Changes In Glucose Research Articles

Pain Reduction and Changes in Serum Cortisol, Adrenocorticotropic Hormone, and Glucose Levels after Epidural Injections With Different Doses of Corticosteroid

BACKGROUND: An epidural steroid injection (ESI) effectively relieves acute lumbar discogenic radicular pain. Corticosteroids, a key ESI component, reduce pain by curbing inflammation and blocking pain signal transmission via C-fibers. While prior research confirms the efficacy of 40 mg and 80 mg methylprednisolone, the effectiveness of lower doses remains uncertain. OBJECTIVES: This trial aimed to compare the pain-relieving effects of ESI using varying methylprednisolone doses (10 mg, 20 mg, and 40 mg). Additionally, it sought to examine changes in fasting plasma glucose (FPG), serum cortisol, and serum adrenocorticotropic hormone (ACTH) levels across these groups. STUDY DESIGN: A prospective observational study. SETTING: Department of Pain Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, People’s Republic of China. METHODS: Ninety-three patients underwent a single epidural injection of methylprednisolone at different doses: 10 mg (n = 28), 20 mg (n = 32), and 40 mg (n = 33). We evaluated their Numeric Rating Scale (NRS-11) score and Oswestry Disability Index (ODI) score at preinjection and 7 days postinjection. We also measured FPG, serum cortisol, and ACTH levels at baseline and one day postinjection. RESULTS: Significant differences were observed in the likelihood of achieving substantial pain relief among the 3 groups at 7 days postinjection. Specifically, 10 mg vs 20 mg had an odds ratio (OR) of 6.546 (95% CI, 1.161 - 26.513, P = 0.008), and 10 mg vs 40 mg had an OR of 7.753 (95% CI, 1.98 - 30.353, P = 0.003). However, there was no significant difference between 40 mg and 20 mg, with an OR of 0.844 (95% CI, 0.239 - 2.987, P = 0.793) in Model 3. Additionally, the baseline NRS-11 score significantly predicted substantial pain relief, with an OR of 0.47 (95% CI, 0.287 - 0.768, P = 0.003). Furthermore, at 7 days postinjection, the ODI score was significantly lower in the 20 mg group (P = 0.007) and the 40 mg group (P < 0.001) compared to the 10 mg group. Moreover, the difference in serum cortisol and FPG between the 40 mg and 10 mg groups was more pronounced (P < 0.01), while the difference in ACTH was similar among all 3 groups (P = 0.191). LIMITATIONS: Potential selection bias and a short follow-up period may have influenced our study, and certain imaging results were omitted from the regression models. CONCLUSIONS: The effectiveness of ESI in relieving pain was found to be similar for both 20 mg and 40 mg doses, but with fewer changes in FPG and serum cortisol levels for the former (which were not statistically significant). As a result, it may be clinically viable to use a 20 mg dose for achieving short-term pain relief. Moreover, the baseline NRS-11 scores were found to be a reliable predictor of pain relief efficacy, with milder baseline pain intensity being associated with better pain relief outcomes. KEY WORDS: Epidural steroids, epidural injection, herniated disc, methylprednisolone, dose, cortisol, glucose, adrenocorticotropic hormone

Methylparaben induces hepatic glycolipid metabolism disorder by activating the IRE1α-XBP1 signaling pathway in male mice

