Glycohemoglobin Levels Research Articles

Oedema index trajectories at heart failure nurse clinics over 6 months after acute heart failure predict patient outcomes: a retrospective cohort study.

Fluid accumulation is associated with poor outcomes in patients with heart failure (HF). After acute HF, HF nurses provide home care suggestions based on oedema status assessed at outpatient clinics. However, the pattern of serial oedema changes and their associations with patient outcomes are unknown. We investigated the trajectories of bioimpedance analysis (BIA)-derived oedema index (EI) changes following acute HF and their prognostic value. This was a retrospective cohort study. We recruited 761 patients hospitalized for HF. Multisegmented and multifrequency BIA-derived EIs were measured at HF nurse outpatient clinics after discharge for 6 months. We explored the trajectories of EIs and their associations with all-cause rehospitalization and death within 2 years. Four EI trajectories were identified: trajectory 1 [T1, no oedema, n = 181 (23.8%)], T2 [transient, n = 341 (44.8%)], T3 [fluctuation, n = 195 (25.6%)], and T4 [worsening, n = 44 (5.8%)]. Compared with the T1 group, the T3 and T4 groups included more females; were older; had higher natriuretic peptide and glycohaemoglobin levels; and had higher incidences of comorbidities but lower albumin and cholesterol and worse kidney function (all P < 0.05). The Kaplan-Meier survival curves showed that T2, T3, and T4 patients had lower event-free survival rates than did T1 patients (all P < 0.01). Multivariable analysis demonstrated that T3 and T4 were independently associated with an increased risk for events (P < 0.001). During the 6-month outpatient period after hospitalization, the EI trajectory of fluctuation or worsening was associated with poor outcomes. In the post-acute phase, monitoring the EI trajectory helps identify high-risk patients for optimizing HF management.

Serum Phosphorus and Hypophosphatemia During Therapy of Diabetic Ketoacidosis in Children: Single-Center, Retrospective Cohort 2016-2022.

To assess factors associated with serum phosphorus (P) and hypophosphatemia in children with type 1 diabetes mellitus (T1DM) treated for diabetic ketoacidosis (DKA). Retrospective cohort. Community-based PICU in a university-affiliated hospital. Patients 1-20 years old with T1DM hospitalized for DKA from July 1, 2016, to July 31, 2022. None. We collected age, sex, duration of T1DM, conscious state at presentation, and most recent glycohemoglobin level. P was tested initially and then every 4 hours. Probability of hypophosphatemia and time to hypophosphatemia and hospital length of stay (LOS) were analyzed via binomial and linear mixed-effects regression analyses, respectively. A total of 852 DKA episodes occurred in 365 patients (46.3% female, median age 14.7 yr), of which 158 (18.5%) episodes were new-onset T1DM. Hypophosphatemia developed during 656 of 852 (77%) episodes, including 49 of 852 (5.8%) episodes of severe hypophosphatemia with median (interquartile range) onset 8.0 hours (4.7-11.9 hr) and 12.0 hours (8.1-17.6 hr), respectively, following initiation of therapy. Higher glycohemoglobin was associated with greater odds of hypophosphatemia (odds ratio [OR], 1.22; p < 0.001). However, lower odds of hypophosphatemia were associated with older age (OR, 0.89; p < 0.01), male (OR, 0.11; p = 0.01), longer T1DM duration (OR, 0.87; p < 0.001), and having initial normal conscious state (OR, 0.18; p < 0.01). Older age (3.0%/yr; p = 0.02), T1DM duration (4.1%/yr; p = 0.01), and initial serum P (23.4%/mg/dL; p < 0.001) were associated with later hypophosphatemia. LOS was shorter with increased T1DM duration (3.6%/yr; p < 0.001) and normal conscious state (33.1% shorter; p < 0.001), but longer with increasing glycohemoglobin (4.0%; p < 0.001). All patients survived with normal neurologic function. Higher glycohemoglobin was associated with greater odds of hypophosphatemia and longer LOS. Older male, longer duration of T1DM, and conscious at admission were factors associated with lower odds of developing hypophosphatemia and with later onset when it occurred. Hypophosphatemia was associated with longer LOS.

