Glucose Control In Diabetic Patients Research Articles

Tailored diffusion limiting membrane for microneedle glucose sensors with wide linear range

Continuous glucose monitoring is very important to daily blood glucose control in diabetic patients, but its accuracy is limited by the narrow linear range of the response of biosensor to the glucose concentration because of the oxygen starvation in tissue and the limited maximum conversion rate of glucose oxidase. In this work, a biocompatible diffusion limiting membrane based on two medical-grade polyurethanes is developed via blending modification to restrict the diffusion flux of glucose to match the oxygen concentration and the maximum conversion rate. The expansiveness of the linear range for the nanomaterials-modified electrode in the glucose biosensor can be achieved through the regulation of two polyurethanes, the solvent, and the thickness of the membrane. In addition, the mass transport of hydrogen peroxide and interfering substances is also limited of the membrane. The in vitro experiments demonstrated that the membrane-modified microneedle biosensor exhibited a rapid response to the concentration variation of glucose, a wide linear range that is sufficient to cover the blood concentration of healthy and diabetic people, the ability to resist the oxygen concentration fluctuation and interfering substances, good reproducibility and long-term stability. The custom wearable electrochemical system, possessing these characteristics, has been proven to accurately monitor the blood concentration in a living rat in real time. This demonstrates a significant potential for application in both daily and clinical blood glucose monitoring.

Novel α-Glucosidase Inhibitory Peptides Identified In Silico from Dry-Cured Pork Loins with Probiotics through Peptidomic and Molecular Docking Analysis.

Diabetes mellitus is a serious metabolic disorder characterized by abnormal blood glucose levels in the body. The development of therapeutic strategies for restoring and maintaining blood glucose homeostasis is still in progress. Synthetic alpha-amylase and alpha-glucosidase inhibitors can improve blood glucose control in diabetic patients by effectively reducing the risk of postprandial hyperglycemia. Peptides of natural origin are promising compounds that can serve as alpha-glucosidase inhibitors in the treatment of type 2 diabetes. Potential alpha-glucosidase-inhibiting peptides obtained from aqueous and saline extracts from dry-cured pork loins inoculated with probiotic LAB were evaluated using in vitro and in silico methods. To identify the peptide sequences, liquid chromatography-mass spectrometry was used. For this purpose, in silico calculation methods were used, and the occurrence of bioactive fragments in the protein followed the ADMET approach. The most promising sequences were molecularly docked to test their interaction with the human alpha-glycosidase molecule (PDB ID: 5NN8). The docking studies proved that oligopeptides VATPPPPPPPK, DIPPPPM, TPPPPPPG, and TPPPPPPPK obtained by hydrolysis of proteins from ripening dry-cured pork loins showed the potential to bind to the human alpha-glucosidase molecule and may act effectively as a potential antidiabetic agent.

Advances in Research on the Mechanism of Association Between Periodontitis and Diabetes Mellitus

Periodontitis and diabetes mellitus are both chronic diseases with a rather high prevalence and they are closely associated with each other. On one hand, diabetes mellitus poses as a risk factor for periodontitis. On the other hand, periodontitis has a negative impact on glucose control in diabetic patients. The two-way relationship has aroused a lot of research interest in recent years. Herein, approaching the issue by looking at the effect of periodontitis on diabetes, we summarized the mechanism of the traditional periodontal pocket-blood circulation pathway and reviewed the role of the oral-gut axis in the mechanism, which has been proposed in recent years. In addition, regarding the impact of diabetes on periodontitis, we summarized new findings concerning changes in oral microbiota, abnormal levels of cytokines and adipokines, oxidative stress, unbalanced osteogenic and osteoclastic activities, and the accumulation of advanced glycation end-products. We hope this paper will be helpful for further studies on the mechanism of association between periodontitis and diabetes.

The effects of topical anesthesia on outcomes and glucose control in diabetic patients treated with split-thickness skin graft surgery.

