Fluid Glucose Concentration Research Articles

HFpEF and glycemic variability: GHIDD Trial

Abstract Background Recently the guidelines of European Association of Preventive Cardiology reported that the prevalence of diabetes mellitus in patients with diastolic heart failure (HFpEF) is around 31%. Glunovo® is a transdermal device capable of detecting and storing the concentration of glucose in the abdominal interstitial fluid 480 times a day for up to 14 consecutive days. Purpose In our study we evaluated the non diabetic patients with HFpEF with Glunovo to evaluate the glycaemic variability in this population Methods 100 patients with HFpEF admitted to cardiology units of 4 Italian centres on the major islands were enrolled consecutively. Glunovo® was applied to each enrolled patient for 7 days. At the end of the glycaemic monitoring were calculated for each patient the glycaemic variability and the incidence of hyperglycaemia and hypoglycaemia. Glycaemic variability refers to a blood glucose value of ≥ 200 mg / dL or ≤ 59 mg / dL detected more than 3 times in a day for at least 4 days. The inclusion criterion was the presence of diastolic heart failure while the only exclusion criterion was the presence of diabetes diagnosis. Overall, 43 males and 57 females were enrolled with a mean age of 69.3 years (39-87 years). All patients underwent a timely glucose measurement at admission which excluded the presence of hyperglycaemia. No potentially hyperglycaemic drugs were added to the treatment during the hospital stay. Continuous glucose monitoring was performed as an integral part of the hospitalization diagnostic routine. Results In 94 of the 100 patients enrolled it was possible to conclude the analysis, detecting the glycaemic variability, the point glycaemia values and the estimated glycated haemoglobin value. A glycaemia ≥200 mg/dL was found in 53 patients (56%) while a high glycaemic variability was found in 51 patients (54%). A blood glucose value <59 mg / dl was found in 48 patients (51%). Only 5 times the estimated glycated Hb values were> 7%. 32 of the patients who had at least 3 punctual glucose values ≥200 mg/dL were prescribed an oral glucose load curve, which in 100% of cases confirmed the diagnosis of diabetes.No statistically significant differences were found based on age group or sex. In the control group, consisting of 10 patients without DHF undergoing continuous glucose monitoring at one of the participating cardiology units, an unknown hyperglycaemia was found in only 1 patient (10%) and a glycaemic variability in only 1 patient (10%). Conclusions Our experience suggests an incidence of hyperglycaemia and glycaemic variability more then 65% in patients affected by HFpEF. If our data were reproducible on a large scale, a so high prevalence of diabetes in patients with HFpEF cold explain the efficacy of SGLT-2 inhibitor and GLP-1 Agonist in this class of patients.

Amniotic fluid glucose concentration as a predictor of fetal trisomy.

We aimed to assess the amniotic fluid glucose concentration cut-off as an indicator of fetal chromosomal abnormalities, such as trisomy 13, 18, and 21. This prospective observational study included pregnant females who underwent amniocentesis. Participants were divided into two groups on the border of 22 weeks of gestational age (<22 and ≥22-week groups). In total, 224 pregnant females were included in the analysis. In the <22 week group, 15 females had trisomies 13/18/21 and 174 females had no trisomies. In the ≥22 week group, 18 females had trisomies 13/18/21 and 17 had no trisomies. In each group, there was a difference in amniotic fluid glucose concentration between fetuses with trisomies 13, 18, and 21 and other fetuses with normal karyotype or minor chromosomal abnormalities. In both groups, the amniotic glucose concentration was noticeably lower in trisomies 13/18/21 (p = 0.002 in the <22 week group; p = 0.039 in the ≥22 week group). According to receiver operating characteristic curves, the optimal cut-off point of glucose concentration was 46 mg/dL in the <22 week group (odds ratio 6.55; 95% confidence interval 1.78-24.1) and 24 mg/dL in the ≥22 week group (odds ratio 8.40; 95% confidence interval 1.83-38.6). Our study suggested that glucose concentration in amniotic fluid is an indicator of trisomy 13, 18, and 21. Amniotic fluid glucose concentration itself does not diagnose fetal trisomy, but this may be helpful in selecting treatment facilities.

