Fructosamine Levels Research Articles

Kedilerde Perioperatif Serum Glukoz ve Serum Fruktozamin Seviyelerinin Karşılaştırılması

In this study, the changes in serum glucose and fructosamine levels according to the sampling time in cats anaesthetised for castration and ovariohysterectomy were investigated. The study material consisted of 25 cats aged between 6 months and 2 years. Blood samples were collected from the anaesthetised cats (medetomidine, butorphanol, ketamine) before anaesthesia, at the beginning of anaesthesia, before awakening from anaesthesia and after awakening from anaesthesia. Glucose, fructosamine, cholesterol, triglyceride, total protein and albumin levels were measured in the sera obtained. In the statistical comparison made according to the measurement times, it was found that serum glucose level changed significantly. However, no statistically significant difference was found in serum fructosamine levels. It was evaluated that the variation in glucose levels in the perioperative period may be related to anaesthetic agents, and although there was no statistically significant change in fructosamine levels, one of the reasons for the increase in glucose levels observed in the perioperative period was probably operation stress. The results of the study showed that serum glucose measurements are important in perioperative glycaemic control of cats, and serum fructosamine measurements have diagnostic value in the exclusion of possible perioperative hyperglycemia that may develop for different reasons. The stable serum fructosamine level in the perioperative period can be accepted as an indication that it was not affected by the anaesthetic agents used in this study.

The Therapeutic Effects and Mechanisms of Gardenoside on Inflammatory Injury via the INS/NF-κB Pathway in a T2DM Zebrafish Model

Objective: This study utilized the zebrafish model to investigate the therapeutic effects of gardenoside on inflammatory damage in type 2 diabetes mellitus (T2DM) through the INS/NF-κB pathway. Methods: The study employed 7-8-month-old AB strain zebrafish and induced T2DM models by continuous exposure to a 2% glucose solution for 14 days. Control, model, gardenoside low-, medium-, and high-dose groups (2.5 mg/L, 5 mg/L, 10 mg/L), and a metformin group were established. Parameters such as zebrafish body weight, fasting blood glucose levels, and behavioral analyses were monitored. Fructosamine levels were measured using ELISA, while real-time polymerase chain reaction (Real-time PCR) was employed to assess the relative expression levels of INS, IRS, NF-κB, IL-1β, and IL-6 genes. Intestinal histological examination was conducted to observe inflammation levels. Results: Compared to the control group, the model group exhibited significantly increased blood glucose levels, weight gain, and fructosamine content. High-speed locomotion time increased, while low-speed locomotion time decreased. Relative expression levels of INS, NF-κB, IL-1β, and IL-6 genes were elevated (P < 0.0001), whereas IRS relative expression levels decreased (P E0.001). In comparison to the model group, the gardenoside and metformin groups demonstrated reduced blood glucose levels and no significant change in body weight. The gardenoside low and medium dose groups, as well as the metformin group, showed reduced high-speed locomotion time and increased low-speed locomotion time. The relative expression levels of INS, NFκB, IL-1β, and IL-6 genes in the gardenoside and metformin groups decreased (P < 0.01 or P < 0.0001), while IRS relative expression levels increased (P < 0.001 or P < 0.0001). Conclusion: Gardenoside may suppress inflammatory responses, alleviate insulin resistance, and ameliorate diabetes-related inflammatory symptoms, potentially through the regulation of the INS/NF-κB signaling pathway.

Correlation between Serum Fructosamine and Self- Monitoring Blood Glucose in Patients with Diet-Controlled Gestational Diabetes Mellitus

Objective: To determine the correlation between serum fructosamine and self-monitoring blood glucose (SMBG) levels in gestational diabetes mellitus (GDM) patients treated by dietary control and to identify the cutoff level of serum fructosamine for determining poorly controlled GDM. Materials and Methods: A cross-sectional study conducted between October 2021 and August 2022 at Queen Savang Vadhana Memorial Hospital that included 78 singleton pregnancies diagnosed with GDM assigned to diet therapy with lifestyle modification. The daily home SMBG was performed following the standard protocol and the serum fructosamine was measured one month after starting dietary control. The correlation between serum fructosamine and means of SMBG were analyzed. The receiver operating characteristics (ROC) curve was plotted to identify the cutoff level of serum fructosamine for predicting poorly controlled GDM based on SMBG levels. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the cutoff level were calculated. Results: The correlation between serum fructosamine and SMBG were 0.436 (p<0.001) and 0.618 (p<0.001) in pre-prandial and post-prandial glucose levels, respectively. The poorly controlled SMBG group had serum fructosamine greater than the well-controlled group with a mean of 165.7±35 and 132.8±23 μmol/L (p<0.001). The ROC curve showed that using 160 μmol/L as the optimal cutoff level to determine poorly controlled GDM had 72.7% sensitivity, 88% specificity, 50% PPV, 95.2% NPV, and 85.9% accuracy. Conclusion: The serum fructosamine was very useful for monitoring dietary control of GDM in terms of drawing blood less frequently, convenient, and more economical. An optimal cutoff point for screening a poorly controlled GDM was 160 mol/L. Keywords: Gestational diabetes mellitus; Serum fructosamine; Self-monitoring blood glucose

Relationship between seminal plasma composition and sperm quality parameters of the catfish Pseudoplatystoma reticulatum

