Glycemic Instability Research Articles

Type 1 Diabetes Mellitus Associated with Dermatomyositis: A Case Report

Abstract Type 1 diabetes mellitus (T1DM) is an autoimmune illness that targets specific organs and associated with other autoimmune conditions. Dermatomyositis is an idiopathic systemic autoimmune condition involving skeletal muscles and skin. Co-occurrence of both disorders is quite rare. We diagnosed dermatomyositis in a young male with T1DM who presented with muscle weakness and cutaneous manifestations. There is an additional metabolic hurdle in T1DM, as high doses of glucocorticoids used in dermatomyositis management are related to glycemic instability which requires regular blood sugar monitoring and insulin dose titration accordingly. Considering the prognostic consequences, early diagnosis and management of dermatomyositis is essential.

Predictors of in-hospital mortality in COVID 19 patients with type 2 diabetes mellitus in South India: A cross sectional study

Introduction: Evidence suggests that patients with diabetes who developed the COVID-19 infection are known to have glycaemic instability, impaired immunity and associated comorbidities such as heart diseases and obesity leading to increased risk of mortality. Hence the current study was planned to assess the factors affecting mortality in diabetic COVID-19 patients admitted in tertiary care hospitals in South India. Methods: This was a retrospective study involving diabetic COVID-19 patients hospitalized in South India, data was collected from hospital records using pre-tested semi-structured validated questionnaire from January 2021 to February 2022. Results: Out of 397 study patients, 66% (263) them were males. Mean age of the patients was 61± 11.6, male 60.6±11.8, and female was 61.5±11.3. Most common presenting symptoms were fever 62% (235), cough 47% (172), breathlessness 42% (149), followed by weakness 29% (114). 46% (184) patients had uncontrolled diabetes. Co-morbidity like hypertension etc., were seen in 63% (250) of the patients. Saturation below 93% was seen in 20% (75) patients. 26% (69) were on ventilators, 48(42%) were admitted in intensive care unit. Laboratory profile showed high C-reactive protein in (86%) 264, elevated D-dimer in 86% (240), low lymphocyte in 46% (182), elevated ferritin in 63% (177), high neutrophil in 30% (118) and low Hb in 24% (85). Radiological finding shows interstitial opacity in 58 % (148) and CT-ground glass opacity in 21% (86). Complications like acute kidney injury were seen in 29% (115) and acute respiratory distress in 10% (39). The case fatality rate was 14% (56). Elevated neutrophil, elevated aspartate aminotransferase, low oxygen saturation was found to be significantly associated with mortality in COVID-19 diabetic patients. Conclusion: In diabetic COVID 19 patients elevated aspartate alanine transaminase, neutrocytosis and oxygen saturation below 93% are independent risk factors for mortality.

Catabolism of fats and branched-chain amino acids in children with Type 1 diabetes: Association with glycaemic control and total daily insulin dose.

Hyperglycaemia in Type 1 diabetes (T1D) results from an absolute insulin deficiency. However, insulin resistance (IR) may exacerbate glycaemic instability in T1D and contribute to long-term cardiovascular complications. We previously showed that IR in teenagers with obesity is associated with sex-dependent derangements in the catabolism of branched-chain amino acids (BCAA) and fatty acids. Here we hypothesized that byproducts of BCAA and fatty acid metabolism may serve as biomarkers or determinants of glycaemic control and IR in prepubertal or early pubertal children with T1D. Metabolites, hormones and cytokines from fasting blood samples were analysed in 28 children (15 females, 13 males; age 6-11 years) with T1D. Principal components analysis (PCA) and multiple linear regression models were used to correlate metabolites of interest with glycaemic control, total daily insulin dose (TDD, units/kg/d), adiponectin and the triglyceride (TG) to high-density lipoprotein (HDL) ratio. Males and females were comparable in age, BMI-z, insulin sensitivity, glycaemic control, inflammatory markers, BCAAs and C2/C3/C5-acylcarnitines. The majority of components retained in PCA were related to fatty acid oxidation (FAO) and BCAA catabolism. HbA1c correlated positively with Factor 2 (acylcarnitines, incomplete FAO) and Factor 9 (fasting glucose). TDD correlated negatively with C3 and C5 and Factor 10 (BCAA catabolism) and positively with the ratio of C2 to C3 + C5 and Factor 9 (fasting glucose). These findings suggest that glucose intolerance in prepubertal or early pubertal children with T1D is accompanied by incomplete FAO while TDD is associated with preferential catabolism of fats relative to amino acids.

