Glycemic Abnormalities Research Articles

Cystic fibrosis-related diabetes: an update on pathophysiology, diagnosis, and treatment.

Cystic fibrosis (CF) is a highly prevalent autosomal recessive disorder that is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene (7q31.2), which encodes the CFTR chloride-anion channel that is expressed in several tissues. Life expectancy has increased significantly over the past few decades due to therapeutic advances and early diagnosis through neonatal screening. However, new complications have been identified, including CF-related diabetes (CFRD). The earliest detectable glycemic abnormality is postprandial hyperglycemia that progresses into fasting hyperglycemia. CFRD is associated with a decline in lung function, impairments in weight gain and growth, pubertal development, and increased morbidity and mortality. Annual screening with oral glucose tolerance test is recommended beginning at the age of 10, and screenings are recommended for any age group during the first 48h of hospital admission. Fasting plasma glucose levels ≥126mg/dL (7.0mmol/L) or 2-h postprandial plasma glucose levels ≥200mg/dL (11.1mmol/L) that persist for more than 48h are diagnostic criteria for CFRD. Under stable health condition, the diagnosis is made when laboratory abnormalities in accordance with the American Diabetes Association criteria are detected for the first time; however, levels of HbA1c <6.5% do not rule out the diagnosis. Treatment for CFRD includes insulin replacement and a hypercaloric and hyperproteic diet that does not restrict carbohydrates, fats or salt, and diabetes self-management education. The most important CFRD complications are nutritional and pulmonary disease deterioration, though the microvascular complications of diabetes have already been described.

MON-381 Endocrinological Evaluation of Adult Thalassemia Patients

Background: Endocrine disorders are among the most common complications in thalassemia patients. Although cardiac complications are the main cause of mortality, endocrinological disturbances have a significant impact on morbidity and quality of life. Methods: Sixty-eight patients (35 F, 33 M; 60 thalassemia major, 8 thalassemia intermedia) admitted to our outpatient clinic between August 2015 - December 2017 were included in the study. Patients were evaluated for short stature, hypogonadism, glycemic abnormalities, hypoparathyroidism, hypothyroidism and osteoporosis. Results: The average height of thalassemia major patients was 165.67±8.8 cm in men and 155.6±6.6 cm in women. Nine patients had short stature (4 F, 5 E), but 91.5% (54/59) of the whole group had low IGF-1 levels. There were 23 thalassemia major patients (11 F, 12 M) who had a history of hormonal induction therapy for delayed puberty. Overall, 60% (n = 36) of the patients were currently receiving hormone replacement therapy for central hypogonadism (19 F, 17 M). The median age at diagnosis of central hypogonadism was 22.5 years in men (IQR: 16.5-27.5) and 18 years in women (IQR: 16-25). There were five diabetic thalassemia major patients in study group whose median age at diagnosis was 20 (16-36). Of the 47 patients who underwent OGTT, 13 thalassemia major patients had prediabetes (27.7%). None of the thalassemia intermedia patients had glycemic abnormalities. Subclinical hypothyroidism was present in 19.7% (13/66) of the whole group, hypoparathyroidism was found in 8.5% (9/59) of thalassemia major patients, and vitamin D deficiency (25OH D < 20 ng/ml) was found in 70.8% (46/65) of all patients. Of 64 patients who underwent BMD, 25 had osteoporosis (39.1%) while 23 hadosteopenia (35.9%). The incidence of pathological fractures in thalassemia major patients was 20% (11/55). Conclusions: The incidence of endocrine disorders may increase in thalassemia patients due to prolonged duration of lifespan. Regular screening for newly emerging endocrinopathies during adulthood has great value. In our study, the most common endocrine disorders were vitamin D deficiency, hypogonadism, osteoporosis and glycemic abnormalities; respectively. Early diagnosis and treatment would prevent patients from having related morbidities and therefore increase quality of life.

