Fasting Plasma Glucose Values Research Articles

Association between the cut-off value of the first trimester fasting plasma glucose level and gestational diabetes mellitus: a retrospective study from southern China

PurposeOur previous studies have suggested that the first trimester fasting plasma glucose (FPG) level is associated with gestational diabetes mellitus (GDM) and is a predictor of GDM. The aim of the present study was to provide valuable insights into the accuracy of the first trimester FPG level in the screening and diagnosis of GDM in southern China.MethodsThis retrospective study included pregnant women who had their first trimester FPG level recorded at 9–13+6 weeks and underwent screening for GDM using the 2-h 75 g oral glucose tolerance test (OGTT) between the 24th and 28th gestational weeks. Differences between the GDM and non-GDM groups were assessed by Student’s t test and the chi-squared test according to the nature of the variables. A restricted cubic spine was used to explore the relationship between the first trimester FPG level and the odds ratio (OR) of GDM in pregnant women. Cut-off values of first trimester FPG were determined using receiver operating characteristic (ROC) curves and the area under the curve (AUC), and 95% confidence intervals (CIs), the positive predictive value (PPV) and the negative predictive value (NPV) were calculated.ResultsThe medical records of 28,030 pregnant women were analysed, and 4,669 (16.66%) of them were diagnosed with GDM. The average first trimester FPG level was 4.62 ± 0.37 mmol/L. The OR of GDM increased with increasing first trimester FPG levels and with a value of first trimester FPG of approximately 4.6 mmol/L, which was equal to 1 (Chi-Square = 665.79, P < 0.001), and then started to increase rapidly afterwards. The ROC curve for fasting plasma glucose in the first trimester (4.735 mmol/L) for predicting gestational diabetes mellitus in pregnant women was 0.608 (95% CI: 0.598–0.617), with a sensitivity of 0.490 and a specificity of 0.676.ConclusionBased on the research, we recommend that all pregnant women undergo FPG testing in the first trimester, particularly at the first antenatal visit. Furthermore, we suggest that the risks of GDM should be given increased attention and management as soon as the first trimester FPG value is more than 4.7 mmol/L. First trimester FPG levels should be considered a screening marker when diagnosing GDM in pregnant women but this needs to be confirmed by more prospective studies. These factors may have a significant impact on the clinical treatment of pregnant women.

Associations of polychlorinated biphenyls exposure with plasma glucose and diabetes in general Chinese population: The mediating effect of lipid peroxidation

Polychlorinated biphenyls (PCBs) exposure has been related to the abnormal glucose metabolism and the risk of diabetes. However, the joint effects of various PCBs are uncertain and the potential mechanisms remain unclear. Our objectives were to evaluate the associations of serum PCBs with fasting plasma glucose (FPG) and the risk of diabetes among a general Chinese population, and to estimate the mediating effects of oxidative stress in the above associations. Serum levels of seven indicator-PCBs (PCB-28, 52, 101, 118, 138, 153, and 180) and FPG values were determined among 4498 subjects from the Wuhan-Zhuhai cohort. Oxidative DNA damage biomarker (urinary 8-hydroxy-2′-deoxyguanosine, 8-OHdG) and lipid peroxidation biomarker (urinary 8-isoprostane, 8-iso-PGF2α) were also measured. Positive relationships of serum PCBs with FPG values as well as the risk of diabetes were observed. With each 1% increment in the natural log-transformed values of wet weight serum PCBs, FPG levels increased a 0.125% for PCB-52, 0.168% for PCB-118, 0.221% for PCB-138, 0.273% for PCB-153, and 0.379% for ΣPCB (the sum of seven PCBs). The adjusted odds ratios of diabetes associated with wet weight PCBs were 1.186 for PCB-52, 1.373 for PCB-118, 1.635 for PCB-153, and 1.456 for ΣPCB. The seven serum PCBs showed positive overall effect on the risk of diabetes. Elevated PCB-28, PCB-52, PCB-118, PCB-138, PCB-153, and ΣPCB were associated with the increased urinary 8-iso-PGF2α, which was positively related with FPG values. Furthermore, urinary 8-iso-PGF2α partially mediated the positive associations between PCBs and FPG values, with the mediated proportions ranged from 3.20 to 12.93%. In conclusion, our results suggested that serum PCBs were positively related with increased oxidative stress, FPG values, and the risk of diabetes among a general Chinese population. Serum PCBs mixture had positive overall effect on the risk of diabetes. Lipid peroxidation partly mediated the FPG elevation induced by PCB exposure.

The correlation between pseudoexfoliation syndrome and the Triglyceride-Glucose index.