Using split-thickness skin grafting to treat diabetic foot and leg ulcers is common. Diabetic patients usually exhibit multiple comorbidities and high risks of adverse responses to general and spinal anesthesia. Topical anesthesia can be an alternative to avoid these risks. In this study, the clinical experience of split-thickness skin grafting under topical anesthesia was demonstrated, to evaluate its effectiveness and benefits in diabetic patients. From 2018 to 2020, diabetic patients with foot or leg wounds undergoing split-thickness skin grafting were reviewed and categorized into two groups according to the anesthesia methods: topical anesthesia and general/spinal anesthesia. Patient demographics, wound characteristics and healing status, postoperative complications, and perioperative blood glucose levels were recorded and analyzed. During the study period, 28 patients underwent split-thickness skin grafting under topical anesthesia and 46 under general/spinal anesthesia. The rate of complete wound healing in 4 weeks was similar in both the groups. The topical anesthesia group suffered fewer postoperative infections (3.6% vs 21.7%, p = 0.044), required shorter postoperative hospitalization (8.3 ± 6.2 vs 11.1 ± 7.2 days, p = 0.048), and exhibited lower mean blood glucose levels and less glucose variability than the general/spinal anesthesia group. Conducting split-thickness skin grafting under topical anesthesia was shown to be a safe and effective means of treating leg and foot wounds in diabetic patients.

Effects of break in sedentary behaviour on blood glucose control in diabetic patients. Systematic review

IntroductionOne of the main goals of prescribing physical activity for people with type 2 diabetes is to reduce hyperglycaemia, as it is a risk factor for the development of chronic complications. As less time spent each day in sedentary behaviour would lead to higher glucose consumption by skeletal muscle tissue, this could have significant positive effects on blood glucose control parameters. For this reason, the aim of this study was to analyse the information from different protocols for breaking sedentary behaviour and the association with blood glucose control parameters in patients with type 2 diabetes. Material and methodsA systematic search was carried out for randomised controlled studies on this topic published in the scientific literature. The following databases were considered: PubMed, Cochrane, EBSCO, WoS, ScienceDirect and Medline. Results24 studies were identified and analysed using the COVIDENCE platform. Seven articles were selected for the final analysis, comprising 138 patients. The results show that breaks in sedentary behaviour with light physical activity in people with type 2 diabetes are effective in reducing insulin resistance, the area under the glucose curve, fasting and postprandial blood glucose, and blood glucose variability. ConclusionsAcute interruption of sedentary behaviour, through light-intensity and short-duration exercise, can improve blood glucose indicators in patients with type 2 diabetes, including short term blood glucose variability.

Intelligent Blood Glucose Control in Diabetic Patients by Designing and Simulating an Artificial Pancreas With a Predictive Sliding Mode Control Method

Background: Diabetes mellitus (DM) is a common chronic disease with various complications. About 10% of the world’s population suffers from this disease. For smart control of the blood glucose in DM patients, an artificial pancreas was designed and simulated by a predictive sliding mode controller considering the time delay of insulin effect. Methods: In this method, one of the time-delay glucose-insulin models was first selected. Then, using the predictive sliding mode control model, the stability of the blood glucose and insulin concentration was considered as the target. The performance and efficiency of the design were then verified by simulating the parameters of the proposed model in MATLAB software. Results: Using the proposed method, despite considering a 25-minute delay from insulin injection to its effect, the glucose and insulin concentrations reached stability in 60 and 50 minutes, respectively. Conclusion: The results of this study indicate that the combined controller of the predictive sliding mode model control can control blood glucose more effectively than previous controllers and therefore can help reduce disease complications, improve patients’ quality of life, and reduce costs and individual and health systems.

Evaluation of plasma glucose control in diabetic patients on hemodialysis a single center study

Objectives: The aim of study is to evaluate plasma glucose control in diabetic patient on hemodialysis by measure plasma glycated albumin and HbA1c and correlate them with parameters like serum electrolytes blood urea, serum creatinine, hemoglobin, serum albumin, total serum bilirubin, serum uric acid, parathyroid hormone, serum ferritin; to evaluate the effects of these parameters on the level of diabetic control.
 Methods: This is a cross sectional study which included type 2 diabetic patients on hemodialysis these patients are currently undergoing hemodialysis and are on hemodialysis for more than three months. Total 50 type 2 diabetic patients on hemodialysis; between ages of 47-62 years of either gender were selected randomly and comparison done between the effect of different factors on HbA1c and glycated albumin.
 Results: There were 50 patients enrolled in this study with a mean age of 54.5 ± 4.7 (range: 47 – 62) years. Males represented 58% (29 patients) while female represent 42% (21 patients) of the studied group with male to female ratio of 1.38 to one. The duration of diabetes (DM) ranged 4 – 20 years and two thirds of the cases had duration of 15 years or less. Regarding the treatment of DM, 35 patients (70%) were on soluble insulin while 15 patients neither receive insulin nor oral antidiabetic agent and their treatment was off. poor glycemic control was significantly associated with younger age, patients aged < 50 years were more frequent among the poor glycemic. good glycemic control had significantly lower HbA1C% level.
 Conclusion: Most of our diabetic patient on HD has controlled diabetes reflected by the level of HbA1c and GA. Serum ferritin levels is positively correlate with HbA1c levels in diabetic patient on hemodialysis which suggests that serum ferritin levels can be a marker of glycemic control in type 2 DM.