Histological, metabolic, and inflammatory changes in the renal tissues of high-fat diet-induced obese rats after vitamin D supplementation

PurposeObesity is a major risk factor for chronic renal fibrosis and kidneys’ structural and inflammatory impairments. This study aims to examine the possible therapeutic effects of vitamin D supplementation against renal inflammatory and kidney’s structural fibrosis and degeneration.Design/methodology/approachForty male Wistar rats were divided into two groups for 16 weeks: normal diet (ND) and high-fat diet (HFD); then, each group was subdivided into two groups including ND, ND + vitamin D and HFD, HFD + vitamin D. Vitamin D supplementation was done for five weeks at 500 IU/kg dosage. Renal tissue concentrations of tumor necrosis factor (TNF)-α, interleukin 6, interleukin 1 beta, monocyte chemoattractant protein (MCP)-1 and transforming growth factor-beta (TGF-β), serum values of lipids, markers of glucose homeostasis and urea, creatinine and uric acid and renal tissue histological and structural changes were determined.FindingsHFD feeding caused remarkable histological and structural changes including higher TNF-α, MCP-1 and TGF-βconcentrations in renal tissues of rats, whereas vitamin D has potent anti-inflammatory effects (P= 0.036, 0.047 and 0.02, respectively). Vitamin D administration also reduced urea and uric acid concentrations (P= 0.023 and 0.049, respectively). Moreover, vitamin D reduced glomerulomegaly, reduced lipid accumulation and limited dilated Bowman’s space in rats and improved glycemic status by increasing insulin (P= 0.04) and reducing insulin resistance (P= 0.006).Research limitations/implicationsThe current study has some limitations. It was better to measure the level of inflammatory cytokines’ expression in the kidney tissues. Additionally, the measurement of baseline values of inflammatory cytokines was not possible because of the possibility of animals’ drop-out.Practical implicationsAccording to the study findings, vitamin D treatment in the current report showed a significant therapeutic role in reducing inflammation, improving glycemic and lipid abnormalities and structural and histological modifications in renal tissues of rats. These findings have a great value because after confirming in a human model, vitamin D can be suggested as a potential therapeutic tool in clinical practice.Social implicationsAfter being confirmed by other animal or human researches, the results of the current work could have great social implications by reducing the prevalence of obesity-related renal complications and highlighting the beneficial roles of vitamin D.Originality/valueTo the best of the authors’ knowledge, this is the first study to investigate the histological and inflammatory changes in the kidneys and metabolic parameters in the HFD induced rats and also clarified the therapeutic roles of vitamin D in ameliorating the inflammatory, histological, metabolic and functional changes in the kidneys of obese rats.

Increased Mortality Burden in Young Asian Subjects with Dysglycemia and Comorbidities.

Background: High blood glucose level has a linear relationship with all-cause mortality. However, the influence of glycemic abnormality on mortality differs by age group. We aimed to analyze all-cause mortality according to glycemic status, age groups, and comorbidities using a national health database. Methods: The 6,330,369 participants who underwent Korean National Health Screening in 2009 were followed up until 2016, with a median follow-up of 7.3 years. All-cause mortality rates were analyzed according to glycemic status (normoglycemia, impaired fasting glucose [IFG], newly diagnosed diabetes, diabetes duration <5 years, diabetes duration ≥5 years), age groups (20–39, 40–65, and ≥65 years), and comorbidities using the Korean National Health Insurance System database. Results: At baseline, 712,901 (11.3%) subjects had diabetes. Compared with subjects without diabetes, those with diabetes at baseline showed increased mortality risk after adjustment for multiple risk factors (hazard ratio [HR] 1.613; 95% confidence interval [CI] 1.598,1.629), and those with IFG showed a significantly increased mortality risk compared with normoglycemic subjects (HR 1.053; 95% CI 1.042,1.064). Mortality risk associated with glycemic status decreased gradually from younger to older age groups and was consistently higher in those with diabetes with coronary heart disease, ischemic stroke or decreased renal function than those without comorbidities. Conclusion: Compared with normoglycemic subjects, subjects with diabetes and IFG had an increased mortality risk and the mortality risk was higher in the younger age group than in the older age group. The presence of diabetes and comorbid diseases synergistically increased mortality risk.

