants were identified. HIIT significantly decreased the FI, HOMA-IR, TC, TG, LDL-c and SBP in participants with obesity. With regard to changes in blood glucose and lipids, participants who underwent HIIT showed great improvement in FI (mean difference: -3.09 µU/mL, 95% confidence interval [CI] -3.71 to -2.46, P<0.0001), HOMA-IR (mean difference: -0.64, 95% CI -0.82 to -0.46, P<0.0001), TG (mean difference: -0.21 mmol/L, 95% CI -0.31 to -0.10, P<0.0001) and LDL-c (mean difference: -0.35 mmol/L, 95% CI -0.48 to -0.22, P<0.001) than the control group. Similar results were found for SBP (mean difference: -3.61 mmHg, 95% CI -5.85 to -1.37, P=0.002). However, no significant differences in changes in FG, HDL-c and DBP were observed between HIIT and control groups. HIIT can produce a positive effect on cardiometabolic risk factors in obese children and adolescents. HIIT may be an alternative and effective training method for managing childhood obesity.

The effect of combined supplementation with vitamin D and omega-3 fatty acids on blood glucose and blood lipid levels in patients with gestational diabetes.

To investigate the effects of vitamin D and omega-3 fatty acids on glucose and blood lipid metabolism in gestational diabetes (GDM) women. A total of 150 patients with GDM aged 18-40 who were admitted to our hospital from May 2019 to December 2020 were enrolled in this study. The subjects were divided into test and control groups according to whether they took vitamin D and omega-3 fatty acids. The test group took 40,000 IU of vitamin D and 8,000 mg of omega-3 fatty acids twice a day. Comparative analysis of the changes in blood glucose and blood lipid levels of the two groups of patients was performed after 6 weeks. The t-test was used to compare the differences between groups, and the chi-square test was used to assess percentage differences. Repeated measures variance was used to analyze the effects of vitamin D and omega-3 fatty acids on insulin metabolism markers and blood lipid profiles. After adjusting for baseline age and weight, it was found that the fasting blood glucose (FBG), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), triglycerides (TGs), total cholesterol, low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL) in the test group were decreased by 0.3±0.2 mmol/L, 1.0±0.6 uIU/mL, 0.2±0.1, 0.3±0.1 mmol/L, 0.5±0.2 mmol/L, 1.1±0.4 mmol/L, and 0.03±0.01 mmol/L, respectively, while homeostasis model assessment of beta cell (HOMA-β) was increased by 0.4±0.1. Compared to the placebo group, the test group's FBG, insulin, HOMA-IR, TGs, total cholesterol, LDL, and VLDL were all significantly decreased, and HOMA-β was markedly improved. However, no notable statistical difference was observed in the change of high-density lipoprotein (HDL) (P>0.05). Combined supplementation with vitamin D and omega-3 fatty acids for 6 weeks in patients with GDM can effectively reduce blood sugar and blood lipids, improve HOMA-β and insulin resistance, and ultimately effectively improve the glucose and lipid metabolism of patients.

The Role of Obesity in the Development of Kidney and Glomerular Ultrafiltration Barrier Injuries: Leptin Contributions

