Euglycemic Patients Research Articles

Triglyceride-glucose index as a predictor of cardiac adverse events in acute coronary syndrome patients undergoing percutaneous coronary intervention: role of diabetes

BackgroundTriglyceride-glucose index (TyG), a surrogate marker of insulin resistance (IR), could be a potential prognostic marker in patients with acute coronary syndromes (ACS). We evaluated the effect of the TyG index on major adverse cardiac and cerebrovascular events (MACCE) in patients with ACS undergoing percutaneous coronary intervention (PCI).MethodsThis registry-based cohort study was conducted at Tehran Heart Center from 2015 to 2021 and the median follow-up duration was 378 days. The primary outcome was MACCE and the secondary outcomes were MACCE components: all-cause mortality, myocardial infarction, stroke, target vessel revascularization, target lesion revascularization, and coronary artery bypass grafting. For comparison among TyG quartiles (Q), the log-rank test was used. Unadjusted and adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs) were used to describe the association between TyG quartiles and MACCE. A subgroup of euglycemic patients was also evaluated.ResultsA total of 13,542 patients were included. Patients in the fourth TyG quartile (Q4) were younger, had higher mean BMI, and higher prevalence of hypertension, diabetes, and dyslipidemia. The adjusted Cox model showed that a 1-unit increment of the TyG index was associated with a significantly higher risk of MACCE (aHR 1.18, 95% CI 1.08 to 1.30, p < 0.001). Among TyG quartiles, there was a higher MACCE incidence in Q4 compared to Q1 (aHR 1.29, 95% CI 1.08 to 1.53, p = 0.005). In the euglycemic subgroup of the population, there was no significant association between MACCE incidence and a 1-unit increase in TyG or among TyG quartiles.ConclusionBased on our findings, while higher TyG levels and quartiles were associated with higher rates of MACCE in ACS, there was no such effect in the euglycemic population. If confirmed in future studies, these results can be beneficial for clinicians to risk stratify these patients with an easy-to-use index and determine clinical plans based on their risk.Graphical abstract

Hyperglycemia in Orthopaedic Trauma Patients: Implications, Management, and Future Directions

Physiologic stress-induced hyperglycemia (SIH) significantly impacts patient outcomes in both non-diabetic and diabetic individuals following orthopaedic trauma. This review synthesizes current literature on SIH's effects, highlighting its association with increased surgical site infections (SSI), extended hospital stays, wound complications, nonunion, need for revision surgery, and mortality. Non-diabetic patients with SIH face worse outcomes compared to euglycemic patients, including a higher risk of deep infections and systemic complications. Diabetic patients experience exacerbated hyperglycemia during trauma, leading to poor wound healing and heightened infection risk. Effective glycemic control, through preoperative optimization, intraoperative monitoring, and postoperative management, is crucial for improving outcomes. Special considerations are discussed for the geriatric population, who are particularly vulnerable to SIH-induced morbidity and mortality. Future directions emphasize developing tailored glycemia management algorithms, utilizing continuous monitoring systems, and fostering multidisciplinary collaboration to optimize care for orthopaedic trauma patients.

Proportion of Newly Detected Hypothyroidism among the Diabetic and Nondiabetic Pregnant Ladies and Correlation of Different Parameters with Thyroid Stimulatory Hormone in Pregnancy Attending a Tertiary Care Hospital

ABSTRACT Background: Subclinical hypothyroidism and gestational diabetes are the two most common endocrinopathy encountered in daily clinical practice. Many literature showed a higher frequency of hypothyroidism in the persons with diabetes but others did not find it. Objectives: The study was intended to compare the proportion of newly detected hypothyroidism in persons with diabetes and without diabetes in pregnancy (DIP). Materials and Methods: This cross-sectional, observational study enrolled 175 pregnant women by convenient sampling from the Department of Obstetrics and Gynecology, BIRDEM General Hospital, with or without diabetes after IRB clearance. According to the study protocol, Thyroid function test (TFT) and oral glucose tolerance test were done in the participants. Thyroid stimulatory hormone (TSH), free thyroxin, and antithyroid antibodies were tested using the chemiluminescent technique by the ADVIA centaur, Siemens. Plasma glucose was analyzed by Advia-1800, SIEMENS, USA by glucose oxidase method. Data were analyzed by SPSS version 25. Nonparametric tests were chosen for statistical analysis. Results: The median maternal age was 30 years, and half of the participants had a family history of diabetes mellitus (DM). Hundred patients had diabetes either gestational DM or DIP or preexisting diabetes. Among the persons with diabetes, 34% had hypothyroidism, and in euglycemic patients, 29.3% had hypothyroidism. There was no statistically significant (P = 0.785) difference in the median values of TSH across the glycemic status among the hypothyroid subjects. TSH had a positive correlation with thyroid peroxidase antibody (P = 0.174) within the hypothyroid patients. In the study subjects, TSH was inversely correlated with hemoglobin (P &lt; 0.001). Conclusions: There is no statistically significant concordance in diagnosing hypothyroidism in pregnancy between the persons with diabetes and without diabetes.

