Fasting Hyperglycemia Research Articles

10-OR: The Triple Roles of Tubular Mitochondria AKT in the Regulation of Renal Function, Insulin Resistance, and Body Composition during Development of Diabetic Nephropathy

Diabetic nephropathy is a major cause of end-stage renal disease. We have recently shown translocation of AKT to mitochondria in proximal tubules played a renoprotective role in murine ischemia/reperfusion injury. In this study, we tested the hypothesis that activation of mitochondrial AKT (mito-AKT) signaling in renal proximal tubules improves kidney function in diabetic nephropathy and modulates overall glucose homeostasis. We used renal tubule-specific bigenic mice that harbor tamoxifen-inducible mitochondria-targeting constitutively active AKT1 (KMCAKT), which were fed with either normal chow diet or high fat and fructose diet (HFFD). Wild type mice fed with HFFD developed nephropathy after 24 wks. Activation of renal tubular mito-AKT significantly attenuated urinary albumin, creatinine, and glucose excretion in the KMCAKT mice on HFFD. Interestingly, activation of tubular mito-AKT also decreased fasting hyperglycemia, and improved glucose tolerance of HFFD-fed mice. Insulin resistance (HOMA-IR) was significantly reduced when tubular mito-AKT was activated. In addition, mito-AKT activation reduced plasma cholesterol. Furthermore, mito-AKT activation increased total body weight and fat mass of HFFD-fed mice, but had no effect on their water and food intake. To dissect the underlying mechanism, we used 18F-fluoro-4-thia-oleate PET scan to define organ specific fatty acid uptake, and revealed a significant increase of uptake in white and brown adipose tissues in KMCAKT mice on HFFD. In conclusion, this is the first report to demonstrate critical roles of mitochondrial AKT in renal tubules in the regulation of whole-body metabolism, insulin sensitivity, and body composition beyond its local effect on kidney function in diabetic nephropathy, which suggests kidney function and nephropathy associated metabolic dysfunction could be mediated through a common pathway in tubular mitochondria. Disclosure E.Salem: None. A.Ta: None. H.Y.H.Lin: None. J.Li: None. P.H.Wang: Research Support; ViaCyte, Inc. Funding Shannon & Amy Ko Foundation

91-OR: AdoShell Islet, a New Biomaterial for Allogenic Islet Encapsulation Shows Six Months Insulin Secretion in Diabetic Immunocompetent Rats

Islet transplantation is an effective cure for T1D but the requirement for immunosuppression makes its application limited. AdoShell® is an implantable and fully retrievable scaffold for islet transplantation without immunosuppression. It is based on a permselective hydrogel film that allows the diffusion of insulin and prevents immune cell invasion. AdoShell® is a soft biomaterial with 95% water, synthetized from non-degradable polymers cross-linked by bio-orthogonal click chemistry. Encapsulated human islets displayed a gluco-responsive insulin secretion comparable to naked islets in perifusion experiments after 7 days and 1 month (N=3 donors 7 days / N=2 donors 1 month). Wistar rat allogenic islets encapsulated in AdoShell® were implanted in immunocompetent STZ-induced diabetic rats. Insulin levels in vivo were on average 121pM/day over 41 days (n=22 rats), a significant increase versus negative control (45pM/day, n=9 rats) (M.W. t-test, p<0.0001). AdoShell® Islets led to physiological weight gain, reduction of fasting hyperglycemia, and sustained C-peptide and insulin secretion for over 6 months in diabetic rats. It was well tolerated and did not trigger inflammatory reaction nor fibrosis after the 6-month implantation period in rat peritoneal cavity. Neither biodegradation, nor immune cell penetration were observed. Disclosure A.Geissler: Employee; Adocia, Stock/Shareholder; Adocia. O.Jouannot: Employee; ADOCIA, Stock/Shareholder; ADOCIA. A.Gaffuri: Employee; ADOCIA, Stock/Shareholder; ADOCIA. C.Gautier: Employee; Centre européen d'étude du diabète, Biomeostasis, Charles Rivers Laboratories, Institut de recherche contre les cancers de l'appareil digestif, GenOway, NAMSA. Y.P.Courbebaisse: None. K.Bouzakri: Consultant; Adocia, Stock/Shareholder; ILONOV. R.Eloy: Stock/Shareholder; Adocia. O.Soula: Employee; Adocia, Stock/Shareholder; Adocia.