Methylparaben (MP), a preservative widely used in daily supplies, exists in both the environment and the human body. However, the potential health risks posed by MP remain unclear. This study aimed to unravel the mechanisms by which MP disrupts glucose and lipid homeostasis. For this, we administered MP to mice and observed changes in glucose and lipid metabolism. MP exposure led to hyperglycemia, hyperlipidemia, visceral organ injury, and hepatic lipid accumulation. RNA sequencing results from mice livers indicated a close association between MP exposure and endoplasmic reticulum (ER) stress, inflammatory response, and glucose and lipid homeostasis. Western blotting and quantitative reverse transcription–polymerase chain reaction revealed that MP activated ER stress, particularly the inositol-requiring enzyme 1 (IRE1)/X-box binding protein 1 (XBP1) pathway, which further promoted the activation of the nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinase (MAPK) pathways. The activation of these pathways phosphorylated insulin receptor substrate-1 (IRS1) (ser 307), resulting in decreased phosphorylation of protein kinase B (Akt) (ser 473), leading to insulin resistance. Additionally, MP exposure promoted lipogenesis through ER stress. To explore potential remedies, we administered the ER stress inhibitor 4-phenylbutyric acid (4-PBA) and the IRE1α-XBP1 pathway inhibitor toyocamycin to mice, both of which protected against metabolic disorders and organ injury caused by MP. These findings suggest that MP induces disruptions in glucose and lipid metabolism through ER stress, primarily through the IRE1α-XBP1 pathway.

Efficacy and safety of insulin glargine 300 units/mL vs insulin degludec in patients with type 1 and type 2 diabetes: a systematic review and meta-analysis.

Ultra-long-acting insulin analogs [insulin degludec (IDeg) and insulin glargine 300 units/mL (IGla-300)] offer a longer duration of action with less risk of hypoglycemia compared to other long-acting insulins. However, data about the comparative efficacy and safety are inconsistent. We searched CENTRAL, PubMed, Embase, ICTRP Search Portal, and ClinicalTrials.gov on 7 October 2022. Randomized controlled trials (RCTs) comparing the safety and efficacy of IDeg (100 or 200 units/mL) and IGla-300 in patients with type 1 or type 2 diabetes were included. Three review authors independently selected trials, assessed the risk of bias, extracted data, and evaluated the overall certainty of the evidence using GRADE. The primary outcomes were the change in glycated hemoglobin (HbA1c) and any hypoglycemia; the secondary outcomes were the change in fasting plasma glucose (FPG) and severe and nocturnal hypoglycemia. Four open-label RCTs were included (2727 participants), 3 parallel and 1 cross-over. Overall, the risk of bias assessment yielded some concern or high risk. There was a comparable change in HbA1c from baseline to the end of treatment, a mean difference of 0.07% (95% confidence interval (CI) 0.06 - 0.19; p = 0.29; 3 trials; 2652 patients; very low-certainty evidence), and a comparable rate of any hypoglycemia, rate ratio 1.02 (95% CI 0.8 - 1.3; p = 0.87; 3 trials; 2881 patients; very low-certainty evidence). IDeg resulted in more reduction in FPG compared to IGla-300, mean difference of 10.27 mg/dL (95% CI 7.25 - 13.29; p < 0.001; 3 trials; 2668 patients; low-certainty evidence). Similar rates of nocturnal and severe hypoglycemia were observed, rate ratio of 1.13 (95% CI 0.72 - 1.78; p = 0.54; 3 trials; 2668 patients; very low-certainty evidence) and 1.4 (95% CI 0.41 - 4.73; p = 0.59; 2 trials; 1952 patients; very low-certainty evidence), respectively. There is no evidence of a difference between IDeg and IGla-300 in the mean change in HbA1c and the risk of anytime, nocturnal, and severe hypoglycemia. IDeg appeared to cause a higher reduction in FPG compared to IGla-300. However, this finding should be interpreted with caution due to the small number of trials included and their high risk of bias. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022364891, identifier CRD42022364891.

Promoting healthy eating in early pregnancy in individuals at risk of gestational diabetes mellitus: does it improve glucose homeostasis? A study protocol for a randomized control trial.

Healthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM. This unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care. Population: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada's Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10-14, 24-26, and 34-36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval. This RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM. https://clinicaltrials.gov/study/NCT05299502, NCT05299502.

