Glucose Tolerance In Patients Research Articles

Utilization of a Postpartum Fasting Blood Glucose to Predict Impaired Glucose Tolerance in Patients with Gestational Diabetes Mellitus.

The Endocrine Society recommends a postpartum fasting blood glucose (FBG) be performed for patients with gestational diabetes mellitus (GDM) prior to hospital discharge to screen for ongoing hyperglycemia. There are limited data, however, on whether an FBG can screen for glucose intolerance and if it correlates with the gold standard 4- to 12-week 2-hour oral glucose tolerance test (OGTT). Our objective was to evaluate if FBG correlates with the gold standard 2-hour OGTT. This retrospective cohort study of patients with GDM who delivered >20 weeks' gestation at two urban centers from January 2017 to December 2020 included those who completed both a postpartum FBG prior to discharge and a 2-hour 75-g OGTT within 1 year of delivery. Abnormal 2-hour OGTT was defined as fasting value ≥100 mg/dL and/or 2-hour value ≥140 mg/dL. We evaluated test characteristics (e.g., sensitivity, specificity) of postpartum FBG cut-offs to predict an abnormal 2-hour OGTT result. A total of 235 patients met inclusion criteria, of which 63% were diet-controlled and 37% required medical management. FBG ranged from 64 to 134 mg/dL, with 6/235 (2.6%) with values ≥126 mg/dL. A total of 39/235 (16.6%) of patients had an abnormal 2-hour OGTT. Overall, area under the curve for FBG predicting abnormal 2-hour OGTT was 0.65. Traditionally considered high cut-offs (≥126 mg/dL) for predicting persistent impaired glucose intolerance demonstrated poor positive predictive value (PPV; <20%). In contrast, low cut-offs demonstrated excellent NPV (>90%). A postpartum FBG of 88 mg/dL was determined to be the optimal cut-off for FBG with NPV = 92.4% (Youden index = 0.34). In this dataset, if FBG ≥ 88 mg/dL was used to determine if 2-hour OGTT was required, almost half of GDM patients could avoid further glucose tolerance testing. While previously thought of as best utilized for its PPV, the FBG may be best used for its NPV. In our study, clinical application of an FBG < 88 mg/dL was highly correlative with a normal 2-hour OGTT. · Screening for postpartum glucose intolerance is essential for gestational diabetes.. · A promising initiative includes offering screening tests while in the hospital, including an FBG.. · Application of a postpartum FBG < 88 mg/dL is highly correlative with a normal 2-hour OGTT..

Early onset of abnormal glucose tolerance in patients with cystic fibrosis: a systematic review and meta-analysis

Early onset of abnormal glucose tolerance in patients with cystic fibrosis: a systematic review and meta-analysis

THU279 Long duration Of CFTR Modulators Consistently Improve Glucose Metabolism Parameters In Patients With Cystic Fibrosis

Abstract Disclosure: A. Cohen: None. A. Mass: None. D. Zangen: None. M. Cohen-Cymberknoh: None. Background: Impaired glycemic control and consequently Cystic fibrosis Related Diabetes (CFRD) due to gradual pancreatic β-cell dysfunction is a common complication (upto 50% in adults) in patients with cystic fibrosis (CF.) The novel use of CFTR modulators (CFTRm), improve pulmonary function and reduce disease exacerbations. Data regarding the long-term effect of CFTRm on glycemic control is limited. In this observational-retrospective study, we evaluate the effect of CFTRm on the classical pathophysiological deterioration in glucose tolerance in patients with CF. Methods and Results: 15 patients with CF (ages 13-37) treated with CFTRm were followed by routine Oral Glucose Tolerance Test (OGTT). OGTT Results of Pre and 3-81 months (mean 28) post initiation of CFTRm therapy were compared and also classified to 4 classic categories: normal glucose tolerance (NGT), indeterminate (INDET), impaired glucose tolerance (IGT) and diabetes (CFRD). The end point of OGTT at 120 minutes significantly improved post CFTRm therapy being 159.7 (80-419.4) compared to 130.4 (54-286) pre-CFTRm (p = 0.047). Regarding the categories sub-classification of patients: Two patients with CFRD improved after CFTRm therapy to NGT or INDET. 2 with INDET pre-therapy improved to NGT post therapy.Of 3 patients with IGT, 2 improved to NGT or INDET and 1 worsened to CFRD. Out of the 6 patients who had NGT pre CFTRm therapy, 4 remained NGT, one worsened to INDET, and one became CFRD. Conclusions: This is the first and largest study so far demonstrating consistent significant improvement in glycemic control in CFRD after CFTRm treatment of at least 3 months duration. Treatment seems to delay and possibly reverse the deterioration in glycemic control that is typical to the natural history of patients with cystic fibrosis. Larger studies are indicated but awareness to the current findings may prevent hypoglycemic events while staying on a fixed insulin dose while on CFTRm therapy. Presentation: Thursday, June 15, 2023