Abstract Sperm quality is a fundamental parameter for the effective reproduction of fish in captivity and the development of reproductive techniques, such as semen cryopreservation. This study aimed to determine the composition of the seminal plasma of Pseudoplatystoma reticulatum and analyze the relationships between plasma components and sperm characteristics. Nine males were induced to spermiation with carp pituitary extract in the reproductive period of the species (November and December/2019). Semen characteristics were evaluated: subjective sperm motility, motility, duration, released sperm volume, sperm concentration, pH, osmolality, and seminal plasma composition, including levels of calcium, chloride, sodium, magnesium, potassium, glucose, fructosamine, triglycerides, and total protein. To determine the relationship between seminal plasma components and sperm motility parameters, a principal component analysis (PCA) was performed. The seminal plasma of P. reticulatum is composed mainly of the Na+ ion and organic components such as protein and glucose. Through PCA, it was observed that sperm motility had a strong positive correlation with motility time, sperm concentration, and total protein and a negative correlation with osmolality and fructosamine.

The Influence of Caramel Carbon Quantum Dots and Caramel on Platelet Aggregation, Protein Glycation and Lipid Peroxidation.

Caramel, defined as a coloring agent and as an antioxidant, is used in several kinds of food products and is consumed by many people in different amounts. In our research we showed that the caramelization of sucrose under special conditions leads to the formation of carbon quantum dots (CQDs). So, it makes sense that humans also consume this type of CQDs, and it is theoretically possible for these particles to affect the body. Despite an increasing number of studies describing different types of CQDs, their biosafety is still not clearly understood. In our in vitro research, we examined the effects on platelet aggregation, protein glycation and lipid peroxidation of CQDs and caramel formed from a 20% sucrose solution. In vitro aggregation tests were conducted using freshly collected whole rat blood in a multiplate platelet function analyzer and measurer of electric impedance. The cytotoxic effect of the tested solutions on blood platelets was evaluated based on the release of lactate dehydrogenase. The formation of glycated bovine serum albumin was measured as fluorescence intensity and fructosamine level. The reducing power of the solutions was determined in adipose tissue, and their effect on lipid peroxidation in adipose tissue in vitro was also assessed. By measuring the intensity of hemolysis after incubation in solutions with red blood cell, we assessed their influence on the integration of the red blood cell membrane. All tests were performed in comparison with glucose and fructose and other frequently used sweeteners, such as erythritol and xylitol. Our study showed that caramel and CQDs formed from caramel may influence the glycation process and integrity of the red blood cell membrane, but unlike glucose and fructose, they decrease lipid peroxidation and may reduce Fe (III). Additionally, it is unlikely that they affect platelet aggregation. Compared to glucose and fructose, they may be safer for patients with metabolic disorders; however, further research is needed on the safety and biological activity of caramel and CQD.

Assessment of Glycemic Control by Continuous Glucose Monitoring, Hemoglobin A1c, Fructosamine, and Glycated Albumin in Patients With End-Stage Kidney Disease and Burnt-Out Diabetes.

Patients with diabetes and end-stage kidney disease (ESKD) may experience "burnt-out diabetes," defined as having an HbA1c value <6.5% without antidiabetic therapy for >6 months. We aim to assess glycemic control by continuous glucose monitoring (Dexcom G6 CGM) metrics and glycemic markers in ESKD patients on hemodialysis with burnt-out diabetes. In this pilot prospective study, glycemic control was assessed by continuous glucose monitoring (CGM), HbA1c measures, and glycated albumin and fructosamine measurements in patients with burnt-out diabetes (n = 20) and without a history of diabetes (n = 20). Patients with burnt-out diabetes had higher CGM-measured daily glucose levels, lower percent time in the range 70-180 mg/dL, higher percent time above range (>250 mg/dL), and longer duration of hyperglycemia >180 mg/dL (hours/day) compared with patients without diabetes (all P < 0.01). HbA1c and fructosamine levels were similar; however, patients with burnt-out diabetes had higher levels of glycated albumin than did patients without diabetes. The use of CGM demonstrated that patients with burnt-out diabetes have significant undiagnosed hyperglycemia. CGM and glycated albumin provide better assessment of glycemic control than do values of HbA1c and fructosamine in patients with ESKD.

Are We Diagnosing and Managing Diabetes in Patients with Sickle Cell Disorders Accurately?