Introduction Obesity is associated with multiple risk factors to the development of comorbidities such as kidney injuries. Lesions in the glomerular ultrafiltration barrier may cause impairment of the kidney filtration process. Nephrin is one of the main components of the glomerular ultrafiltration barrier, so changes in the expression of this protein indicate impaired renal function. Thus, the aim of this study is to investigate the role of obesity in the development of kidney and glomerular ultrafiltration barrier injuries. The contribution of leptin to kidney function in this context was also evaluated. Methods The protocols are in agreement with CEUA (nº 13/2017). Twenty-four mice aged 18 weeks were used: Six C57BL / 6J were assigned to the lean control group (CTL) and 18 ob/ob (provided by Prof. Dr. José Donato Junior from ICB-USP) were randomly assigned to obese control group (ob/ob) and obese treated with leptin group (ob/ob - lep). Leptin treatment was performed through osmotic mini-pump (model 1004, Alzet) insertion. Mini-pumps were filled with a solution containing leptin at a dose of 3.5 μg/day for 42 days. During the treatment period food intake was monitored daily. Weight gain and blood glucose were monitored weekly. At the end of the treatment period, the animals were kept in metabolic cages for 24 hours to evaluate water intake and urine collection. Ultimately, the animals were submitted to euthanasia by exsanguination. Renal function was assessed by plasma concentration of creatinine and urea, and urinary albumin excretion. Renal tissue was used to evaluate gene expression by qPCR, histological and immunofluorescence analysis. Results Plasma leptin measurements confirm that ob/ob animals did not produce leptin and that introduction of exogenous leptin elevated the levels of this hormone to values close to control. Ob/ob - lep group had a reduction in food intake and body weight when compared to ob/ob group, this reduction led to values of food intake and body weight similar to CTL group. There were no changes in water intake, urine flow and blood glucose among groups. There were also no changes in plasma creatinine values among groups, however, in the ob/ob group, there was an increase in serum urea and leptin treatment partially reversed this parameter to values closer to CTL. In ob/ob animals, there was an increase in urinary albumin excretion and leptin treatment lowered this parameter to values closer to CTL group. Inflammation of the renal tissue in obese animals was confirmed by increased IL-6 mRNA expression, leptin had no effect at this parameter. There was no significant difference in the expression of mRNA to MCP1 between groups. However, there is a tendency to increasing that gene's expression in obese animals and leptin treatment reduces that parameter back to control. In 42 days of protocol, there was no glomerular hypertrophy in the ob/ob group, however, there was a reduction in the expression of nephrin and leptin treatment did not reverse this parameter. Conclusion: Obesity impairs renal function, increases expression of inflammatory molecules and decreases nephrin expression. Leptin therapy was partially renoprotective since it reversed some of the observed parameters.

Chronic Renal Artery Insulin Infusion Decreases 24 hr/day Renal Blood Flow in Diabetic Rats

The renal effects of type 1 diabetes, e.g. natriuresis and vasodilation, are ascribed directly to the hyperglycemia. We reported that 6 days of diabetes (~ 400 mg/dl) in dogs did not cause sustained natriuresis if plasma insulin was not allowed to decrease below normal. This suggested that the decrease in insulin and loss of its sodium retaining influence, rather than hyperglycemia, was responsible for sustained natriuresis in type 1 diabetes. This study tested the role of the decrease in insulin in mediating the renal blood flow (RBF) response to diabetes. Rats were instrumented with a chronic catheter in the left renal artery, inserted via a puncture in the aorta at the origination of the renal artery. The right kidney was removed, and a Transonic flow probe was placed on the left renal artery. Artery and vein catheters were implanted. The flow probe cable and catheters were exteriorized through a button in the scapular region and rats were placed in metabolic cages. They were connected to a Dragonfly commutator and Instech dual-channel hydraulic swivel mounted in series for continuous, 24 hr/day intravenous (IV) and intrarenal (IR) infusion while measuring RBF continuously, 24 hr/day. In 5 rats, RBF averaged 10.8±1.5 ml/min during baseline and averaged 11.0±0.7 ml/min during 1-4 days of diabetes (STZ, 40 mg/kg). Insulin then was added to the IR saline vehicle at a dose of 0.3 mU/kg/min, which we have reported did not spill over systemically in rats. The next four days of IR insulin infusion yielded decreasing RBF values of 10.9±1.3, 10.2±1.1, 7.9±1.2, and 7.8±1.0 ml/min. RBF did not recover when IR insulin was stopped, so 2 Control rats underwent 7 days of diabetes without IR insulin. Baseline RBF averaged 7.8 ml/min, and over the next 7 days averaged: 8.4, 12.0, 11.9, 10.9, 10.2, 10.6, and 10.7 ml/min. The RI insulin infusion also was tested in one additional rat that was not diabetic. There was no change in RBF or blood glucose over 4 days of infusion. These results suggest a chronic renal vasoconstrictor influence of insulin under diabetic conditions. We hypothesize this suggests that the decrease in insulin may contribute directly to the renal vasodilation that occurs in type 1 diabetes.