247-LB: Link between Hyperglycemia and Cognitive Deficits in T2DM Animal Model

The Goto-Kakizaki (GK) rat is a model of spontaneously developing non-obese type 2 diabetes mellitus (T2DM). With age, GK rats exhibit insulin resistance, decreased pancreatic function, and hyperglycemia. Studies have shown that GK rats experience cognitive impairment concurrent with hyperglycemia, but the mechanisms is unclear. In this study, we aimed to elucidate the potential link between hyperglycemia and cognitive impairment in this unique T2DM model. Longitudinal assessments of fasting blood glucose (FBG) were performed in male GK rats and age-matched Wistar rats. Our results showed that FBG in GK group was significantly higher than that in the Wistar group starting from 6 weeks of age, and there was progressive fasting hyperglycemia in GK group. In the spatial probe test of Morris water maze (MWM) at 33 weeks old, the GK rats spent less time in the target quadrant (12.16 ± 2.18s vs. 22.17 ± 1.21, P<0.001) and took more time to reach the location of the formerly hidden platform (36.78 ± 6.141 vs. 6.422 ± 0.8783s, P<0.001) than Wistar rats, suggesting that GK rats showed spatial memory deficits. In mechanistic studies, insulin receptors (IR) and synaptic proteins were down-regulated and impaired insulin signaling pathways in the hippocampus of GK rats (Figure), suggesting impaired neuroplasticity and neuropathological processes may lead to cognitive dysfunction. Disclosure L. Chen: Board Member; Hua Medicine. J. Ni: None. L. Feng: Employee; Hua Medicine. X. Zhang: None. Q. Wang: None. Y. Chen: Stock/Shareholder; Silaiputai (Shanghai) Biopharmaceutical Company. Funding Hua Medicine Co., Ltd.

Incidence and risk factors of fasting hyperglycaemia following first-attack acute pancreatitis before discharge: a retrospective study

BackgroundPancreatic endocrine insufficiency is more likely to occur after acute pancreatitis (AP), but the risk factors affecting pancreatic endocrine function remain controversial. Therefore, exploring the incidence and risk factors of fasting hyperglycaemia following first-attack AP is important.MethodsData were collected from 311 individuals with first-attack AP without previous diabetes mellitus (DM) or impaired fasting glucose (IFG) history treated in the Renmin Hospital of Wuhan University. Relevant statistical tests were performed. A two-sided p-value < 0.05 was considered statistically significant.ResultsThe incidence of fasting hyperglycaemia in individuals with first-attack AP was 45.3%. Univariate analysis showed that age (χ2 = 6.27, P = 0.012), aetiology (χ2 = 11.184, P = 0.004), serum total cholesterol (TC) (χ2 = 14.622, P < 0.001), and serum triglyceride (TG) (χ2 = 15.006, P < 0.001) were significantly different between the hyperglycaemia and non-hyperglycaemia groups (P < 0.05). The serum calcium concentration (Z=-2.480, P = 0.013) was significantly different between the two groups (P < 0.05). Multiple logistic regression analysis showed that age- ≥60 years (P < 0.001, OR = 2.631, 95%Cl = 1.529–4.527) and TG ≥ 5.65 mmol/L (P < 0.001, OR = 3.964, 95%Cl = 1.990–7.895) were independent risk factors for fasting hyperglycaemia in individuals with first-attack AP (P < 0.05).ConclusionsOld age, serum triglycerides, serum total cholesterol, hypocalcaemia, and aetiology are associated with fasting hyperglycaemia following first-attack AP. Age ≥ 60 years and TG ≥ 5.65 mmol/L are independent risk factors for fasting hyperglycaemia following first-attack AP.

DYSLIPIDEMIA AND HYPERGLYCEMIA IN HYPERTENSIVE PATIENTS ASSOCIATE WITH GNB3 (RS5443) AND NOS3 (RS2070744) GENES’ ALLELIC STATE

Objective: More than 700 million people worldwide live with untreated essential arterial hypertension (EAH). The objective of the study was to evaluate the risks of metabolic disorders in EAH patients depending on guanine nucleotide-binding protein-↓3 subunit (GNB3, rs5443) and endothelial nitric oxide synthase (NOS3, rs2070744) genes’ allelic state. Design and method: The cohort case-control study involved 100 EAH patients (moderate-very high cardiovascular risks, aged 45-65 years) and 48 practically healthy (control). Metabolic disorders were evaluated by glucose blood value and lipids panel: total cholesterol (TC), triglycerides (TG), Low-, and High- density lipoprotein cholesterol (LDL-C, HDL-C) levels. The atherogenic index (AI) was calculated by the equation: (TC-HDL-C)/HDL-C. GNB3 (rs5443) and NOS3 (rs2070744) genotyping perfrmed by TaqMan probes in CFX96 Real-Time PCR Detection System. Results: Hyperglycemia (&gt;6.1 mmol/l), hypertriglyceridemia (TG&gt;1.7 mmol/l) and decreased HDL-C (&lt;1.2 mmol/l) were relatively more common in EAH patients than in the control group by 36.11% (⇙2 = 17.88; p&lt;0.001), 23.61% (⇙2 = 6.43; p = 0.011) and 25.0% (⇙2 = 8.32; p = 0.004) respectively. Therefore, the fasting hyperglycemia increases the EAH risk in the examined population ninefold [OR95%CI:2.86-27.08; p&lt;0.001], hypertriglyceridemia and decreased HDL-C elevates the risk almost 3 and 3.5 times as well [OR95%CI:1.23-5.56; p = 0.009 and OR95%CI:1.46-8.71; p = 0.003], respectively. The risk of metabolic disorders (dyslipidemia and hyperglycemia) in EAH patients does not depend on NOS3 gene polymorphism (rs2070744). Contrary, in T-allele patients of the GNB3 gene (rs5443) prevailed subjects with elevated LDL-C (&gt;3.0 mmol/l) over those with CC-genotype by 13.89% (p = 0.05). Other parameters of lipid metabolism and hyperglycemia did not differ significantly between GNB3 (rs5443) genes allelic state. However, the mutational T-allele of the GNB3 gene (825C&gt;T) increases the risk of hyperlipidemia 8.5 times [OR 95%CI:0.99-72.70; p = 0.05] due to atherogenic LDL-C, with the protective role of CC-genotype [OR = 0.12; OR 95%CI:0.01-1.0; p = 0.048]. Conclusions: Fasting hyperglycemia, hypertriglyceridemia and lowered HDL-C, enhance the arterial hypertension risk 3-9 times (p&lt;0.01). The polymorphic site of GNB3 (rs5443) gene, but not NOS3 (rs2070744) gene associate with hyperlipidemia in hypertensive patients.