Cortisol awakening response in bipolar patients with comorbid type 2 diabetes mellitus

IntroductionBipolar Disorder (BD) is a severely debilitating psychiatric disorder with high rates of morbidity and mortality, and patients with BD have a 10-year reduction in their life expectancy. Bipolar disorder (BD) is frequently associated with type 2 diabetes mellitus (T2DM). BD patients with comorbid T2DM have been shown to have three times higher odds of a chronic course and rapid cycling and are more likely to present worse outcomes to treatment with lithium and/or other mood stabilisers when compared to BD patients without IGM (impaired glucose metabolism).ObjectivesThe functioning of the hypothalamic-pituitary-adrenal (HPA) axis has been never investigated in BD with respect to the glucose metabolic status. Therefore, we assessed the cortisol awakening response (CAR) in bipolar patients with or without comorbid T2DM.MethodsTwenty euglycemic bipolar patients [12 males and eight females; mean age (±SD): 47.4 ± 14.4 years; mean (±SD) duration of illness: 18.3 ± 12.1 years], 16 BD patients with T2DM [11 males and five females; mean age (±SD): 63.6 ± 12.8 years; mean (±SD) duration of bipolar illness: 17.1 ± 10.8 years; mean (±SD) duration of T2DM: 5.2 ± 5.3 years], 18 healthy subjects [seven males and 11 females; mean age (±SD): 45.0 ± 12.1 years] and 12 non-psychiatric subjects with T2DM [eight males and four females; mean age (±SD): 56.7 ± 11.2 years; mean (±SD) duration of T2DM: 5.2 ± 3.5 years] were recruited. Saliva cortisol was measured at awakening and after 15, 30, and 60 min.ResultsWith respect to both healthy controls and controls with T2DM, euglycemic and diabetic BD patients exhibited a CAR occurring at significantly lower levels. No significant difference emerged in the CAR between the two groups of bipolar patients. Controls with T2DM had an overall post-awakening cortisol production significantly higher than healthy controls.ConclusionsOur results show that the CAR of patients with BD is reduced in terms of overall cortisol production but normal in terms of cortisolo reactivity independently from the occurrence of comorbid T2DM. The dampened CAR points to a tuning down of the functioning of the HPA axis in both euglycemic and diabetic BD patients, which may be a factor of vulnerability, since a preserved HPA axis functioning is essential to deal with stressors, which may precipitate affective episodesDisclosure of InterestNone Declared

Comparative analysis of hemodialysis and peritoneal dialysis on the risk of new onset diabetes mellitus

BackgroundDiabetes mellitus is a significant risk factor for cardiovascular events and mortality in dialysis patients. The impact of different dialysis modalities on the risk of new onset diabetes mellitus (NODM) remains a subject of debate. Previous studies did not adequately account for critical confounding factors such as pre-dialysis glycemic status, medication use, and nutritional status, which may influence the association between dialysis modality and NODM risk. MethodsWe conducted a retrospective cohort study of 1426 non-diabetic end-stage renal disease (ESRD) patients who underwent either hemodialysis (HD) or peritoneal dialysis (PD) at a single medical center. We used different statistical methods, adjusting for potential confounding factors, and accounted for competing risk of death. ResultsOver 12 years, 331 patients (23 %) developed NODM. After adjusting for potential confounding factors and mortality, PD patients had a significantly higher risk of NODM compared to HD patients (adjusted HR 1.52, p = 0.001). A propensity-matched cohort sensitivity analysis yielded similar results. Among patients with prediabetes, those receiving PD had a 2.93 times higher risk of developing NODM than those receiving HD (p for interaction <0.001), whereas no significant difference was observed among euglycemic patients. NODM was also associated with a 1.78 times increased risk of major cardiovascular events. ConclusionOur study provides evidence that PD treatment may increase the risk of NODM in ESRD patients, particularly among those with preexisting prediabetes. These findings highlight the importance of personalized treatment approaches, and nephrologists should consider prediabetes when choosing the dialysis modality for their patients.