Association of exposure to multiple heavy metals during pregnancy with the risk of gestational diabetes mellitus and insulin secretion phase after glucose stimulation

Association of exposure to multiple heavy metals during pregnancy with the risk of gestational diabetes mellitus and insulin secretion phase after glucose stimulation

Propolis extract supplementation in the complementary treatment of adults and elderly with Type 2 Diabetes Mellitus: a systematic review of clinical trial

Background &amp; aims: bee products, such as propolis, have important natural properties to help reduce the risk of chronic noncommunicable diseases. Therefore, the objective of this review was to determine whether propolis intake helps to improve laboratory and anthropometrics indicators related to metabolic changes in type 2 Diabetes mellitus. Methods: systematic review of randomized clinical trials, published between 2000 and 2021, in Pubmed, Lilacs and SciELO databases, which indicated significant effects of propolis on laboratory indicators related to glycemic homeostasis, antioxidant and anti-inflammatory status. The articles were obtained according to the model recommended by PRISMA. After general analysis, protocols were used to assess the quality of evidence, using the Jadad scale, Consort and Cochrane. Results: glycemic homeostasis was evaluated using the following laboratory indicators: HOMA-IR, HOMA-β, fructosamine, fasting glucose and glycated hemoglobin. Significant changes in fasting glucose, 2-hour postprandial glucose were indicated in 71.43% of the studies. The antioxidant potential of propolis was evaluated in 71.43% of clinical trials. There was a significant reduction in pro-inflammatory cytokines, an increase in catalase activity and an increase in the antioxidant capacity of glutathione. The lipid profile was analyzed in 42.86% of the studies, indicating significant changes in total, LDL and HDL cholesterol. Conclusion: propolis can be considered an aggregating alternative for the conventional treatment of type 2 Diabetes mellitus. However, this food supplement is not a “miraculous” product, which eliminates the need for changes in lifestyle, including eating habits and regular physical activity, as well as the use of drugs, when necessary.

Evaluation of Nutritional Interventions in Preventing Type 2 Diabetes Mellitus: A Randomized Controlled Trial

This study aimed to evaluate the effectiveness of the structured dietary intervention in reducing the risk of developing type 2 diabetes mellitus and improving associated metabolic health indicators. We included 530 participants randomly assigned to an intervention group with a Mediterranean-style diet and a control group with generic dietary guidelines. The incidence of type 2 diabetes mellitus was the primary outcome, whereas changes in fasting plasma glucose, lipid profiles, and body composition were the secondary outcomes. After 24 months, the incidence of type 2 diabetes mellitus was significantly lower among participants in the intervention group than those in the control group (P &lt; 0.05). Fasting glucose, hemoglobin A1c, total cholesterol, and low-density lipoprotein levels were decreased (P &lt; 0.05), and high-density lipoprotein levels were increased among participants in the intervention group than in those in the control group (P &lt; 0.05). Also, body weight, blood pressure, and body mass index, major negative predictors of fasting glucose levels, were significantly decreased in participants in the intervention group than in those in the control group (P &lt; 0.05), irrespective of other covariates. Dietary intervention substantially reduced the risk of developing type 2 diabetes mellitus and improved glycemic control, lipid profiles, and overall metabolic health.

Effects of a 2-Week Kinect-Based Mixed-Reality Exercise Program on Prediabetes: A Pilot Trial during COVID-19.