Increased Particle Size of Triglyceride Remnant Lipoproteins, but not Their Plasma Concentration or Lipid Content, Augment Risk Prediction of Incident Type 2 Diabetes: Prospective Results from ELSA-Brasil

Importance: Type 2 Diabetes (T2DM) prevention requires accurate identification of those at high risk. Plasma triglycerides are predictive for T2DM, but triglyceride remnant lipoproteins (TRL) more accurately reflect pathophysiological changes that underlie progression to T2DM, such as pancreatic steatosis and inflammation. We hypothesized that TRL-related factors could improve risk prediction for development of T2DM. Methods: We included individuals aged 35-74 years from the ELSA-Brasil cohort who had HbA1c and an oral glucose tolerance test at baseline. Regression models were used to predict incident T2DM, starting with medical history and metabolic syndrome traits, followed by TRL-related measurements (plasma concentration, particle size, cholesterol and triglyceride content). TRL features were measured by NMR spectroscopy. Discrimination was assessed with area under receiver operator curves (AUROCs) and net reclassification improvement (NRI). Results: Among 4,466 individuals at-risk, there were 368 new cases of T2DM after 3.7 (SD=0.6) years follow-up. We derived a 14-variable model with AUROC 0.849 (95%CI: 0.842-0.875). Overall TRL-related markers did not improve predictive capacity for T2DM. However, TRL particle diameter (TRLZ) increased AUROC, particularly in individuals with Hba1c<5.7% (n=3,300 and 174 cases of incident T2DM). In this subgroup, AUROC increased from 0.74 (95%CI: 0.72-0.76 – Baseline-model) to 0.80 (95%CI: 0.77-0.84 – Baseline-model + TRLZ) (p-value=0.0002) and NRI by 21.49% (95%CI: 0.5-34.5, p=0.0103). TRLZ was highly correlated with obesity, insulin resistance and inflammation in those with pre-diabetes at baseline, but less so in those with Hba1c<5.7%. Conclusions: TRL particle diameter improves prediction of T2DM, particularly in subjects with no glycemic abnormalities at baseline. Trial Registration: This study is registered with clinicaltrials.gov, NCT02320461. Funding Statement: This study was funded by the Brazilian Ministry of Health (Science and Technology Department) and the Brazilian Ministry of Science, Technology and Innovation (Financiadora de Estudos e Projetos [Finep] and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico [CNPq]). Grant numbers: 01 06 0010.00 and 01.10.0643.03 (RS); 01 06 0212.00 and 01.10.0742-00 (BA); 01 06 0300.00 and 01.12.0284.00 (ES); 01 06 0278.00 and 01 10 0746 00 (MG); 01 06 0115.00 and 01.10.0773-00 (SP); and 01 06 0071.00 and 01.11·0093.01 (RJ). LSFC and RDS are recipients of scholarships from the CNPq grants # 437413/2018-7 and # 303734/2018-3, respectivelly. ACS is a recipient of a scholarship from the CNPq grant # 301465/2017-7 and the Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (Fapesp) grant # 13/07607-8. This study was funded in part by the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (Capes) and the CNPq. Declaration of Interests: RDS has received honoraria related to consulting, research and or speaker activities from: Amgen, Ache, Astra Zeneca, Esperion, Kowa, Merck, Novo-Nordisk, PTC, Pfizer, and Sanofi/Regeneron. The other authors declare that they have no conflict of interest. Ethics Approval Statement: De-identified data was used, and the research protocol was approved by the ethics committee at each institution in Brazil and by the National Research Ethics Committee.

Impact of blood glucose abnormalities on outcomes and disease severity in patients with severe sepsis: An analysis from a multicenter, prospective survey of severe sepsis.

Dysglycemia is frequently observed in patients with sepsis. However, the relationship between dysglycemia and outcome is inconsistent. We evaluate the clinical characteristics, glycemic abnormalities, and the relationship between the initial glucose level and mortality in patients with sepsis. This is a retrospective sub-analysis of a multicenter, prospective cohort study. Adult patients with severe sepsis (Sepsis-2) were divided into groups based on blood glucose categories (<70 (hypoglycemia), 70-139, 140-179, and ≥180 mg/dL), according to the admission values. In-hospital mortality and the relationship between pre-existing diabetes and septic shock were evaluated. Of 1158 patients, 69, 543, 233, and 313 patients were categorized as glucose levels <70, 70-139, 140-179, ≥180 mg/dL, respectively. Both the Acute Physiological and Chronic Health Evaluation II and Sequential Organ Failure Assessment (SOFA) scores on the day of enrollment were higher in the hypoglycemic patients than in those with 70-179 mg/dL. The hepatic SOFA scores were also higher in hypoglycemic patients. In-hospital mortality rates were higher in hypoglycemic patients than in those with 70-139 mg/dL (26/68, 38.2% vs 43/221, 19.5%). A significant relationship between mortality and hypoglycemia was demonstrated only in patients without known diabetes. Mortality in patients with both hypoglycemia and septic shock was 2.5-times higher than that in patients without hypoglycemia and septic shock. Hypoglycemia may be related to increased severity and high mortality in patients with severe sepsis. These relationships were evident only in patients without known diabetes. Patients with both hypoglycemia and septic shock had an associated increased mortality rate.

Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016

Individuals with prediabetes are at increased risk of developing type 2 diabetes, chronic kidney disease, and cardiovascular disease. The incidence and prevalence of type 2 diabetes in the US adolescent population have increased in the last decade. Therefore, it is important to monitor the prevalence of prediabetes and varying levels of glucose tolerance to assess the future risk of type 2 diabetes in the youngest segment of the population. To examine the prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and increased glycated hemoglobin A1c (HbA1c) levels in US adolescents (aged 12-18 years) and young adults (aged 19-34 years) without diabetes. This cross-sectional analyses of the 2005-2016 National Health and Nutrition Examination Survey assessed a population-based sample of adolescents and young adults who were not pregnant, did not have diabetes, and had measured fasting plasma glucose, 2-hour plasma glucose after a 75-g oral glucose tolerance test, and HbA1c levels. Analysis began in April 2017. Impaired fasting glucose was defined as fasting plasma glucose of 100 mg/dL to less than 126 mg/dL, IGT as 2-hour plasma glucose of 140 mg/dL to less than 200 mg/dL, and increased HbA1c level as HbA1c level between 5.7% and 6.4%. The prevalence of IFG, isolated IFG, IGT, isolated IGT, increased HbA1c level, isolated increased HbA1c level, and prediabetes (defined as having IFG, IGT, or increased HbA1c level) were estimated. Fasting insulin levels and cardiometabolic risk factors across glycemic abnormality phenotypes were also compared. Obesity was defined as having age- and sex-specific body mass index (calculated as weight in kilograms divided by height in meters squared) in the 95th percentile or higher in adolescents or 30 or higher in young adults. Of 5786 individuals, 2606 (45%) were adolescents and 3180 (55%) were young adults. Of adolescents, 50.6% (95% CI, 47.6%-53.6%) were boys, and 50.6% (95% CI, 48.8%-52.4%) of young adults were men. Among adolescents, the prevalence of prediabetes was 18.0% (95% CI, 16.0%-20.1%) and among young adults was 24.0% (95% CI, 22.0%-26.1%). Impaired fasting glucose constituted the largest proportion of prediabetes, with prevalence of 11.1% (95% CI, 9.5%-13.0%) in adolescents and 15.8% (95% CI, 14.0%-17.9%) in young adults. In multivariable logistic models including age, sex, race/ethnicity, and body mass index, the predictive marginal prevalence of prediabetes was significantly higher in male than in female individuals (22.5% [95% CI, 19.5%-25.4%] vs 13.4% [95% CI, 10.8%-16.5%] in adolescents and 29.1% [95% CI, 26.4%-32.1%] vs 18.8% [95% CI, 16.5%-21.3%] in young adults). Prediabetes prevalence was significantly higher in individuals with obesity than in those with normal weight (25.7% [95% CI, 20.0%-32.4%] vs 16.4% [95% CI, 14.3%-18.7%] in adolescents and 36.9% [95% CI, 32.9%-41.1%] vs 16.6% [95% CI, 14.2%-19.4%] in young adults). Compared with persons with normal glucose tolerance, adolescents and young adults with prediabetes had significantly higher non-high-density lipoprotein cholesterol levels, systolic blood pressure, central adiposity, and lower insulin sensitivity (P < .05 for all). In the United States, about 1 of 5 adolescents and 1 of 4 young adults have prediabetes. The adjusted prevalence of prediabetes is higher in male individuals and in people with obesity. Adolescents and young adults with prediabetes also present an unfavorable cardiometabolic risk profile, putting them both at increased risk of type 2 diabetes and cardiovascular diseases.

Impaired glucose tolerance and albuminuria in patients with chronic heart failure: a subanalysis of the SUPPORT trial.