Euglycemic Diabetic Ketoacidosis: Experience with 44 Patients and Comparison to Hyperglycemic Diabetic Ketoacidosis.

Euglycemic diabetic ketoacidosis (DKA) (glucose <250milligrams per deciliter (mg/dL) has increased in recognition since introduction of sodium-glucose co-transporter 2 (SGLT2) inhibitors but remains challenging to diagnose and manage without the hyperglycemia that is otherwise central to diagnosing DKA, and with increased risk for hypoglycemia with insulin use. Our objective was to compare key resource utilization and safety outcomes between patients with euglycemic and hyperglycemic DKA from the same period. This is a retrospective review of adult emergency department patients in DKA at an academic medical center. Patients were included if they were >18years old, met criteria for DKA on initial laboratories (pH ≤7.30, serum bicarbonate ≤18millimoles per liter [mmol/L], anion gap ≥10), and were managed via a standardized DKA order set. Patients were divided into euglycemic (<250milligrams per deciliter [mg/dL]) vs hyperglycemic (≥250mg/dL) cohorts by presenting glucose. We extracted and analyzed patient demographics, resource utilization, and safety outcomes. Etiologies of euglycemia were obtained by manual chart review. For comparisons between groups we used independent-group t-tests for continuous variables and chi-squared tests for binary variables, with alpha 0.05. We identified 629 patients with DKA: 44 euglycemic and 585 hyperglycemic. Euglycemic patients had milder DKA on presentation (higher pH and bicarbonate, lower anion gap; P < 0.05) and lower initial glucose (195 vs 561mg/dL, P < 0.001) and potassium (4.3 vs 5.3mmol/L, P < 0.001). Etiologies of euglycemia were insulin use prior to arrival (57%), poor oral intake with baseline insulin use (29%), and SGLT2 inhibitor use (14%). Mean time on insulin infusion was shorter for those with euglycemic DKA: 13.5 vs 19.4 hours, P = 0.003. Mean times to first bicarbonate >18mmol/L and first long-acting insulin were similar. Incidence of hypoglycemia (<70mg/dL) while on insulin infusion was significantly higher for those with euglycemic DKA (18.2 vs 4.8%, P = 0.02); incidence of hypokalemia (<3.3mmol/L) was 27.3 vs 19.1% (P = 0.23). Compared to hyperglycemic DKA patients managed in the same protocolized fashion, euglycemic DKA patients were on insulin infusions 5.9 hours less, yet experienced hypoglycemia over three times more frequently. Future work can investigate treatment strategies for euglycemic DKA to minimize adverse events, especially iatrogenic hypoglycemia.

Higher Prehospital Blood Glucose Levels Associated With Return of Spontaneous Circulation in Out-of-Hospital Non-traumatic Cardiac Arrests

ObjectiveCardiac arrest leads to an array of metabolic disturbances. We aimed to investigate the association between prehospital blood glucose levels (BGLs) and rates of return of spontaneous circulation (ROSC) in non-traumatic out-of-hospital cardiac arrests (OHCAs). MethodsA retrospective analysis of adult non-traumatic OHCAs within Kalamazoo County, MI, from January 2018 to May 2020 using the Michigan Emergency Medical Services Information System database was performed. Demographic data, Utstein variables, and BGLs (hypoglycemia < 70 mg/dL, euglycemia 70-120 mg/dL, and hyperglycemia >120 mg/dL) were abstracted. Chi-square and Wilcoxon rank sum tests were used to evaluate the relationship between BGL and ROSC. ResultsIn total, 314 patients met the inclusion criteria. The mean age was 62.9 years. ROSC was achieved in 147 (46.8%) patients. Fifty (15.9%), 75 (23.9%), and 189 (60.2%) patients were hypoglycemic, euglycemic, and hyperglycemic, respectively. An association was found between the glycemic group and ROSC (P < .0001), with an estimated odds of ROSC being 77% lower (95% confidence interval, 46%-90%) for hypoglycemic than euglycemic or hyperglycemic patients. The point difference between median ROSC-yes BGL (median [interquartile range] = 160 mg/dL [110-225 mg/dL]) was 33 mg/dL (95% CI, 13-51 mg/dL) greater than the ROSC-no group (median [interquartile range] = 127 mg/dL [75-190 mg/dL], P = .001). ConclusionNon-traumatic OHCA patients achieving ROSC had a significantly higher prehospital BGL than the ROSC-no group. Further study is warranted to investigate the role intra-arrest BGL may have as a prognostic marker for ROSC.