Pseudoexfoliation (PEX) syndrome is an age-related disease characterized by the accumulation of extracellular material in many ocular structures, skin and internal organs. Recent studies have shown that the Triglyceride-Glucose (TyG) index has clinical importance for the evaluation of vascular damage. The purpose of this study was to determine the relationship between PEX syndrome and TyG index, and to detect the risk in terms of vascular diseases. In the present study, 50 patients with PEX syndrome who were admitted to the ophthalmology outpatient clinic were evaluated along with 50 others who made up the control group. The Triglyceride-Glucose index was calculated with fasting plasma glucose and triglyceride values. The mean age was 68.2 ± 1.2years and 61.0% of the patients were male. There was no statistically significant difference between the two groups in terms of blood sugar and lipid profile (except triglyceride) (p > 0.05). The TyG index value was 8.9 ± 0.5 in the PEX group and 8.6 ± 0.6 in the control group. This difference was statistically significant (p = 0.003). In univariate regression analysis, TyG index (OR = 2.81; CI: 1.37-5.75; p = 0.005) was found to be correlated with PEX. In multivariate logistic regression analysis, this correlation remained statistically significant when adjusted for age and sex (OR = 2.89; CI: 1.35-6.18; p = 0.006). Results showed that the TyG index was high in patients diagnosed with PEX. The risk of vascular diseases can be determined by examining the TyG index in patients with PEX, and this predetermination would have significant consequences for public health.

Developing a simple and practical decision model to predict the risk of incident type 2 diabetes among the general population: The Di@bet.es Study

AimsTo develop a simple multivariate predictor model of incident type 2 diabetes in general population. MethodsParticipants were recruited from the Spanish Di@bet.es cohort study with 2570 subjects meeting all criteria to be included in the at-risk sample studied here. Information was collected using an interviewer-administered structured questionnaire, followed by physical and clinical examination. CHAID algorithm, which collects the information of individuals with and without type 2 diabetes, was used to develop a decision tree based type 2 diabetes prediction model. Results156 individuals were identified as having developed type 2 diabetes (6.5% incidence). Fasting plasma glucose (FPG) at the beginning of the study was the main predictive variable for incident type 2 diabetes: FPG ≤ 92 mg/dL (ref.), 92–106 mg/dL (OR = 3.76, 95%CI = 2.36–6.00), > 106 mg/dL (OR = 13.21; 8.26–21.12). More than 25% of subjects starting follow-up with FPG levels > 106 mg/dL developed type 2 diabetes. When FPG <106 mg/dL, other variables (fasting triglycerides (FTGs), BMI or age) were needed. For levels ≤ 92 mg/dL, higher FTGs levels increased risk of incident type 2 diabetes (FTGs > 180 mg/dL, OR = 14.57; 4.89–43.40) compared with the group of FTGs ≤ 97 mg/dL (FTGs = 97–180 mg/dL, OR = 3.12; 1.05–9.24). This model correctly classified 93.5% of individuals. ConclusionsThe type 2 diabetes prediction model is based on FTGs, FPG, age, gender, and BMI values. Utilizing commonly available clinical data and a simple blood test, a simple tree diagram helps identify subjects at risk of developing type 2 diabetes, even in apparently low risk subjects with normal FPG.

Adiponectin to Leptin Ratio and its Association with Insulin Resistance in Women with Polycystic Ovarian Syndrome

Background:Adiponectin and leptin play a major role in metabolic homeostasis. Adiponectin to Leptin ratio can be used as an indicator of insulin resistance and a marker of polycystic ovarian syndrome (PCOS). The study was planned to compare serum adiponectin, leptin, and adiponectin to leptin ratio in age and BMI matched women with and without PCOS and to find out the association of adiponectin to leptin ratio with Insulin resistance in these women.Methods:It was a cross-sectional study done in the Gynecology outpatient clinic in a tertiary care center. A total of 120 women, 60 with PCOS and 60 age and BMI matched women without PCOS, who presented in the clinic after the index cases were enrolled and tested for serum adiponectin, leptin, and insulin sensitivity. The main outcome measures were serum levels of adiponectin, leptin, adiponectin to leptin ratio, oral glucose tolerance test, serum insulin and HOMA-IR.Results:PCOS women had lower serum Adiponectin, higher serum Leptin level and lower Adiponectin to Leptin ratio compared to non PCOS women, 2.15 ± 3.07 ng/ml vs 10.7 ± 27.91 ng/ml, P < 0.0001; 24.25 ± 16.5 ng/ml vs 13.89 ± 11.19 ng/ml, P = 0.0003 and 0.15 ± 0.24 vs 3.03 ± 15.04, P < 0.0001, respectively. Plasma glucose 2 hours after 75 gm glucose and serum Insulin was significantly increased in PCOS women (108.78 ± 10.22 mg/dl vs 100.18 ± 4.89 mg/dl, P = 0.001 and 5.7 ± 9.53 mU/ml vs 3.02 ± 5.34 mU/ml, P = 0.02, respectively). The mean values of fasting plasma glucose and HOMA-IR were comparable in both groups, P = 0.145, P = 0.719, respectively. There was no significant association of A/L Ratio with BMI, plasma glucose 2 hours after 75 gm glucose, serum Insulin and HOMA-IR, in these women, r = -0.074, P = 0.5754; r = -0.203, P = 0.12; r = -0.018, P = 0.8915; and r = -0.041, P = 0.757, respectively.Conclusion:Adiponectin to leptin ratio is significantly reduced in women with PCOS but has no association with insulin resistance.