Glucose Levels of the Oral Glucose Tolerance Test (oGTT) Can Predict Adverse Pregnancy Outcomes in Women with Gestational Diabetes (GDM).

Gestational diabetes (GDM) is a common pregnancy complication defined as a glucose intolerance diagnosis during pregnancy. GDM is strongly associated with adverse fetal and maternal outcomes. In Germany, to screen and diagnose GDM we use a 1 h 50 g oGCT (oral glucose challenge test) followed by a 2 h 75 g oGTT if the first was pathological. This analysis examines the correlation of 75 g oGTT glucose levels and fetomaternal outcome. Data from 1664 patients from a gestational diabetes consultation clinic at the Charité University Hospital in Berlin, Germany, were analyzed retrospectively from 2015 to 2022. The 75 g oGTT blood glucose levels were categorized into isolated fasting hyperglycemia (GDM-IFH), isolated post-load hyperglycemia (GDM-IPH) and combined hyperglycemia (GDM-CH), using the levels of the fasting, 1 h and 2 h values, after glucose application. These subtypes were compared based on their baseline characteristics as well as fetal and maternal outcome. GDM-IFH and GDM-CH women displayed higher pre-conceptional BMI and required insulin therapy more frequently (p < 0.001). The GDM-IFH group was at higher risk of having a primary cesarean section (p = 0.047), while GDM-IPH women were significantly more likely to have an emergent cesarean section (p = 0.013). The offspring of GDM-IFH and GDM-CH women were born with a significantly higher mean birthweight (p < 0.001) and birth weight percentiles (p < 0.001) and were at increased risk of being large for gestational age (LGA) (p = 0.004). Women from the GDM-IPH group delivered significantly more neonates who were small for gestational age (p = 0.027) or with low fetal weight <30th percentile (p = 0.003). This analysis shows a strong association between the glucose response pattern in the 75 g oGTT and adverse perinatal fetomaternal outcome. The differences among the subgroups, specifically concerning insulin therapy, mode of delivery and fetal growth, suggest an individualized approach to prenatal care after a GDM diagnosis.

Effects of subtotal pancreatectomy and long-term glucose and lipid overload on insulin secretion and glucose homeostasis in minipigs.

Nowadays, there are no strong diabetic pig models, yet they are required for various types of diabetes research. Using cutting-edge techniques, we attempted to develop a type 2 diabetic minipig model in this study by combining a partial pancreatectomy (Px) with an energetic overload administered either orally or parenterally. Different groups of minipigs, including Göttingen-like (GL, n = 17) and Ossabaw (O, n = 4), were developed. Prior to and following each intervention, metabolic assessments were conducted. First, the metabolic responses of the Göttingen-like (n = 3) and Ossabaw (n = 4) strains to a 2-month High-Fat, High-Sucrose diet (HFHSD) were compared. Then, other groups of GL minipigs were established: with a single Px (n = 10), a Px combined with a 2-month HFHSD (n = 6), and long-term intraportal glucose and lipid infusions that were either preceded by a Px (n = 4) or not (n = 4). After the 2-month HFHSD, there was no discernible change between the GL and O minipigs. The pancreatectomized group in GL minipigs showed a significantly lower Acute Insulin Response (AIR) (18.3 ± 10.0 IU/mL after Px vs. 34.9 ± 13.7 IU/mL before, p < .0005). In both long-term intraportal infusion groups, an increase in the Insulinogenic (IGI) and Hepatic Insulin Resistance Indexes (HIRI) was found with a decrease in the AIR, especially in the pancreatectomized group (IGI: 4.2 ± 1.9 after vs. 1.5 ± 0.8 before, p < .05; HIRI (×10-5 ): 12.6 ± 7.9 after vs. 3.8 ± 4.3 before, p < .05; AIR: 24.4 ± 13.7 µIU/mL after vs. 43.9 ± 14.5 µIU/mL before, p < .005). Regardless of the group, there was no fasting hyperglycemia. In this study, we used pancreatectomy followed by long-term intraportal glucose and lipid infusions to develop an original minipig model with metabolic syndrome and early signs of glucose intolerance. We reaffirm the pig's usefulness as a preclinical model for the metabolic syndrome but without the fasting hyperglycemia that characterizes diabetes mellitus.