Introduction: Patients with hemolytic anemias, especially those resulting from severe sickle cell disorders (SCD), may experience increased red blood cell (RBC) turnover, influencing hemoglobin (Hb) glycation rates. The American Diabetes Association (ADA) recommends measuring plasma glucose levels for diabetes mellitus (DM) diagnosis. However, to monitor glycemic control, fructosamine provides a valuable measure of glycated serum protein byproduct, independent of RBC lifespan. It is important to note that G6PD can aggravate anemia and its co-existence with SCDs is reported to vary between 7%-35.83% depending on genotype, ethnicity and location. Despite National Glycohemoglobin Standardization Program's (NSGP) reporting that most chemistry analyzers exhibit no assay interference, Lacy et al. showed that HbA1C systematically underestimated past glycemia in black patients with sickle cell trait. It is hypothesized that numerous SCD patients with DM receive diagnosis and management based on HbA1C. This study seeks to evaluate the management patterns and the correlation between Hb and HbA1C in the context of a hemoglobinopathy, aiming to enhance patient care standards. Methods: We identified 61 adult sickle cell disorder patients who also had a diagnosis of type 2 DM or prediabetes between January 2019 and May 2023. Patients with acute blood loss events (with or without transfusions), iron deficiency, hyperbilirubinemia, liver or renal disease, HIV infection on antiretroviral therapy, and those receiving Vit A/C supplementation were excluded from the study, as these conditions are known to impact the HbA1C levels. HbA1C testing at our institution was formerly done using Siemens Dimension Vista 500/1500 analyzer until it was switched to Abbott Alinity-c in October 2022. According to NGSP, there are no reports of assay interference in patients with Sickle Cell Disease (SCD) for either of these chemistry analyzers. Descriptive statistics were utilized to report data as means and percentages. Pearson correlation coefficient was used to assess the relationship between Hb and HbA1C values. Results: Mean age of the study participants was 52.59 years (SD 15.56) with a female predominance (53/61, 86.89%). All patients were of African American descent. The study included 49/61 (80.33%) patients with sickle cell trait, 3/61 (4.92%) with HbSC, 2/61 (3.28%) with HbSS, and 1/61 (1.64%) with HbS β+thal genotype. None of the patients had documented evidence of G6PD testing. Initially, all 61 patients had been diagnosed with DM or prediabetes via HbA1C. Only 3/61 (4.92%) patients had a fructosamine test documented in chart. The mean and median HbA1c values were 7.57% and 6.70% respectively (SD 2.07%). Among the participants, 53/61 (86.89%) patients were actively undergoing treatment for DM or prediabetes. There was a negative correlation (r = -0.142) between average Hb (at diagnosis) and HbA1C (at diagnosis) values (p = 0.286) (Figure 1). Conclusions: None of the patients in our study had evidence of G6PD testing. All patients with SCD and DM or prediabetes were initially diagnosed and managed using HbA1C. Only 3/61 patients had documentation of a fructosamine test. In the context of SCD, there was a poor correlation between Hb and HbA1C. The HbA1C test can either overpredict or underpredict DM in SCD patients due to assay interference (Siemens DCA Vantage analyzer is known to overpredict and is commonly used for point-of-care testing in an office setting) or hemoglobinopathy, respectively. Marked discrepancies between plasma glucose levels and measured HbA1C should prompt alternate diagnostic testing. It is recommended to use fasting blood glucose or oral glucose tolerance test to diagnose DM and prediabetes in patients with SCD. The reported cost difference between these tests is not significant. Fructosamine levels remain unaffected by hemoglobinopathies and can thus be used to monitor DM in patients with SCD.

Predictive value of different glycemic control markers in total hip or knee arthroplasty: A prospective study.

The optimal glycemic control marker before total hip or knee arthroplasty remains inconclusive. Hemoglobin A1c (HbA1c) is widely used, while fructosamine may be valuable for predicting periprosthetic joint infection (PJI). Fructosamine levels can be affected by serum albumin levels; albumin-corrected fructosamine (AlbF) can be calculated to overcome this issue. The objective of this study was to evaluate the predictive value of different markers for complications after primary total hip or knee arthroplasty. This prospective cohort study included 304 patients (mean age: 65 years [range, 16-85), mean follow-up: 32 months (range, 12-49)] who underwent primary total hip or knee arthroplasty between 2018 and 2021. Of them, 156 patients had diabetes. Mean HbA1c was 6.5% (range, 4.8%-13%), fructosamine 244 µmol/L (range, 98-566 µmol/L), and AlbF 632 (range, 238-2308). Patients who did and did not have diabetes were matched 1 : 1. Hemoglobin A1c 7% and fructosamine 292 µmol/L were used as cutoff. Complications were documented. Glycemic markers were compared using logistic regression analyses, with a special focus on PJI. In the logistic regression analyses, HbA1c was strongly associated with total complications [adjusted odds ratio (OR): 3.61; 95% CI, 1.65-7.91, P = .001], while fructosamine was associated with PJI (adjusted OR: 13.68; 95% CI, 1.39-134.89, P = .025). Albumin-corrected fructosamine did not show any additional benefits. Preoperative assessment before total hip or knee arthroplasty must not focus on a single marker; HbA1c is a good predictor of total complications, while fructosamine is a better predictor of PJI. To the best of our knowledge, in its first orthopedic study, AlbF did not show any advantages. Level II, Prognostic Study.