Global metagenomics analyses demonstrate metformin‐induced changes in the gut mycobiome in subjects with type 2 diabetes

The fungal component of the gut microbiota (mycobiome) has been less well studied than bacterial populations; however, emerging evidence suggests that the mycobiome might play an important role in metabolic disease. Intestinal fungi play an important role in modulating immune responses at mucosal and systemic sites, but the extent of host‐bacterial‐fungi interactions in disease pathogenesis remains unknown. Metabolic diseases such as obesity and type 2 diabetes are accompanied by an altered gut microbiome, known as dysbiosis, and recent work suggests that the gut mycobiome may also be perturbed in metabolic diseases. Correcting gut dysbiosis is hypothesized as a therapeutic target for obesity and some metabolic diseases, however, little data is available regarding the effects of medications on the gut mycobiome and associated host‐bacterial‐fungi interactions. Metformin is globally the most prescribed drug for type 2 diabetes mellitus (T2D), and its therapeutic effects cause decreased hepatic gluconeogenesis and consequently circulating blood glucose. Metformin treatment also impacts the gut microbiome composition, lowering circulating lipopolysaccharide and therefore reducing toll‐like‐receptor‐mediated inflammation. To date, the potential effects of metformin on the gut mycobiome are entirely unknown. Therefore, this study aims to address this knowledge gap by characterizing the impact of metformin on the gut mycobiome of healthy adults and adults with pre‐diabetes and T2D, defined by fasting plasma glucose values. We searched for published research articles with archived, publicly accessible shotgun metagenomics data and re‐processed the data with one uniform bioinformatics pipeline to identify fungal taxa and relative abundance. Our analysis involved a total of 4510 samples from 13 individual studies ranging from randomized clinical trials to cross‐sectional cohorts. We performed analyses on the compiled dataset to (1) characterize the impact of metformin treatment in healthy, pre‐diabetic, and T2D individuals on the gut mycobiome; and (2) correlate the changes in relative abundance of fungal taxa to available clinical covariates, such as body mass index and fasting blood glucose. Secondary analysis of a randomized controlled trial of 44 newly diagnosed, treatment‐naïve T2D patients who were prescribed metformin for three days demonstrated a significant effect of metformin on the gut mycobiome richness (Shannon and Simpson indices; t test p = 0.02 and p = 0.0061 respectively) and diversity (PERMANOVA p = 0.001). Additionally, the relative abundance of Saccharomyces,a well‐characterized yeast genus, was significantly higher after three days of metformin treatment (Wilcoxon p = 0.019). This study provides novel insight into the interactions between human hosts, the gut microbiome, and the gut mycobiome in response to metformin, a widely used drug to treat T2D. Furthermore, these analyses may provide greater understanding of the role of the mycobiome‐microbiome interaction in metabolic diseases.

The Reproducibility and Usefulness of Estimated Average Glucose for Hyperglycemia Management during Health Checkups: A Retrospective Cross-Sectional Study.

HbA1c reflects average glucose levels over 3 months, but it does not measure glycemic variability. This study aimed to determine the reproducibility and usefulness of HbA1c-derived estimated average glucose (eAG) and to analyze the factors associated with eAG during health checkups. This cross-sectional retrospective study consecutively selected subjects who had undergone health checkups at 16 health-promotion centers in 13 Korean cities in 2020. The subjects comprised 182,848 healthy subjects with normoglycemia, 109,555 with impaired fasting glucose (IFG), and 35,632 with diabetes. eAG was calculated using Nathan’s regression equation. In all subjects, fasting plasma glucose (FPG) was found to be fairly strongly correlated with eAG (r = 0.811). When the subjects were divided into FPG subgroups, the strength of the correlation decreased among those with normoglycemia and IFG (p < 0.001). Higher eAG levels were associated with older age, females, higher FPG, and lower HDL-C and triglycerides (p < 0.05). The proportion of subjects with a higher value of FPG than eAG was 46.3% in poorly controlled diabetic patients, compared with only 1.5% in normoglycemic subjects. This suggests eAG could help patients to understand their glycemic variability intuitively and healthcare providers to identify patients who might worsen in hyperglycemia control through measuring the difference between eAG and FPG.

IDF21-0380 An integrated diabetes ecosystem to address patient barriers in low-income communities in Philippines