Exposure to Maternal Diabetes during Pregnancy Is Associated with Aggravated Short-Term Neonatal and Neurological Outcomes following Perinatal Hypoxic-Ischemic Encephalopathy.

Infants of diabetic mothers (IDM) are at higher risk of perinatal morbidities and glycemic instability, but the impact of maternal diabetes on neonatal and neurological short-term outcomes of neonates with hypoxic-ischemic encephalopathy (HIE) remains poorly described. Our objective was to determine the impact of maternal diabetes on neonatal and neurological short-term outcomes following neonatal HIE. This was a retrospective single-center study including 102 term neonates with HIE who received therapeutic hypothermia (TH) treatment between 2013 and 2020. Multiple regression analysis was used to assess the relationship between the presence of maternal diabetes and short-term outcomes. Neonates with HIE and maternal diabetes exposure had a significantly lower gestational age at birth (38.6 vs. 39.7 weeks of gestation, p = 0.005) and a significantly higher mean birth weight (3,588 ± 752 vs. 3,214 ± 514 g, p = 0.012). IDM with HIE were ventilated for longer duration (8 vs. 4 days, p = 0.0047) and had a longer neonatal intensive care unit (NICU) stay (18 vs. 11 days, p = 0.0483) as well as took longer time to reach full oral feed (15 vs. 7 days, p = 0.0432) compared with neonates of nondiabetic mother. Maternal diabetes was also associated with an increased risk of death or abnormal neurological examination at discharge in neonates with HIE (odds ratio: 6.41 [1.54-26.32]). In neonates with HIE, maternal diabetes is associated with an increased risk of death or short-term neonatal morbidities, such as longer duration of ventilation, prolonged neonatal stay, greater need for tube feeding, and being discharged with an abnormal neurological examination. Strategies to prevent, reduce, or better control maternal diabetes during pregnancy should be prioritized to minimize complications after perinatal asphyxia. · Maternal DB is associated with unfavorable outcomes.. · IDM have longer ventilatory support and tube feeding.. · IDM have higher risk of abnormal neurological examination..

Prevalence and factors associated with school failure in children with type 1 diabetes.

Type 1 diabetes mellitus (T1DM) is ahealth problem that can be difficult for young people to accept. The aim of this study is to determine the prevalence and characteristics of school failure in children with T1DM and to identify the associated factors. This is aretrospective study conducted in the endocrinology department of the Farhat Hached Hospital in Sousse, regarding T1DM patients, by analysing their school and career paths according to their clinicobiological and social data. School failure was defined in our study by the presence of at least one year's repetition and/or exclusion from school. Our study included 70 patients. School failure was recorded in 71.4% of cases. School drop-out was observed in 47.1% of patients. The reasons for school drop-out were iterative hospitalizations in 31.4% of cases and glycaemic instability with hyper/hypoglycaemic fluctuations in 17.1%. Multivariate analysis showed that the risk factors significantly associated with school failure were, respectively, number of hospitalizations for ketosis ≥ 5 (p=0.037) and higher mean HbA1c at the last consultations (p=0.001). Use of functional insulin therapy (p=0.031) and use of insulin analogue (p=0.004) were significantly protective factors. The risk of school failure in T1DM is real and should not be underestimated. Socioeconomic factors such as lack of financial resources, limited family support, and an unfavourable social environment can contribute to school avoidance.