Association of hypoglycaemia with the risks of arrhythmia and mortality in individuals with diabetes - a systematic review and meta-analysis.

Hypoglycaemia has been linked to an increased risk of cardiac arrhythmias by causing autonomic and metabolic alterations, which may be associated with detrimental outcomes in individuals with diabetes(IWD), such as cardiovascular diseases (CVDs) and mortality, especially in multimorbid or frail people. However, such relationships in this population have not been thoroughly investigated. For this reason, we conducted a systematic review and meta-analysis. Relevant papers published on PubMed, Embase, Cochrane, Web of Knowledge, Scopus, and CINHAL complete from inception to December 22, 2022 were routinely searched without regard for language. All of the selected articles included odds ratio, hazard ratio, or relative risk statistics, as well as data for estimating the connection of hypoglycaemia with cardiac arrhythmia, CVD-induced death, or total death in IWD. Regardless of the heterogeneity assessed by the I2 statistic, pooled relative risks (RRs) and 95% confidence intervals (CI) were obtained using random-effects models. After deleting duplicates and closely evaluating all screened citations, we chose 60 studies with totally 5,960,224 participants for this analysis. Fourteen studies were included in the arrhythmia risk analysis, and 50 in the analysis of all-cause mortality. Hypoglycaemic patients had significantly higher risks of arrhythmia occurrence (RR 1.42, 95%CI 1.21-1.68), CVD-induced death (RR 1.59, 95% CI 1.24-2.04), and all-cause mortality (RR 1.68, 95% CI 1.49-1.90) compared to euglycaemic patients with significant heterogeneity. Hypoglycaemic individuals are more susceptible to develop cardiac arrhythmias and die, but evidence of potential causal linkages beyond statistical associations must await proof by additional specifically well planned research that controls for all potential remaining confounding factors.

Frequency of Diabetes Mellitus and Newly Diagnosed Hyperglycemia and Their Impacts on Hospitalized COVID-19 Patients

Background: The coronavirus disease 2019 (COVID-19) pandemic and its associated morbidities are a great global concern. Diabetes mellitus (DM) is associated with adverse clinical outcomes and high mortality in patients with COVID-19. Objectives: This study examined the frequency of DM, newly diagnosed hyperglycemia, and their impacts on hospitalized patients with COVID-19. Methods: This retrospective study examined 810 medical records of PCR-confirmed COVID-19 patients admitted to Razi Hospital, Ahvaz, Iran. The clinical presentations, severity, and impacts of COVID-19 were compared between patients with and without DM. Disease severity was determined based on the NEWS2 scoring system. Results: This study included 810 medical records of COVID-19 patients, of whom 326 had pre-existing DM, and 484 were non-DM. The rates of diabetes and newly diagnosed hyperglycemia were 40.2% and 11.2%, respectively. The most common underlying diseases were hypertension (35.3%), ischemic heart disease (17.9%), and chronic kidney disease (11.9%), which were higher in people with diabetes than non-diabetics. The rate of acute kidney injury was higher in patients with diabetes than in non-diabetics (30.7% vs. 19.2%; P &lt; 0.001) and in patients with severe COVID-19 than in those whose disease was not severe (27.8% vs. 21.5%; P = 0.04). The rates of severe COVID-19 (46.3% vs. 34.7%; P = 0.093), ICU admission (40.7% vs. 27.4%; P = 0.012), and mortality (18.5% vs. 10.5%; P = 0.079) were higher in patients with newly diagnosed hyperglycemia than in euglycemic patients. Conclusions: This study showed that COVID-19 infection is linked with newly diagnosed hyperglycemia and pre-existing DM, both associated with severe COVID-19, more need for ICU admission, and mortality.

CLINICAL PROFILE OF ISCHEMIC STROKE AND ITS OUTCOME IN RELATION TO GLYCEMIC STATUS ON PRESENTATION AT A TERTIARY CARE CENTRE: A PROSPECTIVE OBSERVATIONAL STUDY