Analytical Performance of the FreeStyle Libre 2 Glucose Sensor in Healthy Male Adults.

Continuous Glucose Monitoring (CGM) not only can be used for glycemic control in chronic diseases (e.g., diabetes), but is increasingly being utilized by individuals and athletes to monitor fluctuations in training and everyday life. However, it is not clear how accurately CGM reflects plasma glucose concentration in a healthy population in the absence of chronic diseases. In an oral glucose tolerance test (OGTT) with forty-four healthy male subjects (25.5 ± 4.5 years), the interstitial fluid glucose (ISFG) concentration obtained by a CGM sensor was compared against finger-prick capillary plasma glucose (CPG) concentration at fasting baseline (T0) and 30 (T30), 60 (T60), 90 (T90), and 120 (T120) min post OGTT to investigate differences in measurement accuracy. The overall mean absolute relative difference (MARD) was 12.9% (95%-CI: 11.8-14.0%). Approximately 100% of the ISFG values were within zones A and B in the Consensus Error Grid, indicating clinical accuracy. A paired t-test revealed statistically significant differences between CPG and ISFG at all time points (T0: 97.3 mg/dL vs. 89.7 mg/dL, T30: 159.9 mg/dL vs. 144.3 mg/dL, T60: 134.8 mg/dL vs. 126.2 mg/dL, T90: 113.7 mg/dL vs. 99.3 mg/dL, and T120: 91.8 mg/dL vs. 82.6 mg/dL; p < 0.001) with medium to large effect sizes (d = 0.57-1.02) and with ISFG systematically under-reporting the reference system CPG. CGM sensors provide a convenient and reliable method for monitoring blood glucose in the everyday lives of healthy adults. Nonetheless, their use in clinical settings wherein implications are drawn from CGM readings should be handled carefully.

Solid-State Electrodes Towards a Real-Time Sensor Array for Health Monitoring

The healthcare industry has been transformed by advances in biotechnology, resulting in improved health outcomes. Central to this has been advances in medical diagnostics that can both monitor patients as well as provide actionable data at the point-of-care. However, further improvements are needed to maximize the utility of diagnostics at times where acute care may be required, such as when individuals are unstable after experiencing physical trauma. When medical resources are limited, the ability to rapidly and effectively triage patients that have experienced trauma is critical to maximizing health outcomes. Notably, individuals that have experienced significant trauma can degrade quickly. Therefore, continuous monitoring approaches are needed that can provide critical biometric and biomarker information that will enable updating of the triage in real-time.At present time, patients are assessed continuously using biometric monitoring. However, biometrics are often a lagging indicator to biochemical markers, and thus while easier to measure, less informative. Currently, the ISTAT-8 is a point-of-care unit to perform an automated, rapid biochemical panel that can assess the patient’s ability to maintain homeostasis by monitoring eight biomarkers. However, the ISTAT-8 captures biochemical data only at a point in time instead of continuously; this is a drawback, as the health of patients who have undergone trauma can improve or deteriorate rapidly. Therefore, a continuous biochemical monitoring solution is needed to allow for triage to happen in real-time.Advances in biotechnology have for the first time made real-time biochemical sensing a reality. Unfortunately, commercial continuous biochemical sensors to-date are limited to subcutaneous continuous glucose monitors (CGMs). CGMs monitor glucose concentrations in the interstitial fluid (ISF), which strongly correlates to blood values. While the CGM is now commonly used, the current devices are not easily multiplexed. Therefore, a scalable, easy to insert system is needed to perform multiplexed measurements; microneedle-based platforms have the promise to enable sensing in the ISF leveraging five or more distinct sensors.Here we present a solid-state platform that can enable multiplexed sensing leveraging hollow, wicking microneedles in fluidic contact with solid-state electrodes. Our approach leverages optimized sensor formulations and electrode materials fabricated onto a printed circuit board (PCB). The putative sensor array can be produced in a modular fashion leveraging scalable technologies and processes. Notably, this talk focuses on methods and approaches to fabricate an array of solid-state sensors that are capable of detecting ions and metabolites over extended periods (> 1 week) and can be readily integrated with microneedles for sensing interstitial fluid.

