Glucose Regulation In Patients Research Articles

The Effect of Sargassum fusiforme and Fucus vesiculosus on Continuous Glucose Levels in Overweight Patients with Type 2 Diabetes Mellitus: A Feasibility Randomized, Double-Blind, Placebo-Controlled Trial.

Brown seaweed is promising for the treatment of type 2 diabetes mellitus (T2DM). Its bioactive constituents can positively affect plasma glucose homeostasis in healthy humans. We investigated the effect of the brown seaweeds Sargassum (S.) fusiforme and Fucus (F.) vesiculosus in their natural form on glucose regulation in patients with T2DM. We conducted a randomized, double-blind, placebo-controlled pilot trial. Thirty-six participants with T2DM received, on a daily basis, either 5 g of dried S. fusiforme, 5 g of dried F. vesiculosus, or 0.5 g of dried Porphyra (control) for 5 weeks, alongside regular treatment. The primary outcome was the between-group difference in the change in weekly average blood glucose levels (continuous glucose monitoring). The secondary outcomes were the changes in anthropometrics, plasma lipid levels, and dietary intake. The data were analyzed using a linear mixed-effects model. The change in weekly average glucose levels was 8.2 ± 2.1 to 9.0 ± 0.7 mmol/L (p = 0.2) in the S. fusiforme group (n = 12) and 10.1 ± 3.3 to 9.2 ± 0.7 mmol/L (p = 0.9) in the F. vesiculosus group (n = 10). The between-group difference was non-significant. Similarly, no between-group differences were observed for the changes in the secondary outcomes. A daily intake of 5 g of fresh, dried S. fusiforme or F. vesiculosus alongside regular treatment had no differential effect on weekly average blood glucose levels in T2DM.

Covid-19 Pandemic and Diabetes - Pandemic Effects on Blood Glucose Regulation

Background: COVID-19 (Novel Coronavirus Disease) pandemic has led to quarantines and restrictions sometimes partly and sometimes throughout the country in Turkey and as well as many other countries. Many people remained inactive since they could not go out, and follow-up of chronic diseases has become difficult because of the inability to access hospital due to the pandemic. Aim: In this study we aimed to investigate the effects of COVID-19 pandemic, which occasionally causes lockdown and partial quarantine implementations, on blood glucose regulation in patients with Type 2 Diabetes Mellitus (DM). Study Design: Single-center, Retrospective, Observational study Methods: The laboratory findings of type 2 DM patients who had been followed-up by our clinic for at least 2 years before the pandemic and who also came for control after the 3-months nationwide lockdown in Turkey (June 2020). Data were obtained from the hospital information system and examined. The values before pandemic and after lockdown were compared. Results: The study included a total of 169 patients. Of the participants 49.7% were female and 50.3% were male. The mean age was 57.7 years in female patients and 54.8 years in male patients. Triglyceride level was significantly increased after the lockdown compared to before the pandemic in all patients (p<0.005). The levels of Fasting Blood Glucose (FBG) and glycated Hemoglobin (HbA1c) were significantly lower after the lockdown in the patients aged over 65 years, while these values were increased in the other age group, but the difference was not statistically significant. Conclusion: COVID-19 pandemic led to statistically insignificant disruption in glucose regulation especially in young type 2 DM patients, while glucose regulation improved in the elderly population under quarantine conditions. Our study was conducted in a short-term and limited population and therefore, further studies with larger populations are needed.

Denosumab Attenuates Glucolipotoxicity-Induced β-Cell Dysfunction and Apoptosis by Attenuating RANK/RANKL Signals.