Pre-diabetes can develop into type 2 diabetes mellitus, but can prevented by regular exercise. However, the outcomes when combining unsupervised Kinect-based mixed-reality (KMR) exercise with continuous glucose monitoring (CGM) remain unclear. Therefore, this single-arm pilot trial examined changes in blood glucose (BG) concentrations over 672 hours (4 weeks), including a 2-week period of KMR exercise and CGM in individuals with pre-diabetes. This was a pre-and post-treatment case-control study with nine participants. General questionnaires were administered and body composition, fasting BG concentrations, and 2-hour oral glucose tolerance test (2-OGTT) results were measured pre-and post-treatment. Weekly average glucose concentrations, hyperglycemia rate, hypoglycemia rate, average glucose concentration over time, amount of physical activity, amount of food intake, and pre- and postprandial BG (immediately and 30, 60, 90, and 120 minutes after lunch) were measured over 4 weeks (pre-test, exercise, and post -test weeks). Glucose concentrations were measured before exercising, between sets, and 30 and 60 minutes after exercise during the 2 weeks of unsupervised exercise (3 days/week). In all participants, body mass index (27.16±2.92 kg/m2), fasting BG (108.00±7.19 mg/dL), 2-OGTT (162.56±18.12 mg/dL), hyperglycemia rate (P=0.040), and 90-minute postprandial BG (P=0.035) were significantly reduced during the 2 exercise weeks, and the 2-OGTT result (P=0.044) and diastolic blood pressure (DBP) (P=0.046) were significantly reduced at the post -test as compared with the pre-test. This study found that 2 weeks of unsupervised KMR exercise reduced 2-OGTT, DBP, hyperglycemia rate, and 90-minute postprandial BG concentration. We believed this effect could be identified more clearly in studies involving a larger number of participants and longer durations of exercise.

Endocrine activities modulated by adipose-mesenchymal stem cell in an animal model induced to polycystic ovary syndrome

Purpose - Animal models offer a useful way to study the reproductive and metabolic abnormalities, including PCOS. MSCs have received increasing attention as a potential cell-based therapy and regenerative medicine, due to their effects in modulation of different molecular and biological pathways. The aims of the present work were to investigate modulation of the ovarian microenvironment by AdMSCs in an animal model induced to PCOS. Methods - Female rats were divided into control, polycystic ovary, and mesenchymal stem cell groups, evaluated at two different times after PCOS induction and injection of AdMSCs. Results - The polycystic ovary group showed changes in ovarian cycles, the presence of cysts in the ovaries, and hyperandrogenemia. In addition, changes in plasma insulin, glucose, leptin, and osteocalcin were observed in the polycystic ovary group. These metabolic changes were modulated by the injection of AdMSCs into the ovary. Data are presented for female rats in an animal model integrating PCOS with AdMSCs, together with the relationships among ovaries, bones, and adipocytes. Conclusion - The results suggested the existence of endocrine-metabolic-reproductive microenvironment relationships modulated by AdMSCs, which should help in guiding further investigations to clarify pathophysiological mechanisms that have not yet been fully elucidated.