Кореляція маркерів материнського та плодового запалення

Fetal inflammatory response syndrome (IFRS) is an inadequate reaction of the fetal immune system to the inflammatory process in the placenta, which is accompanied by an increase in neonatal mortality and morbidity. Aim - to assess the dependence of IFRS on the markers of the inflammatory process of the mother in premature births in different gestational periods to determine the date of delivery. Materials and methods. 405 mothers with premature singleton deliveries and their premature newborns were examined. The Spearman correlation method was used to calculate the relationship between IL-6 content in the umbilical cord blood of a newborn and laboratory markers of maternal inflammation in peripheral blood (containing leukocytes and rod-shaped neutrophils, C-reactive protein, procalcitonin, pro-inflammatory interleukins), amniotic fluid (glucose, secretory inhibitor of leukocyte proteinase (SILP) and pro-inflammatory interleukins) and cervical mucus (pro-inflammatory interleukins). Results. Between the indicators of the mother's peripheral blood circulation and the value of IL-6, only a moderate connection was found, and the content of IL-6 in the amniotic fluid shows a strong correlation with the concentration of IL-6 in the umbilical cord blood of extremely premature newborns. For SILP, a strong correlation with the laboratory marker SFZV was found. A negative correlation with IL-6 of umbilical cord blood was found in cervical mucus for SILP. Signs of infection in the newborn show a strong dependence on the concentration of C-reactive protein and procalcitonin in the peripheral blood of the mother, but this was not found for extremely premature newborns. A strong correlation was found between the concentration of glucose in the amniotic fluid and signs of infection in premature infants in both gestational categories. Conclusions. Among indicators of peripheral blood circulation of a pregnant woman, none shows a strong correlation with IFRS. The concentration of SILP in the amniotic fluid has a strong correlation with signs of fetal inflammation, regardless of gestational age. The content of SILP in the cervical mucus has a strong negative correlation with the criterion of IFRS in preterm infants against the background of intact fetal membranes. A strong correlation between the glucose content in the amniotic fluid and signs of infection in the premature infant was revealed. For extremely premature newborns, no indicator of the mother's peripheral blood correlates with signs of infection. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. The authors declare no conflict of interest.

Defect-rich cypress-leaf-like Cu2+1O@NiF for high-performance non-invasive glucose detection with low detection limit

Non-invasive detection of body fluid glucose concentration is of great significance in the diagnosis and treatment of diabetes, which poses a new challenge to the reduction of the detection limit of glucose sensors. In this work, a novel non-enzymatic glucose sensor (defect-rich cypress-leaf-like Cu2+1O@NiF) was proposed by rapid electrodeposition of cypress-leaf-like Cu2+1O on the surface of nickel foam (NiF) substrate. Due to the high electrochemical active surface area and abundant defects of cypress-leaf-like Cu2+1O providing more catalytic active sites, the prepared non-enzymatic sensor has an ultra-low detection limit (0.9 nM), high sensitivity (88,419.4 μA∙mM−1∙cm−2 (1 nM-0.5 μM) and 2095.5 μA∙mM−1∙cm−2 (1 μM-4.33 mM)) and wide linear range (1 nM-4.33 mM) with good selectivity, reproducibility and stability. Furthermore, the obtained sensors exhibited high detection stability, accuracy and recovery for glucose detection of human body fluid samples, which means that the defect-rich cypress-leaf-like Cu2+1O@NiF electrode is an ideal candidate for non-invasive glucose sensors.

Vagal nerve and sympathetic nerve activity in response to glucagon-like peptide-1 (GLP-1) receptor stimulation in conscious rats