Background: Stroke, also known as a cerebrovascular accident, is common in patients and can be a major cause of morbidity and mortality. Stroke and hyperglycemia appear to be linked in two ways. Diabetics are known to have a greater stroke rate than non-diabetics. Even in non-diabetics, a mild degree of hyperglycemia early in a stroke has been reported to increase infarct size and lead to a bad prognosis. Aim: To study the clinical prole, infarct size on CT scan, and clinical outcome of cerebral infraction in relation to glycemic status at presentation. Material and Methodology: This prospective observational study was conducted in the medicine department of Jhalawar Medical College, Jhalawar, a tertiary care center in south-east Rajasthan, from January 2020 to June 2021. The study included all ischemic stroke patients. Data were analyzed in SPSS 21. Independent t-tests and Chi-square tests were applied. A p value of &lt; 0.05 was considered statistically signicant. Results: The current study revealed that out of 100 participants, 39 were euglycemic, 27 had stress hyperglycemia, and 34 had diabetes; a small, medium, or large infarct was present in 39, 27, and 34 patients, respectively. Diabetes patients had a statistically signicant high NIHSS score, blood sugar level, and deaths, followed by stress hyperglycemia, and euglycemic patients had the lowest. Conclusion: Hyperglycemia, including stress hyperglycemia and diabetes, was a common nding in patients with ischemic stroke, and NIHSS, blood sugar, and death were associated with hyperglycemia in ischemic stroke patients.

Correlation of Anemia with Glycated Hemoglobin among Euglycemic Type 2 Diabetic Patients.

Diabetes mellitus (DM) and anemia are both prevalent in India. Glycated hemoglobin (HbA1c) is the gold standard test for the diagnosis of DM and monitoring of glycemic status. Hemoglobin (Hb) being the integral component of HbA1c, there is a possibility that anemia can also affect the level of HbA1c apart from the various other factorsObjectives: To study the prevalence, type of anemia, and correlation between HbA1c and anemia, including red blood cell (RBC) indices in euglycemic type 2 DM patients. The study was conducted with the objective of studying the correlation between HbA1c and anemia in euglycemic diabetic patients having controlled blood glucose over a period of 3 monthsMethodology: This cross-sectional study was conducted between May 2020 and May 2021 at the Department of General Medicine, Government Medical College, Kota, Rajasthan, India. All euglycemic diabetic patients with controlled blood glucose over a period of 3 months attending the outpatient department and fulfilling inclusion and exclusion criteria were enrolled in the studyInclusion criteria: All euglycemic type 2 DM patients with controlled blood glucose having three consecutive normal blood glucose levels [fasting blood sugar (FBS)-80-130 mg/dL and postprandial blood sugar (PP2BS) test-&lt;180 mg/dL] over a period of 3 months from the outpatient departmentExclusion criteria: Type 1 DM and latent autoimmune diabetes of adults, patients with hemolytic anemia, pregnancy, chronic alcoholism, chronic kidney disease, chronic liver disease, combined deficiency anemia, patients with increased FBS and PP2BS, acute and chronic inflammatory state, malignancy, anemia of chronic disease, and vitamin B12 deficiency were excluded from our studyDetailed investigations of diabetes and anemia were conducted. The effect of anemia on HbA1c was assessed, and the correlation of anemia with mean HbA1c was analyzed statistically Results: The prevalence of anemia in diabetic patients is 56.8%. Normocytic normochromic anemia is the most common, which was observed among 48.86% of diabetic patients. The median HbA1c of anemic patients is higher than nonanemic patients (p &lt; 0.01). There is a negative correlation between Hb and HbA1c (p &lt; 0.01). The correlation of RBC indices, that is, mean corpuscular Hb (MCH), mean corpuscular volume (MCV), and MCH with HbA1c, is also negative (p &lt; 0.01). There is a negative correlation between HbA1c and serum ferritin level, as indicated by the Pearson correlation test (p-value of &lt;0.01)Conclusion: Anemia is prevalent in type 2 DM patients without renal involvement, and also normocytic normochromic type is the most common, followed by iron deficiency anemia (IDA). HbA1c levels are significantly affected by the presence of moderate anemia in spite of controlled glycemia.

Inhibitors of sodium-glucose transport protein 2: A new multidirectional therapeutic option for heart failure patients.

Several mechanisms have been suggested to explain positive cardiovascular effects observed in studies with sodium-glucose co-transporter 2 (SGLT2) inhibitors. The reduction in glucose reabsorption in proximal tubuli induced by SGLT2 inhibitors increases urinary glucose and sodium excretion resulting in increased osmotic diuresis and consequently in decreased plasma volume, followed by reduced preload. In addition, the hemodynamic effects of SGLT2 inhibition were observed in both hyper and euglycemic patients. Due to the complex and multidirectional effects induced by SGLT2 inhibitors, this originally antidiabetic group of drugs has been successfully used to treat patients with heart failure as well as for subjects with chronic kidney disease. Moreover, their therapeutic potential seems to be even broader than the indications studied to date.