An oral liraglutide nanomicelle formulation conferring reduced insulin-resistance and long-term hypoglycemic and lipid metabolic benefits.

Type 2 diabetes is a chronic disease characterized by insulin resistance and often worsened by obesity. Effective management involves the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to assist with glycemic control and weight management. However, these drugs must be administered subcutaneously due to their low oral bioavailability. We developed an oral liraglutide (LRG) formulation by electrostatic complexation of GLP-1 RA with bile acid derivatives and nanomicelle (NM) formation, with non-ionic surfactant n-dodecyl-β-d-maltoside (DDM). The optimized formulation, LDD[1:2:4]-NM, had a mean particle size of 75.9 ± 5.60 nm and a permeability 1347 % higher than that of unformulated LRG when tested in Caco-2/HT29-MTX-E12 cell monolayers. In rats, oral bioavailability was 4.63-fold higher than that of unformulated LRG (1.11 ± 0.20 % vs. 5.14 ± 0.63 %). The absorption mechanism included clathrin-mediated endocytosis, macropinocytosis, and an ASBT-mediated pathway. A 12-week oral treatment consisting of a daily dose of 20 mg LDD[1:2:4]-NM/kg significantly reduced glycohemoglobin levels, a marker of diabetic control, and the HOMA-IR index, a marker of insulin resistance. The weight of epididymal and inguinal white adipose tissue and brown adipose tissue (BAT) was also reduced. Moreover, LDD[1:2:4]-NM had a greater impact on BAT activation, pro-inflammatory gene expression, and lipid metabolism than subcutaneous LRG. This study showed that an oral NM formulation can efficiently deliver LRG. Long-term treatment led to improved hyperglycemic effects, insulin resistance, and modulated lipid metabolism. LDD[1:2:4]-NM is thus a promising oral therapeutic option for the management of type 2 diabetes, potentially transforming treatment paradigms based on the availability of a more convenient administration route.

Association between prognostic nutritional index and stroke: A nationally representative cross-sectional study from NHANES

BackgroundThe correlation between the prognostic nutritional index (PNI) and the risk of stroke has become a hot spot within the medical research community. The available evidence from a large sample regarding the correlation between PNI and stroke is inadequate. There is also a need for more research analysis from national surveys. ObjectiveThe principal goal of this research is to improve our understanding of the relationship between PNI and the risk of stroke. This study also intends to investigate the potential synergistic influence of PNI on stroke in combination with other interacting variables. MethodsA cross-sectional study was conducted with 35,549 participants selected from the National Health and Nutrition Examination Survey (NHANES) 2005–2018 cycle. Information was gathered from all participants regarding the following: lymphocyte count, albumin levels, stroke occurrence, age, sex, race/ethnicity, education level, poverty income ratio (PIR), marital status, body mass index (BMI), smoking habits, drinking status, physical activity measured in total metabolic equivalents (PA_total_MET), diabetes status, glycohemoglobin levels, total cholesterol, direct high-density lipoprotein cholesterol(direct HDL-cholesterol), hypertension, and coronary heart disease. Curve fitting, subgroup analysis, and multifactor weighted logistic regression analysis were used to examine the relationship between PNI and stroke. ResultsThe overall prevalence of stroke was found to be 3.9%, PNI quartile 4(Q4) had an increased prevalence of stroke than quartile 1, 2, and 3(Q1,2,3). Our research suggested a negative association between PNI and the risk of stroke, as indicated by the odds ratio (OR=0.98) with a 95% confidence interval (CI=0.97∼0.99) and a p-value <0.05 (P=0.005), even after adjusting for all confounders. Subsequent subgroup analysis indicated a significant difference in the impact of PNI on stroke between individuals with different body mass index(BMI) levels (p for interaction = 0.02). ConclusionOur findings underscore that lower PNI in US adults is associated with an increased stroke risk, shedding light on a potential interrelationship between nutrition, inflammatory parameters, and stroke.