Glycemic Abnormalities in Pancreatic Cystic Lesions—A Single-Center Retrospective Analysis

Background and Objectives: Glucose metabolism alterations are very common in solid pancreatic lesions, particularly in pancreatic cancer. Similarly, diabetes and especially new-onset diabetes (NOD) have been associated with the malignant transformation of pancreatic cysts. We aimed to assess the prevalence and relevant associations of glycemic abnormalities in pancreatic cystic lesions (PCLs) in a retrospective analysis. Materials and Methods: We retrospectively recruited all patients who underwent endoscopic ultrasound for a PCL over a period of 36 months (January 2018 to December 2021). Final diagnosis was set by means of tissue acquisition, surgery, follow-up, or board decision. Demographic and clinical data, laboratory workup, and imaging features were extracted from the patients’ charts according to a predefined protocol. We considered fasting blood glucose (FBG) and HbA1c values and stratified the patients as nondiabetic (FBG ≤ 99 mg/dL, HbA1c ≤ 5.6%, no history of glycemic abnormalities), prediabetic (FBG 100–125 mg/dL, HbA1c 5.7–6.4%), or diabetic (long-lasting diabetes or NOD). Results: Altogether, 81 patients were included, with a median age of 66 years, and 54.3% of them were male. The overall prevalence of fasting hyperglycemia was 54.3%, comprising 34.6% prediabetes and 22.2% diabetes, of which 16.7% had NOD. The mean FBG and HbA1c levels were higher in malignant and premalignant PCLs (intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), cystadenocarcinoma, and cystic neuroendocrine tumor) compared to the benign lesions (pseudocysts, walled-off necrosis, and serous cystadenoma): 117.0 mg/dL vs. 108.3 mg/dL and 6.1% vs. 5.5%, respectively. Conclusions: Hyperglycemia and diabetes are common in PCLs, with a high prevalence in premalignant and malignant cysts. Screening and follow-up for glycemic abnormalities should be routinely conducted for PCLs, as they can contribute to a tailored risk assessment of cysts.

Restoration of lysosomal acidification rescues autophagy and metabolic dysfunction in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the world. High levels of free fatty acids in the liver impair hepatic lysosomal acidification and reduce autophagic flux. We investigate whether restoration of lysosomal function in NAFLD recovers autophagic flux, mitochondrial function, and insulin sensitivity. Here, we report the synthesis of novel biodegradable acid-activated acidifying nanoparticles (acNPs) as a lysosome targeting treatment to restore lysosomal acidity and autophagy. The acNPs, composed of fluorinated polyesters, remain inactive at plasma pH, and only become activated in lysosomes after endocytosis. Specifically, they degrade at pH of ~6 characteristic of dysfunctional lysosomes, to further acidify and enhance the function of lysosomes. In established in vivo high fat diet mouse models of NAFLD, re-acidification of lysosomes via acNP treatment restores autophagy and mitochondria function to lean, healthy levels. This restoration, concurrent with reversal of fasting hyperglycemia and hepatic steatosis, indicates the potential use of acNPs as a first-in-kind therapeutic for NAFLD.

Can We Predict Isolated Fasting Hyperglycemia in Patients With GDM? [ID: 1368593

INTRODUCTION: One-third of patients with gestational diabetes mellitus (GDM) require hypoglycemic agents. There is a subset of patients who control their postprandial values with diet, yet they have persistent fasting hyperglycemia requiring bedtime hypoglycemic agents (GDMHS). As fasting hyperglycemia is an independent risk factor for adverse pregnancy outcomes, we aimed to identify risk factors to predict (and subsequently counsel) GDM patients with a risk of isolated fasting hyperglycemia requiring treatment with bedtime hypoglycemic agents. METHODS: This was an IRB-approved retrospective cohort study of patients diagnosed with GDM after 24 weeks from 2016 to 2020. Patients monitored glucose four times daily (fasting and 2 hours postprandial); fasting hyperglycemia was defined as more than 50% fasting values greater than 90 mg/dL. Patients completely controlled with diet (GDMA1) were compared to those with GDMHS. A multivariate analysis assessed whether age, body mass index (BMI), fasting glucose tolerance test (GTT) value, HbA1c at diagnosis, history of polycystic ovarian syndrome or previous GDM, Asian race, or family history of diabetes predicted isolated fasting hyperglycemia. RESULTS: Four hundred five patients had GDM. 57% had GDMA1, and 28% had GDMHS. Compared to GDMA1, patients with GDMHS were older, had higher BMI, higher fasting GTT value, higher HbA1c, and higher incidence of previous GDM or family history of diabetes. After adjusting for confounders, higher HbA1c at GDM diagnosis (odds ratio [OR] 3.55), older age (OR 1.08), and higher fasting GTT value (OR 1.06) were significantly associated with an increased probability of persistent fasting hyperglycemia. Asian race was associated with decreased probability of fasting hyperglycemia but was confounded by lower fasting GTT and lower BMI. CONCLUSION: Our data suggest that elevated HbA1c, higher fasting GTT value, and older age may predict persistent isolated fasting hyperglycemia in GDM patients who are otherwise controlled with diet. These data can be used to educate and counsel patients to alleviate frustration encountered with persistent fasting hyperglycemia despite postprandial diet control.