Diabetes downregulates the antimicrobial peptide psoriasin and increases E. coli burden in the urinary bladder

Diabetes is known to increase susceptibility to infections, partly due to impaired granulocyte function and changes in the innate immunity. Here, we investigate the effect of diabetes, and high glucose on the expression of the antimicrobial peptide, psoriasin and the putative consequences for E. coli urinary tract infection. Blood, urine, and urine exfoliated cells from patients are studied. The influence of glucose and insulin is examined during hyperglycemic clamps in individuals with prediabetes and in euglycemic hyperinsulinemic clamped patients with type 1 diabetes. Important findings are confirmed in vivo in type 2 diabetic mice and verified in human uroepithelial cell lines. High glucose concentrations induce lower psoriasin levels and impair epithelial barrier function together with altering cell membrane proteins and cytoskeletal elements, resulting in increasing bacterial burden. Estradiol treatment restores the cellular function with increasing psoriasin and bacterial killing in uroepithelial cells, confirming its importance during urinary tract infection in hyperglycemia. In conclusion, our findings present the effects and underlying mechanisms of high glucose compromising innate immunity.

HIF-1α Expression Increases Preoperative Concurrent Chemoradiotherapy Resistance in Hyperglycemic Rectal Cancer.

Simple SummaryPreoperative Concurrent Chemoradiotherapy (CCRT) is one of the standard treatments for patients with locally advanced rectal cancer. However, the efficacy of CCRT in hyperglycemic rectal cancer patients does not seem to be as expected. Therefore, we used clinical specimens, ectopic hyperglycemia animal models, and rectal cancer cells in a high-glucose environment to confirm how the high-glucose environment causes radiation resistance. The results confirmed that the high-glycemic environment could induce the overexpression of HIF-1α to cause CCRT tolerance in rectal cancer and suggest that combining HIF-1α inhibitors could reverse radioresistance in a high glucose environment. In future, HIF-1α inhibitors might be used as sensitizers to improve the efficacy of hyperglycemic rectal cancer patients receiving CCRT.Purpose: Preoperative concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced rectal cancer patients. However, the poor therapeutic efficacy of CCRT was found in rectal cancer patients with hyperglycemia. This study investigated how hyperglycemia affects radiochemotherapy resistance in rectal cancer. Methods and Materials: We analyzed the correlation between prognosis indexes with hypoxia-inducible factor-1 alpha (HIF-1α) in rectal cancer patients with preoperative CCRT. In vitro, we investigated the effect of different concentrated glucose of environments on the radiation tolerance of rectal cancers. Further, we analyzed the combined HIF-1α inhibitor with radiation therapy in hyperglycemic rectal cancers. Results: The prognosis indexes of euglycemic or hyperglycemic rectal cancer patients after receiving CCRT treatment were investigated. The hyperglycemic rectal cancer patients (n = 13, glycosylated hemoglobin, HbA1c > 6.5%) had poorer prognosis indexes. In addition, a positive correlation was observed between HIF-1α expression and HbA1c levels (p = 0.046). Therefore, it is very important to clarify the relationship between HIF-1α and poor response in patients with hyperglycemia receiving pre-operative CCRT. Under a high glucose environment, rectal cancer cells express higher levels of glucose transport 1 (GLUT1), O-GlcNAc transferase (OGT), and HIF-1α, suggesting that the high glucose environment might stimulate HIF-1α expression through the GLUT1-OGT-HIF-1α pathway promoting tolerance to Fluorouracil (5-FU) and radiation. In the hyperglycemic rectal cancer animal model, rectal cancer cells confirmed that radiation exposure reduces apoptosis by overexpressing HIF-1α. Combining HIF-1α inhibitors was able to reverse radioresistance in a high glucose environment. Lower HIF-1α levels increased DNA damage in tumors leading to apoptosis. Conclusions: The findings here show that hyperglycemia induces the expression of GLUT1, OGT, and HIF-1α to cause CCRT tolerance in rectal cancer and suggest that combining HIF-1α inhibitors could reverse radioresistance in a high glucose environment. HIF-1α inhibitors may be useful for development as CCRT sensitizers in patients with hyperglycemic rectal cancer.

Missed Opportunities for Screening and Management of Dysglycemia among Patients Presenting with Acute Myocardial Infarction in North India: The Prospective NORIN STEMI Registry.