Correlation of exercise blood pressure levels with concomitant cardiovascular disease.

Hypertension is a fatal but preventable risk factor for cardiovascular disease and an important cause of death from cardiovascular disease. Exercise training has a definite clinical effect on blood pressure control. However, inappropriate exercise is ineffective and may also cause disease. The aim of this study was to evaluate the possible factors influencing blood pressure level in an exercise treadmill test and its relationship with accompanying clinical diseases. Five hundred sixty-four patients who underwent exercise treadmill test were selected and divided into the abnormal exercise blood pressure group (n = 156, age 60.46 ± 9.2 years) and normal exercise blood pressure group (n = 408, age 56.57 ± 8.8 years) according to whether the peak exercise systolic blood pressure was more than or equal to 180 mm Hg. General clinical data and associated clinical diseases were collected from both groups. The prevalence of hypertension and coronary atherosclerotic heart disease in the abnormal exercise blood pressure group was significantly higher than that in the normal exercise blood pressure group (all P < .05). At the same time, the smoking rate and glycohemoglobin level of the patients with abnormal exercise blood pressure were significantly increased (all P < .05), but there was no statistically significant difference in age, sex, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and other indicators between the 2 groups (all P > .05). Patients with abnormal exercise blood pressure response have a higher prevalence of hypertension and coronary heart disease. Exercise blood pressure level may be an important factor affecting patients' cardiovascular prognosis.

6666 Asymptomatic Fasting Hypoglycemia After Sleeve Gastrectomy

Abstract Disclosure: K. Mitrollari: None. H.K. Deveaux: None. A. Gundeti: None. A.P. Calimag: None. T. Yasmeen: None. Introduction: Post-bariatric surgery hypoglycemia (PBSH), though previously considered rare, is increasingly recognized, occurring not only after Roux-en-Y gastric bypass (RYGB,) but also following various bariatric procedures. PBSH can manifest as postprandial or fasting hypoglycemia, requiring thorough investigation and prevention due to potential asymptomatic presentations that may lead to severe consequences, including coma and death. Case Report A 45-year-old female with a history of type 2 DM, ESRD on HD, gastric sleeve surgery, bilateral trans-metatarsal amputations, coronary artery disease, and congestive heart failure presented with bilateral lower extremity wounds. On admission her venous blood glucose was 71 mg/dL. Glycohemoglobin was 3.9% and fructosamine was 225 (205-285 umol/L). Her glycohemoglobin levels consistently remained below 6.4% status post sleeve gastrectomy off diabetes medications. Throughout admission, she experienced almost daily episodes of fasting asymptomatic hypoglycemia correlated with venous sample with lowest blood glucose reading 38 mg/dL. Initially, these episodes were attributed to NPO status for procedures or decreased PO intake. Her diet consisted of fast food brought by her family, which she reported was similar to her diet at home. Workup during a hypoglycemic episode (glucose 51 mg/dL,) revealed insulin 4 mUnits/L, proinsulin 7.1 pmol/L (&amp;lt;=7.2 pmol/L), C-peptide 25.7 ng/mL (0.8-3.9 ng/mL), and beta-hydroxybutyrate 0.5 mmol/L (0.0-0.3 mmol/L). Negative insulin antibodies and sulfonylurea panel, normal cortisol, and ACTH levels were noted. The patient was placed on a 10% dextrose infusion to avoid further episodes of hypoglycemia. However, she continued to experience hypoglycemia and was started on oral diazoxide. A CT pancreas with and without contrast was unremarkable, and endoscopic ultrasonography only revealed a 10 mm accessory spleen. The patient was discharged with counseling on glucose monitoring, dietary changes, and follow-up with endocrinology. Conclusion: PBSH should be considered as a differential diagnosis in patients with unexplained hypoglycemia and a history of bariatric surgery. PBSH mimics insulinoma or non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) with elevated insulin, proinsulin, C-peptide, and low beta-hydroxybutyrate during hypoglycemia, however NIPHS is exclusive to non-bariatric patients. Imaging is crucial to rule out insulinoma, and invasive tests such as endoscopic ultrasound aid diagnosis. PBSH is a diagnosis of exclusion; therefore, workup involves ruling out other causes of hypoglycemia. First-line treatment involves diet modification, with medications like diazoxide or acarbose considered if dietary changes prove insufficient. This case underscores the complexity of hypoglycemia, implicating bariatric surgery as a contributing factor. Presentation: 6/3/2024