Relationship between the changes in thromboxane B2, 6-keto-prostaglandin Fla, and blood glucose levels and progressive ischemic stroke.

Progressive ischemic stroke is a common cerebrovascular disease with high morbidity. This study aimed to investigate the relationship between changes of Thromboxane B2 (TXB2), 6-keto-prostaglandin Fla (6-k-PGFla), and blood glucose (BG) levels with progressive ischemic stroke. A total of 106 patients with progressive ischemic stroke admitted to our hospital from December 2016 to December 2018 were recruited as the observation group, and 110 patients who received physical examination in our hospital during the same period were selected as the control group. The levels of TXB2, 6-k-PGFla, and BG in different groups were compared, the related risk factors affecting the prognosis of patients with progressive ischemic stroke were analyzed, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of TXB2, 6-k-PGFla, and BG for the prognostic mortality of patients with progressive ischemic stroke. The levels of TXB2, 6-k-PGFla, and BG in the observation group were significantly higher than those in the control group (P<0.05). The prognostic mortality of participants with abnormally increased expression of TXB2, 6-k-PGFla, and BG was significantly higher than that of patients with normal expression of TXB2, 6-k-PGFla, and BG (P<0.05). Hypertension, diabetes, collateral circulatory disorders, hyperlipidemia, TXB2 (abnormal increase), 6-k-PGFla (abnormal increase), and BG (abnormal increase) were risk factors affecting the prognosis of patients with progressive ischemic stroke (P<0.05). The area under the curve (AUC) of the ROC curve showed that TXB2, 6-k-PGFla, BG, and the combination of them were 0.846, 0.893, 0.835, and 0.971, respectively, showing that the AUC of the combination of them was the largest. Hypertension, diabetes, collateral circulatory disorders, hyperlipidemia, TXB2 (abnormal increase), 6-k-PGFla (abnormal increase), and BG (abnormal increase) are risk factors affecting the prognosis of patients with progressive ischemic stroke. The combined detection of the 3 indicators showed high sensitivity and specificity in evaluating the prognostic mortality of patients with progressive ischemic stroke, indicating that clinicians might improve the early diagnosis rate of progressive ischemic stroke by combining the detection of TXB2, 6-k-PGFla, and BG to predict the prognosis of patients.

Probiotics Contribute to Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

This systematic review aimed to evaluate the effectiveness and safety of probiotics for glycemic control in adults with impaired glucose control, including prediabetes and type 2 diabetes mellitus (T2DM). We searched PubMed, Embase, and Cochrane databases, and trial registries up to February 2019.We included randomized controlled trials (RCTs) of participants with prediabetes or T2DM. Eligible trials compared probiotics versus either placebo, no intervention, or comparison probiotics, or compared synbiotics versus prebiotics.Primary outcomes were mean change in fasting blood glucose (FBG) and glycated hemoglobin (HbA1c) from baseline to short term (<12 wk) and long term (≥12 wk). We performed meta-analyses using the random-effects model. We included 28 RCTs (1947 participants). Overall, probiotics reduced FBG more than the placebo/no intervention group with a mean difference (MD) of -12.99mg/dL (95% CI: -23.55, -2.42; P value: 0.016) over the short term; and -2.99mg/dL (95% CI: -5.84, -0.13; P value: 0.040) over the long term. There was also some evidence for reduced HbA1c in the probiotics group at both short term (MD: -0.17; 95% CI: -0.37, 0.02; P value: 0.084) and long term (MD: -0.14; 95% CI: -0.34, 0.06; P value: 0.172), however, these did not reach statistical significance possibly because only a few trials reported HbA1c as an outcome. Subgroup analyses showed a greater reduction in HbA1cin participants not receiving insulin therapy than those receiving insulin therapy. Furthermore, the effect of probiotics on the reduction of FBG was more pronounced in participants with FBG >130mg/dL and those not receiving insulin therapy than their counterparts. Probiotics were also effective in lowering serum cholesterol over the short and long term. In conclusion, we found thatprobiotics may have a glucose-lowering effect in T2DM participants. The effect appeared to be stronger in participants with poorly controlled diabetes and those not on insulin therapy. Systematic review registration: CRD42019121682.