Obesity is strongly associated with insulin sensitivity in type 2 diabetes (T2D), mainly because free fatty acids (FFAs) are released from excess fat tissue. Long-term exposure to high levels of FFAs and glucose leads to glucolipotoxicity, causing damage to pancreatic β-cells, thus accelerating the progression of T2D. Therefore, the prevention of β-cell dysfunction and apoptosis is essential to prevent the development of T2D. Unfortunately, there are currently no specific clinical strategies for protecting β-cells, highlighting the need for effective therapies or preventive approaches to improve the survival of β-cells in T2D. Interestingly, recent studies have shown that the monoclonal antibody denosumab (DMB), used in osteoporosis, displays a positive effect on blood glucose regulation in patients with T2D. DMB acts as an osteoprotegerin (OPG) by inhibiting the receptor activator of the NF-κB ligand (RANKL), preventing the maturation and function of osteoclasts. However, the exact mechanism by which the RANK/RANKL signal affects glucose homeostasis has not been fully explained. The present study used human 1.4 × 107 β-cells to simulate the T2D metabolic condition of high glucose and free fatty acids (FFAs), and it investigated the ability of DMB to protect β-cells from glucolipotoxicity. Our results show that DMB effectively attenuated the cell dysfunction and apoptosis caused by high glucose and FFAs in β-cells. This may be caused by blocking the RANK/RANKL pathway that reduced mammalian sterile 20-like kinase 1 (MST1) activation and indirectly increased pancreatic and duodenal homeobox 1 (PDX-1) expression. Furthermore, the increase in inflammatory cytokines and ROS caused by the RANK/RANKL signal also played an important role in glucolipotoxicity-induced cytotoxicity, and DMB can also protect β-cells by reducing the mechanisms mentioned above. These findings provide detailed molecular mechanisms for the future development of DMB as a potential protective agent of β-cells.

Hydrogen-Rich Water Ameliorates Metabolic Disorder via Modifying Gut Microbiota in Impaired Fasting Glucose Patients: A Randomized Controlled Study.

Molecular hydrogen (H2) exhibits antioxidant, anti-inflammatory and anti-apoptotic effects, and has shown benefits in glucose and lipid metabolism in certain animal metabolic disorder models. However, the potential benefits of H2 treatment in individuals with impaired fasting glucose (IFG) has seldom been studied. This randomized controlled study (RCT) aims to investigate the effects of hydrogen-rich water (HRW) on IFG subjects and explore the underlying mechanism involved. Seventy-three patients with IFG were enrolled in a randomized, double-blind, placebo-controlled clinical study. These patients were assigned to receive either 1000 mL per day of HRW or placebo pure water (no H2 infusion) for a duration of eight weeks. Metabolic parameters and fecal gut microbiota were assessed at baseline (week 0) and at week 8. A combined analysis of metabolomics and intestinal microbiota was conducted to investigate the correlation between the effect of H2 on the metabolisms and the diversity of intestinal flora in the IGF patients. Both pure water and HRW demonstrated a significant reduction in fasting blood glucose in IFG patients, with a significant difference between pure water and HRW after eight weeks. Among IFG patients with abnormal pre-experimental fatty liver, 62.5% (10/16) in the HRW group and 31.6% (6/19) in the pure water group achieved remission. Furthermore, 16S RNA analysis revealed HRW-modified gut microbiota dysbiosis in the fecal samples of IGF patients. Through Pearson correlation analysis, the differential gut microbiota obtained by 16S analysis was found to be highly correlated with nine metabolites. H2 slightly improved metabolic abnormalities and gut microbiota dysbiosis, providing a novel target and theoretical basis for the prevention and treatment of blood glucose regulation in patients with IFG.

Participatory Development of an Integrated, eHealth-Supported, Educational Care Pathway (Diabetes Box) for People With Type 2 Diabetes: Development and Usability Study.