β-cell function and long-term glycemic control in patients newly diagnosed with type 2 diabetes with moderate hyperglycemia after a 6-month course of basal insulin therapy

AimsTo evaluate whether treatment with insulin is advantageous compared with oral anti-diabetic drugs (OAD) for patients newly diagnosed with type 2 diabetes with moderate hyperglycemia. MethodsPatients newly diagnosed with type 2 diabetes with moderate hyperglycemia were recruited and randomized to receive insulin, metformin or sitagliptin treatment. The oral glucose tolerance test (OGTT) was performed before treatment and 6 months thereafter. The primary outcome was the glycohemoglobin (HbA1c) level change. For the secondary efficacy analysis, the β-cell function and insulin sensitivity were calculated from the OGTT, as was the proportion of subjects who reached the treatment target (HbA1c level < 7.0 % or < 6.5 %) at 6 months. ResultsWe randomized 50 patients to the three groups and 32 patients who received the allocated treatment were analyzed. The change of HbA1c level in the insulin, metformin, and sitagliptin groups was − 2.06 ± 1.37 %, −0.43 ± 0.32 %, and − 1.62 ± 0.92 %, respectively. This change was smallest in the metformin group. There was no significant difference in the changes or final HbA1c levels between the insulin and sitagliptin groups. The treat-to-target (HbA1c level < 7.0 %) rates in the insulin, metformin and sitagliptin were 75 %, 50 % and 100 %, respectively. The treat-to-target rates were not significantly different among the three groups. The insulin secretion indices, including the Matsuda index and HOMA-IR, indicated that the groups did not differ after 6 months of therapy. ConclusionA 6-month course of basal insulin therapy did not benefit patients newly diagnosed with diabetes with moderate hyperglycemia in terms of insulin sensitivity or insulin secretion.

Immune checkpoint inhibitors-related endocrinopathies exhibit increased severity in breast cancer patients: a real-world study.

This study aims to systematically evaluate the incidence of immune checkpoint inhibitors (ICIs)-related endocrinopathies and their onset time in patients with breast cancer (BC) in a real-world setting. An analysis was conducted on the medical records of 122 BC patients who underwent ICIs therapy at the Department of Breast Surgery, Guangdong Provincial People's Hospital, from April 2019 to September 2021. Follow-up data continued until October 2022. The research indicated that 60.66% of BC patients experienced ICI-related endocrinopathies. The endocrinopathies included pituitary injury (7.38%), primary thyroid dysfunction (34.43%), supranormal fasting blood glucose or glycohemoglobin levels (16.39%), and adrenal injury (2.46%). Subgroup analyses were further performed based on clinical characteristics, demonstrated variability in the incidence of ICI-related endocrinopathies. Notably, subpopulations harboring genetic mutations exhibited a markedly higher prevalence of hypophysitis, as evidenced by a statistically significant association (P = 0.022). Similarly, individuals with HER2 positivity were found to have a significantly increased incidence of pancreatic islet injury (P = 0.023). Moreover, the study documented that the median onset times of ICIs-related endocrinopathies in pituitary, thyroid, pancreatic, and adrenal damage were 264, 184, 99 and 141 days, respectively, which were substantially longer compared to previous reports involving other tumors. Remarkably, even after 500 days of initiating ICI therapy, new cases of ICI-related endocrine disorders continue to emerge, suggesting a situation of delayed onset of ICI-related endocrinopathies in BC patients. The retrospective analysis confirmed a higher incidence and longer median onset time of ICI-related endocrinopathies in BC patients compared to other cancers. These outcomes underscore the critical need for regular and extended monitoring of endocrine functions in BC patients receiving ICI therapy, advocating for personalized monitoring approaches based on individual clinical profiles.