Adherence to medication and glucose control in diabetic patients in Duhok, Iraq

Background: Diabetes mellitus is a chronic, progressive disorder that causes a variety of health problems. Adherence to medication is a major factor in the treatment outcome. The goal of this study is to translate and test the psychometric features of the Kurdish version of the Morisky Medication Adherence Scale (MMAS-8) among type 2 diabetic patients.Methods: The research used a cross-sectional approach. The researchers looked at a convenient sample of diabetic Kurdish individuals. MMAS-8 was translated into Kurdish using a normal “forward–backward” technique. It was then tested on 307 type 2 diabetic outpatients in a convenience sample. Internal consistency was checked for reliability. Convergent and known group validity were used to confirm validity. For the authentic statistical analysis, the Statistical Package for Social Sciences (SPSS) version 20 was used.Results: According to MMAS-8, 20 patients (6.5%) had a high adherence rate, 66 (21.5%) had a medium adherence rate, and 221 (72%) had a low adherence rate. There was no significant link between adherence score and gender (P = 0.055), illness duration (P = 0.251), or educational level (P = 0.12). There was a significant connection between adherence and HBA1C (P 0.001).Conclusion: The results of this validation study show that the Kurdish version of the MMAS-8 is a reliable and valid measure of medication adherence that may now be used. non-adherent. Developing patients’ treatment adherence will improve treatment managements and control.

Effect of high-protein vs. high-fat snacks before lunch on glycemic variability in prediabetes: A study protocol for a randomized controlled trial.

BackgroundChina has the largest number of patients with Type 2 Diabetes Mellitus (T2DM), and it tends to increasingly grow in the future, putting an enormous burden on disease control and prevention in China. While glycemic variability (GV) came to be an important indicator of blood glucose control in diabetic patients, studies suggested that premeal snacks may help blood glucose control, but there are still some problems to be researched. Therefore, we designed this trial to evaluate which kind of premeal snacks would lead to better effects on GV under two diet patterns in pre-diabetes subjects and to evaluate assessments of acceptability and compliance, behavior, and metabolism changes in individuals will be described.Methods and analysisThe study is a single-center, open-label, multiparallel group, randomized controlled trial. A total of 32 male and female volunteers will be randomized into 4 groups in a single allocated ratio of soy milk (powder) snack, milk (powder) snack, almonds snack, and placebo control with 250 ml of water taken 30 min before lunch, respectively. The study consists of two intervention periods over 11 days. The first intervention period under habitual diet conditions from D3 to D6 (4 days), during which all subjects are asked to maintain their habitual eating and daily activities similar to the run-in period. The second intervention consists of prelunch snacks with standard meals. We will examine both the effect of GV and various metabolic and behavioral outcomes potentially associated with the interventions. At the end of this study, we will assess the acceptability and maintainability of the intervention through interviews.Clinical trial registrationChinese Clinical Trial Registry, identifier ChiCTR2200058935.