THYROID FUNCTION IN POSTMENOPAUSAL WOMEN IN WESTERN INDIA AND ITS IMPACT ON MENOPAUSAL SYMPTOMS, BMI, GLYCEMIC, LIPID AND CARDIAC PROFILE

Background Menopause is characterized by estrogen deciency and appearance of variety of menopausal symptoms like lethargy, hotushes, anxiety, sexual problems, tiredness, insomnia, weight gain and mood swings. Many of these symptoms are similar to symptoms of thyroid dysfunction and hence there is likelihood of symptoms of thyroid dysfunction in this age group being misinterpreted as menopausal symptoms and thyroid dysfunction remaining undetected. If thyroid dysfunction remains undetected and untreated, it can lead to health hazards like hyperlipidemia, atherosclerosis and heart disease.2Presently there are no clear cut guidelines about screening menopausal patients for thyroid function and existing studies on screening of menopausal women for thyroid disorders are not conclusive. Therefore this study was undertaken to look at thyroid functions in postmenopausal women and impact of thyroid dysfunction on their cardiovacular health through its action on their glycemic status, BMI and lipid prole. Aims And Objectives 1. To assess the basic thyroid functions in postmenopausal women. 2. To evaluate the effect of abnormal thyroid function on glycemic status, lipid prole, body weight and BMI in postmenopausal women. 3. To look for association of severity of menopause symptoms with the degree of thyroid dysfunction in postmenopausal women. Materials And Methods A cross-sectional observational study was carried out in the indoor and outdoor sections of Department of Medicine at SSG Hospital Vadodara for a period of one year from March 2015 to Feb 2016 in which 130 patients were enrolled. All patients were subjected to a standardized interview in which their symptoms were graded on the basis of the Simplied Menopausal Index , their BMI was calculated from their height and weight and investigations (Fasting thyroid prole, fasting blood sugar, fasting lipid prole, ECG) were carried out. Association between abnormalities in thyroid prole and severity of menopausal symptoms as well as abnormalities in BMI , fasting blood sugar, lipid prole and ECG were analyzed using appropriate statistical tests (Odd's ratio). A P value&lt;0.05 was considered statistically signicant. Thyroid dysfunction is Conclusion common in postmenopausal females and the symptoms of the two entities overlap but with a higher intensity in the former and the simplied menopausal index score can be used as an efcient tool to further increase the index of suspicion for thyroid dysfunction in postmenopausal women. Abnormal thyroid function is statistically associated with BMI with higher prevalence of hypothyroidism in overweight, preobese and obese postmenopausal subjects and hyperthyroidism in underweight postmenopausal subjects. Abnormal thyroid function is statistically associated with abnormal glucose metabolism with higher prevalence of fasting hyperglycemia at either end of the spectrum of thyroid disorders. Abnormal thyroid function is statistically associated with Dyslipidemia in the form of raised total cholesterol, LDL cholesterol and serum triglycerides with no signicant association with HDL cholesterol in postmenopausal women. There is no statistically signicant association between thyroid dysfunction and ischemic heart disease

Abstract #1408177: Spinal Muscle Atrophy Presenting with Non-Diabetic Ketoacidosis

Spinal muscle atrophy (SMA) is an untreatable neurodegenerative disease related to loss of survival motor neuron (SMN) 1 gene resulting in muscle atrophy leading to significant morbidity and mortality. Patients with SMA may present with metabolic disturbances including impaired glucose tolerance, fatty acid metabolism and hyperlipidemia. We present a case of SMA presenting with recurrent metabolic acidosis. 51-year-old female with hypertension, osteoporosis, and SMA (homozygous deletion of exon 7 in the SMN1 gene) with quadriplegia and chronic ventilator dependent respiratory failure was admitted with diarrhea, poor oral intake, nausea, and abdominal pain. She did not report sick contacts or fever and had no history of diabetes. She had similar past episodes of metabolic acidosis with acute illness. Vital signs were BP 135/74mmHg, HR 110/min, RR 20/min, afebrile, and SpO2 96% on room air. On exam she appeared ill and debilitated with dry oral mucosa, + abdominal distension and tenderness with no rebound. Labs showed anion gap metabolic acidosis, Na 136mEq/L, K 3.9mEq/L, Cl 102 mEq/L, CO2 12 mEq/L, Anion gap 22, pH 7.13, Creatinine <0.01mg/dl, glucose 110 mg/dl, 2+ urine ketones, beta hydroxybutyrate 7.39 mmol/L, WBC 23.97 K/ul and HbA1c 5.2%. She was treated for non-diabetic ketoacidosis with IV fluids and fixed dose IV insulin infusion with dextrose infusion in tandem. She had hypernatremia, hypocalcemia, hypophosphatemia and hypokalemia likely due to poor nutrition and dehydration, and with aggressive electrolyte replacement, she showed significant clinical improvement during hospitalisation. Patients with SMA are prone to metabolic derangements e.g. ketoacidosis. Several factors may contribute to ketoacidosis such as decreased muscle mass, defects in endocrine pancreatic function and abnormal fatty acid metabolism regardless of triggering factors. One study investigated glucose metabolism and pancreas development in the Smn (2B/-) intermediate SMA mouse model and type I SMA patients. In mice it demonstrated a dramatic cell fate imbalance within pancreatic islets, with a predominance of glucagon-producing α cells at the expense of insulin-producing β cells and mice displayed fasting hyperglycemia, hyperglucagonemia, and glucose resistance. Similar abnormalities in pancreatic islet cells were seen in deceased children with the severe infantile form of SMA indicating that defects in glucose metabolism may play an important contributory role in SMA pathogenesis. There are no present guidelines to manage this entity, but case reports indicated a role of volume resuscitation and electrolyte replacement for improvement and future prevention by avoiding fasting.