Higher Dietary Inflammatory Index and Increased Mortality Rate of Adults With Hyperuricemia: Findings From the National Health and Nutritional Examination Survey (2001-2018).

This study aimed to assess the association between Dietary Inflammatory Index (DII) score and death among adults with hyperuricemia. We collected data from the 2001 to 2018 cohorts of the National Health and Nutritional Examination Survey. Death information was obtained based on death certificate records from the National Death Index through December 31, 2019. The associations between DII score and all-cause, cardiovascular disease (CVD), and cancer death were investigated by using Cox proportional hazards regression models. We enrolled 7,786 participants with hyperuricemia in this study. The DII score ranged from -4.42 to 4.61. Higher DII score was significantly associated with higher levels of body mass index, glycohemoglobin, glucose, low-density lipoprotein-cholesterol, and C-reactive protein (all P < 0.05). During 67,851 person-years of follow-up, deaths of 1,456 participants were identified, including 532 CVD deaths and 246 cancer deaths. After adjusting for potential variables, significant higher risk of all-cause (hazard ratio [HR] 1.18, 95% confidence interval [95% CI] 1.03-1.36, P = 0.01) and CVD (HR 1.30, 95% CI 1.03-1.63, P = 0.02) death was observed for individuals with higher DII scores. Considering the DII score as a continuous variable, the risk of all-cause and CVD death increases 5% (HR 1.05, 95% CI 1.01-1.08) and 8% (HR 1.08, 95% CI 1.02-1.15) with each one-unit increment in DII score, respectively. Subgroup analysis indicated that the association between DII score and all-cause death among participants with hyperuricemia was more significant in males. DII score is found to be positively associated with all-cause and CVD death of adults with hyperuricemia. Controlling the intake of proinflammatory food might be a potential strategy to reduce the mortality rate.

Neuroprotective Potential of Hygrophila auriculata Targeting Oxidative Stress-Mediated Deficits in Streptozotocin-Induced Sciatic Nerve Injury

Abstract Objective Diabetic neuropathy, a microvascular complication of diabetes, affects 50% of individuals. Addressing this challenge is challenging due to its poorly understood origin and existing therapeutic approaches. This study used a methanolic extract from Hygrophila auriculata (MEHA) to treat oxidative stress-induced sciatic nerve injury in diabetic rats. Materials and Methods A study was conducted to assess the nociceptive reflex after a single streptozotocin (STZ) (45 mg/kg intraperitoneal.) injection. The rats were divided into six groups (n = 6 rats per group). Group I nondiabetic (ND) rats received oral gavage of 1% carboxymethyl cellulose (CMC). The diabetic rats in groups II to VI were given 1% CMC, 100, 200, and 400 mg/kg of MEHA, and 180 mg/kg of metformin (MET). The freshly prepared 1% (w/v) CMC suspension of both MEHA and MET was administered over a 4-week period, commencing from the 28th day through the 56th day post-STZ injection. The impact of STZ-induced sciatic nerve injury was analyzed through the estimation of serum glucose and glycohemoglobin levels, paw withdrawal and tail-flick latencies, oxidative stress markers, and neural histoarchitecture. Results Diabetic (STZ) control group II showed significantly altered serum glucose and glycohemoglobin levels, a reduced paw withdrawal threshold, and reduced paw withdrawal and tail-flick latencies in contrast to ND group I. Furthermore, increased oxidative stress in the sciatic nerve correlates with a reduced nociceptive threshold and disrupted neural histoarchitecture in diabetic rats. These behavioral, biochemical, and molecular changes were markedly and dose-dependently reduced by MEHA and MET treatments. Conclusion The antioxidant efficacy of MEHA modulated oxidative stress in STZ-sensitized diabetic rats and corrected neuropathic pain by attenuating hyperglycemia.

Red Yeast Rice and Statin Therapy in Patients with Hypercholesterolemia and the Comorbidities: A Retrospective Cohort Study on Lipid-Lowering Effects and Cardiovascular Outcomes.