A randomized controlled trial of a structured program combining aerobic and resistance exercise for adults with type 2 diabetes in Japan.

We assessed the effect of supervised, combined aerobic and resistance exercise on diabetic parameters in Japanese patients with type 2 diabetes mellitus (T2DM). This 12-week, multicenter (17 medical institutions), open-label, parallel-group study (clinicaltrials.jp; JapicCTI-184002), randomized (1:1) Japanese patients aged 20-75years with T2DM and hemoglobin A1c (HbA1c) of 7.0-10.0% to supervised exercise (n = 113) or standard therapy (n = 115). The supervised exercise group undertook supervised aerobic (30min) and resistance exercise 3 times/week (20 designated gyms). Primary endpoint was change in HbA1c from baseline at week 13. Secondary endpoints were change in fasting blood glucose (FBG), glycoalbumin, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and HOMA-β at week 13. Of 228 randomized patients, 97 (85.8%) in the supervised exercise group and 108 (93.9%) in the standard therapy group completed the study. Supervised exercise significantly lowered HbA1c at week 13 versus standard therapy (estimated difference in change from baseline [95% confidence interval]:- 0.44% [-0.61,-0.28], p < 0.001). Supervised exercise also significantly decreased FBG (estimated difference:-13.0 [-19.2,-6.7] mg/dL) and glycoalbumin (estimated difference: -1.52% [-2.10,-0.93]) compared with standard therapy. Fasting insulin (-0.5 µIU/mL) and HOMA-IR (-0.3) decreased with supervised exercise, but group differences were not significant. Treatment-emergent adverse events were more frequent in the supervised exercise group (42.5%) than in the standard therapy group (29.6%); however, no major safety concerns were identified. A structured, supervised, aerobic and resistance exercise program improved HbA1c and was well accepted among patients with T2DM. The online version contains supplementary material available at 10.1007/s13340-021-00506-5.

The future of insulin therapy

Although insulin therapy was already introduced one-hundred years ago, insulin formulations are still being refined to reduce the risk of hypoglycaemia and of other insulin side effects such as weight gain. This review summarises the available clinical data for some ongoing developments of new insulins and evaluates their potential for future insulin therapy.Once-weekly insulins will most likely be the next addition to the insulin armamentarium. First clinical studies indicate low peak-to-trough fluctuations with these insulins indicating the potential to achieve better glycaemic control or reduce hypoglycaemic events versus available basal insulins. Proof-of-concept has also been established for hepato-preferential and oral insulins; however, adverse effects and low bioavailability still need to be overcome. It will take much longer, before glucose-responsive “smart” insulins will be available. A first clinical study and numerous pre-clinical data show the potential, but also the challenges of designing an insulin that quickly reacts to blood glucose changes and prevents hypoglycaemia and pronounced hyperglycaemia. Nevertheless, it is reassuring that the search for better insulins has never stopped since its first use one-hundred years ago and is still ongoing. New developments have a high potential of further improving the safety and efficacy of insulin therapy in the future.

Placebo controlled phase II clinical trial: Safety and efficacy of combining intranasal insulin &amp; acute exercise

A growing number of investigations are exploring the utility of intranasal insulin as a means of mitigating cognitive decline. However, as a basic tenant of dementia prevention programs is increasing physical activity, it is essential to obtain a preliminary assessment of the safety profile of combining intranasal insulin with physical activity; to ensure that undue risks are not incurred. Utilizing a randomized double-blind placebo-controlled design, a sample of 116 non-diabetic, fasted college-aged adults were randomly assigned to receive a dose of 0-to-120 IU of NovoLog (Insulin Aspart) before being randomized to 20min of exercise or sitting control condition. The safety of intranasal insulin was assessed by examining the incidence of potential symptoms of hypoglycemia and changes in peripheral blood glucose. The efficacy of a combination therapeutic approach was assessed using behavioral measures of inhibition and sustained attention alongside neuroelectric indices of attentional engagement. The frequency of symptoms reported following administration of intranasal insulin were not observed to interact with exercise so as to make their occurrence any more or less prominent, nor was the frequency observed to relate to the dose of intranasal insulin. However, doses of intranasal insulin of 100 IU or more were observed to result in a 7-fold increase in the likelihood of a level 1 hypoglycemic event for those individuals in the exercise condition. This study provides preliminary evidence to suggest that exercise is not associated with an increase in risk when combined with lower doses of intranasal insulin.Clinical trial registrationThe trial is registered at ClinicalTrials.gov, number NCT04292535.