THU253 The Hemoglobin Wayne Variant And Association With Falsely Elevated HbA1c

Abstract Disclosure: N. Mulpuri: None. A. Bryant: None. D. Shahin: None. K. Soe: None. Background: Hemoglobin Wayne (Hb Wayne) is a rare, silent alpha chain variant caused by a frameshift mutation in the HbA2 gene. Although clinically silent, this mutation falsely elevates HbA1c values. Clinical cases: We are presenting three cases of Hb Wayne patients referred to our diabetes clinic within the last 5 years. All three cases were Caucasian-American males diagnosed with uncontrolled diabetes based on high HbA1c values of ranging from 10.1-10.6 %. One of the patients was initially started on metformin while the other patients’ treatment plan included dietary and lifestyle modifications. Review of the labs showed that renal function, complete blood count and fasting plasma glucose were within the normal range. High HbA1c value was noted by routine screening lab without having any symptoms related to DM or features of insulin resistance. The discrepancy between high HbA1c values and other glycemic index parameters (serum glucose and FSBG values) was noted. Subsequently, further work up was done (repeat HbA1c with different assay and fructosamine) to verify the diagnosis of uncontrolled DM. Fructosamine levels and repeat HbA1c with a different assay (enzymatic assay at Quest lab) were normal. Hemoglobin electrophoresis confirmed presence of an abnormal alpha variant consistent with Hb Wayne. The patients were reassured and educated about this Hb variant, and no further treatment for DM was pursued. Conclusion: Rare hemolgobinopathies may be more common than previously expected as they can be clinically silent and easily overlooked. While HbA1c has been an important clinical tool for diagnosis and management of diabetes, clinicians should look for underlying reasons which can affect HbA1c assay if there is any discrepancy between HbA1c, FSBG and plasma glucose values. The laboratory at our institution uses cation- exchange High Performance Liquid Chromatography method (Bio-Rad D-100 instrument) resulting in falsely high HbA1c values. Some hemoglobinopathies can affect the widely used HbA1c testing method such as CE-HPLC. The impact on HbA1c values will differ depending on hemoglobin variant and specific method and assay used. Given the limitations of HbA1c testing, clinicians should avoid relying heavily on HbA1c values in management and diagnosis of diabetes. It is vital that clinicians use their clinical judgment to correlate HbA1c with other clinical parameters such as continuous glucose monitoring data, glycated albumin,1,5 anhydroglucitrol (1,5 –AG), fingerstick blood glucose, plasma glucose and fructosamine values. Presentation: Thursday, June 15, 2023

FRI628 Subnormal Fructosamine Levels In Non Diabetic Pregnant Women

Abstract Disclosure: U.M. Kabadi: None. S. Exley: None. Introduction: American College of Obstetrics and Gynecology (ACOG) and American Diabetes Association (ADA) recommend 2 step testing for diagnosis of Gestational Diabetes (GDM). The process is cumbersome and inconvenient. HbA1c levels are adopted as a screening test in nonpregnant adults but not during pregnancy. Alternatively, serum Fructosamine is not tested for diagnosis of DM in any population. We are in the process of examining utility of serum Fructosamine as a screening test for diagnosis of GDM. However, no data is available regarding Fructosamine concentrations in nondiabetic pregnant women. Therefore, we determined serum Fructosamine levels in pregnant women at 24 to 28 weeks at the time of 1 hour or 3 hour OGTT. Subjects and Methods: Random glucose (mg/dl), Fructosamine ( mcM/l) and HbA1c (%) were determined at 24-30 weeks in 200 pregnant women, age 24-40 years in whom the diagnosis of GDM was eliminated by either normal 1 hour OGTT or by normal 3 hour OGTT in presence of abnormal 1 hour OGTT according to criteria established by ACOG and ADA. 21 age matched nonpregnant women participated as controls. Normal reference ranges for all determinations were established by the local laboratory (Glucose, 60-139; Fructosamine, 200-285; HbA1c, 4.4-5.6). Statistical comparisons between 2 groups were conducted using Student’s ‘t’ test. Results: Fructosamine levels (182 ± 4) were significantly lower (p&amp;lt; 0.01) in non diabetic pregnant women when compared with age matched non pregnant women ( 224 ± 5). Cutoff Fructosamine between groups was 182. Glucose (96 ±7) and HbA1c (5.1 ± 0.2) were not significantly different amongst groups. Conclusion: In non diabetic pregnant women, Serum Fructosamine concentrations are subnormal whereas random glucose and HbA1c levels remain within normal range noted in age matched non pregnant women. Further studies are underway to assess the utility of serum Fructosamine as a screening test in diagnosis of GDM. Presentation: Friday, June 16, 2023

THU385 Refractory Hyperglycemia As Main Presenting Symptom In A Patient With Acromegaly

Abstract Disclosure: T. Rave: None. J. Vidovic: None. Y. Gu: None. Acromegaly is a rare disorder caused by the overproduction of growth hormone (GH) from an anterior pituitary adenoma. GH regulates glucose control and about 10% of patients with acromegaly can have complications of hyperglycemia. GH stimulates hepatic release of insulin-like growth hormone-1 (IGF-1), which increases gluconeogenesis and lipolysis and decreases glucose uptake throughout the body. The increase in gluconeogenesis and decrease in glucose uptake results in hyperglycemia. The excess release of fatty acids increases insulin resistance. In this case report we present a case of hyperglycemia resistant to multiple modes of medical management with limited acromegaly features found to have acromegaly induced hyperglycemia. A 58-year-old male with a past medical history of type II diabetes mellitus, hypertension, and obesity presented to the endocrinology clinic with treatment resistant hyperglycemia. The patient also endorsed having progressive carpal tunnel symptoms. He had been using an insulin pump and requiring 3 or more boluses per day for the last 6 months. Trulicity was added in addition to current insulin pump therapy, however, sugars remained elevated with an unimproved A1c level of 9% and a fructosamine level of 538 µmol/L correlating to an A1c of 10.8%. An IGF-1 level was sent to rule out acromegaly in the setting of carpal tunnel symptoms. The IGF-1 resulted in 580 ng/mL with a z-score of +5.1. The patient underwent a GH suppression test with a glucose load which showed a significantly elevated nadir GH level of 26.3 ng/mL. Of note, the patient did not have other acromegaly symptoms such as frontal bossing, ring or shoe enlargement, coarse facial features, headaches or vision changes. An MRI pituitary was obtained which was notable for an enlarged pituitary gland with heterogeneous signal, measuring approximately 2.0cm CC x 1.5cm AP x 1.7cm TV, with the pituitary stalk deviated to the left. At this time the intervention for hyperglycemic therapy shifted. The patient was started on octreotide and referred to neurosurgery for transsphenoidal surgery. The pathophysiology of type II diabetes is complex and multifaceted. Additionally, secondary causes of hyperglycemia must be considered in refractory cases, such as in this patient. This case highlights the importance of considering acromegaly and other hormonal conditions in the treatment of patients with uncontrolled hyperglycemia, even in otherwise asymptomatic patients. Presentation: Thursday, June 15, 2023