Background: Diabetes in the Philippines is considered as a major public health concern. Diabetes care in the Philippines has challenges with respect to access to healthcare resources and government insurance coverage, With the national insurance system not covering comprehensive care and the private insurance companies only offer limited diabetes coverage. Patients mainly rely on the out-of-pocket system of healthcare for outpatient services such as lab procedures and medications. The high cost serves as a disincentive and contributes to low adherence and suboptimal care. Consequently, poor access to glycaemic monitoring and adherence to treatment impairs prevention of complications There is a need to improve diabetes care and its access in the Philippines to reduce overall clinical and economic burden. Aim: To evaluate an integrated diabetes care program addressing the healthcare awareness needs, screening, and accessibility of low cost medications to people living with Type 2 Diabetes (T2DM) and to also reinforce medical training to HCPs, to bring better outcomes in Diabetes care. Method: A stratified multistage sampling design was adopted where stratification was done on the geographical distribution and population size to provide a sample of individuals representing the Philippine population. A community inclusive approach was taken to understand patient barriers and develop services to address those challenges. All field workers (FW) underwent training before commencing field work. Field activities began with mapping procedures, spreading awareness, collection of data points like BMI, administering questionnaires, collecting Fasting Plasma Glucose (FPG) values, referring to health care providers, supplying of low-cost medications, etc. The program involved multi-organizational approach to provide comprehensive care, including diagnostics and monitoring devices (glucometers, strips). The program also provided insulins at 10 cents per day promise to patients ($2.5/vial) vs significantly higher market prices. With a door-to-door delivery method, patients could save long commutes to pharmacies and hospitals. Results: A total of 14,275 community residents were approached by FW to spread awareness about diabetes. One thousand nine hundred and forty-two people were screened using the risk assessment questionnaire and advised for FPG tests. Out of 1,942 people who took FPG test, 1,040 (56%) had FBG ≤99 mg/dl, 500 (26%) had FBG between 100 –125 mg/dl (prediabetes) and 352 (18%) had FBG ≥126 mg/dl. Among the 352 patients with diabetes, 22 (6.2%) patients had an HbA1c value of ≥ 9%. Based on the recommendations, HCPs prescribed insulin to 42 patients, of which, only 12 patients adhered to treatment with the low priced insulin. The treating HCPs also underwent a comprehensive medical educational module on diabetes where the impact of program was measured with pre and post-test questionnaire. The knowledge scores of pre & post training was recorded among HCPs (22.5/24 vs. 20/24) and nurses (18.3/24 vs. 15.7/24). The follow up of the12 patients on insulin is under progress and the outcome data will be updated on completion of 6 months. Discussion: This effort provides comprehensive data to understand how an evolving diabetes ecosystem involving awareness, screening, diagnosis, and affordable treatment (insulin) supplemented with medical education empowering HCPs can lead to better health outcomes among patients with T2DM.

Viscoelastic and Viscoplastic Glucose Theory (VGT #29): Applying viscoelastic Glucose Theory with CGM Sensor Measured Fasting Plasma Glucose (FPG) Values as the Strain along with the FPG Change Rate Multiplied by a Viscosity Factor as the Stress, and Finally Utilizing the Viscoelastic Perturbation Model to Calculate the Predicted FPG Values to Compare Against the Measured FPG Values Based on GH-Method:

The author has studied strength of materials and theory of elasticity through his undergraduate courses at the University of Iowa. He also conducted research work to earn a master’s degree in Biomechanics under Professor James Andrews. At that time, he used the spring and dashpot models to simulate the behaviors of human joints, bones, muscles, and tendons in order to investigate the human-weapon interactions during the Vietnam war era. Later, he went to MIT to pursue his PhD study under Professor Norman Jones, who taught him theory of plasticity and dynamic plastic behaviors of various structure elements. He also took additional graduate courses in the field of fluid dynamics and thermodynamics. Since then, many advancements have been made in the biomechanics branch, especially with human body tissues that possess certain viscoelastic characteristics, such as bones, muscles, cartilages, tendons (connect bone to muscle), ligaments (connect bone to bone), fascia, and skin. For example, the author suffered plantar fasciitis for many years. He understood that the night splint dorsiflexes forefoot, at the back of the foot, increases plantar fascia tension to offer stress-relaxation for the pain. This model where muscles and tendons connect the lower leg and foot is a form of viscoelastic study for medical problem solving. When dealing with human internal organs, it is not easy to conduct live experiments to obtain accurate measurements for the biomedical material properties. Blood itself is a viscous material (time-dependent) and its viscosity factor may fall between water, honey, syrup, or gel. The author’s research focuses on “glucose” where the blood sugar amount is produced by the liver and carried by red blood cells, not the blood itself. Fasting plasma glucose (FPG) has nothing to do with either diet or exercise during sleep hours and is mainly relying on the health condition of both liver and pancreatic beta cells, which produces glucose and releases insulin, to control the glucose level in blood. Therefore, it is nearly impossible to measure the material geometry or material properties to determine the viscosity of “glucose” like in engineering research work. As a result, the best the author could do is to apply the “concept of viscoelasticity and/or viscoplasticity” to construct an analogy model of time-dependent glucose behaviors.

Efficacy of Pharmaceutical Care in Patients with Type 2 Diabetes Mellitus and Hypertension: A Randomized Controlled Trial.