Genetic and clinical characteristics of Turkish children with Maturity Onset Diabetes of the Young Type 2 (MODY2): A single center experience

Objective: The aim of the study was to investigate the clinical and molecular genetic characteristics of children with maturity-onset diabetes of the youth-glucokinase (MODY-GCK, MODY type 2). Method: Medical files of 21 patients with suspected MODY-GCK were reviewed retrospectively. The file records of the clinical findings, laboratory results and the suspected clinical diagnoses of MODY were based on (1) asymptomatic fasting hyperglycemia (glucose ≥100mg/dl, HbA1c &amp;lt; 7.5% (at least twice measurement) 2) parents with a history of diabetes without complications or mild fasting hyperglycemia (100-144mg/dL). Results: The mean age at diagnosis was 11.5±4.3 years (min-max, 1.9-17.2). The mean (SD) fasting blood glucose level was 119.1 (9.8) mg/dL. The mean (SD) fasting C-peptide level was 1.3 (0.7) ng/mL, the mean (SD) insulin level was 5.9 (2.3) IU/ml, and the mean (SD) HbA1c level at diagnosis was 6.2 (0.5) %. Among 12 variants detected in the GCK gene, 8 were missense mutation, 2 were non-sense mutation, 1 of them was splice site and 1 of them was frameshift mutation. Eight of them (p. Val227Met, p. Ser282Ala, p.Val183Met, p.Met239Thr, p.Arg304Gln, p.Thr229Met, p.Gly163Asp, p.Cys130Ter) have been previously reported in the literature and 4 variants (c.582+4delA, p.Glu436Ter, p.His106ThrfsTer11, p.Asp133Gly) were novel. Conclusion: We found similar phenotype characteristic of children with GCK-MODY among the children with different variants. The most common mutation type was missense and followed by nonsense, splice site and frameshift mutations. Detection of the molecular defect in patients with MODY is vital for the implementation of appropriate treatment approaches.

Reduced platelet-lymphocyte ratio in a Saudi population with impaired fasting glycemia and hyperglycemia

BackgroundDiabetes mellitus (DM) is an inflammatory disorder characterized by elevated fasting blood glucose (FBG) with life-threatening complications. However, the physiological response of peripheral blood cells to impaired fasting glycemia (IFG) and hyperglycemia (HG) is ill-defined. AimIn this report, we investigated the patterns of change in platelet-lymphocyte ratio (PLR) relative to glycemic control. MethodsWBC count, PLR, C-reactive protein (CRP), FBG, HbA1c, and Hb results for 1,793 subjects were retrospectively analyzed. ResultsPLR was significantly reduced in HG compared to IFG and to normoglycemia (NG) while FBG was only significantly lower in males with elevated PLR. Increased PLR was less prevalent in subjects with HG and was a protective factor against HG. Upon stratification by HbA1c, PLR was found to be significantly lower in IFG compared to NG only in females. Importantly, PLR performed better than CRP in discriminating NG and HG in females. ConclusionThis report provides insights into the cellular physiological response to DM and evaluates PLR as a novel marker for DM management.