ODP202 Geriatric Type 1 Diabetes- unique management challenge

Abstract Case Presentation A 87 year old female with a past medical history of Type 1 Diabetes Mellitus (DM), Parkinson's disease and osteoporosis was sent from an assisted living facility to the emergency department for evaluation of elevated blood glucose levels. She had a long standing history of type 1 DM and further review revealed that she had extremely labile (brittle) blood sugars, with multiple prior hospitalizations for both hypoglycemia and hyperglycemia. Assisted living facility staff reported that her blood sugars were persistently elevated despite receiving scheduled insulin doses. On presentation, she did not have any specific complaints except for polydipsia and polyuria. She was hemodynamically stable, alert and oriented to time, place and person. Initial lab work included serum glucose 754 (70-79 mg/dL), bicarbonate 25 (21-31 mmol/L), anion gap 10 (6-14 mmol/L), ketone 0.9 (< 0.6 mmol/L), leukocyte count 4.7 (4-11 k/mm u) and creatinine 1. 06 (0.6-1.2 mg/dL). Urinalysis showed glycosuria and proteinuria but no evidence of infection. IVF and insulin were started. Extensive infectious work-up was negative. Her blood glucose levels stabilized with basal-bolus regimen and correctional doses of insulin. Tight glycemic control was avoided due to her history of hypoglycemic unawareness and multiple previous episodes for severe and recurrent hypoglycemia. Discussion Brittle diabetes is a disorder commonly seen in patients with Type 1 DM and is characterized by extreme swings in blood glucose levels (severe recurrent hypoglycemic and hyperglycemic episodes) without a clear cut precipitating cause requiring hospitalizations. It has been linked to autonomic dysfunction, hormonal imbalance, psychological issues, nutrient malabsorption and autoimmune conditions. Geriatric Type 1 DM presents great challenges in management as it combines micro and macro vascular complications of long standing DM with geriatric syndrome - concurrent comorbidities, cognitive losses of various degrees, vision and hearing loss, loss autonomic and hormonal counter-regulation, and progressive frailty leading to severe glycemic instability makes self management of DM near impossible. Our patient was an elderly female with osteoporosis, Parkinson's and hypoglycemic unawareness. Great care was taken to maintain her blood glucose levels in the optimal range both during and after hospitalization. Daily insulin was being administered by staff after checking blood glucose levels, avoiding the possibility of dose omission or errors. Detailed instructions on administration of the correct dose of insulin according to caloric consumption and physical activity were provided. With this case, we wish to highlight the unique challenge Brittle Diabetes in geriatric presents, and as this sector of population is growing owing to better treatment options for diabetics and longer life expectancy, there is a growing need to recognize this entity, adopt a multi-disciplinary patient centered approach and prioritize prevention of both hypoglycemia and extreme hyperglycemia over tight glycemic control. Presentation: No date and time listed

The Effects of Long COVID on Thai Teenagers

The post-COVID-19 condition, also known as the Long COVID syndrome, was first widely acknowledged in the scientific and medical worlds. Since it affects COVID-19 survivors at all disease severity levels, including younger individuals, children, and those who are not in hospitals, this illness is poorly understood. Presently, there is a limitation to the definition of the post-COVID condition. This study would fill in this gap by surveying the most common symptoms among Thai teenagers (10–24). This data is gathered by the online survey: Google Form and statistically analyzed through percentages. Consequently, the majority of symptoms are aches and pains (37.037%), asymptomatic (31.579%), depression (18.324%), and bedridden symptoms (6.324%) as a result of the prolonged quarantine. In terms of drug complications, the majority of respondents had none (89.330%), acid reflux (4.715%), and glycemic instability (1.489%). In terms of physical health effects following illness, the majority of respondents reported symptoms such as shortness of breath (30.615%), fatigue (27.227%), chronic cough (13.802%), insomnia (11.543%), and so on. This study shows that Long COVID has an impact on the respondents' daily lives at levels 1-10 on level 7 (15.960%), level 5 (13.965%), and level (13.965%). Keywords: Long COVID, Thai teenager, Thailand

A Century-long Journey From the Discovery of Insulin to the Implantation of Stem Cell-derived Islets.

For the past century, insulin injections have saved millions of lives, but glycemic instability is still a persistent challenge for people with diabetes, leading to tremendous morbidity and premature mortality. Research in the field of islet transplantation has demonstrated that replacing insulin-producing β cells can restore euglycemia comparable to individuals without diabetes. However, a short supply of cadaveric islet donors, the technically challenging process of isolating islets, and the requirement for chronic immune suppression have impeded widespread clinical adoption. Rather than relying on cadaveric cells, pluripotent stem cells could serve as a virtually unlimited supply of insulin-producing β cells. Protocols have been developed that mimic the normal in vivo development of the human pancreas to generate pancreatic progenitor cells in vitro. Ongoing investigations have yielded progressively more mature β-like cells in vitro that produce insulin but do not yet fully mimic healthy mature β cells. Alongside development of differentiation protocols, other work has provided insight into potential implantation sites for stem cell-derived islet cells including the subcutaneous space, portal vein, and omentum. To optimize implanted cell survival and function, development of immune modulation therapies is ongoing, including selection of immunomodulatory medications and genetic modification of implanted cells to evade immune responses. Further, macroencapsulation or microencapsulation devices could be used to contain and/or immunoprotect implanted cells from the immune response including by using 3-dimensional bioprinting to facilitate the process. Remarkably, ongoing clinical trials have now yielded the first patient relying on differentiated stem cells rather than syringes as their insulin replacement therapy.