Background The rates of treatment adherence and treat-to-target rates of blood pressure and blood glucose-related indexes in patients with hypertension and type 2 diabetes mellitus (T2DM) are associated with prognosis. This study aimed to investigate the efficacy of pharmaceutical care postdischarge for treatment adherence in hypertensive patients with type 2 diabetes mellitus (T2DM). Methods This was a randomized controlled trial of patients with combined T2DM and hypertension treated between January and May 2018. Pharmaceutical care included free access to a clinical pharmacist, education material, a WeChat account for live discussion, and a telephone follow-up. The primary endpoint was the 3-month medication adherence. The secondary endpoints included the achieving levels of target rates and values of fasting plasma glucose (FPG), 2 h postprandial glucose (2hPG), and hemoglobin A1c (HbA1c) and the rates of reaching the achieving target rate of blood pressure target <130/80. Results In 80 participants, the 3-month medication adherence was higher in the pharmaceutical care group than the routine group (90.0% vs. 52.5%, P < 0.001). In terms of FPG, 2hPG, and HbA1c, there were also significant differences between the pharmaceutical care and routine groups (FPG, 6.50 (6.00, 7.18) vs. 7.00 (6.83, 7.78) mmol/L, P=0.004; 2hPG, 8.45 (7.45, 9.28) vs. 9.35 (8.23, 10.15), P=0.007; HbA1c, 6.5% (6.3%, 7.0%) vs. 7.0% (6.5%, 7.4%), P=0.007). The achieving target rate of reaching the blood pressure target in the pharmaceutical care group (92.5%) was significantly higher than that in the routine group (62.5%; P < 0.05). Conclusion The postdischarge pharmaceutical care program in patients with T2DM and hypertension improves medication adherence.

Viscoelastic and Viscoplastic Glucose Theory (VGT #32): A Step-By-Step Illustration of How to Apply VGT and Viscoelasticity Perturbation Model with the Average Value of Normalized Body Weight and Body Temperature in Early Morning as the Viscosity Factor to Predict Average Fasting Plasma Glucose Values over 7-Hours of Sleep Time Based on GH-Method: MathPhysical Medicine (No. 613)

The author has studied strength of materials and theory of elasticity through his undergraduate courses at the University of Iowa. He also conducted research work and earned a master’s degree in Biomechanics under Professor James Andrews. In 1970-1971, he used a combined spring and dashpot model to simulate the behaviors of human joints, bones, muscles, and tendons (which he took some related courses at School of Medicine at UI) in order to investigate the soldier-weapon biophysical interactions during the Vietnam war era. Later, he went to MIT to pursue his PhD study under Professor Norman Jones, who taught him theory of plasticity and dynamic plastic behaviors of various structure elements. To further his education, he took additional graduate courses in various fields of fluid dynamics, thermodynamics, bridge design using energy absorption pad, and soil mechanics under earthquake strike forces which deal with “time-dependency” issues. Since then, many advancements have been made in the biomechanics branch, especially with human body live tissues that possess certain viscoelastic characteristics, such as bones, muscles, cartilages, tendons (connect bone to muscle), ligaments (connect bone to bone), fascia, and skin. For example, the author suffered plantar fasciitis for many years. He understood that the night splint dorsiflexes forefoot, at the back of the foot, increases plantar fascia tension to offer stress-relief for the pain. This model where muscles and tendons connect the lower leg and foot is a form of viscoelastic study for medical problem solving.

Viscoelastic Glucose Theory (VGT #8): Applying Viscoelastic Glucose Theory with Finger-Piercing Measured Fasting Plasma Glucose (FPG) as the Strain Along with the FPG Change Rate Multiplied by Body Weight in the Early Morning as the Stress, to Calculate the Predicted FPG Values and then Comparing Against Another Predicted FPG Values Using Statistical Linear Regression Model Based on GH-Method: Math-Physical Medicine

The author has studied strength of materials and theory of elasticity through his undergraduate courses at the University of Iowa. He also conducted research work to earn a master’s degree in Biomechanics under Professor James Andrews. At that time, he used the spring and dashpot models to simulate the behaviors of human joints, bones, muscles, and tendons in order to investigate the human-weapon interactions during the Vietnam war era. Later, he went to MIT to pursue his PhD study under Professor Norman Jones, who taught him theory of plasticity and dynamic plastic behaviors of various structure elements. He also took additional graduate courses in the field of fluid dynamics and thermodynamics. Since then, many advancements have been made in the biomechanics branch, especially with human body tissues that possess certain viscoelastic characteristics, such as bones, muscles, cartilages, tendons (connect bone to muscle), ligaments (connect bone to bone), fascia, and skin. For example, the author suffered plantar fasciitis for many years. He understood that the night splint dorsiflexes forefoot, at the back of the foot, increases plantar fascia tension to offer stress-relaxation for the pain. This model of muscles and tendons connecting the lower leg and foot is a form of viscoelastic study for medical problem solving. However, when dealing with human internal organs, it is not easy to conduct live experiments to obtain accurate measurements for the biomedical material properties. Although blood is a viscous material (time-dependent), its viscosity factor may fall between water, honey, syrup, or gel, the author’s research subject is “glucose” where the blood sugar amount is produced by the liver and also carried by red blood cells, not the blood itself. Fasting plasma glucose (FPG) has nothing to do with either diet or exercise during sleep hours and is mainly relying on the pancreatic beta cell’s health condition, which produces and releases insulin, to control the glucose level in blood. Therefore, it is nearly impossible to measure material geometry or certain engineering properties of glucose, for example, to determine the viscosity of “glucose”. As a result, the best he could do is to apply the “concept of viscoelasticity and/or viscoplasticity” to construct an analogy model of time-dependent glucose behaviors.