Qi-Ju-Di-Huang-Pill delays the progression of diabetic retinopathy

Ethnopharmacological relevanceQi-Ju-Di-Huang-Pill (QJDH pill) is a Chinese decoction. Although it is commonly used to treat eye conditions, such as diabetic retinopathy (DR), its exact mechanism of action is unknown. Aim of the studyTo investigate the specific mechanism by which QJDH pill slows the progression of diabetic retinopathy (DR) based on animal and cellular experiments. Material and methodsThe major components of QJDH pill were characterized by ultrahigh-performance liquid chromatography-tandem mass spectrometry (UHPLCMS/MS). C57BL/6J mice were randomly divided into five groups as follows: normal group (control group), model group (STZ group), low-dosage QJDH pill group (QJDH-L group), medium-dosage QJDH pill group (QJDH-M group) and high-dosage QJDH pill group (QJDH-H group). Changes in water intake, urination, food intake, and body mass were monitored weekly, while changes in blood glucose were monitored monthly. Fluorescein fundus angiography (FFA), optical coherence tomography angiography (OCTA), and optical coherence tomography (OCT) were utilized to analyze the changes in fundus imaging indications. Hematoxylin & eosin (H&E) and transmission electron microscopy (TEM) were employed to examine histopathologic and ultrastructural changes in retina. The levels of interleukin-6 (IL-6), interleukin-17 (IL-17), tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF) in peripheral blood were detected using Enzyme-linked immunosorbent assay (ELISA). The mouse retina apoptotic cells were labeled with green fluorescence via terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (Tunel). The protein levels of Bcl-2-Associated X (Bax), B cell lymphoma 2 (Bcl-2), Caspase-3, PI3K, phosphorylated PI3K (p-PI3K), protein kinase B (AKT) and phosphorylated AKT (p-AKT) were quantified by Western blot (WB). The retinal pigment epithelium (RPE) cells were cultured and classified into five groups as follows: normal glucose group (NG group), high glucose group (HG group), high glucose + QJDH pill group (HG + QJDH group), high glucose + inhibitor group (HG + LY294002 group), and high glucose + inhibitor + QJDH pill group (HG + LY294002 + QJDH group). Cell viability and apoptosis were detected via Cell Counting Kit-8 (CCK8) and then analyzed by flow cytometry. ResultsIn vivo experiments revealed that the QJDH pill effectively reduced blood glucose, symptoms of increased water intake, elevated urination, increased food intake and decreased body mass in DR mice. QJDH pill also slowed the development of a series of fundus imaging signs, such as retinal microangiomas, tortuous dilatation of blood vessels, decreased vascular density, and thinning of retinal thickness, downregulated IL-6, IL-17, TNF-α, and VEGF levels in peripheral blood, and inhibited retinal cell apoptosis by activating the PI3K/AKT signaling pathway. Moreover, in vitro experiments showed that high glucose environment inhibited RPE cell viability and activated RPE cell apoptosis pathway. In contrast, lyophilized powder of QJDH pill increased RPE cell viability, protected RPE cells from high glucose-induced damage, and decreased apoptosis of RPE cells by activating the pi3k pathway. ConclusionQJDH pill induces hypoglycemic, anti-inflammatory effects, anti-VEGF and anti-retinal cell apoptosis by activating PI3K/AKT signaling pathway, and thus can protect the retina and slow the DR progression.

Molecular pathways underlying sympathetic autonomic overshooting leading to fear and traumatic memories: looking for alternative therapeutic options for post-traumatic stress disorder.

The sympathoadrenal medullary system and the hypothalamic-pituitary-adrenal axis are both activated upon stressful events. The release of catecholamines, such as dopamine, norepinephrine (NE), and epinephrine (EPI), from sympathetic autonomic nerves participate in the adaptive responses to acute stress. Most theories suggest that activation of peripheral β-adrenoceptors (β-ARs) mediates catecholamines-induced memory enhancement. These include direct activation of β-ARs in the vagus nerve, as well as indirect responses to catecholamine-induced glucose changes in the brain. Excessive sympathetic activity is deeply associated with memories experienced during strong emotional stressful conditions, with catecholamines playing relevant roles in fear and traumatic memories consolidation. Recent findings suggest that EPI is implicated in fear and traumatic contextual memories associated with post-traumatic stress disorder (PTSD) by increasing hippocampal gene transcription (e.g., Nr4a) downstream to cAMP response-element protein activation (CREB). Herein, we reviewed the literature focusing on the molecular mechanisms underlying the pathophysiology of memories associated with fear and traumatic experiences to pave new avenues for the treatment of stress and anxiety conditions, such as PTSD.

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.

Intestinal Morphology and Glucose Transporter Gene Expression under a Chronic Intake of High Sucrose.

Sucrose is a disaccharide that is degraded into fructose and glucose in the small intestine. High-sucrose and high-fructose diets have been reported, using two-dimensional imaging, to alter the intestinal morphology and the expression of genes associated with sugar transport, such as sodium glucose co-transporter 1 (SGLT1), glucose transporter 2 (GLUT2), and glucose transporter 5 (GLUT5). However, it remains unclear how high-fructose and high-sucrose diets affect the expression of sugar transporters and the intestinal morphology in the whole intestine. We investigate the influence of a chronic high-sucrose diet on the expression of the genes associated with sugar transport as well as its effects on the intestinal morphology using 3D imaging. High sucrose was found to increase GLUT2 and GLUT5 mRNA levels without significant changes in the intestinal morphology using 3D imaging. On the other hand, the delay in sucrose absorption by an α-glucosidase inhibitor significantly improved the intestinal morphology and the expression levels of SGLT1, GLUT2, and GLUT5 mRNA in the distal small intestine to levels similar to those in the proximal small intestine, thereby improving glycemic control after both glucose and sucrose loading. These results reveal the effects of chronic high-sugar exposure on glucose absorption and changes in the intestinal morphology.