EPS4.04 A stitch in time saves nine – abnormal glucose tolerance in patients with cystic fibrosis: systematic review and meta-analysis

Objectives: Basic science results suggest that abnormalities of the endocrine pancreas in cystic fibrosis (CF) occur earlier than was believed so far. All stages of the spectrum of glucose metabolism disorders are associated with increased morbidity and mortality which could be reduced by early recognition and treatment. However, screening for abnormal glucose tolerance (AGT) is recommended only from the age of 10 according to the actual guidelines. We conducted a systematic review and meta-analysis on the prevalence of abnormal glucose tolerance in patients with CF with a focus on children under 10 years of age.

Extracellular volume fraction of the pancreas predicts glucose intolerance in patients undergoing major pancreatic surgeries

PurposePancreatic T1 value and extracellular volume fraction (ECV) are potential imaging biomarkers for pancreatic exocrine and endocrine function. This study aims to evaluate the ability of native T1 value and ECV of the pancreas in predicting postoperative new-onset diabetes (NODM) and worsened glucose tolerance in patients undergoing major pancreatic surgeries. MethodsThis retrospective study involved 73 patients who underwent 3 T pancreatic MRI with pre- and postcontrast T1 mapping before major pancreatic surgeries. Patients were divided into non-diabetic, pre-diabetic and diabetic groups based on their glycated hemoglobin (HbA1c) value. Preoperative native T1 value and ECV of the pancreas were compared among the three groups. The correlation of pancreatic T1 value and ECV with HbA1c was assessed by linear regression analysis, and the ability of pancreatic T1 value and ECV for predicting postoperative NODM and worsened glucose tolerance was assessed using Cox Proportional hazards regression analysis. ResultsNative pancreatic T1 value and ECV were both significantly higher in diabetic patients compared to pre-diabetic/non-diabetic patients, and ECV was also significantly higher in pre-diabetic patients compared to non-diabetic patients (all p < 0.05). Both native pancreatic T1 value and ECV showed positive correlation with preoperative HbA1c value (r = 0.50 and 0.55, respectively, both p < 0.001). ECV > 30.7% was the only independent predictor for NODM (HR = 5.687, 95% CI: 1.557, 13.468, p = 0.012) and worsened glucose tolerance (HR = 6.783, 95% CI:, 1.753, 15.842, p = 0.010) after surgery. ConclusionsPancreatic ECV predicts the risk of postoperative NODM and worsened glucose tolerance in patients undergoing major pancreatic surgeries.