Viscoelastic Glucose Theory (VGT #6): Applying Viscoelastic Glucose Theory with Fasting Plasma Glucose (FPG) as the Strain Along with the FPG Change Rate Multiplied by Body Temperature in the Early Morning as the Stress, to Illustrate the Viscoelastic Stress-Strain Diagram and Calculate the Predicted FPG Values Using the Perturbation Theory Model and Amplified Body Temperature Ratio as the “Perturbation Factor”,

The author has studied strength of materials and theory of elasticity through his undergraduate courses at the University of Iowa. He also conducted research work to earn a master’s degree in Biomechanics under Professor James Andrews. At that time, he used the spring and dashpot models to simulate the behaviors of human joints, bones, muscles, and tendons in order to investigate the human-weapon interactions during the Vietnam war era. Later, he went to MIT to pursue his PhD study under Professor Norman Jones, who taught him theory of plasticity and dynamic plastic behaviors of various structure elements. He also took additional graduate courses in the field of fluid dynamics and thermodynamics. Since then, many advancements have been made in the biomechanics branch, especially with human body tissues that possess certain viscoelastic characteristics, such as bones, muscles, cartilages, tendons (connect bone to muscle), ligaments (connect bone to bone), fascia, and skin. For example, the author suffered plantar fasciitis for many years. He understood that the night splint dorsiflexes forefoot, at the back of the foot, increases plantar fascia tension to offer stress-relaxation for the pain. This model of muscles and tendons connecting the lower leg and foot is a form of viscoelastic study for medical problem solving. However, when dealing with human internal organs, it is not easy to conduct live experiments to obtain accurate measurements for the biomedical material properties. Although blood itself is a viscous material (time-dependent), its viscosity factor may fall between water, honey, syrup, or gel. But the author’s research subject is “glucose” where the blood sugar amount is produced by the liver and also carried by red blood cells, not the blood itself. Fasting plasma glucose (FPG) has nothing to do with either diet or exercise during sleep hours and is mainly relying on the pancreatic beta cell’s health condition, which produces and releases insulin, to control the glucose level in blood. Therefore, it is nearly impossible to measure material geometry or certain engineering properties of glucose, for example, to determine the viscosity of “glucose”. Therefore, the best he could do is to apply the “concept of viscoelasticity and/or viscoplasticity” to construct an analogy model of time-dependent glucose behaviors.

Viscoelastic Glucose Theory (VGT #9): Applying Viscoelastic Glucose Theory with Sensor Measured Fasting Plasma Glucose (FPG) as the Strain Along with the FPG Change Rate Multiplied by Averaged Value of Body Weight and Body Temperature in the Morning as the Stress, to Calculate the Predicted FPG Values and then Comparing Against Another Predicted FPG Values Using TwoVariables Regression Model Based

The author has studied strength of materials and theory of elasticity through his undergraduate courses at the University of Iowa. He also conducted research work to earn a master’s degree in Biomechanics under Professor James Andrews. At that time, he used the spring and dashpot models to simulate the behaviors of human joints, bones, muscles, and tendons in order to investigate the human-weapon interactions during the Vietnam war era. Later, he went to MIT to pursue his PhD study under Professor Norman Jones, who taught him theory of plasticity and dynamic plastic behaviors of various structure elements. He also took additional graduate courses in the field of fluid dynamics and thermodynamics. Since then, many advancements have been made in the biomechanics branch, especially with human body tissues that possess certain viscoelastic characteristics, such as bones, muscles, cartilages, tendons (connect bone to muscle), ligaments (connect bone to bone), fascia, and skin. For example, the author suffered plantar fasciitis for many years. He understood that the night splint dorsiflexes forefoot, at the back of the foot, increases plantar fascia tension to offer stress-relaxation for the pain. This model of muscles and tendons connecting the lower leg and foot is a form of viscoelastic study for medical problem solving. However, when dealing with human internal organs, it is not easy to conduct live experiments to obtain accurate measurements for the biomedical material properties. Although blood is a viscous material (time-dependent), its viscosity factor may fall between water, honey, syrup, or gel, the author’s research subject is “glucose” where the blood sugar amount is produced by the liver and also carried by red blood cells, not the blood itself. Fasting plasma glucose (FPG) has nothing to do with either diet or exercise during sleep hours and is mainly relying on the pancreatic beta cell’s health condition, which produces and releases insulin, to control the glucose level in blood. Therefore, it is nearly impossible to measure material geometry or certain engineering properties of glucose, for example, to determine the viscosity of “glucose”. As a result, the best he could do is to apply the “concept of viscoelasticity and/or viscoplasticity” to construct an analogy model of time-dependent glucose behaviors.

Revised Glycemic Index for Diagnosing and Monitoring of Diabetes Mellitus in South Indian Population.