GLP-1 (Glucagon-Like Peptide-1) is a type of gastrointestinal hormone that plays an integral role in regulating glucose homeostasis and appetite control. GLP-1 receptors are expressed throughout the body, and it has been suggested that GLP-1 can be detected by vagal afferent nerve activity, leading to changes in sympathetic nerve activity. However, the details of the effects of GLP-1 receptor stimulation on autonomic nerve activity have not been reported. Therefore, this study investigated the effects of different sites of GLP-1 receptor stimulation on autonomic nerve activity by administering GLP-1 receptor agonists via three routes: intravenous (IV), intraportal vein (iport), and intraperitoneal (iperi). Male Wistar rats were chronically implanted with electrodes, catheters for measuring cervical vagal activity, renal and lumbar sympathetic nerve activity, electroencephalogram, electromyogram, electrocardiogram, arterial pressure, sensors for tissue fluid glucose concentration, and catheters for drug administration in the vein, portal vein, and abdominal cavity. Exendin-4, a GLP-1 receptor agonist, was administered to conscious rats via one of the following routes: intravenous, intra-portal vein, or intra-abdominal. Cervical vagal activity was increased in all routes of Exendin-4 administration. Renal sympathetic nerve activity was rapidly decreased by Exendin-4 administration and gradually recovered to pre-administration levels. There were no significant differences in renal sympathetic nerve activity among the different routes of Exendin-4 administration. On the other hand, lumbar sympathetic nerve activity increased slowly after Exendin-4 administration through the iperi and iport routes, while it decreased initially, then gradually increased following administration through the IV route. These results demonstrate that stimulation of GLP-1 receptors by Exendin-4 increases vagal nerve activity, decreases renal sympathetic nerve activity, and produces regionally different responses in lumbar sympathetic nerve activity depending on the site of stimulation. JST (JPMJMS2023). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Nutrient deprivation induces mouse embryonic diapause mediated by Gator1 and Tsc2.

Embryonic diapause is a special reproductive phenomenon in mammals that helps embryos to survive various harsh stresses. However, the mechanisms of embryonic diapause induced by the maternal environment is still unclear. Here, we uncovered that nutrient deficiency in uterine fluid was essential for the induction of mouse embryonic diapause, shown by a decreased concentration of arginine, leucine, isoleucine, lysine, glucose and lactate in the uterine fluid of mice suffering from maternal starvation or ovariectomy. Moreover, mouse blastocysts cultured in a medium with reduced levels of these six components could mimic diapaused blastocysts. Our mechanistic study indicated that amino acid starvation-dependent Gator1 activation and carbohydrate starvation-dependent Tsc2 activation inhibited mTORC1, leading to induction of embryonic diapause. Our study elucidates the essential environmental factors in diapause induction.

Performance of an interstitial glucose monitoring device in patients with type 1 diabetes during haemodialysis.

The use of interstitial glucose monitoring devices such as flash glucose monitoring has been shown to be beneficial in patients with type 1 diabetes mellitus (T1DM). However, these devices have been little studied in patients with diabetes treated by chronic haemodialysis (HD). The goal of this prospective, observational, multicentric study was to evaluate the analytical performance of the FreeStyle Libre 2 (FSL2) sensor in T1DM patients during HD sessions. During three HD sessions, interstitial fluid glucose (ISFG) concentrations given by the FSL2 were compared every 15minutes with blood glucose (BG) concentrations obtained simultaneously. BG concentrations were measured by two different glucometers: the Accu-Chek Guide and StatStrip meters. Twelve HD patients were included, with a mean age of 54±11years and a mean diabetes duration of 36.5±11.6years. Dialysis vintage was 35±22months. A total of 565 pairs of ISFG/BG values were available for analysis. The mean absolute relative difference, defined as the mean of the absolute relative differences between the ISFG and BG measurements, was 17.4% and 20.9% when the ISFG was compared with the StatStrip meter or Accu-Chek Guide, respectively. Interstitial results tend to underestimate blood results, but all values were classified as having clinically acceptable error. The differences observed remained stable during the dialysis session and were not associated with the ultrafiltration rate. Use of the FSL2 interstitial glucose monitoring device in HD patients with T1DM is clinically acceptable, even though the accuracy of the device is generally poorer than in studies including non-dialysis patients.