Insights into the conformational, secondary structural, dynamical and hydration pattern changes of glucose mediated glycated HSA: a molecular dynamics approach

The robust structural nature of human serum albumin (HSA) is responsible for its multifarious functional property. The site specific glycation of HSA due to hyperglycaemia (excess glucose) causes structural changes which have an impact on the functioning of the protein. This work investigates the effects of glucose-mediated glycation in the altered inter-domain motion, distorted binding site conformation and modified hydration patterns, Trp214 orientation, and secondary structure transition using simulation approach. Here we have observed an increase of turns in the helices of glycated HSA, which modulates the open-close conformation of Sudlow I & II. The secondary structure changes of glycated HSA indicate plausible reduction in the alpha helical content in the helices which participates in ligand binding. It also affects geometrical features of drug binding sites (Sudlow I and II) such as volume and hydration. We found that glycation disturbs domain specific mobility patterns of HSA, a substantial feature for albumin drug binding ability which is also correlated with changes in the local environment of Trp214. Communicated by Ramaswamy H. Sarma

Longitudinal trajectories of blood glucose and 30-day mortality in patients with diabetes mellitus combined with acute myocardial infarction: A retrospective cohort analysis of the MIMIC database.

Although blood glucose changes have been suggested to be a potential better target for clinical control than baseline blood glucose levels, the association of blood glucose changes with the prognosis in acute myocardial infarction (AMI) patients with diabetes mellitus (DM) is unclear. Herein, this study aimed to investigate association of short-term longitudinal trajectory of blood glucose with 30-day mortality in this population. Data of AMI patients with DM were extracted from the Medical Information Mart for Intensive Care (MIMIC) database in 2003-2019 in this retrospective cohort study. The latent growth mixture modeling (LGMM) model was utilized to classify the 24-hour longitudinal trajectory of blood glucose of the patients. Kaplan-Meier (KM) curve was drawn to show 30-day mortality risk in patients with different trajectory classes. Univariate and multivariate Cox regression analyses were employed to explore the association of longitudinal trajectory of blood glucose within 24 hours after the ICU admission with 30-day mortality. Also, subgroups analysis of age, gender, and AMI types was performed. The evaluation indexes were hazard ratios (HRs) and 95% confidence intervals (CIs). Among 1,523 eligible patients, 227 (14.9%) died within 30 days. We identified 4 longitudinal trajectories of blood glucose, including class 1 (a low initial average blood glucose level with steady trend within 24 hours), class 2 (a high initial average blood glucose with gently decreased trend), class 3 (the highest initial average blood glucose with rapidly decreased trend) and class 4 (a high initial average blood glucose level with the trend that increased at first and then decreased). After adjusting for covariates, an average blood glucose level of ≥200 mg/dL was linked to higher risk of 30-day mortality, comparing to that of <140 mg/dL (HR = 1.80, 95%CI: 1.23-2.63). Comparing to patients whose longitudinal trajectory of blood glucose conformed to class 1, those with class 2 (HR = 2.52, 95%CI: 1.79-3.53) or class 4 (HR = 3.53, 95%CI: 2.07-6.03) seemed to have higher risk of 30-day mortality. Additionally, these associations were also significant in aged ≥60 years old, female, male, NSTEMI, and STEMI subgroups (all P<0.05). A low level of average blood glucose at the ICU admission or reducing blood glucose to a normal level quickly with adequate measures in 24 hours after ICU admission may be beneficial for AMI patients with DM to reduce the risk of 30-day mortality. These findings may provide some information for further exploration on appropriate range of blood glucose changes in clinical practice.