Aim: To find the optimal threshold of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) for diagnosis of diabetes mellitus (DM) and to evaluate the association with diabetic retinopathy (DR) in the South Indian population.Settings and Design: A retrospective population-based study.Methods and Materials: A total of 909 newly detected type 2 DM patients were selected from our two previously conducted studies, which include an urban and a rural population of South India. All underwent estimation of fasting, postprandial plasma glucose (PPG), and other biochemical tests. A comprehensive and detailed ophthalmic examination was carried out. The fundi of patients were photographed using 45°, four-field stereoscopic photography. Based on receiver operating characteristic (ROC) curves, sensitivity and specificity were derived.Results: The optimal cut-off values determined by maximizing the sensitivity and specificity of FPG and HbA1c using the Youden index were ≥ 6.17 mmol/L and ≥ 6.3%, respectively. By distributing the cut-off points into deciles and comparing them to the WHO criteria, we found that our HbA1c level of 6.60% was more than the WHO threshold (6.5%), with higher sensitivity (81.6%) and lower specificity (48.3%). The FPG level of 6.80 mmol/L was lower to the WHO criteria (7 mmol/L) with increased sensitivity (77.0%) and lower specificity (45.7%). Prevalence of DR by HbA1c levels between 6.5% and 6.9% was 15.3%. The prevalence of DR was more in the FPG category between 6.4 and 6.9 mmol/L and ≥ 7.5 mmol/L.Conclusion: Our population-based data indicate that for the South Indian population HbA1c value of ≥63 % and FPG value of ≥6.17 mmol/L may be optimal for diagnosing DM with a high level of accuracy and will be useful for the identification of mild and moderate DR.

Associations between HbA1c-derived estimated average glucose and fasting plasma glucose in patients with normal and abnormal hemoglobin patterns

Fasting plasma glucose (FPG) and HbA1c are well-known tests for monitoring short and long-term glycemic control, respectively. Estimated average glucose (eAG) is derived from the HbA1c for expression in the same units as FPG. The present study aimed to evaluate the association between eAG and FPG values. This retrospective study was performed on 1285 patients who measured the FPG and HbA1c (capillary electrophoresis method) values on the same day. They were initially divided into 3 hemoglobin-pattern groups, normal, HbE, and high HbA2, and then these 3 groups were further subdivided into whole group, subgroup 1 (HbA1c ≤ 7%) and subgroup 2 (HbA1c >7%) for analytical comparisons. The eAG values were calculated using Nathan’s equation. The differences, agreements, and correlations between eAG and FPG were evaluated. Good agreements and strong positive correlations between eAG and FPG values were observed in all 3 whole groups. In subgroup analysis, the degrees of agreement and correlation depended on the level of glycemic control, as all associations became stronger with better glycemic control. Additionally, the HbA1c levels and different eAG-FPG values between the normal and other groups were not significantly different in either whole group or subgroup comparisons. Our study found good agreements and strong positive correlations between eAG and FPG in all groups, indicating that high HbA2 or HbE did not affect the HbA1c levels or thus the associations between eAG and FPG. Reporting the eAG together with the HbA1c value should help improve the understanding of glycemic status in patients, leading to improved blood glucose control.

Study of serum C-peptide levels in newly diagnosed diabetic mellitus subjects of North Gujarat region of India

Background: Serum C-peptide has appeared as the chief clinical and practically adequate marker of β-cell function of pancreas. Serum insulin and C-peptide are concomitantly secreted into the blood circulation in equal amount. The aim of the study was to determine serum C-peptide levels in newly diagnosed diabetic mellitus subjects of North Gujarat region of India.Methods:The present cross-sectional study was done on 50 subjects of recently diagnosed Diabetes mellitus (T2DM) and non-diabetic healthy controls at Banas Medical College and our trust-based hospital. All diabetics patients were further classified into two groups; normal FC group consist of subjects with FC level 0.5-3.2 ng/ml (N=14) and high FC group included subjects with FC&gt;3.2 ng/ml (N=36). The patients' demographic and anthropometric parameters were recorded; detailed history and clinical examination were performed in the entire cases. All biochemical parameters were analyzed. Results: Predominance of the T2DM subjects was in the age group of 41-50 years. Mean value for age (p&lt;0.01), anthropometric (p&lt;0.01), fasting plasma glucose (p&lt;0.001), HbA1c (p&lt;0.01), cholesterol (p&lt;0.01), triglycerides (p&lt;0.001) and C-peptide (p&lt;0.001) were significantly higher in the T2DM subjects. The mean values of fasting plasma glucose (p&lt;0.001) and HbA1c (p&lt;0.01) are significantly higher in T2DM subject with high C-peptide level as compared to normal C-peptide level. Conclusions:In our study, we conclude that elevated levels of fasting C-peptide in newly diagnosed T2DM. Therefore, we suggested that serum C-peptide levels are valuable as marker of endogenous insulin production from β-cell of pancreas.

Consumption of caffeinated and decaffeinated coffee enriched with cocoa and fructo-oligosaccharides among non-diabetic persons: Double blind randomized clinical trial.