1505-PUB: Impact of Diabetes on Radiotherapy-Related Infection

Background and Purpose: Poor perioperative glucose control in diabetes patients is associated with infectious adverse effects (AEs) . Radical radiotherapy (RT) for head and neck (H&N) cancer extensively destroys skin and the mucosa barrier function, and can be as invasive as surgery. In this study, the risk of radiation-induced acute infectious AEs was investigated in a cohort of diabetic patients given RT for H&N cancer. Materials and Methods: Acute AEs associated with RT in diabetic patients treated between January 2017 and July 2021 at three institutions were retrospectively analyzed. Patients were included if they met the following criteria: confirmed diagnosis of type 1 or 2 diabetes mellitus, age > years, stable on glucose-lowering therapy before starting RT, and had undergone RT for pathologically proven malignancies. The endpoint was the rate of acute infectious AEs graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events v5.0. Results: A total of 216 patients were eligible for the present study (median follow-up, 15.6 months; range, 1.3-33.3 months; median age, 72 years; range, 33-90 years) . The median glycated hemoglobin (A1c) value at the start of RT was 7.4% (range, 4.1%-12.7%) . Grade ≥ 3 acute infectious AEs that occurred in 31 (14.4%) patients included mucosal infection, pneumonia, and sepsis. Five patients died due to infectious AEs that developed during or after RT. Concurrent chemoradiotherapy (CCRT) (OR, 2.0; 95%CI, 0.9-4.6; P = 0.08) tended to be a predictor of severe infectious AEs. The frequency of glucose control by diabetologists during CCRT was significantly lower than during RT alone (P = 0.001) . Conclusions: The incidence of severe infectious AEs was high in the present cohort of irradiated diabetic patients with H&N cancer compared with historical data. Patients with CCRT had a higher risk of AEs, which should be considered before irradiation. Therapeutic intervention for glucose control by diabetologists during CCRT may lead to fewer severe infectious AEs. Disclosure K. Ito: None.

Withdrawn: SGLT2 inhibitor ipragliflozin poses a low risk of hypoglycaemia owing to its blood glucose-dependent urinary glucose excretion mechanism in mice.

Sodium-glucose cotransporter (SGLT) 2 inhibitors, which inhibit renal reabsorption of glucose and stimulate urinary glucose excretion, have been proposed as useful drugs for treating diabetes. This study examined the effects of the SGLT2 inhibitor ipragliflozin on blood glucose-dependent urinary glucose excretion in mice. To investigate the antihyperglycemic effects of ipragliflozin, several oral glucose tolerance tests (glucose load: 1-4 g/kg) were performed. Ipragliflozin significantly suppressed the increases in blood glucose levels concomitant with urinary glucose excretion. To investigate the risk of hypoglycemia, the effects of ipragliflozin were examined under fasting conditions in mice that prefasted for various time periods (0-24 h). Ipragliflozin significantly decreased blood glucose levels in mice that had prefasted for 0 or 6 h (non-hypoglycemic conditions), but not in mice that had prefasted for 12 h or more (hypoglycemic conditions). These ipragliflozin-induced hypoglycemic and urinary glucose excretion effects were well correlated with blood glucose levels. These results suggest that ipragliflozin-induced increases in urinary glucose excretion and accompanying hypoglycemic effects were caused by blood glucose-dependent mechanisms. Thus, ipragliflozin may be a useful antidiabetic agent that achieves ideal blood glucose control in diabetic patients with little risk of hypoglycemia.

Eleocharis dulcis individually and in combination with Brassica rapa as a best cure of diabetes with zero side effects

There is a lot of robust evidence of the use of various medicinal plants in lowering metabolic glucose levels in diabetic patients. The current study was designed to focus on the antidiabetic properties of Eleocharis dulcis and Brassica rapa. The stages carried out in this research are sample extraction, phytochemical analysis, FTIR analysis, proximate analysis, antioxidant, and clinical trial for antidiabetic activity. Twenty-two male and female diabetic patients were selected from Lahore who was already taking the oral hypoglycemics drug. They were asked to take orally the equally mixed powder of both E. dulcis and B. rapa (almost 500 g) one time per day for 20 days. Blood glucose levels were assessed with the assistance of a glucometer. It was taken note that after utilizing the E. dulcis individually and in combination with B. rapa, blood glucose level was altogether decreased in both males and females. The current experiment and investigation established a pharmacological indication to support the traditional claim that B. rapa and E. dulcis are good antidiabetic agents. Novelty impact statement The outcomes of this study back up previous studies on the effects of Brassica rapa and Eleocharis dulcis consumption on glucose control in diabetic patients. The findings of proximate and phytochemical studies of aqueous, hexane, and ethanolic extracts, as well as crushed powder demonstrated that both E. dulcis and Brassica rapa pulp contain a significant amount of nutrients.