Background:Dysglycemia is a major and increasingly prevalent cardiometabolic risk factor worldwide, but is often undiagnosed even in high-risk patients. We evaluated the impact of protocolized screening for dysglycemia on the prevalence of prediabetes and diabetes among patients presenting with ST-segment elevation myocardial infarction (STEMI) in North India.Methods:We conducted a prospective NORIN STEMI registry-based study of patients presenting with STEMI to two government-funded tertiary care medical centers in New Delhi, India, from January to November 2019. Hemoglobin A1c (HbA1c) was collected at presentation as part of the study protocol, irrespective of baseline glycemic status.Results:Among 3,523 participants (median age 55 years), 855 (24%) had known diabetes. In this group, baseline treatment with statins, sodium-glucose cotransporter 2 inhibitors, or glucagon-like peptide-1 receptor agonists was observed in 14%, <1%, and 1% of patients, respectively. For patients without known diabetes, protocolized inpatient screening identified 737 (28%) to have prediabetes (HbA1c 5.7–6.4%) and 339 (13%) to have newly detected diabetes (HbA1c ≥ 6.5%). Patients with prediabetes (49%), newly detected diabetes (53%), and established diabetes (48%) experienced higher rates of post-MI LV dysfunction as compared to euglycemic patients (42%). In-hospital mortality (5.6% for prediabetes, 5.1% for newly detected diabetes, 10.3% for established diabetes, 4.3% for euglycemia) and 30-day mortality (8.1%, 7.6%, 14.4%, 6.6%) were higher in patients with dysglycemia. Compared with euglycemia, prediabetes (adjusted odds ratio (aOR) 1.44 [1.12–1.85]), newly detected diabetes (aOR 1.57 [1.13–2.18]), and established diabetes (aOR 1.51 [1.19–1.94]) were independently associated with higher odds of composite 30-day all-cause mortality or readmission.Conclusions:Among patients presenting with STEMI in North India, protocolized HbA1c screening doubled the proportion of patients with known dysglycemia. Dysglycemia was associated with worse clinical outcomes at 30 days, and use of established pharmacotherapeutic risk-reduction strategies among patients with known diabetes was rare, highlighting missed opportunities for screening and management of dysglycemia among high-risk patients in North India.

Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry

BackgroundFindings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF.MethodsPatients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D.ResultsCompared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 ml/Kg/min, 18.4 ± 4.3 ml/Kg/min and 16.5 ± 4.3 ml/Kg/min, p < 0.003). Longitudinal data demonstrated higher deterioration of RVAUC, RV dimension, and peak VO2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2).ConclusionThe higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis.Trial registration ClinicalTrials.gov identifier: NCT023358017

Blood glucose level on admission as potential indicator of in-hospital mortality in non-diabetic patients presenting with acute stroke

Background: A stroke or cerebrovascular accident is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Stress hyperglycemia has been defined as hyperglycemia in previously euglycemic patients that corrects once the acute process resolves.Methods: The present study was conducted in the medicine department, Guru Nanak Dev hospital attached to government medical college, Amritsar from April 2021-December 2021 after taking approval from institutional ethics committee. This was a prospective observational study. A total of 50 non-diabetic patients of acute stroke with age group &gt;18 to &lt;75 of either sex were enrolled in this study. Comparison of mortality was done in hyperglycemic and non hypergylcemic non-diabetic patients on 1st day of admission and up to 10th day during hospital stay.Results: Mortality percentage on day 1 was higher among those who had high blood glucose levels but there was no significant association between glucose levels and day 1 outcome (survival or death) observed in our study (p=0.078). Mortality percentage on day 10 was higher among those who had high blood glucose levels and there was significant association between glucose levels and day 10 outcome (survival or death) observed in our study (p=0.001). A significant association was observed between glucose levels and overall outcome in our study (p&lt;0.001).Conclusions: We conclude that even in non-diabetic patients, hyperglycemia on admission is independently associated with a higher risk of in-hospital mortality.

Insulin for hyperglycemia prevention and management during postgastrectomy nutrition support in gastric cancer: Reduced complications in a retrospective cohort study in China.