Impaired Glucose Tolerance in Patients with Polycystic Ovarian Syndrome

Background: Polycystic ovary syndrome first described by Stein and Leventhal, is a complex genetic trait of unclear etiology characterized by Oligomenorrhea or anovulation, biochemical or clinical hyperandrogenism and polycystic ovarian morphology on ultrasonography. Women with polycystic ovarian syndrome have an increased risk of developing impaired glucose tolerance and type 2 diabetes mellitus. This study aims to determine the prevalence of impaired glucose tolerance in patients with polycystic ovary syndrome. Study Design: Cross-sectional study Study Duration: This study was conducted in the Department of Endocrinology Ayub Teaching Hospital Abbottabad from 1st Nov 2021 to 30th April 2022. Materials and Methods: All patients with age range 16 to 40 years who were diagnosed with polycystic ovarian syndrome were included in the study. Age, ovarian volume, clinical signs of hyperandrogenism, menstrual abnormalities, serum testosterone, blood glucose at baseline and following 75g of oral glucose load, Body mass index etc. were recorded. Data was analyzed using SPSS-23. Results: Among 139 patients, 35(25.2%) were in the age range 16-25 years while 104(74.8%) were in the age range 26-40 years. Mean age was 28.6(SD±4.2) years. 69(49.6%) patients had BMI&gt; 30 Kg/m2, 60(43.2%) had BMI between 25-29.9 Kg/m2, while only 10(7.2%) patients had their BMI within normal range (18.5-24.9). Mean BMI was 30.7 Kg/m2 (SD±4.4). 47(33.8%) patients had ovarian volume less than 25ml while, 92(66.2%) had ovarian volume greater than 25ml. Mean ovarian volume was 25.5(SD±6.7). 106(76.3%) patients had serum testosterone less than 70ng/dl while, 33(23.7%) had serum testosterone greater than 70ng/dl. Mean serum testosterone was 48.8(SD±26.4). Hirsutism and Acne was observed in 92 (66.2%) and 91(65.5%) patients respectively. 75 (54%) women had positive family history of Diabetes, 56 (40.3%) had family history of polycystic ovary syndrome and 71 (51.1%) patients had past or current history of oral contraceptive pills. Impaired glucose tolerance was found in 52(37.4%) patients. Post stratification results were statistically significant. Conclusions: The prevalence of impaired Glucose tolerance with polycystic ovary syndrome can be as high as 37.4%. Increasing age and Body Mass Index, raise serum testosterone level and increasing ovarian volume are significant predictors for developing impaired glucose tolerance in women with polycystic ovary syndrome. Keywords: Polycystic Ovarian Syndrome, Impaired Glucose Tolerance, Predictive Factors.

Formulation and Evaluation of Metformin Hydrochloride Sustained Release Tablet

Metformin hydrochloride (MET) is an oral hypoglycemic agent which improves glucose tolerance in patients with type 2 diabetes and diminishes basal plasma levels of glucose. The aim of this study was to develop and optimize MET matrix tablets for SR application. The SR matrix tablet of MET was prepared by wet granulation technique using Polyvinyl pyrrolidone K30 and hydroxyl propyl methylcellulose of different viscosity grades (HPMC K4M, HPMC K15M, and HPMC K100M). The influence of varying the polymer ratios was evaluated. The excipients used in this study did not modify physicochemical properties of the drug. MET has relatively short plasma half-life, low absolute bioavailability. The need for the administration 2 to 3 times a day when larger doses are required can decrease patient fulfillment. SR formulation that would maintain plasma level for 8-12 h might be sufficient for daily dosing of MET. SR products are needed for MET to prolong its duration of action and to improve patient compliances. The development of oral sustained release systems has been a challenge to formulation scientists due to their inability to restrain and localize the system at targeted areas of the gastrointestinal tract. From all the formulation trial batches, formulation F3 shows the best results. It has been observed that HPMC K100M alone cannot give satisfactory drug release profile but the blend of HPMC K100M and Polyvinyl pyrrolidone K30 together give the best drug release kinetics. Thus, sustained release matrix tablets of metformin hydrochloride can be expected to reduce the frequency of administration and decrease the dose dependent side effects. Keywords: Metformin hydrochloride, SR matrix tablet, HPMC K100M, Wet granulation technique

Pilot Trial on the Effect of 5-Aminolevulinic Acid on Glucose Tolerance in Patients with Maternally Inherited Diabetes and Deafness.

The amino acid 5-aminolevulinic acid (5-ALA) is the first heme biosynthetic precursor. The combination of 5-ALA with sodium ferrous citrate (SFC) enhances heme production, leading to increased adenosine triphosphate (ATP) production in mitochondria. We investigated whether administering 5-ALA/SFC improves glucose tolerance with an increase in insulin secretion in patients with maternally inherited diabetes and deafness (MIDD), which is characterized by an insulin secretory disorder due to impaired mitochondrial ATP production. This was a single-arm, open-label, interventional study. We prospectively administered the oral glucose tolerance test (OGTT) twice in five patients with MIDD who had received intensive insulin therapy: before and 24weeks after an administration of 5-ALA/SFC (200/232mg per day). We measured the concentrations of glucose, insulin, C-peptide, and proinsulin at fasting, and 30, 60, and 120min after glucose load in each OGTT. The primary endpoint was the changes in the area under the curve (AUC) of serum insulin from 0 to 120min during OGTT from baseline to 24weeks. The serum insulin AUC (µU/mL) during the 120-min OGTT tended to increase from baseline to 24weeks but not significantly (17.1 ± 13.7 versus 22.3 ± 13.4, p = 0.077). The plasma glucose AUC (mg/dL) during the 120-min OGTT at 24weeks was not significantly decreased; the late phase of glucose excursion from 60 to 120min was significantly decreased compared with baseline (357 ± 42 versus 391 ± 50, p = 0.041). The mean level of glycated hemoglobin (HbA1c) decreased from 8.3 ± 1.2% at baseline to 7.9 ± 0.3% at 24weeks (p = 0.36) without increasing the daily dose of insulin injections. The 24-week administration of 5-ALA/SFC did not demonstrate a significant improvement in insulin secretion in patients with MIDD. Further investigations with a larger number of patients and a placebo control group are required to clarify the potential efficacy of 5-ALA/SFC for ameliorating mitochondrial dysfunctions in MIDD. UMIN-CTR000040581 and jRCT071200025.