AimsThe study aims to evaluate the prognostic significance of impaired glucose tolerance (IGT) with reference to albuminuria in patients with chronic heart failure (CHF).Methods and resultsWe examined 535 CHF patients (mean 66 years, women 25%) in the control arm of our SUPPORT trial, in which we examined additive impact of olmesartan in hypertensive patients with symptomatic CHF treated with β‐blockers and/or angiotensin‐converting enzyme inhibitors. We examined the association between glycaemic abnormality (assessed by 75 g of oral glucose tolerance test) and albuminuria for a composite outcome of all‐cause death, myocardial infarction, stroke, and HF hospitalization. IGT patients (N = 113, mean 67.2 years) were older and more frequently treated with β‐blockers compared with those with normal glucose regulation (N = 142, mean 64.0 years) and those with diabetes mellitus (N = 280, mean 65.7 years). Multivariable Cox proportional hazard models revealed that, as compared with normal glucose regulation (NGR), IGT was associated with increased risk of the outcome when complicated by albuminuria [hazard ratio (HR) 2.25; 95% confidence interval (CI) 1.14–4.42; P = 0.019] but not when uncomplicated by albuminuria (HR 0.76; 95% CI 0.35–1.60, P = 0.47) (P for interaction = 0.041). This was also the case for diabetes mellitus and albuminuria (HR 2.06; 95% CI 1.17–3.61; P = 0.012). Among IGT patients without albuminuria, 21 (29%) developed albuminuria at 1‐year visit, which was again associated with poor prognosis (HR 7.36; 95% CI 1.39–38.98, P = 0.019).ConclusionsThese results indicate that IGT is associated with poor prognosis when complicated by albuminuria in CHF patients, demonstrating the importance of combined early stages of glucose intolerance and renal dysfunction in the management of CHF.

Cystic fibrosis related diabetes: Medical management

Cystic Fibrosis Related Diabetes Mellitus (CFRD) drives excess pulmonary morbidity and mortality in patients with cystic fibrosis (CF). The recommended treatment is insulin therapy. Insulin therapy in CF should be customized to the specific patient. CF patients typically require intensive insulin regimens such as multiple daily injections or insulin pump therapy, but frequently require lower doses than in type 1 diabetes mellitus. Patients with CF may also need insulin to cover intravenous or enteral feedings. Pre-diabetic glycaemic abnormalities are also associated with clinical decline in cystic fibrosis prior to the diagnosis of CFRD, however, whether and how this should be treated is not fully determined. There is also interest, but inadequate data regarding other treatments besides insulin (i.e., oral medications) for treatment of pre-diabetes or CFRD. CFTR potentiator and corrector therapy has yet to demonstrate an effect on the rate of CFRD, but may improve insulin secretion. There is great opportunity for further research to better understand when and how best to treat glycaemic abnormalities in cystic fibrosis.

Glycemic abnormalities and their outcome in critically ill pediatric patients admitted in pediatric intensive care unit of tertiary care hospital

Background: In normal healthy state, human body maintains homeostasis and normal glycemic levels, however in stress associated with any critical states, this control is impaired or lost. Hyperglycemia represents an extreme form of stress. There is no consensus about cut off blood glucose levels to be labeled as hyperglycemia in pediatric age group. Different studies considered different levels of blood glucose as hyperglycemia. Aims & Objectives: To determine frequency of glycemic abnormalities and to correlate this abnormalities with outcome in critically ill children admitted in Pediatric intensive care unit.Methodology: This was a prospective observational study. Total 61 number of cases in the age group of 1month to 17 years were enrolled in the study, by considering inclusion and exclusion criteria.Results: Out of 61 patients, 50.8% were females and 49.2% were males. Out of 61 patients, 73.8% had Hyperglycemia, 24.5% had Euglycemia, 1.6% patient had Hypoglycemia. There was a statistically significant association between hyperglycemia and those cases requiring mechanical ventilation and on vasopressors. Outcome was poor in those cases which had hyperglycemia and the risk of death was 5.78 times more in them.Conclusion: Prevalence of mean hyperglycemia was 80.3%, 72%, 31%, when cut off levels of blood glucose was considered as >126 mg/dl,>150 mg/dl, >200 mg/dl respectively. There was an increased morbidity and mortality in critically ill patients having hyperglycemia. As there are no definite cut off levels of hyperglycemia in critically ill patients, more studies and consensus is needed.