Red yeast rice (RYR) is known for its lipid-lowering effects in patients with hypercholesterolemia; however, its comparative efficacy with statins and risk reduction remains uncertain. This retrospective study analyzed data from 337,104 patients with hyperlipidemia in the Chang Gung Research Database cohort, spanning from January 2016 to December 2021. Exclusion criteria were applied to ensure data completeness and compliance, including an age limit of [Formula: see text] years, absence of RYR or statin treatment, and a treatment duration of [Formula: see text] days. Propensity score matching was employed to minimize bias based on baseline factors, with one patient matching with four patients in the comparison group. The study encompassed a total of 5,984 adult hyperlipidemic patients, with 1,197 in the RYR group and 4,787 in the statin group. The patients were also stratified into statin ([Formula: see text]) or combined use ([Formula: see text]) groups for further comparison. Following one year of treatment, both the RYR and statin groups exhibited reductions in total cholesterol and triglyceride levels. Most biochemical parameters showed no significant differences, except for elevated glutamic oxaloacetic transaminase levels in the RYR group ([Formula: see text]) and increased glycohemoglobin levels in the statin group at the three-month mark ([Formula: see text]). In patients with comorbid diabetes, hypertension, kidney, or liver diseases, RYR and statins demonstrated comparable risks for emergency room (ER) visits, stroke, and myocardial infarction (MI). However, the combination of RYR and statins was associated with reduced stroke-related hospitalizations in patients with diabetes, hypertension, and kidney disease, as well as decreased MI-related hospitalizations in patients with hypertension and kidney disease (all [Formula: see text]). In conclusion, both RYR and statins effectively lower blood lipid levels and mitigate related complications. Combining these therapies may lead to fewer ER visits, reduced stroke frequency, and fewer MI hospitalizations in hypertensive and kidney disease patients, and they decreased all-cause mortality in the kidney disease population. Further research on combined therapy is warranted.

Genetic CYP2A6 Polymorphism May Worsen Glycohemoglobin Levels: Study among Javanese Indonesian Smokers

We have examined the inactive CYP2A6 alleles gene, including CYP2A6*4, CYP2A6*7, and CYP2A6*9, associated with glycohemoglobin levels among Javanese Indonesian smokers. There are 106 smokers participating in this study. Due to the number of cigarettes smoked per day, there are three groups of smokers: light, intermediate, and heavy smokers, with 98.7% being light and intermediated smokers while the rest are heavy smokers. All participants had smoked for more than 10 years, indicating they had been exposed to nicotine for a long time. Based on their genotype, there were four groups of smokers, including fast, intermediate, slow, and poor metabolizers. Most fast and intermediate metabolizers have HbA1c levels in the normal range (&lt;5.7). On the other hand, most slow metabolizers have Hb1c levels &gt;5.7, and all fast metabolizers have HbA1c levels &gt;5,7, indicating that they the prediabetes and diabetes. The chi-square test showed a relationship between CYP2A6 polymorphism and HbA1c levels among the participants (P-value 0.000 &lt;0.005 and χ2=54.6, df=1). The presence of an inactive allele will worsen the HbA1c levels in smokers.

Epigenetic alterations of 11beta-hydroxysteroid dehydrogenase 1 gene in the adipose tissue of patients with primary aldosteronism.

11Beta-hydroxysteroid dehydrogenase 1 (11β-HSD1) is a key enzyme involved in metabolic syndrome. Transcript-specific epigenetic regulation of the gene encoding 11β-HSD1 (HSD11B1) has been reported. We examined the mRNA level and methylation status of the HSD11B1 promoter region in the adipose tissue of patients with primary aldosteronism (PA). We compared 10 tissue specimens from patients with PA caused by aldosterone-producing adenoma (APA) with 8 adipose tissue specimens from patients with subclinical Cushing's syndrome (SCS) caused by cortisol-producing adenomas, 4 tissue specimens from patients with Cushing's adenoma (Cu), or 7 tissue specimens from patients with non-functioning adrenal adenoma (NFA). PA, SCS, and Cu were diagnosed according to the guideline of the Japan Endocrine Society. The mRNA level of HSD11B1 was quantified using real-time PCR. Isolated DNA was treated with bisulfite and amplified using primers specific to the human HSD11B1 promoter region. The glycohemoglobin level was significantly higher in patients with APA, SCS, or Cu than in those with NFA (p < 0.05). Blood pressure was significantly higher in patients with APA than in those with SCS, Cu, or NFA (p < 0.01). The HSD11B1 mRNA level was significantly increased in the adipose tissues of APA or SCS patients compared with Cu or NFA patients (p < 0.05). The methylation ratio was significantly lower in SCS patients than in APA, Cu, or NFA patients (p < 0.05). HSD11B1 expression is partly controlled by an epigenetic mechanism in human tissues. The pathophysiological role of epigenetic regulation of HSD11B1 expression in adipose tissue requires further study.