ODP158 A Pilot Trial on the Efficacy of 5-Aminolevulinic Acid on Glucose Tolerance in Patients with Maternally Inherited Diabetes and Deafness

Abstract Objective Maternally inherited diabetes and deafness (MIDD) is characterized by progressive insulin secretory disorder caused by impairment of mitochondrial adenosine triphosphate (ATP) production in pancreatic beta-cells. The amino acid 5-aminolevulinic acid (5-ALA) is the first heme biosynthetic precursor and the administration of 5-ALA combined with sodium ferrous citrate (SFC) enhance heme production, leading to improvement of mitochondrial function and ATP production. Several studies showed that the treatment with 5-ALA/SFC improved glycemic tolerance in both patients with prediabetes and those with type 2 diabetes. However, no previous studies investigated the efficacy of 5-ALA in patients with MIDD. We carried out the pilot trial to investigate whether the administration of 5-ALA/SFC can improve insulin secretion and glucose tolerance in patients with MIDD. Methods We enrolled five patients with MIDD receiving multiple daily injections of insulin. The patients were administered 5-ALA/SFC 100 mg twice a day (200 mg per day) for 24 weeks as adjunctive to insulin treatment. The patients underwent a 75-g oral glucose tolerance test (OGTT) twice before (1 st -OGTT) and 24 weeks after the initiation of 5-ALA/SFC (2 nd -OGTT). We measured levels of plasma glucose, insulin, and glucagon at fasting (0 min), and 30, 60 and 120 min after glucose load (Study protocol: Nakamura Y et al. Medicine (Baltimore). 2021; 100: e25100). Results The mean levels of HbA1c tended to decrease from 8.3% to 7.9% (p = 0.36) even though total insulin doses had not changed during the 24 weeks of 5-ALA/SFC administration. In the 2nd -OGTT comparing to the 1 st -OGTT, four of the five patients showed a tendency of improvement in glucose levels with a certain degree of insulin increase, but one patient did not show any improvement. The means of area under the curve (AUC) of serum insulin from fasting to 120 min during 2nd -OGTT was 30% larger but not significant compared to that during 1st -OGTT (p = 0. 077). The late phase of glucose excursion during OGTT determined by AUC of plasma glucose from 60 to120 min during 2nd -OGTT showed 10% reduction compared to that during 1st -OGTT (p = 0. 041). The glucagon levels during OGTT were comparable between before and after 5-ALA/SFC administration. The indexes of insulin sensitivity calculated by the homeostasis model assessment of insulin resistance or Matsuda index were not significantly changed between before and after 5-ALA/SFC administration. None of the patients experienced any adverse events during the study. Conclusions The administration of 5-ALA/SFC as adjunctive to insulin therapy might be a novel effective treatment for MIDD that improves insulin secretion via amelioration of mitochondrial function. Presentation: No date and time listed

Genetic variability in the cholecystokinin A receptor affects lipid profile and glucose tolerance in patients with polycystic ovary syndrome