Type 2 diabetes (T2D) tremendously affects patient health and health care globally. Changing lifestyle behaviors can help curb the burden of T2D. However, health behavior change is a complex interplay of medical, behavioral, and psychological factors. Personalized lifestyle advice and promotion of self-management can help patients change their health behavior and improve glucose regulation. Digital tools are effective in areas of self-management and have great potential to support patient self-management due to low costs, 24/7 availability, and the option of dynamic automated feedback. To develop successful eHealth solutions, it is important to include stakeholders throughout the development and use a structured approach to guide the development team in planning, coordinating, and executing the development process. The aim of this study is to develop an integrated, eHealth-supported, educational care pathway for patients with T2D. The educational care pathway was developed using the first 3 phases of the Center for eHealth and Wellbeing Research roadmap: the contextual inquiry, the value specification, and the design phase. Following this roadmap, we used a scoping review about diabetes self-management education and eHealth, past experiences of eHealth practices in our hospital, focus groups with health care professionals (HCPs), and a patient panel to develop a prototype of an educational care pathway. This care pathway is called the Diabetes Box (Leiden University Medical Center) and consists of personalized education, digital educational material, self-measurements of glucose, blood pressure, activity, and sleep, and a smartphone app to bring it all together. The scoping review highlights the importance of self-management education and the potential of telemonitoring and mobile apps for blood glucose regulation in patients with T2D. Focus groups with HCPs revealed the importance of including all relevant lifestyle factors, using a tailored approach, and using digital consultations. The contextual inquiry led to a set of values that stakeholders found important to include in the educational care pathway. All values were specified in biweekly meetings with key stakeholders, and a prototype was designed. This prototype was evaluated in a patient panel that revealed an overall positive impression of the care pathway but stressed that the number of apps should be restricted to one, that there should be no delay in glucose value visualization, and that insulin use should be incorporated into the app. Both patients and HCPs stressed the importance of direct automated feedback in the Diabetes Box. After developing the Diabetes Box prototype using the Center for eHealth and Wellbeing Research roadmap, all stakeholders believe that the concept of the Diabetes Box is useful and feasible and that direct automated feedback and education on stress and sleep are essential. A pilot study is planned to assess feasibility, acceptability, and usefulness in more detail.

Heat Therapy Can Improve Hepatic Mitochondrial Function and Glucose Control.

This review proposes the novel hypothesis that heat can be used as an alternative therapy to exercise to improve hepatic mitochondrial function and glucose regulation in patients with nonalcoholic fatty liver disease. Although exercise has proven benefits in treating nonalcoholic fatty liver disease, barriers to exercise in the majority of patients necessitate an alternative method of treatment.

Association of triglyceride-glucose index and stroke recurrence among nondiabetic patients with acute ischemic stroke

Backgroud and purposeTriglyceride-glucose (TyG) index has been considered a surrogate marker of insulin resistance. We investigated the association between TyG index and stroke recurrence and compared the effectiveness of TyG index with homeostasis model assessment of insulin resistance (HOMA-IR) in predicting stroke recurrence and death in nondiabetic acute ischemic stroke patients.MethodsNondiabetic acute ischemic stroke patients from the ACROSS-China (Abnormal Glucose Regulation in Patients with Acute Stroke across China) registry were included. TyG index was performed and classified into four groups by quartiles. The outcomes were stroke recurrence and death within 1 year. The association between TyG index and the risk of stroke recurrence and death were analyzed by Cox regression models. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the prediction of TyG index and HOMA-IR for stroke recurrence and death. Delong test was used for comparing the differences between area under the curve (AUC) of TyG index and HOMA-IR.ResultsAmong the 1226 patients included, the median (interquartile range) of TyG index was 5.8 (5.5–6.2). Both the third and fourth quartiles of TyG index were associated with an increased risk of stroke recurrence (adjusted hazard ratio 2.04, 95% confidence interval 1.26–3.31; adjusted hazard ratio 1.86, 95% confidence interval 1.13–3.06). Patients with fourth quartiles of TyG index were associated with a higher mortality risk (adjusted hazard ratio, 2.91; 95% confidence interval, 1.62–2.53). Regarding stroke recurrence within 1 year, the AUC (95% confidence interval) of the ROC curve for the TyG index was similar to that of the HOMA-IR[0.56 (0.52–0.61) vs 0.57 (0.52–0.61); P = 0.93]. Regarding death within 1 year, the AUCs (95% confidence interval) of the ROC curve for the TyG index and HOMA-IR were 0.55 (0.50–0.61) and 0.59 (0.53–0.64), respectively (P = 0.32).ConclusionsElevated TyG index was associated with an increased risk of stroke recurrence and death. However, neither of TyG nor HOMA-IR can be a qualified predictor of stroke recurrence and death in nondiabetic acute ischemic stroke patients.