Effect of 5% Dextrose Infusion on Postoperative Nausea and Vomiting in Patients undergoing Laparoscopic Cholecystectomy: A Randomised Controlled Study

Introduction: Postoperative Nausea and Vomiting (PONV) is defined as nausea, vomiting, or retching occurring in the postanaesthesia care unit within the first 24 hours of postoperative period. It is most common following laparoscopic cholecystectomy, causing postoperative discomfort and increasing patients’ stay in the postanaesthesia care unit. Aim: To evaluate the effect of a 500 mL infusion of 5% dextrose on PONV in patients undergoing laparoscopic cholecystectomy. Materials and Methods: A randomised controlled study was conducted at Department of Anaesthesiology, ESICMC PGIMSR, Bengaluru, Karnataka, India from January 2019 to June 2020, involving 90 consenting patients who were randomly assigned to two groups. One group (Group-C) received a 500 mL infusion of 5% dextrose, while the other group (Group-D) received Ringer’s lactate 30 minutes before the end of surgery. Anaesthesia and surgical techniques were standardised for all cases. Postoperatively, primary parameters such as the incidence of nausea, vomiting, and retching, and secondary parameters such as rescue antiemetic consumption and changes in blood glucose changes were recorded. The Bellville scale was used to assess PONV. Data were analysed using the Chi-square (χ2 ) test, with a significance level of 0.05. Continuous variables were reported as mean±Standard Deviation (SD), and categorical variables were reported as proportions. Results: Demographic parameters such as age (p=0.601), gender (p=0.259), weight (p=0.802), height (p=0.391), and Body Mass Index (BMI) (p=0.806) were comparable between the two study groups. A 5% dextrose infusion during laparoscopic cholecystectomy reduced nausea and vomiting during the postoperative period (p&lt;0.05), decreased the overall incidence of PONV (p&lt;0.001), and also reduced the requirement for rescue antiemetic dose (p&lt;0.004). When comparing blood sugar levels, Group-D and Group-C showed no significant difference at T1, but there was a significant difference between the both groups at T2 (T1: p=0.211, T2: p&lt;0.001). Conclusion: A 5% dextrose infusion during laparoscopic cholecystectomy reduces the incidence of PONV and decreases the need for rescue antiemetic medication. Additionally, comparing blood sugar levels, Group-D and Group-C showed a significant difference after the drug infusion. Therefore, a 5% dextrose infusion can be recommended as an effective and safe method for the prophylaxis of PONV in laparoscopic cholecystectomy.

Observation of the Changes in Body Weight, Blood Pressure, Blood Lipids, Blood Glucose, and Blood Uric Acid Levels in Middle-Aged and Elderly Individuals Undergoing Aerobic Exercise

Observation of the Changes in Body Weight, Blood Pressure, Blood Lipids, Blood Glucose, and Blood Uric Acid Levels in Middle-Aged and Elderly Individuals Undergoing Aerobic Exercise

Effect of aqueous-alcoholic extract of Ducrosia Anethifolia Boiss on the fetal liver of diabetic rats