On Standardization and Evaluation of Continuous Glucose Monitoring Systems

Continuous glucose monitoring (CGM) systems are often used to monitor blood glucose levels. Most commercially available CGM systems continuously measure glucose concentrations in the interstitial fluid of subcutaneous adipose tissue. However, there is currently no internationally accepted reference method for measuring interstitial fluid glucose, which is a prerequisite for metrological traceability of glucose measurements obtained using CGM. Since manufacturers do not provide information about the traceability chain and measurement uncertainty of their systems, CGM-derived glucose values cannot currently be adequately traced to standards or higher order reference measurement procedures. Additionally, the «mean absolute relative difference» (MARD) often used to describe the analytical performance of CGM systems is dependent on many factors. For example, the MARD can be significantly affected by the «lag time» between the change in blood glucose and interstitial glucose, especially at high rates of change in glucose. Finally, modern automated insulin delivery (ADI) systems with integrated CGM can automatically suspend or increase insulin infusion in response to current and/or predicted hypoglycemic and hyperglycemic phenomenon in children and adults with type 1 diabetes mellitus (T1DM). The purpose of the review is justification of the necessity to establish metrological traceability of glucose measurements with CGM systems, as well as a discussion of the analytical and clinical characteristics of CGM systems proposed by various professional communities. Based on the results of the review, it was concluded that it is necessary to 1) develop metrological support for glucose measurements performed using CGM systems, 2) solve the problems of ensuring the accessibility and usability of CGM systems by patients in real conditions.

Continuous Monitoring of Interstitial Fluid Glucose Responses to Endurance Exercise with Different Levels of Carbohydrate Intake.

We compared the 24 h changes in interstitial fluid glucose concentration (IGC) following a simulated soccer match between subjects consuming a high-carbohydrate (HCHO; 8 g/kg BW/day) diet and those consuming a moderate-carbohydrate (MCHO; 4 g/kg BW/day) diet. Eight active healthy males participated in two different trials. The subjects were provided with the prescribed diets from days 1 to 3. On day 3, the subjects performed 90 min (2 bouts × 45 min) of exercise simulating a soccer match. The IGC of the upper arm was continuously monitored from days 1 to 4. No significant difference in the IGC was observed between trials during exercise. The total area under the curve (t-AUC) value during exercise did not significantly differ between the HCHO (9719 ± 305 mg/dL·90 min) and MCHO (9991 ± 140 mg/dL·90 min). Serum total ketone body and beta-hydroxybutyrate concentrations were significantly higher in the MCHO than in the HCHO after a second bout of exercise. No significant differences in the IGC were observed between trials at any time point during the night after exercise (0:00-7:00). In addition, t-AUC value during the night did not significantly differ between the HCHO (32,378 ± 873 mg/dL·420 min) and MCHO (31,749 ± 633 mg/dL·420 min). In conclusion, two days of consuming different carbohydrate intake levels did not significantly affect the IGC during a 90 min simulated soccer match. Moreover, the IGC during the night following the exercise did not significantly differ between the two trials despite the different carbohydrate intake levels (8 vs. 4 g/kg BW/day).

Cerebrospinal fluid analysis of metabolites is not correlated to microdialysis measurements in acute brain injured patients

BackgroundCerebral microdialysis (CMD) has become an established bedside monitoring modality but its implementation remains complex and costly and is therefore performed only in a few well-trained academic centers. This study investigated the relationship between cerebrospinal fluid (CSF) and CMD glucose and lactate concentrations. MethodsTwo centers retrospective study of prospectively collected data. Consecutive adult (>18 years) acutely brain injured patients admitted to the Intensive Care Unit between 2010 and 2021 were eligible if CSF and CMD glucose and lactate concentrations were concomitantly measured at least once. ResultsOf 113 patients being monitored with an external ventricular drainage and CMD, 49 patients (25 from Innsbruck and 24 from Brussels) were eligible for the final analysis, including a total of 96 measurements. Median CMD glucose and lactate concentrations were 1.15 (0.51–1.57) mmol/L and 3.44 (2.24–5.37) mmol/L, respectively; median CSF glucose and lactate concentrations were 4.67 (4.03–5.34) mmol/L and 3.40 (2.85–4.10) mmol/L, respectively. For the first measurements, no correlation between CSF and CMD glucose concentrations (R2 <0.01; p = 0.95) and CSF and CMD lactate concentrations (R2 =0.16; p = 0.09) was found. Considering all measurements, the repeated measure correlation analysis also showed no correlation for glucose (rrm = −0.01; 95% Confidence Intervals −0.306 to 0.281; p = 0.93) and lactate (rrm = −0.11; 95% Confidence Intervals −0.424 to 0.236; p = 0.55). ConclusionsIn this study including acute brain injured patients, no correlation between CSF and brain tissue measurements of glucose and lactate was observed. As such, CSF measurements of such metabolites cannot replace CMD findings.