Artificial pancreas under periodic MPC for trajectory tracking: handling circadian variability of insulin sensitivity

Closed-loop glycemic control algorithms have demonstrated the ability to improve glucose regulation in patients with type 1 diabetes mellitus (T1D), both in silico and clinical trials. Many of the proposed control strategies have been developed, based on time-invariant linear models, without considering the parametric variations of T1DM subjects. In this work, a pulsatile Zone Model Predictive Control (pZMPC) is proposed, which explicitly considers patterns of intra-day insulin sensitivity (SI), according to the latest updates of the FDA-approved UVA/Padova simulator. Results show a significant improvement in the performance, which a-priori justifies the increment in the controller complexity.

Association of Neutrophil to Lymphocyte and Platelet To Lymphocyte ratio with Blood Glucose Regulation in Type 2 Diabetes Patients

INTRODUCTION: 
 Diabetes is characterized by chronic hyperglycemia with disturbances of carbohydrate, protein and lipid metabolism. Disorders of lipid metabolism are common in diabetes causing greater cardiovascular risks. Leukocytosis is a major marker of metabolic syndrome. Both neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are related to subclinical inflammation worsening the glycemic control. HbA1c is used as a marker of blood glucose regulation.
 OBJECTIVE:
 To investigate the association of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with blood glucose regulation in patients with type 2 diabetes mellitus.
 
 METHODS:
 This comparative analytical study was conducted in Shifa International Hospital on diabetic patients. Sample size was calculated as 62 by WHO sample size calculator . Non randomized convenient sampling was used. Patients were divided into two groups according to HbA1c level taking 7% as cut off point. Full blood count, lipid profile and liver profile were carried out. Data was analyzed by SPSS version 21. Descriptive statistics were calculated for categorical variables. For quantitative normal and dispersed variables, independent student t and Mann Whitney U test were applied respectively. P Value less than 0.05 was considered significant.
 
 RESULTS:
 Out of total 93 patients,33 (35.4 %) were males and 60(64.5%) were females. The mean duration of disease was 8.26 ± 5.8 years. NLR and PLR were elevated in patients having poor glucose control but that difference was not significant. Significant difference between the groups was found with random blood glucose. LDL, triglycerides , cholesterol ratio, ALT and AST were raised in patients having poor glycemic control.
 
 CONCLUSION:
 Patients having poor blood glucose regulation have increased levels of haematological and serological parameters posing greater cardiovascular health risks to patients with type 2 diabetes

Effects of Acute Resistance Exercise with and without Whole-Body Electromyostimulation and Endurance Exercise on the Postprandial Glucose Regulation in Patients with Type 2 Diabetes Mellitus: A Randomized Crossover Study.

Background: Long hyperglycemic episodes trigger complications in type 2 diabetes mellitus (T2DM) patients. Postprandial glucose excursions can be reduced by acute physical activity. However, it is not yet clear which type of exercise has the best effect on postprandial glucose levels. Methods: Six T2DM patients participated in three 20-min moderate-intensity exercise sessions after breakfast in a randomized order: resistance exercise with whole-body electromyostimulation (WB-EMS), resistance exercise without electromyostimulation (RES) and cycling endurance exercise (END). A continuous glucose monitoring system recorded glucose dynamics. Results: Postprandially-increased glucose levels decreased in all cases. Time to baseline (initial value prior to meal intake) was quite similar for WB-EMS, RES and END. Neither glucose area under the curve (AUC), nor time in range from the start of the experiment to its end (8 h later) differed significantly. A Friedman analysis of variance, however, revealed an overall significant difference for AUC in the post-exercise recovery phase (END seems to have superior effects, but post-hoc tests failed statistical significance). Conclusions: There are no notable differences between the effects of the different types of exercise on glucose levels, especially when comparing values over a longer period of time.