FRI645 A Case Of Diabetic Ketoacidosis After Initiation Of Decitabine And Venetoclax Chemotherapy

Abstract Disclosure: R. Maini: None. J. Milosavljevic: None. S. Aleksic: None. Background: Decitabine, a pyrimidine nucleotide analogue, and venetoclax, a Bcl-2 inhibitor (ABT-199), are chemotherapy agents used for the treatment of myelodysplastic syndromes. Clinical trials have shown hyperglycemia as an adverse reaction for both of these medications, but DKA has not been reported. Clinical Case: A 71-year-old woman with a history of T2D and myelodysplastic syndrome (MDS) presented with nausea, vomiting, and diarrhea for five days. Initial tests revealed blood glucose 839 mg/dL, an anion gap of 19 mEq/L (n 7-16), serum bicarbonate 14 mmol/L (n 20-30), venous pH of 7.24, and hydroxybutyrate &amp;gt;4 mmol/L (n&amp;lt; 0.3), consistent with diabetic ketoacidosis. Her anti-glutamic acid decarboxylase autoantibodies were negative. Chest CT showed bibasilar pulmonary opacities, concerning for multifocal pneumonia. She was placed on an insulin drip and fluids according to the institution's protocol and her anion gap closed within a day. She was transitioned to subcutaneous insulin. The patient had well-controlled T2D, with an HbA1c of 5.6% two weeks before her presentation and an admission fructosamine level of 377 umol/L (n 200-285). Her BMI was 25. Her only T2D medication was semaglutide 0.25 mg weekly but had not taken a dose in three weeks due to the national shortage. Five weeks prior to this presentation, she began weekly chemotherapy infusions of decitabine and oral venetoclax as part of a clinical trial (2021-13466) for MDS treatment, with her last infusion one week before her presentation. Conclusion: This is the first case to demonstrate DKA precipitated by decitabine and venetoclax treatment. While both agents have been linked to severe hyperglycemia in safety clinical trials, DKA has not been previously reported. Data from animal studies have shown that prolonged exposure of mouse islets to Bcl-2 antagonists increase levels of reactive oxygen species and induce pancreatic β cell apoptosis (1). Further research is needed to assess the benefits and risks of this chemotherapy regimen in patients with diabetes.

THU337 Fructosamine As A Predictor Of Diabetic Microvascular Disease In A Population With High Prevalence Of Red Cell Disorders

Abstract Disclosure: A.J. Buckley: None. T. Ashraf: None. M. Iqbal: None. Background: Fructosamine, glucose bound to circulating proteins, is used to evaluate glycaemic control where HbA1c may be unreliable due to variant haemoglobin or altered erythrocyte lifespan. In previous reports fructosamine predicted prevalent diabetic retinopathy, incident cardiovascular disease, and incident CKD3, in populations where it was highly correlated with HbA1c (r=0.80). Consequently in clinical practice fructosamine is converted to estimated HbA1c for interpretation. Use of fructosamine to estimate microvascular risk in populations where it correlates poorly with HbA1c remains unexplored. Aim: To provide evidence-based estimates for risk of incident retinopathy and early diabetic nephropathy according to a single fructosamine reading. Methods: The study population was 1571, predominantly Arab Emirati, individuals managed at Imperial College London Centre Abu Dhabi and Al Ain (60 prediabetes, 161 T1DM, 1350 T2DM), where a clinician suspected that HbA1c (Variant II ion-exchange HLPC, Bio-Rad), was inaccurate. Fructosamine was measured using the Cobas c501 module (Roche) and divided into strata of &amp;lt;250, 250-299, 300-349, 350-399 and ≥400 µmol/L for analysis. Routine yearly digital retinal screening and urinary albumin:creatinine ratio, and results of haematological investigations, were retrieved from electronic records. Results: Fructosamine was weakly associated with HbA1c (r2 = 0.353, p &amp;lt; 0.0001), with both slope and intercept for the relationship significantly varying according to coexisting haemoglobin variant, G6PD deficiency, iron deficiency, or renal impairment. Adjusted for age, systolic BP and smoking status, all fructosamine strata ≥ 300 µmol/L were significantly associated with stepwise increased hazard of new incident retinopathy for each stratum (300-349 µmol/L 2.1 (1.29-3.30) p=0.003; ≥400 µmol/L 3.3 (1.89-5.6) p &amp;lt;0.001), compared with individuals with fructosamine &amp;lt; 250 µmol/L, over mean follow-up of 2.4 ± 1.6 years. Adjusting for age and systolic BP, fructosamine strata ≥ 300 µmol/L were similarly associated with stepwise significant increased hazard of new incident microalbuminuria (300-349 µmol/L 1.40 (1.11-1.8) p=0.005; ≥ 400 µmol/L 2.3 (1.68-3.00) p &amp;lt;0.001). In 746 individuals with HbA1c &amp;lt;7.0% at inclusion, fructosamine strata ≥300 µmol/L remained significantly associated with increased hazard of retinopathy (300-349 µmol/L 2.10 (1.21-1.3.70) p=0.008; ≥ 400 µmol/L 3.6 (1.50-8.80) p=0.004) but not microalbuminuria. Conclusions: Fructosamine ≥ 300 µmol/L is associated with significantly increased hazard of microvascular complications of diabetes in a population with high incidence of haemoglobin variants and G6DP deficiency, even among individuals apparently achieving conventional HbA1c targets. Routine measurement of at least one fructosamine level to refine treatment targets is supported in such populations. Presentation: Thursday, June 15, 2023