Health improvements of type 2 diabetic patients through diet and diet plus fecal microbiota transplantation

Type 2 diabetes (T2D) is a major public health problem, and gut microbiota dysbiosis has been implicated in the emergence of T2D in humans. Dietary interventions can indirectly influence the health status of patients with type 2 diabetes through their modulatory effects on the intestinal microbiota. In recent years, fecal microbiota transplantation is becoming familiar as a new medical treatment that can rapidly improve intestinal health. We conducted a 90-day controlled open-label trial to evaluate the health improvement ability of a specially designed diet, and the diet combined with fecal microbiota transplantation (FMT). According to our study, both diet and diet plus FMT treatments showed great potential in controlling blood glucose and blood pressure levels. Sequencing the V4 region of 16S rRNA gene on the Illumina MiniSeq platform revealed a shift of intestinal microbial community in T2D patients, and the changes were also observed in response to the treatments. FMT changed the gut microbiota more quickly than diet. Beneficial bacterium, such as Bifidobacterium, increased along the study and was negatively correlated with blood glucose, blood pressure, blood lipid and BMI. Sulfate-reducing bacteria (SRB), Bilophila and Desulfovibrio, decreased significantly after treatment, showed a positive correlation with blood glucose indices. Thus, the specially designed diet is beneficial to improve blood glucose control in diabetic patients, it also showed the potential to reverse dyslipidemia and dysarteriotony.

Metformin on Blood Glucose Control in Diabetic Patients

Metformin on Blood Glucose Control in Diabetic Patients

Dapagliflozin Reduces Urinary Albumin Excretion by Downregulating the Expression of cAMP, MAPK, and cGMP-PKG Signaling Pathways Associated Genes

Objective: Diabetic nephropathy (DN), the most severe complication of diabetes mellitus, is characterized by albuminuria and progressive loss of kidney function. Dapagliflozin (DAP), a sodium-glucose cotransporter inhibitor, is an oral medication that improves blood glucose control in diabetic patients. However, the effects and mechanisms of DAP on DN remain unclear. Materials and Methods: The effect of DAP was based on a retrospective cohort study of patients who underwent 2-year surveillance, and the concentration of urine albumin-to-creatinine ratio, glomerular filtration rate, and serum creatinine were collected after treatment with DAP. To investigate the underlying mechanisms through which DAP reduces urinary albumin excretion, we used RNA-sequencing (RNA-seq) to analyze gene expression in human kidney 2 (HK-2) cells treated with DAP. Results: The retrospective cohort analysis indicated that DAP could reduce the excretion rate of urinary albumin in patients with type 2 diabetes and renal impairment. The results of the RNA-seq experiments showed 349 differentially expressed genes between DAP-treated HK-2 cells and control cells. Gene ontology annotation enrichment analysis showed that DAP mainly affected the expression of integral component of membrane- and cell junction-related genes, while the Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis showed that DAP primarily downregulated the expression of gene clusters associated with cyclic adenosine monophosphate, mitogen-activated protein kinase, and cyclic guanosine monophosphate-protein kinase G signaling pathways, which play critical roles in the progression of DN. Conclusion: Our results shed light on the mechanism by which DAP controls DN progression and provide a theoretical basis for the clinical treatment of DN.

Ion Mobility Mass Spectrometry Analysis of Oxygen Affinity-Associated Structural Changes in Hemoglobin

Hemoglobin (Hb) is a major oxygen-transporting protein with allosteric properties reflected in the structural changes that accompany binding of O2. Glycated hemoglobin (GHb), which is a minor component of human red cell hemolysate, is generated by a nonenzymatic reaction between glucose and hemoglobin. Due to the long lifetime of human erythrocytes (∼120 days), GHb is widely used as a reliable biomarker for monitoring long-term glucose control in diabetic patients. Although the structure of GHb differs from that of Hb, structural changes relating to the oxygen affinity of these proteins remain incompletely understood. In this study, the oxygen-binding kinetics of Hb and GHb are evaluated, and their structural dynamics are investigated using solution small-angle X-ray scattering (SAXS), electrospray ionization mass spectrometry equipped with ion mobility spectrometry (ESI-IM-MS), and molecular dynamic (MD) simulations to understand the impact of structural alteration on their oxygen-binding properties. Our results show that the oxygen-binding kinetics of GHb are diminished relative to those of Hb. ESI-IM-MS reveals structural differences between Hb and GHb, which indicate the preference of GHb for a more compact structure in the gas phase relative to Hb. MD simulations also reveal an enhancement of intramolecular interactions upon glycation of Hb. Therefore, the more rigid structure of GHb makes the conformational changes that facilitate oxygen capture more difficult creating a delay in the oxygen-binding process. Our multiple biophysical approaches provide a better understanding of the allosteric properties of hemoglobin that are reflected in the structural alterations accompanying oxygen binding.