Effects of prebiotics on postprandial GLP-1, GLP-2 and glucose regulation in patients with type 2 diabetes: A randomised, double-blind, placebo-controlled crossover trial.

We aimed to investigate the effect of prebiotic inulin-type fructans (ITF) versus a control supplement on postprandial levels of glucagon-like peptide-1 and -2 (GLP-1 and -2), glucose and insulin in people with type 2 diabetes. Adult men and women with type 2 diabetes were randomised in a double-blind, placebo-controlled crossover study. The study participants received 16g/d ITF and 16g/d control supplement (maltodextrin) for 6weeks each in two phases separated by a 4-week washout. A standardised mixed-meal test was performed before and after each intake period. The primary end point was changes in the GLP-1 response, and secondary end points were GLP-2, glucose and insulin responses. Data were analysed using mixed-model analysis. A total of 29 participants were included in the study. Differences between and within the two treatments in estimated area under the curves were not significant. Yet, the predicted means for meal-induced GLP-1 response in plasma showed a 4.8% decline after the prebiotic treatment and an 8.6% increase after the control treatment (difference in changes between the treatments, p<0.001). Fasting or postprandial glucose, insulin or GLP-2levels were not changed. Our findings do not support that ITF improve incretin responses or glucose regulations in this population. Clinicaltrials.gov (NCT02569684).

Blood Glucose Regulation in Patients with Type 1 Diabetes by Robust Optimal Safety Critical Control

Introduction: Diabetes disease is a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. Designing an automated system for regulating blood glucose in patients with diabetes is a solution that researchers have been paying close attention to in recent years. Therefore, safety is the minimum requirement for safety-critical systems such as the artificial pancreas. The present study introduces a safe, robust, performance-guaranteed optimal controller that can safely regulate blood glucose in the disturbance.Material and Methods: In this section, first, regulate blood glucose levels in simulation studies is evaluated. For this purpose, a dynamic model is used. The model includes a virtual patient, an insulin pump, and a continuous blood glucose level sensor. The virtual patient model represents the dynamics of insulin-glucose, carbohydrate-glucose, and exercise-glucose.Results: The need to not reset the controller parameters for patients in each category is one of the suggested controller's benefits. However, the PID controller needs to reset the parameters for each group of patients, the predictive control method requires the estimated model of the patient, and its performance is different on different days because the insulin-glucose dynamics for an individual changes day by day.Conclusion: Taking into account different sensitivities of body tissue to insulin, the results of evaluating the controller for two different groups of patients have shown that the controller is resistant to day-to-day changes in patients who may experience changes in insulin sensitivity, even with stress or medication and will not lose its optimal function. Based on the simulation results, the proposed controller can reduce the external disturbances' effect, whose amplitude is to a good extent within the body's physiological range.

The role of vitamin D deficiency and thyroid dysfunction on blood glucose regulation in patients with type 2 diabetes mellitus: A retrospective cohort study