Food industry has been investing in bringing to the market coffee-based drinks enriched in compounds that promise weight loss, which consequently influences diabetes risk. However, there are no clinical trials showing the effects of brewed coffee (with or without caffeine) enriched with bioactive compounds on body fat and glycemic control in healthy individuals. Therefore, we have evaluated the effect of consuming two coffee formulas enriched with cocoa and fructo-oligosaccharides (FOS) on glycemic and anthropometric biomarkers and blood pressure in non-diabetic adults for 10weeks. In general, we observed that the values of fasting plasma glucose (FPG) (p=.006) and fasting capillary blood glucose (FCBG) (p<.001) had lower values with a tendency to decrease in FCG (p=.003) and FBG (p<.005) in both formulas. We observed statistically significant reductions in waist circumference (WC) (p=.012), arm circumference (AC) (p=.015), and percentage of fat (<0.0001) for all participants. However, we noticed a greater reduction in the caffeinated formula group (-2.92%, p=.005) compared to the decaffeinated formula (-1.62%, p=.008). Consumers of both cocoa and FOS-enriched coffee formulas benefited from reduced FBG, FCG, WC, and body fat percentage. The consumption of caffeinated formula was more effective in reducing the percentage of fat, while the decaffeinated formula was more effective in reducing diastolic blood pressure. PRACTICAL APPLICATIONS: This study provides robust evidence that effects of fortified coffee on non-diabetic people is positive for reduction in blood glucose, body fat and diastolic blood pressure. This study proposes a practical and safe coffee formulation for the consumption of caffeinated and decaffeinated coffee for non-diabetic people.

Variability, Mean, and Baseline Values of Metabolic Parameters in Predicting Risk of Type 2 Diabetes.

The effect of baseline (B) and alteration of metabolic parameters (MPs), including plasma glucose (PG) testing, insulin resistance surrogates, and lipid profile and their mutual interactions on the development of type 2 diabetes mellitus (T2DM), has not been investigated systematically. To access the association of the past variability (V), past mean (M), and B values of various MPs and their mutual interaction with the risk of T2DM. A community-based, longitudinal analysis was conducted using the Korean Genome and Epidemiology Study comprising 3829 nondiabetic participants with completed MPs measurements during 3 biannually visits who were followed over the next 10 years. Outcomes included the incidence of T2DM during follow-up. Among predictors, PG concentrations measured during the oral glucose tolerance test were the most prominent T2DM determinants, in which the M of the average value of fasting PG (FPG), 1-hour, and 2-hour PGs had the strongest discriminative power (hazard ratios and 95% CI for an increment of SD: 3.00 (2.5-3.26), AUC: 0.82). The M values of MPs were superior to their B and V values in predicting T2DM, especially among postload PGs. Various mutual interactions between indices and among MPs were found. The most consistent interactants were the M values of high-density lipoprotein cholesterol and the M and V values of FPG. The findings were similar in normal glucose tolerance participants and were confirmed by sensitivity analyses. Postload PG, past alteration of measurements, and mutual interactions among indices of MPs are important risk factors for T2DM development.

Relationship between glycosylated hemoglobin and iron deficiency anemia: A common but overlooked problem

IntroductionBoth diabetes mellitus (DM) and iron deficiency anemia (IDA) are prevalent in every area of the world, and so, the possibility of these two diseases co-existing is also very high. It is our belief that clinical results of any correlation between iron status of the body and glycosylated haemoglobin (HbA1c) would be beneficial to many patients, therefore in this study, the effect of IDA on HbA1c was investigated. Materials – methodsA total of 146 patients with DM and IDA were evaluated prospectively. While the patients were administered 270 mg/day of ferrous sulphate (80 mg elemental iron) orally for three months for the treatment of IDA, no interventions were made for the treatment of DM. Patient levels of hemoglobin (Hb), hematocrit, red blood cells (RBC), mean corpuscular volume (MCV), platelet, white blood cells (WBC), serum iron, serum iron binding capacity (SIBC), ferritin, fasting plasma glucose (FPG), HbA1c, body mass index (BMI), C-reactive protein (CRP) values were measured at baseline and at the third month of treatment with iron, and were compared. ResultsThe median age of our patients was 45 (40–50) and median duration of diabetes was 3 years (1,75–5). While the baseline median Hb was 10.4 (mg/dL) (9.5–11.1), MCV was 74 (fL) (70.8–77), ferritin was 4 (ug/L) (3–6) at three months, Hb was measured at 12.6 (mg/dL) (12.1–13.2), MCV was measured at 82 (fL) (80–86), ferritin was measured at 15 (ug/L) (9–21.2) and was significantly higher compared to baseline values (p < 0.001). The baseline median HBA1c of patients was 7.09 ± 0.51 (%) and three month HBA1c was 6.69 ± 0.53 (%), which was significantly lower than when comparing baseline values with values at third month (p < 0.001). Baseline and three month values for FPG were 118 (mg/dL) (108–132) and 116 (mg/dL) (106–125) respectively, and there was no significant difference (p:0.07). A 2.2 mg/dL (1.5–3.5) increase in median Hb level accompanied a 0.4 % (0.2–0.6) decrease in median HbA1c levels (Spearman rho = −0.362; p < 0.001). ConclusionOur study has shown conclusivly that IDA is related to increased HbA1c concentrations and HbA1c decreases significantly following treatment with iron. IDA should be considered before making any decisions regarding diagnosis or treatment according to HbA1c.