Strengths and Challenges of Closed-Loop Insulin Delivery During Exercise in People With Type 1 Diabetes: Potential Future Directions.

Exercise has many physical and psychological benefits and is recommended for people with type 1 diabetes; however, there are many barriers to exercise, including glycemic instability and fear of hypoglycemia. Closed-loop (CL) systems have shown benefit in the overall glycemic management of type 1 diabetes, including improving HbA1c levels and reducing the incidence of nocturnal hypoglycemia; however, these systems are challenged by the rapidly changing insulin needs with exercise. This commentary focuses on the principles, strengths, and challenges of CL in the management of exercise, and discusses potential approaches, including the use of additional physiological signals, to address their shortcomings in the pursuit of fully automated CL systems.

Diabetes Mellitus Type 2 Associated Alterations in the Regulation of Blood Sugar, Kidney Function and Oxidative Stress

Background: Diabetes mellitus (T2DM) is a multifactorial disease that produces high blood sugar levels. Duration of study: February 2019 to April 2021 Place of study: Arif Memorial Hospital , Galwera village, Kasur road Lahore Method & Result: 50 Pakistani T2DM individuals were investigated. Insulin, insulin resistance (IR), and insulin sensitivity were the glycemic control measures (IS). Renal function tests looked at urea and creatinine. TAC and ROS were oxidative stress indicators (ROS). T2DM patients exhibited greater fasting blood glucose, HbA1c, insulin, and IR than non-T2DM controls. Pseudo-insulin sensitivity reduced in patients (p˂.01). Urea and creatinine levels climbed somewhat in T2DM patients. TAC increased in patients over controls (P˂.05). Less than 2% of T2DM patients had elevated ROS (P˂.02). TAC and fasting blood glucose exhibit a positive (P˂.02) relationship. Fasting blood glucose and IS have a substantial negative relationship (P0.01). HbA1C correlates with IR, creatinine, and TAC but not with ROS (P˂.01). HbA1C and IS had a strong (P0.01) negative relationship. Diabetes mellitus is associated with insulin resistance (IR). Significant IS, creatinine, and ROS interactions (P˂.01). IS and urea are antithetical (P˂.05). Urea and creatinine have a strong (P˂.01) connection. TAC is anti-ROS (P˂.05). Conclusion: Glycemic instability in diabetic’s More than persistent hyperglycemia, blood glucose fluctuations may cause oxidative damage. The strong positive connection between fasting blood glucose and the other investigated measures shows that hyperglycemia is an independent risk factor for T2DM development. Keywords: Glycemic control, fasting blood glucose, urea, creatinine, total antioxidant capacity, reactive oxygen species.

The effects of short term hyperglycemia on human red blood cells studied using Raman spectroscopy and optical trap.

Management of postprandial hyperglycemia is important for preventing severe complications like cardiovascular disease in diabetes patients. The associated glycemic instability in postprandial hyperglycemia may also cause disorders in circulating red blood cells (RBCs). Therefore, effects of short-term hyperglycemic stress on RBCs such as occur in the postprandial condition, have been studied here ex vivo using single-cell Raman spectroscopy and optical trapping. RBCs incubated in high glucose containing media relevant to postprandial hyperglycemia were studied for changes with respect to controls by analyzing the single-cell Raman spectra acquired with Raman optical tweezers with 532nm excitation light. Use of 532nm light for exciting Raman spectra also results in simultaneous photoreduction of intracellular hemoglobin (Hb). The level of photoreduction was noticed to be limited in hyperglycemia-exposed cells in comparison to the control. Since this suggests formation of permanently oxidized Hb in hyperglycemia-exposed RBCs, a fluorescence study was performed which showed elevated levels of oxidative stress in these cells. The changes in the RBC membrane, which may result due to higher levels of oxidative stress, were investigated using optical stretching experiments under the laser trap. The results indicated a loss of elasticity for the RBC membrane due to hyperglycemic exposure.

A new look at brittle diabetes.