Clinic-on-a-Needle Array toward Future Minimally Invasive Wearable Artificial Pancreas Applications.

In order to reduce medical facility overload due to the rise of the elderly population, modern lifestyle diseases, or pandemics, the medical industry is currently developing point-of-care and home medical device systems. Diabetes is an incurable and lifetime disease, accountable for a significant mortality and socio-economic public health burden. Thus, tight glucose control in diabetic patients, which can prevent the onset of its late complications, is of enormous importance. Despite recent advances, the current best achievable management of glucose control is still inadequate, due to several key limitations in the system components, mainly related to the reliability of sensing components, both temporally and chemically, and the integration of sensing and delivery components in a single wearable platform, which is yet to be achieved. Thus, advanced closed-loop artificial pancreas systems able to modulate insulin delivery according to the measured sensor glucose levels, independently of patient supervision, represent a key requirement of development efforts. Here, we demonstrate a minimally invasive, transdermal, multiplex, and versatile continuous metabolites monitoring system in the subcutaneous interstitial fluid space based on a chemically modified SiNW-FET nanosensor array on microneedle elements. Using this technology, ISF-borne metabolites require no extraction and are measured directly and continuously by the nanosensors. Due to their chemical sensing mechanism, the nanosensor response is only influenced by the specific metabolite of interest, and no response is observed in the presence of potential exogenous and endogenous interferents known to seriously affect the response of current electrochemical glucose detection approaches. The 2D architecture of this platform, using a single SOI substrate as a top-down multipurpose material, resulted in a standard fabricated chip with 3D functionality. After proving the ability of the system to act as a selective multimetabolites sensor, we have implemented our platform to reach our main goal for in vivo continuous glucose monitoring of healthy human subjects. Furthermore, minor adjustments to the fabrication technique allow the on-chip integration of microinjection needle elements, which can ideally be used as a drug delivery system. Preliminary experiments on a mice animal model successfully demonstrated the single-chip capability to both monitor glucose levels as well as deliver insulin. By that, we hope to provide in the future a cost-effective and reliable wearable personalized clinical tool for patients and a strong tool for research, which will be able to perform direct monitoring of clinical biomarkers in the ISF as well as synchronized transdermal drug delivery by this single-chip multifunctional platform.

Correlation of baseline serum 25-hydroxyvitamin D level with the risk of type 2 diabetes mellitus: a prospective cohort study

To investigate the correlation of baseline serum 25(OH) D level with the risk of type 2 diabetes mellitus (T2DM) and blood glucose control in diabetic patients among the middle-aged and elderly individuals in Chengguan District of Lanzhou, Gansu Province. Residents aged 40 to 75 years in Lanzhou were selected from the "REACTION" study conducted in 2011 and had been followed up since 2014. A total of 5044 subjects with complete data from the two surveys were analyzed. Participants were divided into Q1, Q2, Q3, and Q4 subgroups based on quartiles of serum 25(OH)D level for comparison of the incidence of T2DM and blood glucose control. Baseline 25(OH)D level was not found to correlate with FPG, 2h-PG or HbA1c levels among the residents (P>0.05). The participants were followed up for a mean of 3.4±0.6 years, and compared with those in Q1 group, the participants in Q2, Q3 and Q4 groups did not show significantly lowered risk of prediabetes or diabetes regardless of glucose tolerance status. Among the patients with T2DM, the compliance rate of glycemic control after the follow-up was significantly higher than that before the follow-up (63.4% vs 60.6%), and the levels of HbA1c, FPG, and 2h-PG decreased obviously after the follow-up. But compared with Q1 group, Q2, Q3 and Q4 groups showed no significant changes in glycemic control compliance rate or levels of HbA1c, FPG and 2h-PG after the follow-up (P>0.05). There is no evidence that baseline 25(OH)D levels are associated with the risk of diabetes and blood glucose control in patients with T2DM.