Non-invasive Monitoring of Three Glucose Ranges Based On ECG By Using DBSCAN-CNN.

Autonomic nervous system (ANS) can maintain homeostasis through the coordination of different organs including heart. The change of blood glucose (BG) level can stimulate the ANS, which will lead to the variation of Electrocardiogram (ECG). Considering that the monitoring of different BG ranges is significant for diabetes care, in this paper, an ECG-based technique was proposed to achieve non-invasive monitoring with three BG ranges: low glucose level, moderate glucose level, and high glucose level. For this purpose, multiple experiments that included fasting tests and oral glucose tolerance tests were conducted, and the ECG signals from 21 adults were recorded continuously. Furthermore, an approach of fusing density-based spatial clustering of applications with noise and convolution neural networks (DBSCAN-CNN) was presented for ECG preprocessing of outliers and classification of BG ranges based ECG. Also, ECG's important information, which was related to different BG ranges, was graphically visualized. The result showed that the percentages of accurate classification were 87.94% in low glucose level, 69.36% in moderate glucose level, and 86.39% in high glucose level. Moreover, the visualization results revealed that the highlights of ECG for the different BG ranges were different. In addition, the sensitivity of prediabetes/diabetes screening based on ECG was up to 98.48%, and the specificity was 76.75%. Therefore, we conclude that the proposed approach for BG range monitoring and prediabetes/diabetes screening has potentials in practical applications.

Effects of Stocking Transport Duration on Age-0 Walleye

AbstractFish hatcheries are generally not adjacent to stocking locations. Thus, hatchery fish undergo transportation processes for variable durations that can result in changes in water quality, fish physiology (e.g., whole blood glucose and plasma cortisol), and reduced survival. Walleye Sander vitreus are commonly stocked throughout North America with variable stocking success, possibly due to altered physiological responses associated with changes in water quality parameters during transportation. We hypothesized increased transport duration would be associated with increases in water temperature, carbon dioxide, and total ammonia nitrogen and decreases in pH and total alkalinity. We also hypothesized that increases in carbon dioxide, water temperature, un-ionized ammonia, and total ammonia nitrogen would be positively related with Walleye whole blood glucose and plasma cortisol concentrations. Walleye were transported for either 0, 0.5, 3, or 5 h and whole blood glucose and plasma cortisol concentrations and mortality were evaluated for 48 h posttransport. Total ammonia nitrogen concentrations, carbon dioxide, pH, and water temperature increased with transportation duration while total alkalinity decreased. Plasma cortisol and whole blood glucose concentrations of Walleye transported for longer durations took longer to decline relative to those not transported. Water quality parameters were not associated with changes in Walleye whole blood glucose and plasma cortisol concentrations, but they were negatively related with time since transport (P &amp;lt; 0.05). Despite increases in stress, mortality was low (2.5%). Overall, we found evidence to support our hypotheses regarding reduced water quality associated with increasing transport duration. Finally, whole blood glucose and plasma cortisol concentration of Walleye that were transported were similar to those not transported, suggesting handling procedures before transportation could play a significant role in physiological responses measured after transportation. Further, evaluation of stocking procedures aimed at decreasing handling during the loading process could enhance stocking protocols. Elevated concentrations of whole blood glucose and plasma cortisol following transport could make recently stocked Walleye more susceptible to the effects of other environmental factors such as starvation, predation, and disease, all of which could result in increased mortality rates after stocking.