“Brittle diabetes” was first used to describe a life “disrupted by episodes of hypoglycemia or hyperglycemia.” Early descriptions focused on small case reports of mostly young women with psycho-social instability, recurrent diabetic ketoacidosis, poor patient compliance or maladaptation. We redefine “brittle diabetes” as occurring in four specific life stages each with distinct characteristics and associated conditions resulting in severely erratic glycemic control and poor outcomes. Once identified however these factors can often be reversed or significantly mitigated.The first group includes younger patients with associated psychiatric diseases such as bulimia and depression which require specific therapy and are treatable. A second group includes individuals who have another underlying medical condition resulting in disruption of insulin sensitivity or glucose utilization which must be sought. A third group, the largest we believe, has “geriatric type 1 diabetes” and develops severe glycemic instability due to frailty, chronic renal failure, dementia, vision loss, loss of counterregulation and other diseases of aging which lead to unintentional omission of insulin, insulin dosing errors and increasing insulin sensitivity. The fourth group, now seen around the world, suffers lack of insulin access and associated food insecurity. All four of these groups are described.

Construction and study of standardized nursing management model for hypoglycemia in diabetic inpatients

Objective To establish a standardized nursing management model for hypoglycemia in diabetic inpatients and observe its application effects. Methods Totally 9 251 diabetic patients hospitalized in People's Hospital of Zhengzhou between January and December 2017 were selected into the control group, while another 9 636 diabetic patients hospitalized in People's Hospital of Zhengzhou between January and December 2018 were selected into the observation group by cluster sampling. Patients in the control group received routine care and glycemic management. In 2018, in conjunction with the glycemic monitoring system, we established a diabetes education management team and developed a standardized nursing management process for hypoglycemia, which was promoted throughout the hospital to improve the level of hypoglycemic control among nurses throughout the hospital. Patients in the observation group received care and glycemic control using the standardized nursing management model for hypoglycemia and glycemic control. The incidence of hypoglycemia, glycemic fluctuations, and nurses' knowledge of hypoglycemia before and after implementation were compared between the two groups. Results The incidence of hypoglycemia in the observation group was lower than that in the control group [7.51% (724/9 636) vs. 18.30% (1 693/9 251) ], and the difference was statistically significant (χ2=492.7, P<0.001) . The observation group's average blood glucose value (GluAve) , daily mean amplitude of glycemic excursions (MAGE) , glycemic instability index (GLI) , and glycemic coefficient of variation (GluCV) were all lower than the control group, and the differences were statistically significant (t=-18.121, -53.788, -34.362, -61.794; P<0.01) . After the implementation of the standardized management model for hypoglycemia in 2018, the total score dimensional scores of the nurses' knowledge about hypoglycemia were higher than those before the implementation of the standardized nursing process for hypoglycemia in 2017, and the differences were all statistically (t=15.439, 66.542, 73.320, 14.565, 36.101, 34.664; P<0.01) . Conclusions The standardized nursing management model for hypoglycemia can reduce the incidence of hypoglycemia as well as fluctuations of the patients, improve the level of nurses' knowledge of hypoglycemia, and make the patients' glycemic control safer. Key words: Diabetes; Inpatient; Hypoglycemia; Nursing management

Arterial stiffness in children and adolescents with and without continuous insulin infusion.

Background Arterial stiffness is a consequence of aging, but there are several diseases that contribute to this process. The evaluation of pulse wave velocity (PWV) allows a dynamic evaluation of vascular distensibility and the detection of atherosclerosis at an early stage. It was intended to evaluate the PWV in children and adolescents with type 1 diabetes mellitus (T1DM) and to compare their outcome according to the type of treatment used. Methods Forty-eight patients were randomly selected. Inclusion criteria: T1DM, under intensive insulin therapy (multiple daily insulin administrations [MDI] or continuous insulin infusion system [CIIS]). Exclusion criteria: existence of another chronic pathology or microvascular complications. Echocardiography was performed and three measurements of PWV were done, with their mean calculated. Results Most of the children and adolescents presented a PWV ≥ the 75th centile. There was a statistically significant difference for hemoglobin A1c (HbA1c) (7.8 in CIIS vs. 9 in MDI, p < 0.05). There were not statistically significant differences in the PWV between the two groups. This can be attributed to the fact that children with CIIS are those who previously presented greater glycemic instability. There was a significant correlation between PWV and disease duration (Pearson's correlation coefficient [r] = 0.314, p = 0.036). Conclusions This study showed that in children and adolescents with T1DM, there is an important prevalence of arterial stiffness, translated by an increase in PWV. This increase in PWV appears to exist even in very young children with little disease evolution time.