Objective: Moshgak (Ducrosia anethifolia) is a wild plant with medicinal value. The present study aimed to evaluate the effect of Moshgak on the liver tissue of the diabetic rat fetus. Materials and Methods: In this animal study, the aqueous-alcoholic extract of Moshgak was prepared in the standard method. Forty rats were divided randomly into five groups, including control, sham, and three diabetic groups. The rats were diabetic with intraperitoneal injection of a single dose of streptozotocin (80 mg) and 2 diabetic groups were treated with Moshgak extract (280 and 560 mg/kg/bw) for 19 days. The rats were anesthetized and their blood was taken to measure the blood glucose, insulin, and malondialdehyde. Then, their fetuses were removed. The fetal liver sections were obtained by using the stereological methods. The micrometry of the liver tissue was performed and data were analyzed. Results: The finding showed a statistically significant increase (P &lt; 0.01) in the total volume of liver, connective tissue, sinusoid, and hepatocytes in diabetic rats compared to control rats, while these parameters decreased significantly in treated groups with Moshgak. Hepatic cell count hepatic decreased in the treated groups. Furthermore, the changes in blood glucose, malondialdehyde, and insulin in diabetic rats were improved significantly by Moshgak treatment. The dilation of sinusoids, hepatocyte vacuolation, and mild lymphocytosis was observed in all diabetic groups except the treatment group with Moshgak 560 mg/kg/bw. Conclusions: According to obtained results, Moshgak extract was able to compensate partially the changes induced by diabetes in the fetal liver tissue. Therefore, due to the side effects of diabetes during pregnancy, further research on anti-diabetic properties of Moshgak is suggested.

Nilotinib-induced Diabetes in Japanese Patients with Chronic Myeloid Leukemia.

Objective This study aimed to examine the risk of diabetes mellitus induced by nilotinib, a second-generation tyrosine kinase inhibitor. Methods This retrospective study included 25 patients with chronic myeloid leukemia (CML) treated with nilotinib at our hospital. Four patients had diabetes mellitus at the start of nilotinib administration (prior DM group), and five patients were newly diagnosed with diabetes mellitus after the start of nilotinib administration (new DM group). Sixteen patients who were not diagnosed with diabetes mellitus were classified into the non-DM group. Changes in the blood glucose and HbA1c levels were evaluated in each group at the time of nilotinib administration and two years later. Results Molecular genetic remission of CML was achieved in 81.8% of patients with diabetes and 72.2% of patients without non-DM group. There were no cases in this study in which nilotinib was changed or discontinued owing to hyperglycemia. There was no difference in the blood glucose levels at the start of nilotinib treatment among the groups. Two years after starting nilotinib, the blood glucose levels in the new DM group (232 (186-296) mg/dL) and prior DM group (168 (123-269) mg/dL) were significantly higher than those in the non-DM group (100 (91-115) mg/dL). ΔHbA1c levels in the new DM group (1.3 (0.9-2.2) %) and prior DM group (1.6 (0.7-1.7) %) were significantly higher than those in the non-DM group (-0.2 (-0.3-0.1) %). Conclusion Nilotinib caused diabetes in 23.8% of the participants, but there were no hyperglycemia-related severe adverse events. Therefore, nilotinib may be safely continued with regular monitoring for the development of diabetes after nilotinib administration.

Efficacy and Safety of Vildagliptin for Type 2 Diabetes in Patients With Diabetic Kidney Disease.

Vildagliptin is one of the dipeptidyl peptidase-4 (DPP-4) inhibitors that have been shown to improve hyperglycemia in clinical trials among patients with type 2 diabetes. However, few studies have examined the efficacy of vildagliptin in patients with diabetic kidney disease (DKD). Eight patients with DKD received oral vildagliptin 50-100 mg/day. The duration of diabetes was 6.7±5.9 years and observation period was 23.6±9.8 months. Changes in fasting blood glucose, and hemoglobin A1c (HbA1c), estimated glomerular filtration rate (eGFR), and urine protein-to-creatinine ratio (UPCR) were studied before and after the administration of vildagliptin. Vildagliptin treatment significantly decreased fasting blood glucose and HbA1c, compared to baseline (132±56 mg/dl, p=0.036, 6.0±0.3, p=0.041, respectively). UPCR tended to be decreased, albeit without statistical significance. However, eGFR was decreased after the administration of vildagliptin. No significant adverse effects were observed in all patients during the study. Although the sample size was limited and the observation period was brief, vildagliptin was found to be an effective and reasonably well-tolerated treatment for patients with DKD.