Background/Aim: In patients with diabetes mellitus (DM), complications due to hyperglycemia decrease the quality of life and increase mortality. Vitamin D deficiency and thyroid dysfunction negatively affect blood glucose regulation. We aimed to demonstrate effects of treatment of vitamin D deficiency and thyroid dysfunction on blood glucose regulation. This study aimed to reduce the complications that may develop due to hyperglycemia. Methods: In this retrospective cohort study, Type 2 DM patients admitted to our clinic between 2015-2018 were reviewed from hospital registry. Patients who did not attend to their control visits for DM at the 0th, 3rd and 6th months and those with the exclusion criteria were not included. Patients who regularly attended diabetes controls at the 0th, 3rd and 6th months were determined. Among them, those with 25-hydroxy (OH) vitamin D, glycated hemoglobin (HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PPG), free T4, free T3, thyroid stimulating hormone (TSH) values in the hospital registry were sought. Patients with vitamin D deficiencies and thyroid disorders who began treatment at the 0th month were finally included in the study, and the effects of vitamin D replacement treatment and thyroid dysfunction treatment on blood glucose regulation parameters at the 3rd and 6th months were examined. Results: HbA1c levels significantly decreased in Type 2 DM patients whose vitamin D levels were within normal limits at the 3rd month after receiving vitamin D replacement therapy (P=0.023). Vitamin D and HbA1c levels at the 3rd month controls were negatively correlated (r=-0.23, P=0.016, respectively). There were no significant differences in FBG and PPG levels at the 3rd month (P=0.063, P=0.361, respectively). In type 2 DM patients with hypothyroidism at the 0th month who were euthyroid at the 3rd month, there were no statistically significant differences in HbA1c, FBG and PPG (P=0.202, P=0.14, P=0.40, respectively). Six type 2 DM patients became euthyroid at the 3rd and 6th months after beginning levothyroxine treatment at the 0th month, and six patients became euthyroid at the 3rd and 6th months after hyperthyroidism treatment. Two patients had their FBG, and PPG values measured. Due to the insufficient sample size, statistical significance of differences in HbA1c, FBG and PPG levels could not be determined. Conclusion: Vitamin D replacement treatment had positive effects on blood glucose regulation in DM patients with vitamin D deficiency. The effects of vitamin D on blood glucose regulation should be evaluated by HbA1c. Thyroid dysfunctions were not sufficiently questioned during the three-month follow-up of DM patients, so its effects on blood glucose regulation could not be evaluated. Thyroid dysfunction should be questioned in the 3-month follow-up of DM patients and thyroid function tests should be requested.

GIP as a Therapeutic Target in Diabetes and Obesity: Insight From Incretin Co-agonists.

The 2 hormones responsible for the amplification of insulin secretion after oral as opposed to intravenous nutrient administration are the gut peptides, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). However, whereas GLP-1 also inhibits appetite and food intake and improves glucose regulation in patients with type 2 diabetes (T2DM), GIP seems to be devoid of these activities, although the 2 hormones as well as their receptors are highly related. In fact, numerous studies have suggested that GIP may promote obesity. However, chimeric peptides, combining elements of both peptides and capable of activating both receptors, have recently been demonstrated to have remarkable weight-losing and glucose-lowering efficacy in obese individuals with T2DM. At the same time, antagonists of the GIP receptor have been reported to reduce weight gain/cause weight loss in experimental animals including nonhuman primates. This suggests that both agonists and antagonist of the GIP receptor should be useful, at least for weight-losing therapy. How is this possible? We here review recent experimental evidence that agonist-induced internalization of the two receptors differs markedly and that modifications of the ligand structures, as in co-agonists, profoundly influence these cellular processes and may explain that an antagonist may activate while an agonist may block receptor signaling.

Exercise plus caloric restriction lowers soluble RAGE in adults with chronic kidney disease.

SummaryIntroductionThe incidence of chronic kidney disease (CKD) has increased in recent years. CKD is associated with obesity, type 2 diabetes, and cardiovascular disease, although the mechanism remains unclear. Elevated soluble form of the receptor for advanced glycation end products ( RAGE) is related to proinflammatory signaling pathways that may promote diabetic nephropathy and vascular dysfunction. Because lifestyle modification reduces systematic inflammation in adults with obesity and hyperglycaemia, the hypothesis that exercise plus caloric restriction would lower soluble RAGE in adults with CKD was tested in this study.MethodsEight adults (n = 6 females; age: 56.3 ± 2.8 y; BMI: 43.7 ± 2.2 kg/m2; 2‐h OGTT glucose: 215 ± 9.8 mg/dL; eGFR: 49.6 ± 3.3 mL/min/1.73 m2) were enrolled in a 12‐week pilot lifestyle intervention (supervised aerobic exercise [5 d/wk, up to 60 min/d at approximately 65%‐85% HRmax] plus low‐fat dietary counseling). Body composition (DXA), aerobic fitness (VO2max), insulin sensitivity (120 min 75 g OGTT; Matsuda Index), plasma levels of soluble RAGE and fetuin‐A were measured before and after the intervention.ResultsExercise reduced body weight, fasting glucose, and fetuin‐A as well as increased VO2max, glucose tolerance, and insulin sensitivity (all P < .05). Lifestyle intervention decreased plasma soluble RAGE (pre: 1018.1 ± 163 vs post: 810.6 ± 119.6 ng/mL; P = .02), and the decrease was associated with a lower 2‐hour blood glucose (r = 0.76, P = .03) and with increased insulin sensitivity (r = −0.90, P < .01).ConclusionsExercise and caloric restriction are effective at lowering soluble RAGE in relation to glucose regulation in patients with CKD.