Factors influencing glycaemic stability after neonatal hypoglycaemia and relationship to neurodevelopmental outcome

Higher and unstable glucose concentrations in the first 48 hours in neonates at risk of hypoglycaemia have been associated with neurosensory impairment. It is unclear what defines and contributes to instability. This was a prospective study of term and late preterm babies (N = 139) born at risk of neonatal hypoglycaemia who had interstitial glucose (IG) monitoring and ≥1 hypoglycaemic episode <48 hours after birth (blood glucose concentration <2.6 mmol/l [<47 mg/dl]). For 6-hour epochs after each hypoglycaemic episode, masked IG parameters (time to reach maximum IG concentration [hours]; range, average, maximum and minimum IG concentrations; proportion of IG measurements outside the central band of 3–4 mmol/l [54–72 md/dl]; and total duration [hours] of IG concentrations <2.6 mmol/l) were analysed in tertiles and related to: (i) glycaemic instability in the first 48 hours (defined as the proportion of blood glucose concentrations outside the central band in the first 48 hours); (ii) risk factors and treatment for each episode; and (iii) risk of neurosensory impairment at 4.5 years, or at 2 years if a child was not seen at 4.5 years. Glycaemic instability in the first 48 hours was related to IG instability after hypoglycaemia. Risk factors for hypoglycaemia were not related to IG parameters. Treatment with intravenous dextrose was associated with higher IG maximum and range, and lower minimum compared to treatment with dextrose gel plus breast milk, breast milk alone or formula alone. The risk of neurosensory impairment was increased with both shorter and longer time to reach maximum epoch IG (P = 0.04; lower tertile [0.4–2.2 hours] vs middle [2.3–4.2 hours] OR 3.10 [95% CI 1.03; 9.38]; higher tertile [4.3–6.0 hours] vs middle OR 3.07; [95% CI 1.01; 9.24]). Glycaemic response to hypoglycaemia contributes to overall glycaemic instability in newborns and is influenced by treatment. Slow or rapid recovery of hypoglycaemia appears to be associated with neurosensory impairment.

Enhancement of postprandial endogenous insulin secretion rather than exogenous insulin injection ameliorated insulin antibody-induced unstable diabetes: a case report

BackgroundInsulin injection, especially with insulin analogs, occasionally induces the production of insulin antibodies with high binding capacity and low affinity, similar to the insulin autoantibodies characteristic of insulin autoimmune syndrome (IAS). Production of these “IAS-like” insulin antibodies causes marked glycemic fluctuations with postprandial hyperglycemia and fasting hypoglycemia.Case presentationA 66-year-old man with a 27-year history of diabetes was admitted because of marked glycemic fluctuations. Human insulin treatment had been initiated at age 56, followed by multiple daily injections of insulin analogs 5 years later. After the initial year of insulin analog treatment, the patient began to experience frequent morning hypoglycemic attacks and day-time hyperglycemia. Marked hyperinsulinemia (4500 μU/mL) and high titers of insulin antibodies (80.4%) with high binding capacity and low affinity indicated that IAS-like insulin antibodies were causing severe glucose fluctuations. Altering insulin formulations (insulin aspart → regular human insulin→ insulin lispro) proved to be ineffective. After several therapeutic trials, cessation of exogenous insulin and addition of mitiglinide to liraglutide with voglibose finally attenuated glycemic fluctuations with increased postprandial insulin secretion. Continuous glucose monitoring revealed improvement of morning hypoglycemia and postprandial hyperglycemia with smaller mean amplitude of glycemic excursion. Therefore, compared to exogenously injected insulin, endogenously secreted insulin directly and rapidly acts on hepatocytes and suppresses postprandial glucose output.ConclusionsProper enhancement of postprandial endogenous insulin aimed at suppressing postprandial glucose output without stimulating excessive glucose uptake in the periphery is potentially useful for treating diabetes with insulin antibody-induced glycemic instability.

Alexithymia in adults with brittle type 1 diabetes.