The impact of high-intensity interval training and alternate-day fasting on glucose metabolism in rats on a high-fat diet

Abstract The effect of lifestyle modifications in the form of exercise training and fasting intervention on glucose metabolism in subjects on a high-fat diet is not completely understood. The present study aimed to examine the effects of alternate-day fasting (ADF) and high-intensity interval training (HIIT) on serum levels of C-peptide, fructosamine, and glucose in rats under a high-fat diet. Twenty-eight male Wistar rats were initially fed a high-fat diet for 12 weeks, then randomised into the following four groups: HIIT, ADF, HIIT + ADF, and control (CON). The HIIT and ADF interventions were conducted 3 days per week for 6 weeks. The HIIT induced a significant reduction in serum fructosamine levels compared to other groups (), as well as there was a significant reduction in serum glucose levels compared to the ADF and HIIT + ADF groups (). ADF and HIIT + ADF did not cause any significant changes in fructosamine, glucose, and C-peptide serum levels compared to the CON group (). In subjects under a high-fat diet, HIIT but not ADF or HIIT + ADF may be associated with favourable improvements in glucose metabolism markers.

Impact of Oral Administration of Lactiplantibacillus plantarum Strain CNCM I-4459 on Obesity Induced by High-Fat Diet in Mice.

Recent evidence suggests that some lactobacilli strains, particularly Lactiplantibacillus plantarum, have a beneficial effect on obesity-associated syndromes. Several studies have investigated probiotic challenges in models of high-fat diet (HFD)-induced obesity, specifically with respect to its impact on hepatic and/or adipocyte metabolism, gut inflammation and epithelial barrier integrity, and microbiota composition. However, only a few studies have combined these aspects to generate a global understanding of how probiotics exert their protective effects. Here, we used the probiotic strain L. plantarum CNCM I-4459 and explored its impact on a mouse model of HFD-induced obesity. Briefly, mice were administered 1 × 109 CFUs/day and fed HFD for 12 weeks. Treatment with this strain improved insulin sensitivity by lowering serum levels of fasting glucose and fructosamine. Administration of the probiotic also affected the transport and metabolism of glucose, resulting in the downregulation of the hepatic Glut-4 and G6pase genes. Additionally, L. plantarum CNCM I-4459 promoted a decreased concentration of LDL-c and modulated hepatic lipid metabolism (downregulation of Fasn, Plin, and Cpt1α genes). Probiotic treatment also restored HFD-disrupted intestinal microbial composition by increasing microbial diversity and lowering the ratio of Firmicutes to Bacteroidetes. In conclusion, this probiotic strain represents a potential approach for at least partial restoration of the glucose sensitivity and lipid disruption that is associated with obesity.

Features of the course of superficial candidiasis of the skin against the background of changes in carbohydrate metabolism

Objective — to investigate the pattern of the relationship between carbohydrate metabolism and superficial candidiasis for further development of rational therapeutic approaches to the treatment of candidiasis associated with initial disorders of carbohydrate metabolism. Materials and methods. In order to determine the indicators of carbohydrate metabolism and their influence on the course of superficial candidiasis, 93 patients with different severity of this disease were examined. The study of carbohydrate metabolism included the determination of fasting blood sugar level to detect the overt diabetes and glucose tolerance test (with the load of 75 g of glucose). The impaired glucose tolerance was detected in 32 patients, so their levels of glycosylated hemoglobin and fructosamine were additionally determined. HbA1c level was determined in whole blood by ion exchange chromatography. Fructosamine was measured by kinetic colorimetric method in both serum and plasma. Blood sampling was performed on an empty stomach from the cubital vein. The studies were carried out immediately after sampling. The Sentinel CH test system from Intero (Italy) and a spectrophotometer with a 405—425 nm filter were used for the research. Results and discussion. The research showed that in the group of patients with candidal lesions, there was a direct dependence of HbA1c and fructosamine levels on the severity of the disease. In patients with minimal and moderate candidal lesions, an increase in HbA1c and fructosamine indicators (by 1.54 and 1.21 times, respectively) was observed compared to similar indicators in the control group. In patients with significant candidal lesions and relapses, the concentration of HbA1c increased by 2.59 times and the concentration of fructosamine — by 2.26 times compared to the indicators of the control group. Conclusions. As shown by the results of our research, we have proven a direct correlation between the severity of candidiasis and the levels of НbA1с and fructosamine. The identification of correlation patterns is important for the development of a multimodal pathogenetically justified treatment of patients with candidal lesions of the skin and mucous membranes.