Higher Hemoglobin A1c Level Is Associated With Poor Outcome of Intracerebral Hemorrhage.

Background: Pre-morbid chronic hyperglycemia is associated with the poor outcome of ischemic stroke, but the association between chronic hyperglycemia, and the long-term outcome of acute intracerebral hemorrhage is still poor understood.Methods: Data on patients with acute intracerebral hemorrhage in the ACROSS-China registry (Abnormal Glucose Regulation in Patients With Acute Stroke Across China) were reviewed. Elevated hemoglobin A1c (HbA1c) level on admission was indicative of chronic hyperglycemia. According to the clinical categories of HbA1c, patients were divided into three groups. Multivariable logistic regression or Cox method was performed to analyze the association of HbA1c and the prognosis of patients with acute intracerebral hemorrhage (poor functional outcome [modified Rankin scale score 3–6] and mortality) at 1 year.Results: A total of 416 patients were included in this study. Fifty-two (12.5%) patients died and 130 (31.8%) had poor functional outcome at 1-year follow-up. The higher levels of HbA1c (≥6.5%) was associated with a poor functional outcome (OR 2.35, 95% CI, 1.28–4.29) and increased mortality (OR 2.63, 95% CI 1.34–5.15), compared with the lowest category. When further stratified by diabetic or non-diabetic medical history, higher HbA1c (≥6.5%) still increased the risk of poor functional outcome (OR 3.42, 95% CI 1.39–8.44) and mortality (OR 4.48, 95% CI 1.64–12.24) in patients with non-diabetic medical history. However, higher HbA1c didn't have the association with the increased risk of poor functional outcome (OR 1.06, 95% CI 0.37–3.03) and mortality (OR 1.20, 95% CI 0.39–3.72) in patients with diabetic medical history.Conclusions: Higher HbA1c was associated with a higher risk of death and poor functional outcome 1 year after intracerebral hemorrhage, especially in patients without a diabetic history.

Stress Hyperglycemia and Outcome of Non-diabetic Patients After Acute Ischemic Stroke

Background and Purpose: Stress hyperglycemia is relative hyperglycemia after suffering an acute illness such as stroke, even without preexisting diabetes. Our study aimed to determine the relationship between stress hyperglycemia and outcome of non-diabetic patients with acute ischemic stroke.Methods: Data were derived from the ACROSS-China (Abnormal Glucose Regulation in Patients with Acute Stroke across China) registry. Patients with ischemic stroke but without a history of diabetes mellitus were included in this analysis. Stress hyperglycemia was measured by glucose-to-glycated hemoglobin (HbA1c) ratio which was calculated by fasting plasma glucose (FPG) divided by HbA1c. We investigated the association between quartiles of glucose-to-HbA1c ratio and stroke recurrence and all-cause death at 12 months after stroke onset.Results: We included a total of 999 patients, among which there were 105 (10.9%) recurrent strokes and 76 (7.6%) deaths at 12 months. Using the lowest quartile of glucose-to-HbA1c ratio as the reference, patients with the highest quartile were associated with an increased risk of stroke recurrence [16.0 vs. 8.3%; adj.hazards ratio (HR) = 2.19, 95% confidence interval (CI): 1.26–3.83] and death (13.0 vs. 4.3%; adj.HR=2.86, 95%CI: 1.38–5.90) at 12 months after adjusted for potential covariates. We also observed that a higher level of glucose-to-HbA1c ratio was associated with an elevated risk of stroke recurrence and death.Conclusion: Stress hyperglycemia, measured by glucose-to-HbA1c ratio, was related to an elevated risk of stroke recurrence and all-cause death in patients with acute ischemic stroke but without diabetes.