Hyperglycemia increases SCO-spondin and Wnt5a secretion into the cerebrospinal fluid to regulate ependymal cell beating and glucose sensing.

Hyperglycemia increases glucose concentrations in the cerebrospinal fluid (CSF), activating glucose-sensing mechanisms and feeding behavior in the hypothalamus. Here, we discuss how hyperglycemia temporarily modifies ependymal cell ciliary beating to increase hypothalamic glucose sensing. A high level of glucose in the rat CSF stimulates glucose transporter 2 (GLUT2)-positive subcommissural organ (SCO) cells to release SCO-spondin into the dorsal third ventricle. Genetic inactivation of mice GLUT2 decreases hyperglycemia-induced SCO-spondin secretion. In addition, SCO cells secrete Wnt5a-positive vesicles; thus, Wnt5a and SCO-spondin are found at the apex of dorsal ependymal cilia to regulate ciliary beating. Frizzled-2 and ROR2 receptors, as well as specific proteoglycans, such as glypican/testican (essential for the interaction of Wnt5a with its receptors) and Cx43 coupling, were also analyzed in ependymal cells. Finally, we propose that the SCO-spondin/Wnt5a/Frizzled-2/Cx43 axis in ependymal cells regulates ciliary beating, a cyclic and adaptive signaling mechanism to control glucose sensing.

Effects Of Different Carbohydrate Intake Levels On Interstitial Fluid Glucose Concentration During High-intensity Intermittent Exercise

Effects Of Different Carbohydrate Intake Levels On Interstitial Fluid Glucose Concentration During High-intensity Intermittent Exercise

Microneedles coated with composites of phenylboronic acid-containing polymer and carbon nanotubes for glucose measurements in interstitial fluids

A microneedle (MN) sensor coated with a sensing composite material was proposed for measuring glucose concentrations in interstitial fluid (ISF). The sensing composite material was prepared by blending a polymer containing glucose-responsive phenylboronic acid (PBA) moieties (i.e., polystyrene-block-poly(acrylic acid-co-acrylamidophenylboronic acid)) with conductive carbon nanotubes (CNTs). The polymer exhibited reversible swelling behavior in response to glucose concentrations, which influenced the distribution of the embedded CNTs, resulting in sensitive variations in electrical percolation, even when coated onto a confined surface of the MN in the sensor. We varied the ratio of PBA moieties and the loading amount of CNTs in the sensing composite material of the MN sensor and tested them in vitro using an ISF-mimicking gel with physiological glucose concentrations to determine the optimal sensitivity conditions. When tested in animal models with varying blood glucose concentrations, the MN sensor coated with the selected sensing material exhibited a strong correlation between the measured electrical currents and blood glucose concentrations, showing accuracy comparable to that of a glucometer in clinical use.

Hand grip strength is inversely associated with total daily insulin dose requirement in patients with type 2 diabetes mellitus: a cross-sectional study.