To evaluate the effectiveness of insulin addition to the total nutrition admixture (TNA) for glycemic control among patients with gastric cancer (GC) receiving supplementary parenteral nutrition (SPN) after gastrectomy. A retrospective cohort study was conducted among 208 noncritical ill patients who underwent gastrectomy for GC from 2017 to 2019 at a tertiary teaching hospital in Lanzhou, China. All the included patients received individualized SPN and enteral nutrition treatment after gastrectomy. The patients were randomly divided into insulin and noninsulin groups based on the TNA composition. Blood glucose (BG) measurements, glycemic fluctuation, and hypoglycemia incidence during SPN were compared between the two groups. The postoperative comprehensive complications index (CI) and infections were compared according to insulin regimen and postoperative glycemic status. The mean BG was significantly lower and fluctuated less in the insulin group than in the noninsulin group (p<0.05). One unit of insulin per 6 g of parenteral nutrition glucose addition to TNA did not increase hypoglycemia incidence (p>0.05). Comparing CI and the infection rate, no significance was observed between the insulin and noninsulin groups, but a higher postoperative CI was observed in patients with hyperglycemia than in euglycemic patients (p<0.05). Appropriate insulin addition to TNA has an overall positive effect on glycemic management in patients with noncritical GC who received SPN after gastrectomy. Postoperative glycemic status was associated with the incidence of relevant complications. Further research is needed for conclusive recommendations.

Abstract No.: ABS3115: Effect of sevoflurane vs desflurane on blood glucose level in patients undergoing intracranial neurosurgery: A randomised control study

Background & Aims:Patients undergoing neurosurgery are prone to neurological damage due to the anaerobic metabolism of blood glucose. In this study we aimed to to compare the effect of sevoflurane and desflurane on blood glucose levels in patients undergoing intracranial surgery.Methods:All consenting patients of either gender 18-65 years belonging to American Society of Anesthesiologists (ASA) physical status I & II scheduled for intracranial surgery under sevoflurane or desflurane maintenance anaesthesia were included. Patients suffering from diabetes, thyroid dysfunction, renal or hepatic disease, on steroids, beta-adrenergic blocking agents, insulin or oral hypoglycaemic agents, pregnant or lactating patients, chronic alcoholic patients, and non-consenting patients were excluded from the study. The enrolled patients were randomised in the sevoflurane and desflurane groups. The periodic glucose level was measured hourly after induction until completion of surgery using the glucose oxidase peroxidase method.Results:A total of 70 patients was included in the study. Both sevoflurane and desflurane when used as maintenance anaesthetics cause changes in blood sugar levels. Sevoflurane causes a gradual increase in blood sugar intraoperatively whereas desflurane causes an initial rise in blood sugar followed by a decline in blood sugar level in euglycemic patients. There was a significant difference in the trend of blood sugar (mg/dL) over time between the two groups (p =<0.001).Conclusion:The changes in blood sugar level by both agents were statistically significant but clinically insignificant as the values remained within clinically normal range and there were no episodes of hypo or hyperglycaemia.

A patient-centered multidisciplinary cardiac rehabilitation program improves glycemic control and functional outcome in coronary artery disease after percutaneous and surgical revascularization.

BackgroundCardiac rehabilitation (CR) is strongly associated with all-cause mortality reduction in patients with coronary artery disease (CAD). The impact of CR on pathological risk factors, such as impaired glucose tolerance (IGT) and functional recovery remains under debate. The aim of the present study is to determine whether CR had a positive effect beside physical exercise improvement on pathological risk factors in IGT and diabetic patients with CAD.MethodsOne hundred and seventy-one consecutive patients participating in a 3-month CR from January 2014 to June 2015 were enrolled. The primary endpoint was defined as an improvement of peak workload and VO2-peak; glycated hemoglobin (HbA1c) reduction was considered as secondary endpoint.ResultsEuglycemic patients presented a significant improvement in peak workload compared to diabetic patients (from 5.75 ± 1.45 to 6.65 ± 1.84 METs vs. 4.8 ± 0.8 to 4.9 ± 1.4 METs, p = 0.018). VO2-peak improved in euglycemic patients (VO2-peak from 19.3 ± 5.3 to 22.5 ± 5.9 mL/min/kg, p = 0.003), while diabetic patients presented only a statistically significant trend (VO2-peak from 16.9 ± 4.4 to 18.0 ± 3.8 mL/min/kg, p < 0.056). Diabetic patients have benefited more in terms of blood glucose control compared to IGT patients (HbA1c from 7.7 ± 1.0 to 7.4 ± 1.1 compared to 5.6 ± 0.4 to 5.9 ± 0.5, p = 0.02, respectively).ConclusionsA multidisciplinary CR program improves physical functional capacity in CAD setting, particularly in euglycemic patients. IGT patients as well as diabetic patients may benefit from a CR program, but long-term outcome needs to be clarified in larger studies.