P05 Osteoporosis in thalassemia; a case with multifactorial aetiology

Abstract Introduction Thalassemia patients are prone to osteoporosis due to multifactorial reasons, including anaemia, bone marrow expansion, iron overload and hypogonadism. Case description A 41-year-old British Asian male with beta thalassemia major was referred to rheumatology in 2018 for osteoporosis. In 2008, aged 27 years, whilst playing football, he developed a distal radial fracture and ulnar styloid process fracture and a DEXA scan had revealed low bone mineral density (BMD) for age. Subsequently, he was started on Ibandronic acid by his haematologist for a total of 10 years. After he was referred to rheumatology in 2018, bisphosphonates were discontinued as he had 5% improvement in BMD, a decade of bisphosphonates and no further fractures. Further assessment revealed multiple contributory factors for his osteoporosis. • Consistency low vitamin D – 9.6 nmol/L in 2009, average value of 20 • He was diagnosed with hypogonadism, poor compliance with IM testosterone injections • He had diabetes which was not optimally controlled • Evidence of iron overload with average serum ferritin of 2000 ug/L with deferasirox While these factors were optimised, it was decided to adopt a watch and wait policy with regards to specific osteoporosis treatment. Review in 2023 revealed serum testosterone level of 20.1 nmol/L (6.9-23.2) with better compliance with testosterone injections. Fructosamine levels were 310 (normal range 200-285) but it has reduced from a peak of 370. Serum ferritin levels have reduced to 776 down from a high of 5600. Normal vitamin D levels were maintained. The DEXA scan in 2023 revealed a spine T score of −2.4 which showed 10.2% increase in bone mineral density. DEXA scan in 2020 revealed T score of −3.1 in spine and −1.9 in hips. The P1NP level was 56 (19-69) which has reduced from 100 in 2021. Improvements in BMD and bone turnover markers were achieved through optimising contributory factors without any specific osteoporosis treatment. He will be monitored with periodic BMD and bone turnover markers. Discussion Anaemia and subsequent bone marrow expansion is a recognised cause for osteoporosis in thalassemia patients. While regular blood transfusions inhibit bone marrow expansion, ineffective erythropoiesis is not fully supressed. This patient received 3 units of blood every 4 weeks. Bone marrow expansion occurs mostly in trabecular bone resulting in low BMD is areas which generally have increased amount of trabecular bone such as the spine. Our patient had a lower BMD in the spine compared to the femoral neck. Iron overload directly disrupts bone formation and can result in endocrinopathies which contributes to osteoporosis. Hypogonadism is another well-recognised cause and is primarily results from iron deposition in pituitary and at times in the gonads. Hormonal replacement therapy reduces bone loss. Studies have shown that hypogonadic patients have more severe osteoporosis and predominant involvement of the femoral neck. Iron overload can cause diabetes mellitus and impaired growth hormone/ insulin growth factor-1 (IGF-1) axis which can contribute to osteoporosis. Our patient did have diabetes but had normal IGF-1 levels when checked previously. Deferoxamine which is one of iron chelating agents have been shown to reduce collagen synthesis and increases osteoblast apoptosis which might contribute to the development of osteoporosis. Vitamin D levels are well known to be low in patients with thalassemia compared to the general population. While there are no RCT’s to show that bisphosphonates reduce fracture risk, surrogate markers such as increased BMD and reduction in bone turnover markers are known to occur. Therefore, current guidance (Standards for the Clinical Care of Children and Adults with Thalassaemia in the UK) recommends bisphosphonates to be considered in patients with a low BMD for age (Z-score &amp;lt; −2.0, T-score &amp;lt; −2.5 if post-menopausal or over 50), if there are fragility fractures or falling BMD despite adequate vitamin D levels, and hormone supplementation. Key learning points Learning point Important to assess for osteoporosis in thalassaemic patients. There are multiple factors contributing to the development of osteoporosis which needs to be addressed together with endocrinologist and haematologist. Bisphosphonates are recommended though further RCT evidence is required to support this