IntroductionCholecystokinin (CCK) is involved in several metabolic pathways and CCK agonist are considered as potential novel treatment option in populations with increased metabolic risk, including polycystic ovary syndrome (PCOS). As genetic variability of cholecystokinin A and B receptor genes (CCKAR and CCKBR, respectively) may modify its biological actions, we investigated the impact of CCKAR and CCKBR genetic variability on anthropometric and metabolic parameters in patients with PCOS.Material and methodsOur cross-sectional study included 168 patients with PCOS and 82 healthy female controls genotyped for polymorphisms in CCKAR (rs6448456 and rs1800857) and CCKBR (rs2929180, rs1800843, rs1042047 and rs1042048) genes.ResultsThe investigated polymorphisms were not associated with anthropometric characteristics of patients with PCOS, however, among healthy controls carriers of at least one polymorphic CCKBR rs1800843 allele had bigger waist circumference (p=0.027) and more visceral fat (p=0.046). Among PCOS patients carriers of at least one polymorphic CCKAR rs6448456 C allele had significantly higher total blood cholesterol and LDL, and significantly lower blood glucose levels after 30, 60 and 90 minutes of the oral glucose tolerance test (all p&lt;0.05). Healthy controls with at least one polymorphic CCKAR rs1800857 C allele were less likely to have high metabolic syndrome burden (p=0.029).ConclusionsGenetic variability in CCKAR affects lipid profile and post-load glucose levels in patients with PCOS and is associated with metabolic sydrome burden in healthy young women. Further investigation of the role of genetic variability in CCKAR and CCKBR could contribute to development of individually tailored treatment strategies with CCK receptor agonists.

The effects of dietary fiber on common complications in critically ill patients; with a special focus on viral infections; a systematic reveiw.

BackgroundViral infections are mostly highly contagious and may cause widespread health problems. Some studies reported that the dietary fiber (DF) may be effective in reducing the complications of viral infections in intensive care unit (ICU) patients. The present review study aimed to investigate the effect of DF on common complications in critically ill patients with viral infections.MethodsA literature review was conducted for the published papers in English from January 2001 to July 2021 using related keywords. Studies with clinical trial or case‐control design described the effects of fiber intake on the complications of viral infections in patients admitted to the ICU were collected.ResultsDF may reduce the mortality rate of viral infections through modulating inflammatory processes. A higher intake of DF intake may improve hyperglycemia and impaired glucose tolerance in patients with viral infections. A high‐fiber formula in enteral nutrition was reported to reduce the risk of diarrhea in patients with viral infections.ConclusionDF may reduce the complications of viral infections such as inflammation, diarrhea, hyperglycemia, and mortality in critically ill patients. Future longitudinal studies on the amount and type of DF are warranted.

High Albumin Level Is Associated With Regression of Glucose Metabolism Disorders Upon Resolution of Acute Liver Inflammation in Hepatitis B-Related Cirrhosis.

Background and AimTo investigate the short-term dynamic changes and the factors associated with regression of glucose metabolism disorders in patients with hepatitis flare of chronic hepatitis B virus (HBV) infection.MethodsIn this study, 118 patients with severe hepatitis flare of chronic HBV infection were prospectively studied. Oral glucose tolerance test was performed on admission and during follow-up to evaluate dynamic changes in glucose metabolism disorders. The factors associated with regression of glucose metabolism disorders were identified using univariate and multivariate logistic regression analyses.ResultsThe prevalence of diabetes was significantly higher in 70 (47.1%) patients with liver cirrhosis than that in 48 (16.8%) patients without liver cirrhosis. The prevalence of impaired glucose tolerance in patients with liver cirrhosis (35.7%) was significantly lower than that in patients without liver cirrhosis (47.8%). After a follow-up of 20.0 ± 18.7 days, 28 of 31 (90.3%) patients without liver cirrhosis experienced regression of glucose metabolism disorders. Additionally, 30 (54.5%) patients with liver cirrhosis experienced regression of glucose metabolism disorders after 42.0 ± 36.2 days. In patients with liver cirrhosis, those with regression of glucose metabolism disorders had significantly higher levels of homeostasis model assessment-β-cell function, albumin (ALB), and a significantly lower level of fibrosis-4 score. ALB was identified as an independent factor associated with the regression of glucose metabolism disorders in patients with liver cirrhosis.ConclusionSevere acute liver inflammation aggravates glucose metabolism disorders in patients with hepatitis B-related liver cirrhosis and high ALB level is associated with regression of glucose metabolism disorders upon resolution of acute liver inflammation.

Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in Patients with Covid-19

Objective: The aim of this study is to determine the prevalence of diabetes mellitus and impaired glucose tolerance in patients with COVID-19. Study Design:Cross-sectional study Place and Duration:Conducted at department of Medicine, Khyber Teaching Hospital (KTH),Peshawer and Avicenna Teaching Hospital, Lahorefor the duration from July 2020 to December 2020. Methods: There were one hundred and fifteen patients of both genders had coronavirus disease were included in this study.Patients ranged in age from 25 to 80 years.After obtaining informed written permission, we collected detailed demographic information on all of the registered patients, including their age, gender, BMI, educational attainment and place of residence. All of the patients had their blood tested for corona disease using RT-PCR. After screening positive (fasting capillary glucose &gt;100 mg/dl and 200 mg/dl) and each sixth consecutive negative (fasting capillary glucose &lt;100 mg/dl) subjects, the 75-g oral glucose tolerance test was administered. The SPSS 23.0 software was used for analyzing of data. Results:Included patients had mean age 59.4±12.55 years with mean body mass index 29.12±11.76 kg/m2. There were 70 (60.9%) male patients and 45 (38.1%) females. Majority of the patients were illiterate 65 (56.5%) and 49 (42.6%) patients were from urban areas. Most common co-morbidities were hypertension, hyperlipidemia, chronic kidney disease and coronary artery disease. We found 62 (53.9%) patients had diabetes mellitus in which majority of the cases were pre-existing. Frequency of impaired glucose tolerance was found among 26 (22.6%) cases in which majority of the cases had pancreatic cancer. 28 (24.4%) cases had intubation. Overall mortality was found among 18 (15.3%) cases. Conclusion:This research found that people with diabetes and poor glucose metabolism are more likely to have severe Covid-19. A previously undiagnosed symptom of primary infection has been linked to a disorder in glucose metabolism. Pathways through which SARS-CoV-2 affects glucose metabolism must be investigated if disease aetiology is to be fully understood. Keywords:Coronavirus, DM, IGT, Co-morbidities, Mortality

Prevalence of Impaired Oral Glucose Tolerance in Patients with Polycystic Ovarian Syndrome

Objectives: To find the prevalence of PCOS in patients with menstrual irregularities and then to find the prevalence of impaired glucose tolerance among patients with PCOS. Study design: Descriptive cross sectional Place and Duration of Study: Department of Obstetrics and Gynecology, District Headquarter Hospital, Gujranwala from 1st November 2017 to 2nd May 2018. Methodology: Two hundred and twenty threepatients with menstrual irregularities were included In the study. Rotterdam classification criteria were used for proper identification of polycystic ovarian syndrome facilitated by clinical investigation. These patients were called for the oral GTT as explained in operational definitions. All blood samples were sent to our hospital laboratory. Results: Mean age of women was 32.54±7.54 years. Among women, 120 (53.8%) had family history of diabetes. Impaired glucose tolerance was confirmed in 55(24.7%) patients. Women who were diagnosed with PCOS among them impaired glucose tolerance was confirmed in 20(18.2%) patients. Conclusion: Glucose tolerance frequency was not significantly higher. However elderly and obese women had higher frequency of impaired glucose tolerance. Key words: PCOS, Menstrual irregularities, Impaired, Glucose, Tolerance

High prevalence of undiagnosed impaired glucose tolerance in patients with rheumatoid arthritis.