Short-term (2 weeks to 3 months) insulin intensive therapy using continuous subcutaneous insulin infusion (CSII) can improve islet beta cell function and prolong glycemic remission in patients with newly diagnosed type 2 diabetes mellitus (T2DM). However, the total daily insulin dose (TDD, IU/kg/d) required to achieve near-normoglycemic control with CSII still needs to be frequently adjusted based on blood glucose monitoring. Although real-time continuous glucose monitoring (rtCGM), which measures the interstitial fluid glucose concentration continuously without much difficulty, facilitates the adjustment of insulin dosage, its adoption in the T2DM population is strictly limited by insurance coverage and lack of awareness of rtCGM among clinicians. Thus, it is of clinical significance to identify easy-to-use parameters that may allow a more rapid and accurate prediction of TDD requirement. This study aimed to explore the association between hand grip strength (HGS) and TDD requirement in patients with T2DM receiving CSII therapy. A total of 180 eligible patients with T2DM were enrolled in the study and divided into three groups based on their HGS: low (L), medium (M), and high (H). The TDD requirement was calculated on day 7 or 8 of CSII treatment. Anthropometric parameters, including HGS, skeletal muscle mass, skeletal muscle index (SMI) and 6-m gait speed, and laboratory data, were collected on the morning of the second day after admission, within the first 24 h of CSII therapy. These parameters were used to identify significant predictors of TDD requirement using Pearson or Spearman correlation test, and stepwise multiple regression analysis. There were no significant differences in age, duration of T2DM, waist-to-hip ratio (WHR), body mass index (BMI), blood pressure, liver function, estimated glomerular filtration rate, triglyceride, total cholesterol, glycosylated hemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), and homeostasis model assessment of beta cell function (HOMA-β) among the groups. The H group had higher body muscle mass-to-fat ratio (BMFR), skeletal muscle mass-to-fat ratio (SMFR), SMI, 6-m gait speed, and lower TDD requirement than the M and L groups. The HGS negatively correlated with TDD requirement (r = -0.33, p < 0.001) after adjusting for sex, age, BMI, WHR, HbA1c, Ln (HOMA-β), Ln (HOMA-IR), Ln (BMFR), Ln (SMFR), SMI, and 6-m gait speed. Multivariate stepwise regression analysis indicated that HGS was an independent predictor of TDD requirement in patients with T2DM (β = -0.45, p < 0 001). Lower HGS is associated with an increased TDD requirement in T2DM patients. HGS may facilitate the prediction of TDD requirement in T2DM patients receiving CSII therapy.

Performance of the FreeStyle Libre Flash Glucose Monitoring System during an Oral Glucose Tolerance Test and Exercise in Healthy Adolescents.

This study's aim was to assess FreeStyle Libre Flash glucose monitoring (FGM) performance during an oral glucose tolerance test (OGTT) and treadmill exercise in healthy adolescents. This should advance the feasibility and utility of user-friendly technologies for metabolic assessments in adolescents. Seventeen healthy adolescents (nine girls aged 12.8 ± 0.9 years) performed an OGTT and submaximal and maximal treadmill exercise tests in a laboratory setting. The scanned interstitial fluid glucose concentration ([ISFG]) obtained by FGM was compared against finger-prick capillary plasma glucose concentration ([CPG]) at 0 (pre-OGTT), -15, -30, -60, -120 min post-OGTT, pre-, mid-, post- submaximal exercise, and pre- and post- maximal exercise. Overall mean absolute relative difference (MARD) was 13.1 ± 8.5%, and 68% (n = 113) of the paired glucose data met the ISO 15197:2013 criteria. For clinical accuracy, 84% and 16% of FGM readings were within zones A and B in the Consensus Error Grid (CEG), respectively, which met the ISO 15197:2013 criteria of having at least 99% of results within these zones. Scanned [ISFG] were statistically lower than [CPG] at 15 (-1.16 mmol∙L-1, p < 0.001) and 30 min (-0.74 mmol∙L-1, p = 0.041) post-OGTT. Yet, post-OGTT glycaemic responses assessed by total and incremental areas under the curve (AUCs) were not significantly different, with trivial to small effect sizes (p ≥ 0.084, d = 0.14-0.45). Further, [ISFGs] were not different from [CPGs] during submaximal and maximal exercise tests (interaction p ≥ 0.614). FGM can be a feasible alternative to reflect postprandial glycaemia (AUCs) in healthy adolescents who may not endure repeated finger pricks.

Differences in venous, capillary and interstitial glucose concentrations in individuals without diabetes after glucose load