THE IMPACT OF SEX ON METABOLIC AND FUNCTIONAL ABNORMALITIES, INDUCED BY HIGH-FRUCTOSE-DIET IN RATS

Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors, which manifestation may be different for men and women. Changes in sex hormone levels in men and women during lifespan contribute to increased cardiometabolic risk. Data of clinical researches suggest that transition from normal glucose tolerance to dysglycemia lead to more adverse differences in cardiometabolic risk factors in women than in men, suggesting an important impact of sex on the development of metabolic abnormalities. A significant increase in risk may be due to the sex differences in manifestation of some components of metabolic syndrome, but accurate reasons of these discrepancies need future investigations. The aim of this study was to determine the differences in impairment of glucose, lipid metabolism and cardiovascular systems function between male and female rats with different levels of estrogen sufficiency. Materials and Methods. MetS was modelled in male and female rats with different levels of estrogens by chronic (for 8 weeks) intake of fructose (high-fructose diet - HFD) with drinking water at a concentration 200 g/L. Estrogens deficiency was reproduced by bilateral ovariectomy. Experimental rats were divided into five groups: control males (n=6), control females (n=6), males with HFD (n=6), sham-operated females with intact ovaries and HFD (n=6), ovariectomized (OVX) females with HFD (n=6). Glucose homeostasis was assessed by basal glycemia, glycemia during the intra-abdominal glucose tolerance test and fructosamine level. Insulin sensitivity was determined using intra-abdominal insulin tolerance test. Body weight gain, visceral fats, level of total cholesterol, triglycerides, levels of estradiol and testosterone in blood serum were determined. At the end of the study, electrocardiograms were recorded in three standard leads from the limbs. Data are presented as mean ± standard error of mean (SEM). Results. It was established that HFD have not been induced metabolic abnormalities in female rats with intact ovaries. HFD, independently of sex, led to the development of insulin resistance and significant increase in fructosamine level in blood serum of rats. Ovariectomized females with HFD had greater intensity of body weight gain, significantly higher levels of relative mass of fats, more pronounced alterations of lipid metabolism with increased total cholesterol and significantly higher levels of triglycerides, than HFD-treated male rats. However, impairment of glucose tolerance, induced by HFD, was more pronounced in male than in OVX female rats. We found the decline testosterone levels and slight increase in estradiol levels in male rats with HFD. OVX females with HFD had a moderate significant increase in testosterone levels and dramatically decrease in estradiol concentration as result of bilateral ovariectomy. HFD, independently from sex, induced the development of sinus tachycardia in experimental animals. Metabolic abnormalities, induced by HFD, in OVX female rats led to more pronounced disturbances of heart depolarization and repolarization processes and development of diastolic dysfunction compare to HFD-treated males. Conclusions. We revealed that sex and estrogens levels have a great impact on the impairment of glucose and lipid metabolism and cardiovascular systems function, induced by high-fructose diet in rats. The obtained data justifies the necessity to take into account sex and estrogens sufficiency in the development of gender-specific prevention and treatment of metabolic syndrome.

Fructosamine is Not a Reliable Test for the Detection of Hyperglycemia: Insight from the Africans in America Study.

To improve detection of abnormal glucose tolerance (Abnl-GT), attention has moved beyond the oral glucose tolerance test (OGTT), to non-fasting markers of glycemia, specifically, HbA1c, fructosamine (FA) and glycated albumin (GA). Emerging data suggest that in African descent populations, the combination of HbA1c and GA is superior to the combination of HbA1c and FA. However, the diagnosis of Abnl-GT is usually based on tests which are performed only once. As reproducibility of Abnl-GT diagnosis by HbA1c, fructosamine (FA) and glycated albumin (GA) is unknown, reproducibility of Abnl-GT diagnosis by HbA1c, FA and GA were assessed in 209 African-born Blacks living in America. At Visits 1 and 2 (9 ± 4 days apart), samples were obtained for HbA1c, FA and GA levels. Glucose tolerance status was determined at Visit 1 by OGTT. Reproducibility was based on the К-statistic and paired t-tests. Thresholds for the diagnosis of Abnl-GT by FA and GA which corresponded to an HbA1c of 5.7% were 235umol/L and 14.6%, respectively. Abnl-GT occurred in 38% (80/209). Diagnostic reproducibility was excellent for HbA1c (К≥0.86) and GA (К≥0.89), but only moderate for FA (К=0.59). Neither HbA1c nor GA levels varied between visits (both P≥0.3). In contrast, FA was significantly lower at Visit 2 than Visit 1(P<0.01). As HbA1c and GA provided similar diagnostic results on different days and FA did not, HbA1C and GA are superior to FA in both clinical care settings and epidemiologic studies.

Association between Hyperglycemia and Canine Serum Pancreatic Lipase Immunoreactivity Concentration in Diabetic Dogs.

It has been reported that hypertriglyceridemia can partially mediate between diabetes mellitus (DM) and pancreatitis in dogs, implying that another mediator, such as chronic hyperglycemia, might exist. Therefore, this study aimed to evaluate the relationship between hyperglycemia and serum canine pancreatic lipase immunoreactivity (cPLI) concentration in diabetic dogs. This retrospective cohort study included 26 client-owned diabetic dogs, divided according to their serum fructosamine levels (<500 μmol/L = well-controlled DM group; ≥500 μmol/L = untreated or poorly controlled DM group). Five of the 26 DM dogs (19.2%) had serum cPLI concentrations consistent with pancreatitis, among which two showed ultrasonographic evidence of pancreatitis without clinical signs. The serum cPLI concentrations (median [interquartile range]) were significantly higher in the untreated or poorly controlled group (520 μg/L [179.76-1000 μg/L]) than in the well-controlled group (77 μg/L [32.22-244.6 μg/L], P = 0.0147). The serum fructosamine concentration was positively correlated with the serum cPLI concentration (r = 0.4816; P = 0.0127). Multivariate analysis revealed serum triglyceride and fructosamine concentrations were associated with the serum cPLI concentration. In conclusion, this study suggests that chronic hyperglycemia may induce pancreatic inflammation in diabetic dogs; however, the clinical significance of increased cPLI concentration is unknown.