Effects of the Ketogenic Diet on Metabolic Syndrome

The global prevalence of obesity and metabolic syndrome and its pathophysiologic sequela are currently approaching epidemic proportions, with unacceptable levels in much of Westernized and economically developed society. The clinical stigmata of metabolic syndrome typically include the comorbidities of obesity, hypertension, non-insulin dependent diabetes, and hyperlipidemia with decreased plasma high density lipoprotein concentrations. In addition, a common finding of hyperinsulinemia and insulin resistance typical of high carbohydrate diets often accompanies the syndrome. The incorporation of the insulin sparing ketogenic diet as a dietary strategy for the treatment of metabolic syndrome may bring about improvements in insulin action and substrate utilization in peripheral tissues with at least a partial if not significant resolution of the syndrome. Thus, the ketogenic diet in addition to adaptations toward a healthy lifestyle and pharmacologic therapies have been explored as potential mechanisms to resolve the pathophysiologic sequela of obesity and metabolic syndrome and their impact on the delivery of healthcare. Metabolic syndrome (MetS) is a condition defined as a clustering of risk factors that is strongly associated with obesity, heart disease, and diabetes [22]. It has recently been estimated that the global prevalence of MetS has reached epidemic levels including the U.S.A., where it has been estimated that 20% to 25% of the adult global population meets the diagnostic criterion for MetS [3], which may be established when at least three of the five primary risk factors are present. The risk factors include a large waistline (abdominal or visceral obesity), high plasma triglyceride levels, low plasma HDL cholesterol concentrations, elevated blood pressure, and fasting hyperglycemia. The standard and most effective treatments for MetS to date have been incorporation of lifestyle changes, with dietary interventions being one of the major effective lifestyle modifications utilized to treat both obesity and MetS [14];[41]. The Ketogenic Diet (KD) is one dietary intervention that may have the potential to improve MetS risk factors. Historically, one of the primary uses of the KD has been to treat epilepsy, however, there is substantial evidence that it may also help to improve other conditions and illnesses, including obesity and MetS [30]; [48]; [35]. Despite this potential, certain dietary misconceptions may have prevented or slowed further research on the KD applications to weight control and use of the KD, particularly the emergence of the national dietary guidelines that have now promoted a low-fat, high-carbohydrate diet for several decades [18]; [51]; [52]. The purpose of this paper is to conduct a review of the literature regarding MetS, the KD, and the implications of the KD as a treatment for obesity and MetS. Existing research is systematically reviewed regarding the KD’s potential to address MetS and MetS risk factors. The results of the review indicate the validity of the diet and the need for further research on the KD and its potential to address the benefits, potential risks and clinical efficacy of the KD on reducing the pathophysiologic sequalae of obesity and MetS. MetS = Metabolic Syndrome, KD = ketogenic diet, KB = ketone bodies, including metabolic remnants acetoacetate (AcAc),3-beta-hydroxybutyrate (3HB), and acetone, PSMF = Protein Sparing Modified Fast, HDL, HDL-C= plasma high density cholesterol lipoprotein, LDL, LDL-C = low density cholesterol lipoprotein, TG, TRIG = plasma triglycerides, CRP = C-reactive protein, GLUT4 = Glucose Transporter 4, and insulin-linked cellular entity, ATP = Adenosine tri-phosphate, a high energy phosphate, CCK = cholecystokinin, CR = calorie restricted diet, LFD = low fat diet, LCKD = low calorie ketogenic diet, BP = blood pressure; SBP = systolic blood pressure; DBP = diastolic blood pressure, A(1c) = glycosylated hemoglobin fraction, NHLBI = National Heart, Lung and Blood Institute of the National Institutes of Health

DYNAMICS OF THE PARAMETERS OF THE METABOLIC SYNDROME IN OBESE WOMEN WHO HAVE UNDERGONE CAESAREAN SECTION UNDER THE INFLUENCE OF PHYSICAL THERAPY

Purpose: to determine the effectiveness of restoring the health status of obese women who underwent cesarean section, based on the dynamics of metabolic syndrome parameters.&#x0D; Methods. During the research, 44 women aged 25.5±1.6 years at the end of the late postpartum period (2 months after childbirth) were examined. The control group consisted of 17 women with normal body weight who gave birth vaginally and recovered independently in the postpartum period. The comparison group consisted of 14 obese women who independently recovered in the postpartum period. The experimental group consisted of 13 obese women who, for 3 months, performed a physical therapy program (therapeutic exercises for the muscles of the back, abdomen, upper and lower limbs, functional training; pressotherapy; vacuum massage; nutritional recommendations. The criteria for metabolic syndrome were studied: abdominal obesity, fasting hyperglycemia, impaired glucose tolerance (according to the results of a 2-hour loading test), total cholesterol, high triglyceride content, decreased high-density lipoprotein content.&#x0D; Research results. During the observation period (3 months), the women of the control group increased their body weight by 0.61 kg on average, the comparison group - by 1.66 kg, while the women of the experimental group decreased their body weight by 2.57 kg, which was reflected in the dynamics body mass index. In the women of the research group, it was possible to achieve a statistically significant decrease in waist circumference (p&lt;0.05), which can be explained not only by the decrease in the amount of abdominal fat, but also by the toning of the muscles of the anterior abdominal wall, weakened by overstretching during pregnancy. Such dynamics influenced the parameters of the ratio of waist circumference to hip circumference in the direction of its improvement, although normalization was not achieved. Under the influence of physical therapy, the expressiveness of biochemical manifestations of metabolic and dyslipidemic manifestations in the women of the research group decreased relative to the parameters of the first examination. Fasting glucose parameters reached the normal range, tissue sensitivity to glucose was restored. Positive changes in the concentrations of lipid fractions in the direction of decreasing atherogenicity were observed. At the same time, women in the comparison group showed a tendency to increase body weight, worsening of atherogenic dyslipidemia, i.e. signs of metabolic syndrome. In women of the control group with normal body weight, there were no changes in the studied indicators.&#x0D; Conclusions. Obesity as an independent pathological process increases the risks during pregnancy and childbirth for both the mother and the child, leading to an increase in the frequency of abdominal delivery with appropriate postpartum rehabilitation in such women. The improvement of anthropometric indicators and the reduction of dysmetabolic and dyslipidemic manifestations indicate the sufficient effectiveness of physical therapy in correcting body weight in women with obesity in the postpartum period, although in order to achieve normal body weight indicators and complete normalization of indicators, the duration of recovery measures should be longer than three months, and for all patients of this profile need lifelong adherence to a balanced diet.