Objectives:Although the risk of diabetes mellitus has been recognised in rheumatoid arthritis, undiagnosed dysglycaemia remained under-reported. The study aimed to determine the prevalence and associated factors of dysglycaemia among patients with rheumatoid arthritis, utilising the oral glucose tolerance test.Methods:This cross-sectional study involved patients with rheumatoid arthritis, aged ⩾30 years. Following an oral glucose tolerance test, they were divided into two: dysglycaemia and normoglycaemia. Demographic and laboratory parameters were compared using logistic regression analyses.Results:There were 35.5% (55/155) patients with dysglycaemia (including 25.8% impaired glucose tolerance, 7.1% diabetes mellitus and 1.9% with both impaired fasting glucose and impaired glucose tolerance). Patients with dysglycaemia were heavier (65.5 ± 12.3 versus 60.7 ± 10.6 kg, p = 0.01), had wider waist (89.0 ± 12.5 versus 83.1 ± 9.6 cm, p < 0.01), lower high-density lipoprotein cholesterol (1.4 ± 0.3 versus 1.5 ± 0.4 mmol/L, p = 0.02), higher triglyceride (1.3 (0.9–1.8) versus 0.9 (0.8–1.2) mmol/L, p < 0.01) and intercellular adhesion molecule-1 (361.79 (290.38–481.84) versus 315.92 (251.45–407.93) ng/mL, p = 0.01). History of smoking (odds ratio: 5.70, confidence interval: 1.27–25.7), elevated triglyceride (odds ratio: 2.87, confidence interval: 1.33–6.22) and intercellular adhesion molecule-1 (odds ratio: 1.003, confidence interval: 1.001–1.006) were significantly associated with dysglycaemia.Conclusions:Prevalence of undiagnosed dysglycaemia, particularly impaired glucose tolerance, was high in these patients with rheumatoid arthritis, using a 75-g oral glucose tolerance test, which was not associated with disease activity or corticosteroid use. Those with high triglyceride, history of smoking and elevated intercellular adhesion molecule-1 were the two significant predictors for dysglycaemia in our patients with rheumatoid arthritis. Oral glucose tolerance test could be an important laboratory investigation for dysglycaemia in these high-risk patients.

Increased glycated albumin levels in patients with acromegaly related to glucose fluctuation caused by growth hormone excess but not albumin metabolism.

Acromegaly is often complicated by impaired glucose tolerance. The accuracy of glycated hemoglobin (HbA1c) and glycated albumin (GA) levels in representing glycemic profiles in patients with endocrine disorders, such as acromegaly, is unclear. This retrospective study reviewed data from patients whose GA levels had been recorded. 14 patients with acromegaly without diabetes mellitus (DM) (the acromegaly group), 15 patients with severe adult GH deficiency without DM (the growth hormone deficiency (GHD) group), and 55 nondiabetic patients (the control group) were included in this study. GA levels were significantly increased in the acromegaly group compared with the control and GHD groups, but no significant differences were observed between the control and GHD groups. The three groups were matched using propensity score matching (13 patients with acromegaly, 13 with GHD, and 13 control patients). Nonetheless, the results after matching were the same as those before matching. GA levels in the acromegaly group were significantly associated with plasma glucose (PG) levels at 0, 30, and 120 min after a 75-g oral glucose tolerance test (OGTT). Further, GH levels at 120 min after a 75-g OGTT in the acromegaly group were significantly correlated with GA levels and the difference in PG levels at baseline and 30 min. Our findings suggest that increases in PG levels attributable to excess GH after glucose loading are related to increases in GA levels in patients with acromegaly without DM. Hence, both HbA1c and GA should be checked to accurately assess impaired glucose tolerance in patients with acromegaly.

Association of Acrochordons with Diabetes Mellitus - A Hospital based Case Control Study

Introduction Acrochordons or skin tags are common benign cutaneous tumors that occur especially over the neck and major flexures. A possible association with diabetes mellitus and dyslipidemia is observed in numerous past studies with varying results. We aim to find out the association of diabetes mellitus with acrochordons Methods: One hundred patients were enrolled in our study. Among them, 50 (27 males and 23 females) with skin tags were selected as cases and 50 with other dermatologic diseases after matching age and gender were taken as controls. Blood glucose levels including both fasting and post-prandial glucose levels were determined for both cases and controls and compared. Results: There was a higher frequency of Diabetes Mellitus and impaired glucose tolerance in patients with skin tags in comparison to controls (p&lt;0.001). Moreover, there were higher odds of acquiring skin tags in patient with abnormal blood glucose levels. Conclusions: There is an increased risk of developing DM in patients with skin tags. It is highly recommended that suspicion for Diabetes Mellitus is to be done in patients with skin tags for early screening and diagnosis of diabetes.