Abstract Objectives Differences between capillary and venous glucose concentrations have been reported in the past. In continuous glucose monitoring (CGM) system performance studies, comparator measurements are often performed in venous samples, despite CGM systems typically aiming at providing capillary-like values. In this study, differences between venous, capillary and interstitial glucose concentrations, measured with a laboratory analyzer, a self-monitoring of blood glucose (SMBG) system and an intermittent-scanning CGM system were investigated in subjects without diabetes after glucose load. Methods During the study, an oral glucose tolerance test (oGTT) was performed with 41 participants who had no known history of diabetes (mean age 25.5 ± 9.7 years). Venous blood samples for measurement with a laboratory analyzer were collected before drinking the standardized 75 g glucose solution and after 60 and 120 min. In parallel, capillary blood was obtained for measurement with a laboratory analyzer and an SMBG system, and interstitial glucose values were measured with an intermittent-scanning CGM system. Results Glucose concentrations in the fasting state were slightly different for the three different compartments whereas considerable differences (some median differences exceeding 30 %) in glucose concentration were observed 60 and 120 min after the start of the oGTT. Conclusions Marked differences with a high inter-individual variability between venous, capillary, and interstitial fluid glucose concentrations were found especially after glucose load. These differences can affect perceived CGM accuracy in performance studies depending on the specific comparator method used, and they are potentially relevant in clinical practice, like diabetes diagnosis.

Cerebro-spinal fluid glucose and lactate concentrations changes in response to therapies in patIents with primary brain injury: the START-TRIP study

IntroductionAltered levels of cerebrospinal fluid (CSF) glucose and lactate concentrations are associated with poor outcomes in acute brain injury patients. However, no data on changes in such metabolites consequently to therapeutic interventions are available. The aim of the study was to assess CSF glucose-to-lactate ratio (CGLR) changes related to therapies aimed at reducing intracranial pressure (ICP).MethodsA multicentric prospective cohort study was conducted in 12 intensive care units (ICUs) from September 2017 to March 2022. Adult (> 18 years) patients admitted after an acute brain injury were included if an external ventricular drain (EVD) for intracranial pressure (ICP) monitoring was inserted within 24 h of admission. During the first 48–72 h from admission, CGLR was measured before and 2 h after any intervention aiming to reduce ICP (“intervention”). Patients with normal ICP were also sampled at the same time points and served as the “control” group.ResultsA total of 219 patients were included. In the intervention group (n = 115, 53%), ICP significantly decreased and CPP increased. After 2 h from the intervention, CGLR rose in both the intervention and control groups, although the magnitude was higher in the intervention than in the control group (20.2% vs 1.6%; p = 0.001). In a linear regression model adjusted for several confounders, therapies to manage ICP were independently associated with changes in CGLR. There was a weak inverse correlation between changes in ICP and CGRL in the intervention group.ConclusionsIn this study, CGLR significantly changed over time, regardless of the study group. However, these effects were more significant in those patients receiving interventions to reduce ICP.

Glycemic profile and quality of recovery after emergency abdominal surgery-A prospective explorative cohort study.

Associations between degrees of postoperative hyperglycemia and morbidity has previously been established. There may be an association between the glycemic profile and patient-reported recovery, and this may be a target for perioperative quality improvements. We aimed to investigate the association between metrics of the 30-day glycemic profile and patient-reported recovery in nondiabetic patients after major abdominal surgery. In a prospective, explorative cohort study, nondiabetic adult patients undergoing acute, major abdominal surgery were included within 24 h after surgery. Interstitial fluid glucose concentration was measured for 30 consecutive days with a continuous glucose measurement device. The validated questionnaire 'Quality of Recovery-15' was used to assess patient-reported quality of recovery on postoperative days 10, 20, and 30. Follow-up time was divided into five-day postoperative intervals using days 26-30 as a reference. Linear mixed models were applied to investigate temporal changes in mean p-glucose, coefficient of variation, time within 70-140 mg/dl, and time above 200 mg/dl in relation to patient-reported recovery. Twenty-seven patients completed the study per protocol. A hyperglycemic event (>200 mg/dl) occurred in 18 of 27 patients (67%) within the first three postoperative days. Compared to the reference period, the coefficient of variation was significantly increased during all time intervals, indicating prolonged postoperative insulin resistance. During 30 days of follow-up, patient-reported recovery was associated with the coefficient of variation measured for 3 and 5 days before the corresponding recovery score assessment (recovery score estimate -1.52 [p< .001] and -0.92 [p= .006], respectively). We did not find an association between the remaining metrics and patient-reported recovery. Alterations in the glycemic profile are frequent and prolonged during the first postoperative month after major surgery probably due to peripheral insulin resistance. Our findings indicate that high-glycemic variation is associated with poorer patient-reported recovery and might represent a proxy for care improvements in the postoperative period.