NHANES 2011-2014 Reveals Decreased Cognitive Performance in U.S. Older Adults with Metabolic Syndrome Combinations.

A relationship between metabolic syndrome and cognitive impairment has been evidenced across research; however, conflicting results have been observed. A cross-sectional study was conducted on 3179 adults older than 60 from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) to analyze the relationship between metabolic syndrome and cognitive impairment. In our results, we found that adults with abdominal obesity, high triglycerides, and low HDL cholesterol had 4.39 fewer points in the CERAD immediate recall test than adults without any metabolic syndrome factors [Beta = -4.39, SE = 1.32, 17.75 (1.36) vs. 22.14 (0.76)]. In addition, people with this metabolic syndrome combination exhibited 2.39 fewer points in the CERAD delayed recall test than those without metabolic syndrome criteria [Beta = -2.39, SE = 0.46, 4.32 (0.49) vs. 6.71 (0.30)]. It was also found that persons with high blood pressure, hyperglycemia, and low HDL-cholesterol levels reached 4.11 points less in the animal fluency test than people with no factors [Beta = -4.11, SE = 1.55, 12.67 (2.12) vs. 16.79 (1.35)]. These findings suggest that specific metabolic syndrome combinations are essential predictors of cognitive impairment. In this study, metabolic syndrome combinations that included obesity, fasting hyperglycemia, high triglycerides, and low HDL-cholesterol were among the most frequent criteria observed.

A comparison of daily glucose fluctuation among GCK-MODY and type 2 diabetes using continuous glucose monitoring technology.

Glucokinase variant-induced maturity-onset diabetes of the young (GCK-MODY) exhibits the unique clinical features of mild fasting hyperglycaemia. However, formal studies of its glucose excursion pattern in daily life in comparison with those with or without other types of diabetes are lacking. We conducted a case-control study including 25 patients with GCK-MODY, 25 A1c-matched, drug naive patients with type 2 diabetes (T2DM) and 25 age-, BMI- and sex-matched subjects with normal glucose tolerance (NGT). All the subjects wore flash glucose monitoring (FGM) sensors for 2 weeks, and glucose readings were masked. Glucose excursion was significantly lower in the GCK-MODY than that in A1c-matched T2DM during the daytime, but was similar during the nighttime. The daytime coefficient of variation [CV] driven by postprandial glucose could separate GCK-MODY from well-controlled T2DM, but the nighttime CV could not. In discriminating between GCK-MODY and T2DM, the area under the curve (AUC) of the CV was 0.875. However, in GCK-MODY and NGT subjects, the CVs were similar at 24h, whereas the other four excursion parameters were significantly higher in GCK-MODY than those in NGT subjects. FGM confirmed the stability and mildness of hyperglycemia in GCK-MODY patients. Postprandial regulation is a key driver of the difference in excursion between GCK-MODY and T2DM.

Activation of AMPK Entails the Protective Effect of Royal Jelly against High-Fat-Diet-Induced Hyperglycemia, Hyperlipidemia, and Non-Alcoholic Fatty Liver Disease in Rats.

This study examined the mechanism underlying the protective effect of royal jelly (RJ) against high-fat-diet (HFD)-mediated non-alcoholic liver disease (NAFLD) in rats. Adult male rats were divided into five groups (n = 8 each): control fed a standard diet, control + RJ (300 mg/kg), HFD, HFD + RJ (300 mg/kg), and HFD + RJ + CC (0.2 mg/kg). The treatment with RJ reduced weight gain, increased fat pads, and attenuated fasting hyperglycemia, hyperinsulinemia, and glucose tolerance in the HFD-fed rats. It also reduced the serum levels of liver function enzymes, interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), and leptin but significantly increased the serum levels of adiponectin. In addition, and with no effect on lipid excretion in stool, RJ significantly decreased the hepatic mRNA expression of SREBP1, serum, hepatic cholesterol, and triglycerides but increased hepatic mRNA levels of PPARα. Furthermore, RJ reduced the hepatic levels of TNF-α, IL-6, and malondialdehyde (MDA) in the livers of these rats. Of note, with no effect on the mRNA levels of AMPK, RJ stimulated the phosphorylation of AMPK and increased the levels of superoxide dismutase (SOD) and total glutathione (GSH) in the livers of the control and HFD-fed rats. In conclusion, RJ attenuates NAFLD via its antioxidant potential and adiponectin-independent activation of liver AMPK.

IDF2022-1246 Flash glucose monitoring to correct nocturnal and fasting hyperglycemia with basal insulin in T2DM with CKD Stage 3B

IDF2022-1246 Flash glucose monitoring to correct nocturnal and fasting hyperglycemia with basal insulin in T2DM with CKD Stage 3B