Background:The term “brittle” is used to describe an uncommon subgroup of patients with type 1 diabetes whose lives are disrupted by severe glycaemic instability with repeated and prolonged hospitalization. Psychosocial problems and emotional disturbances are the major perceived underlying causes of brittle diabetes. Aim of this study is (a) to assess alexithymia in patients with brittle and non-brittle diabetes, and (2) to examine its relationship with specific parameters of general psychopathology.Methods:Participants comprised 44 patients with brittle diabetes and a case-control group of 88 individuals with stable (non-brittle) diabetes, matched for age, gender, years of education, and diabetes duration. Alexithymia and general psychopathology were assessed using the “20-item Toronto Alexithymia Scale” (TAS-20) and the “Symptom Checklist-90-Revised” (SCL-90-R).Results:Patients with brittle diabetes were more alexithymic than the control group. Alexithymia scores showed significant correlations with SCL-90-R anxiety and somatization subscales, but were relatively independent from gender, education, diabetes duration and complications, depression and glycaemic control. Conclusions: Given the impact of alexithymia on type 1 diabetes, the early detection and intervention of alexithymic subjects are very important for a better outcome of diabetes. (www.actabiomedica.it)

Associations of literacy with diabetes indicators in older adults

BackgroundLiteracy, the ability to access, understand and utilise information and concepts from diverse sources in ways that promote good outcomes is key to successful ageing. Domain-specific health and financial literacy...

Sedentariness and Health: Is Sedentary Behavior More Than Just Physical Inactivity?

Sedentary behavior refers to certain activities in a reclining, seated, or lying position requiring very low energy expenditure. It has been suggested to be distinct from physical inactivity and an independent predictor of metabolic risk even if an individual meets current physical activity guidelines. Over the past decades, a shift in the activity profile of individuals has been observed with vigorous physical activity and sleep being partly replaced by cognitive work, a potential neurogenic stress component considering its hormonal and neurophysiological effects, leading to various impacts on health. Mental work, for instance, may significantly increase glycemic instability leading to an increase in the desire to eat and thus, higher energy intakes. Furthermore, screen-based leisure activities (e.g., television watching) and screen-based work activities (e.g., computer use for work purposes) have often been considered together while they may not trigger the same stress response and/or use of substrate. Thus, the problems of sedentariness may not only be attributed to a lack of movement, but also to the stimulation provided by replacing activities. The objective of this review is to discuss the (1) recent evidence and current state of knowledge regarding the health impact of sedentary behaviors on health; (2) potential neurogenic effects of cognitive work as a sedentary behavior; (3) link between sedentary behaviors and the diet; (4) resemblance between sedentary behaviors and the inadequate sleeper; and (5) potential solutions to reduce sedentary behaviors and increase physical activity.

Association of nutritional parameters and survival in parenteral nutrition-supported (PN) gastrointestinal cancer patients.

10078 Background: PN is a major tool in managing nutritional challenges in cancer patients. However, a clear set of clinical and biochemical indices to determine PN application in cancer patients has not been developed. We assessed the association between PN related nutritional parameters and survival in a large group of gastrointestinal (GI) cancer patients. Methods: 1197 consecutive GI cancer patients who received PN support between 08/01/08 – 08/01/13 were reviewed. Height, weight, plasma glucose (baseline and within 48 hours after PN initiation), surgical history, and pharmacy data including PN contents (dextrose, amino acids, and fat) and non-PN dextrose or fat in drug administration were recorded. Body mass index (BMI), Ideal body weight (IBW), PN and non-PN Calorie, and nitrogen were calculated for analysis. Data were entered into a multivariate analysis controlling for age, gender, cancer site, and medical comorbidities. Results: Median BMI was 25.4. 70% of the patients had unsteady weight ( &gt; 2.5% change) before PN initiation. The magnitude of weight change was inversely related to survival (HR 1.02), P &lt; 0.001). Patients with BMI &gt; 25 and &lt; 7.5% weight change prior to PN initiation had the most favorable survival. Glycemic instability (maximum plasma glucose variation &gt; 100mg/dL) was independently related to shorter survival (HR 1.53, P &lt; 0.001). Total calorie by IBW (kcal/kg/day) (HR 0.97, P &lt; 0.001), non-PN calorie % (HR 1.04, P &lt; 0.001), and calorie to nitrogen ratio (kcal:g) (HR 1.02, P &lt; 0.001) were all independently associated with overall survival. Conclusions: Lower BMI, weight instability, and glycemic instability were adversely associated with survival. Higher total PN calorie and amino acid support were associated with better survival. Higher non-PN calorie % was adversely related to survival. Future studies must focus on developing a set of indices incorporating independent prognostic clinical and biochemical factors in determining PN application and monitoring in cancer patients. Optimum calorie and amino acids in PN support for cancer patients also require further investigation.