Glycemic Disturbances in Pheochromocytoma and Paraganglioma.

In this review article, we aimed to analyze the available data on pheochromocytomas and paragangliomas as it pertains to their not as well-recognized association with significant glycemic abnormalities in the preoperative, perioperative, and postoperative settings as well as how they should be managed clinically. Pheochromocytomas are rare adrenal tumors that account for about 0.1% of hypertension. Paragangliomas, on the other hand, are even less common and have fewer clinical manifestations. Both types of tumors may have unusual modes of presentation which can challenge even the most experienced clinicians and are easy to overlook, resulting in post-mortem diagnosis. We wish to draw further attention to the life-threatening effects on glucose and insulin homeostasis that can occur in the form of hyperglycemic and hypoglycemic states. Hyperglycemia is a result of a glucose intolerant state created in the setting of catecholamine excess, which can present in the form of resistant diabetes, diabetic ketoacidosis (DKA), or even hyperglycemic hyperosmolar states (HHS). In many reported cases, these abnormalities resolve with resection of the tumor. However, past clinicians have also described a state of "reactive hypoglycemia" that can occur following tumor resection, further emphasizing the need for very close perioperative and postoperative monitoring. Severe hypoglycemia may also occur with inherited diseases linked to pheochromocytoma such as von Hippel-Lindau (VHL) disease as well as predominantly epinephrine-producing tumors, given some of the dramatic downstream effects of alpha and beta adrenoceptor agonization. While much of the data remains anecdotal, clinicians will benefit from the awareness of the protean manifestations of these tumors and the varied and lesser-known effects on glucose and insulin homeostasis.

Abstract P076: Regression of Prediabetes and Diabetes is Associated with Mild Weight and Waist Loss - ELSA-Brasil

Introduction: The prevalence of diabetes has risen dramatically in the last decades. Prediabetes, or intermediate hyperglycemia, represents an early stage of diabetes development. Structured diabetes prevention programs can lead to regression of prediabetes, but observational studies may reflect better a real-world scenario for public health planning. Hypothesis: We assessed the hypothesis that regression of prediabetes to normoglycemia (and from newly diagnosed diabetes to prediabetes) is associated with weight loss and with decrease in waist circumference in a well-characterized, nonintervention contemporary cohort, ELSA-Brasil. Methods: We enrolled 15105 civil servants (34-75 years) in 6 capital cities in Brazil from 2008-10 and followed those without previously known diabetes for an average of 3.7 years. We performed a standardized oral glucose tolerance test and measured fasting and 2h plasma glucose as well as HbA1c in a central laboratory. Diabetes and prediabetes were defined using American Diabetes Association criteria at each visit. We measured weight and waist circumference with standardized protocols and obtained sample characteristics by questionnaire. Those with abnormal glycemia were instructed to seek medical attention. Results: Of the 6301 participants with prediabetes at baseline not receiving anti-diabetic medication at either visit, 1671 (27%) had regressed to normal values at follow-up. In Poisson regression analyses adjusting for age, sex, race, family history of diabetes and baseline BMI, glycemia and physical activity, in comparison with those with no change or weight gain, those with weight loss ≤2.05kg had a 30% greater probability of returning to normoglycemia (RR=1.30; 95%CI 1.17-1.43) and those with greater weight loss had a 59% greater probability (RR=1.59; 1.44-1.75). Findings were similar for a decreased waist circumference in comparison to no change or a gain (≤2.6cm loss: RR=1.18; 1.05-1.31; &gt;2.6cm loss: RR=1.52; 1.37-1.68). Of the 661 participants newly ascertained with diabetes at baseline and not receiving medication at either visit, 375 (57%) had non-diabetic values at follow-up. Regression among these newly ascertained cases was also greater among those with decreased weight or waist circumference, though only statistically significant for those with a greater decrease in weight (&gt;2.7kg loss: RR=1.39; 1.19-1.62) or waist circumference (&gt;2.6cm loss: RR=1.35; 1.14-1.61) Conclusion: Small decreases in weight or waist circumference in a free-living population not receiving structured interventions to prevent diabetes can lead to important improvement in glycemia, with impact on the prevalence of prediabetes and newly ascertained diabetes.