Obesity-Stroke Paradox Exists in Insulin-Resistant Patients But Not Insulin Sensitive Patients.

Background and Purpose- The underlying mechanisms of stroke-obesity paradox are still not fully understood. This study aims to investigate the contribution of insulin resistance to the association between body mass index and stroke outcomes. Methods- Patients with ischemic stroke without history of diabetes mellitus in the Abnormal Glucose Regulation in Patients With Acute Stroke Across-China registry were included. Overweight or obese was defined as body mass index ≥23, and the median of homeostasis model assessment-insulin resistance index was chosen as cutoff to define insulin resistance. Cox or logistic regression model was used to assess the interaction between body mass index and homeostasis model assessment-insulin resistance on 1-year prognosis (all-cause mortality and poor functional outcome defined as modified Rankin Scale score 3-6). Results- Of 1227 study participants, the median homeostasis model assessment-insulin resistance was 1.9 (interquartile range, 1.1-3.1) and 863 (70.3%) patients were classified as overweight or obese. Among insulin-resistant patients, overweight/obese patients experienced one-half of the risk of death after stroke than their low/normal weight counterparts (9.42% versus 17.69%, unadjusted hazard ratio, 0.50; 95% CI, 0.31-0.82), while among insulin-sensitive ones, no significant difference of mortality risk was found (7.58% versus 6.91%, 1.07; 0.57-1.99). Similar trends were observed for poor functional outcome. Results were similar after adjustments for confounders. There were significant interactions between body mass index and homeostasis model assessment-insulin resistance on the risks of mortality (P=0.045) and poor functional outcome (P=0.049). Conclusions- We observed the obesity paradox for mortality and functional outcome in insulin-resistant patients but did not find the obesity paradox in insulin-sensitive patients. Insulin resistance may be one of the mechanisms underlying the obesity paradox of the outcome in patients with ischemic stroke.

Levels of personality functioning and not depression predict decline of plasma glucose concentration in patients with type 2 diabetes mellitus

AimsPsychosocial variables influence chronic diseases, such as type 2 diabetes mellitus. While there is evidence for a negative impact of depression, much less is known about stable, personality oriented factors. Aim of the study was to assess the impact of depression and personality functioning on glucose regulation in patients with type 2 diabetes. MethodsSeventy-five adult individuals with a first diagnosis of type 2 diabetes were consecutively recruited in an outpatient medical practice. Plasma glucose (HbA1c) was measured at initial contact, and after three and six months of a standardized disease management program. Depression was assessed by self-report (Patient Health Questionnaire, PHQ-D), levels of personality functioning with the screening version of the Operationalized Psychodynamic Diagnosis structure questionnaire (OPD-SQS). ResultsUsing mixed regression models, OPD-SQS scores were associated with lower baseline levels of HbA1c, but a less steep decline over time. PHQ-D scores were neither associated with intercept nor with slopes of HbA1c. ConclusionsIn type 2 diabetes, levels of personality functioning but not depression predicted decline in plasma glucose during the first six months of a standardized disease management program. Personality functioning may be especially important in chronic diseases that demand a high level of compliance and lifestyle change.

Blood Glucose Regulation in Patients with Type 1 Diabetes Using Model Predictive Control and Data Reconciliation

The need to have mechanisms and technologies for the control of blood glucose levels is essential for people who have diabetes of any type. In this way, this paper presents the results obtained of blood glucose control using Model Predictive Control (MPC) and digital Proportional Integral (PI) control, which has been simulated with virtual patients. Initially, a model describing the dynamics of glucose metabolism in the human body was elaborated and, to make the simulation more real, it was considered the action of disturbances and noises. After modeling the system, the controllers were developed. Signal processing and data reconciliation was done using the Kalman Filter. With the objective of improving the performance of the controllers, the feedback of reconciled data technique was used and the performance of the MPC controller was improved by 83.9% based on the elaborated cost function.