The effect of insulin pump combined with ulinastatin on the levels of PCT, TG, PTX-3, and CX3CL1 in patients with diabetic ketoacidosis and pancreatitis.

The aim of this research is to observe the effect of insulin pump combined with Ulinastatin on the levels of procalcitonin (PCT), triglycerides (TG), pentraxin-3(PTX-3), and C-X3-C motif chemokine ligand 1 (CX3CL1) in patients with diabetic ketoacidosis and pancreatitis.A total of 72 patients with diabetic ketoacidosis and pancreatitis who were admitted to our hospital from February 2016 to February 2020 were selected as the research subjects. They were divided into study groups (36 cases, given insulin pump combined Ulinastatin treatment) and control group (36 cases, given insulin pump treatment). Statistics of changes in blood amylase (AMS), blood glucose, blood ketones, glycosylated hemoglobin (HbA1c), PCT, TG, PTX-3, and chemokine CX3CL in pancreatic tissue before and after treatment.After treatment, the clinical efficacy of the study group was significantly higher than that of the control group (94.44% vs 75.00%), the difference was significant (P < .05). After treatment, the clinical symptoms (abdominal distension, abdominal pain, body temperature, blood sugar, HbA1c and blood amylase) in the study group were significantly less time-to-normal than in the control group, and the difference was significant (P < .05). After treatment, the AMS, blood sugar, HbA1c, and blood ketones of the 2 groups were all lower than before treatment, and the study group's AMS, blood sugar, HbA1c, and blood ketones were all lower In the control group, the difference was significant (P < .05). After treatment, the 2 groups of PCT, TG, PTX-3, and CX3CL were all lower than before treatment, among which the study group PCT, TG, PTX-3, and CX3CL1 were lower than the control group, the difference was significant (P < .05). After treatment, the total adverse reaction rate of the 2 groups was not significantly different (P > .05), but the total adverse reaction rate of the study group was lower than that of the control group.The combination of insulin pump and ulinastatin in the treatment of patients with diabetic ketoacidosis complicated with acute pancreatitis has a effect, which can shorten the recovery time of clinical symptoms, reduce the levels of PCT, TG, PTX-3, and CX3CL1, and has fewer adverse reactions. It is worthy of clinical application.

EFFECTS OF MAT PILATES TRAINING ON BODY COMPOSITION AND CARDIOMETABOLIC MARKERS IN POSTMENOPAUSAL WOMEN WITH MULTIMORBIDITY

Objective: The aim of this study was to evaluate the effects of Mat Pilates training on body composition, resting blood pressure, and lipids, glucose, and adiponectin levels in postmenopausal women with cardiometabolic multimorbidities. Design and method: Forty-seven postmenopausal women between 50 and 70 years were allocated into two groups based on the number of comorbidities: no more than 1 (COM n = 23) and at least 2 comorbidities (MULT n = 24). Both groups performed Mat Pilates three times a week for 12 weeks. Before and after the intervention, resting blood pressure, body composition, and blood samples (lipidogram, adiponectin, glucose, glycated hemoglobin, and uric acid) were evaluated. A two-factor Generalized Estimated Equation was used to compare groups, time, and their interaction (groups∗time). Results: Women in MULT presented higher body mass, body mass index, fat mass, and abdominal circumference than COM (p &lt; 0.01). Blood pressure was reduced (p &lt; 0.05) in both groups. Triglycerides decreased (p &lt; 0.05) in COM and increases in MULT (p &lt; 0.05) over time with no changes in total cholesterol, HDL, or LDL. Uric acid increases (p &lt; 0.01) over time in both groups. Adiponectin had higher (p &lt; 0.01) levels in the COM group and glycated hemoglobin decrease (p &lt; 0.05) over time in both groups without changes in blood glucose. No interaction was found in any analyzed variable. Conclusions: These results suggest that 12 weeks of Mat Pilates training can improve blood pressure and glycated hemoglobin independent of the number of morbidities of cardiometabolic disease, but may not change body composition, lipids, glucose, or adiponectin levels in postmenopausal women.