Glycaemic variability is associated with severity of coronary artery disease in patients with poorly controlled type 2 diabetes and acute myocardial infarction

BackgroundIn patients with type 2 diabetes (T2D), glycaemic variability (GV), another component of glycaemic abnormalities, is a novel potentially aggravating factor for coronary artery disease (CAD).Objectives: The aim of our study was to identify interactions between GV and severity of CAD in diabetes patients admitted for acute myocardial infarction (AMI). MethodsAll patients with T2D admitted to our university hospital for AMI from March 2015 to February 2017 who received intravenous (IV) insulin therapy and underwent coronary angiography were included. GV was assessed by mean amplitude of blood glucose excursion (MAGE) values taken within 2 days of admission. Patients with higher GV (highest MAGE tertile) were compared with those with lower GV (first and second MAGE tertiles). ResultsA total of 204 patients were included: median age was 72 (61–81) years; 32% were female; HbA1c was 7.3% (6.4–8.2%); diabetes duration was 10 (2–17.5) years; and MAGE value was 0.65 (0.43–0.92) g/L. Compared with those with lower GV, patients with the highest GV were more often women, treated with previous insulin, and had higher blood glucose and HbA1c levels. In addition, patients with elevated GV had significantly higher SYNTAX scores: 17 (10–28) vs. 12 (6–22) (P = 0.009). Indeed, SYNTAX scores (OR: 1.05, 95% CI: 1.02–1.08; P = 0.001) remained independently associated with high GV beyond HbA1c levels (OR: 1.51, 95% CI: 1.2–1.89; P < 0.001). ConclusionIn AMI patients with poorly controlled diabetes, GV is associated with CAD severity beyond chronic hyperglycaemia. Although no causality can be determined from our observational study, the results suggest that, in AMI, early evaluation of GV might contribute to the identification of those diabetes patients at high risk, and serve as a therapeutic target for both primary and secondary prevention.

Pancreatic and Adrenal Disorders

Critically ill patients who lack preexisting endocrine diagnoses may still develop endocrine dysfunction, as exhibited by critical illness-related corticosteroid insufficiency and glycemic abnormalities. Glycemic control remains an important issue in critically ill patients, as hyperglycemia, hypoglycemia, and glucose variability are all independently associated with increased mortality. Hyperglycemia is a common manifestation of critical illness that may result from an acute response to stress and injury or may reflect preexisting diabetes mellitus. Hypoglycemia most commonly occurs as a result of treatment of hyperglycemia but may also be due to other causes such as sepsis and decreased nutritional intake. Hypoglycemia and other glycemic emergencies such as diabetic ketoacidosis and a hyperosmolar hyperglycemic state must be quickly recognized and treated. This review provides a general overview of diabetes mellitus, glycemic targets in the critically ill, glycemic emergencies, adrenal gland disorders, pheochromocytoma, and carcinoid syndrome. This review contains 1 figures, 4 tables, and 43 references. Keywords: adrenal crisis, carcinoid syndrome, critical illness-related corticosteroid insufficiency, Cushing syndrome, diabetes mellitus, diabetic ketoacidosis, glycemic goals, hyperosmolar hyperglycemic state, hypoglycemia, pheochromocytoma

Statistical Optimization of Spirulina Maxima Loaded Microspheres and Assessment of Antioxidant, Antidiabetic Potential in Glycemic Abnormalities Induced Wistar Rats by Excessive Fructose Administration

Statistical Optimization of Spirulina Maxima Loaded Microspheres and Assessment of Antioxidant, Antidiabetic Potential in Glycemic Abnormalities Induced Wistar Rats by Excessive Fructose Administration

Joint effects of serum vitamin D insufficiency and periodontitis on insulin resistance, pre-diabetes, and type 2 diabetes: results from the National Health and Nutrition Examination Survey (NHANES) 2009–2010

ObjectivePeriodontitis is strongly associated with diabetes and is increasingly shown to be associated with other glycemic abnormalities. Vitamin D is postulated to have both anti-inflammatory and antimicrobial activity. Therefore, our...