A Possible Advantage of Glucagon-Like Peptide 1 Receptor Agonist in Kidney Transplant Recipients With Type 2 Diabetes

Diabetic kidney disease (DKD), a devastating complication of diabetes, is one of the leading causes of end stage kidney disease (ESKD). Kidney transplantation provides superior outcomes for ESKD patients with type 2 diabetes, giving opportunities to be free from dialysis, but needs lifetime immunosuppressive medications to avoid graft kidney rejection. Post-transplant hyperglycemia, however, remains to be unsolved, because immunosuppressive agents, including glucocorticoids and calcineurin inhibitors, may result in impaired insulin secretion and sensitivity. Safe and promising anti-diabetic strategy is long-awaited among kidney transplant recipients (KTRs) with type 2 diabetes. Enormous evidence has accumulated that Glucagon-like peptide 1 (GLP-1) receptor agonists have potential to maintain kidney function as well as improve glucose tolerance in patients with DKD. The present study was designed to elucidate the association between GLP-1 receptor agonist use and better graft kidney function in KTRs with type 2 diabetes. Among KTRs with type 2 diabetes between 2012 and 2019, 73 with GLP-1 receptor agonist use and 73 without GLP-1 receptor use were identified in our center. After propensity matching, 50 KTRs were newly initiated with GLP-1 receptor agonist use or other antidiabetic medications. Baseline characteristics were well-balanced in the 2 groups. KTRs with GLP-1 receptor agonist use had greater kidney function 12 months after initiation of GLP-1 receptor agonists, compared to their counterpart KTRs without GLP-1 receptor agonists, according to estimated glomerular filtration ratio (p=0.01). Interestingly, transient decrease of body mass index was observed in KTRs with GLP-1 receptor agonist use during the 12 months. All GLP-1 receptor agonist-initiated KTRs were followed up through December 31, 2019. In conclusion, GLP-1 receptor agonist treatment was associated with better graft kidney function in KTRs with type 2 diabetes. Pharmacological GLP-1 receptor activation showed favorable tolerability and may alleviate graft kidney damage in KTRs with type 2 diabetes.

Role of Wnt signaling pathways in type 2 diabetes mellitus.

Type 2 diabetes mellitus (T2DM) has become a major global public health issue in the twenty-first century and its incidence has increased each year. Wnt signaling pathways are a set of multi-downstream signaling pathways activated by the binding of Wnt ligands to membrane protein receptors. Wnt signaling pathways regulate protein expression and play important roles in protecting the body's normal physiological metabolism. This review describes Wnt signaling pathways, and then aims to reveal how Wnt signaling pathways participate in the occurrence and development of T2DM. We found that Wnt/c-Jun N-terminal kinase signaling was closely associated with insulin resistance, inflammatory response, and pancreatic β-cell and endothelial dysfunction. β-catenin/transcription factor 7-like 2 (TCF7L2)-mediated and calcineurin/nuclear factor of activated T cells-mediated target genes were involved in insulin synthesis and secretion, insulin degradation, pancreatic β-cell growth and regeneration, and functional application of pancreatic β-cells. In addition, polymorphisms in the TCF7L2 gene could increase risk of T2DM according to previous and the most current results, and the T allele of its variants was a more adverse factor for abnormal pancreatic β-cell function and impaired glucose tolerance in patients with T2DM. These findings indicate a strong correlation between Wnt signaling pathways and T2DM, particularly in terms of pancreatic islet dysfunction and insulin resistance, and new therapeutic targets for T2DM may be identified.

Glucose tolerance in patients with and without type 2 diabetes mellitus during hemodialysis

AimsThe disposal of a glucose bolus was studied to identify glucose metabolism in patients with and without type 2 diabetes mellitus (T2DM) during their regular hemodialysis (HD) treatment. MethodsPlasma glucose, insulin, and c-peptide concentrations were measured during a 60 min observation phase following a rapid glucose infusion (0.5 g/kg dry weight). Glucose disposition and elimination rates were determined from kinetic analysis, and insulinogenic index was calculated. Insulin resistance (RHOMA) was determined by homeostatic model assessment (HOMA). Results35 HD patients (14 with T2DM) distinguished by a higher age (median: 70 vs. 55 y, p < 0.01) in T2DM patients were studied. Glucose kinetic data showed only small differences between patients with or without T2DM, but as RHOMA measured in all patients increased, a larger fraction of glucose was removed by the extracorporeal system (r = 0.430, p = 0.01). One hour after glucose bolus injection the glucose level was not different from that before HD also in patients with T2DM (p = 0.115). ConclusionsThe larger glucose amount recovered in dialysate in patients with increasing RHOMA indicates that impaired glucose disposal could be measured during HD using a non-invasive dialysis quantification approach without blood sampling. Glucose infusion during HD is safe also in patients with T2DM.