Glycosylated hemoglobin levels and the risk for contrast-induced nephropathy in diabetic patients undergoing coronary arteriography/percutaneous coronary intervention

BackgroundsDiabetes mellitus is an independent risk factor for Contrast-induced nephropathy (CIN) in patients undergoing Coronary arteriography (CAG)/percutaneous coronary intervention (PCI). Glycosylated hemoglobin (HbA1c) is the gold standard to measure blood glucose control, which has important clinical significance for evaluating blood glucose control in diabetic patients in the past 3 months. This study aimed to assess whether preoperative HbA1c levels in diabetic patients who received CAG/PCI impacted the occurrence of postoperative CIN.MethodsWe reviewed the incidence of preoperative HbA1c and postoperative CIN in 670 patients with CAG/PCI from January 1, 2020 to October 30, 2020 and divided the preoperative HbA1c levels into 5 groups. Blood samples were collected at admission, 48 h and 72 h after operation to measure the Scr value of patients. Categorical variables were compared using a chi-square test, and continuous variables were compared using an analysis of variance. Fisher’s exact test was used to compare the percentages when the expected frequency was less than 5. Univariable and multivariable logistic regression analysis was used to exclude the influence of confounding factors, and P for trend was used to analyze the trend between HbA1c levels and the increased risk of CIN.ResultsPatients with elevated HbA1c had higher BMI, FBG, and LDL-C, and they were more often on therapy with hypoglycemic agents, Insulin and PCI. They also had higher basal, 48 h and 72 h Scr. The incidence of CIN in the 5 groups of patients were: 9.8, 11.9, 15.2, 25.3, 48.1%. (p < 0.0001) The multivariate analysis confirmed that in the main high-risk subgroup, patients with elevated HbA1C levels (≥8.8%) had a higher risk of CIN disease. Trend test showed the change of OR (1.000,1.248,1.553,2.625,5.829).ConclusionsStudies have shown that in diabetic patients undergoing CAG/PCI, elevated HbA1c is independently associated with the risk of CIN, and when HbA1c > 9.5%, the incidence of CIN trends increase. Therefore, we should attach great importance to patients with elevated HbA1c at admission and take more active measures to prevent CIN.

HbA1c Is Not Potent Glucose Control Assessment Tool in Type 2 Diabetes Patients Treated With Insulin

Abstract Glycated haemoglobin (HbA1c) is used for defining of glucose control in diabetic patients nevertheless its insufficiency to present overall control in some specific cases. Continuous Glucose Monitoring (CGM) is usually used for adjustment of insulin doses but the derived data are helpful for exact glucose control. We assess the potency of HbAc for defining of real glucose control in subgroup of type 2 diabetes patients treated with different insulin regimens. We studied 54 diabetic patients (33 men, 21 women; age 60.23±5.99 years, disease duration 12.64±5.02 years) - 33 with type 2 diabetes on pre-mixed insulin, 21 with type 2 on multiple insulin injection (MII). Patients performed multiple daily blood glucose measurements of fasting and prandial blood glucose for three months period. HbA1c was measured and CGM by using iProTM for seven days was performed at the end of this period. In pre-mixed insulin treated group and in intensified regimen group, moderate positive correlation was found between HbA1c and mean blood glucose derived from CGM (7.64±1.40% and 7.69±1.23%, respectively 7.64±1.48mmol/l and 7.60±1.30mmol/l), with r1=0.642 (p&amp;lt;0.01) and r2=0.570 (p&amp;lt;0.05). Even lower was correlation between HbA1c and time-in-range (r1=0.431 and r2 =0.401). There were no correlations between HbA1c and percentage of time spent below the target and number of hypoglycemic episodes in each group. Same trend of correlations was found comparing HbA1c and mean BG level in eight-point profile. Based on HbA1c assessment 36.36% of patients on premixed insulin, 19.05% of type 2 patients on MII were with good control. After estimation of results from SMBG these percentage were respectively 28.14% and 12.11%. CGM defined 27.27% of patients on premixed insulin, 13.80% of type 2 patients on MII as well controlled. We conclude that in insulin treated type 2 patients HbA1c gives relative information about overall control with no precise presenting of glucose fluctuations and out-of-range values of blood glucose with no information about hypoglycemic episodes. Nevertheless, short observed period CGM data could give much information that is comparable to three months blood glucose measurement and could replace the use of HbA1c for assessment of overall control. Reference: (1) Chehregosha H, et al. Diabetes Ther. 2019; 10, 853–863 (2) Beyond A1c Writing Group. Diab Care. 2018; 41: e92-e94 (3) Hirsch I et al. Diabetes Tech Ther 2017, 19 (3): S38-S48