Pancreatic and Islet Remodeling in Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Knockout Ferrets

In cystic fibrosis (CF), there is early destruction of the exocrine pancreas, and this results in a unique form of diabetes that affects approximately half of adult CF individuals. An animal model of cystic fibrosis-related diabetes has been developed in the ferret, which progresses through phases of glycemic abnormalities because of islet remodeling during and after exocrine destruction. Herein, we quantified the pancreatic histopathological changes that occur during these phases. There was an increase in percentage ductal, fat, and islet area in CF ferrets over time compared with age-matched wild-type controls. We also quantified islet size, shape, islet cell composition, cell proliferation (Ki-67), and expression of remodeling markers (matrix metalloprotease-7, desmin, and α-smooth muscle actin). Pancreatic ducts were dilated with scattered proliferating cells and were surrounded by activated stellate cells, indicative of tissue remodeling. The timing of islet and duct proliferation, stellate cell activation, and matrix remodeling coincided with the previously published stages of glycemic crisis and inflammation. This mapping of remodeling events in the CF ferret pancreas provides insights into early changes that control glycemic intolerance and subsequent recovery during the evolution of CF pancreatic disease.

Continuous glucose monitoring to evaluate glycaemic abnormalities in cystic fibrosis

ObjectiveThis study aimed to determine the glycaemic profile of patients with cystic fibrosis using a continuous glucose monitoring system (CGMS), and to evaluate the associations of glycaemic abnormalities with sex,...

Are oral hypoglycemic agents suitable as the first-line treatment for newly diagnosed type 2 diabetes in patients with severe hyperglycemia?

Objectives: To investigate if starting oral antihyperglycemic agent was enough to achieve the target glycated hemoglobin (HbA1c) in patients with newly diagnosed type 2 diabetes mellitus (T2DM), despite severe hyperglycemia, with or without symptoms. Patients and Methods: This was a retrospective patient data analysis for patients with newly diagnosed T2DM during January to December 2013. At baseline and after 3 months, HbA1c was measured. All patients started a diet and lifestyle changes in addition to oral hypoglycemic agents. Results: The enrolled patients were 764 in number. Of them, 331 (42.9%) achieved the target HbA1c &lt;7% by oral hypoglycemic agents after 3 months, regardless of the treatment used. Multivariable logistic regression analysis showed that only presenting fasting plasma glucose &lt;150 mg (odds ratio [OR] 2.193, 95% confidence interval [CI] 1.297–3.709) and drug treatment (OR 1.320, 95% CI 1.100–1.585) were the independent variables associated with achieving the glycemic target. Conclusions: Using antihyperglycemic agents as the first line for new T2DM, 42.9% patients can achieve target glycemic control. Even those with gross glycemic abnormalities, more than 60%, can achieve target glycemic control using diet, lifestyle change, and metformin. Prospective trials are needed to confirm such findings.

The Effects of Ginger on Fasting Blood Sugar, Hemoglobin A1c, and Lipid Profiles in Patients with Type 2 Diabetes.

BackgroundLipid and glycemic abnormalities are prevalent in diabetes leading to long term complications. Use of safe and natural foods instead of medications is now considered by many scientists.ObjectivesThis study aimed at determining the effect of ginger on lipid and glucose levels of patients with type 2 diabetes mellitus.MethodsIn a double‐blind placebo-controlled trial, 50 patients with type 2 diabetes were randomly allocated to 2 groups of intervention (n = 25) and placebo (n = 25). Each patient received 2000 mg per day of ginger supplements or placebo for 10 weeks. Serum levels of fasting blood sugar (FBS), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and glycosylated hemoglobin (HbA1C) were analyzed. Daily dietary intakes and anthropometric parameters were also determined.ResultsData from 45 patients were analyzed (23 patients in the ginger group and 22 patients in the control group) at the end of the study. Ginger consumption significantly reduced serum levels of fasting blood glucose (-26.30 ± 35.27 vs. 11.91 ± 38.58 mg/dl; P = 0.001) and hemoglobin A1C (-0.38 ± 0.35 vs. 0.22 ± 0.29 %; P < 0.0001) compared to the placebo group. Ginger consumption also reduced the ratio of LDL-C/HDL-C (2.64 ± 0.85 vs. 2.35 ± 0.8; P = 0.009). However, there was no significant change in serum concentrations of triglycerides, total cholesterol, LDL-C, and HDL-C due to the ginger supplements.ConclusionsThe current results showed that ginger could reduce serum levels of fasting blood glucose and hemoglobin A1C in patients with diabetes.