Epidemiological parameters and monitoring of analysis of treatment of children and adolescents with type 1 diabetes mellitus in insulin pump therapy with modified educational program.

Aim: The aim of the present published work is efficacy evaluation of the modified educational program in achieving the target levels of glycemia in children and adolescents with type 1 diabetes mellitus in pump insulin therapy in Almaty.. Materials and Methods: This study involved 125 children and adolescents with type 1 DM and evaluated the effectiveness of a modified educational program at the School of Type 1 Diabetes Mellitus. Participants were divided into subgroups based on their method of glycemia evaluation. The program's effectiveness was assessed through pre-and post-training questionnaires and measurement of glycohemoglobin levels. Statistical analysis was conducted using the Statistica application. Results: The study evaluated the effectiveness of a modified educational program for children and adolescents with type 1 DM. The results indicated that those who participated in the modified program demonstrated significant improvements in their knowledge and ability to manage their diabetes. They were able to correctly answer 80-90% of the questionnaire questions six months to a year after the training. Additionally, those in the modified program exhibited better carbohydrate metabolism rates and achieved higher rates of their individual treatment goals, especially when using the FreeStyle Libre system for continuous monitoring of blood glucose levels. These findings suggest that a modified educational approach can significantly enhance diabetes management and treatment outcomes in children and adolescents. Conclusions: The study concluded that a modified educational program leads to better target therapy levels in children and adolescents with type 1 diabetes mellitus, highlighting the importance of motivated parents and frequent blood glycemia measurements.

Association of serum 25-hydroxyvitamin D concentrations with all-cause mortality among individuals with kidney stone disease: the NHANES database prospective cohort study.

The purpose of this study was to investigate the correlation between serum 25(OH)D concentrations and all-cause mortality in patients with kidney stone disease (KSD) as the effects of a deficiency in 25-hydroxyvitamin D on KSD patients are currently unclear. For our prospective cohort study, we included 2,916 participants from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The National Death Index (NDI) was utilized to identify all causes of death and cause-specific mortality until December 31, 2018. We calculated hazard ratios (HR) and 95% confidence intervals (CIs) using multivariate Cox regression models. During the 18,859 person-years of follow-up, a total of 375 fatalities occurred, including 83 deaths from cardiovascular disease (CVD) and 79 deaths from cancer. At baseline, individuals with higher blood 25(OH)D concentrations had lower levels of glucose, glycohemoglobin, CRP, and insulin, as well as higher levels of HDL cholesterol (P < 0.01). In the fully adjusted model (Model 3), compared to the group with the lowest 25(OH)D concentrations, those with serum 25(OH)D concentrations ≥75 nmol/L had hazard ratios (HRs) and 95% confidence intervals (CIs) of 0.48 (0.26, 0.87) for all-cause mortality (P=0.02, P for trend = 0.02). The association between serum 25(OH)D concentrations and all-cause mortality in KSD patients was found to be significantly non-linear. A 7% decrease in the risk of death from all causes was observed for each unit-nmol/L increase in serum 25(OH)D concentrations when the concentrations were below 27.7 nmol/L (P < 0.05). Based on the findings, KSD patients with insufficient serum 25(OH)D concentrations were at a higher risk of all-cause mortality. Therefore, it is crucial to maintain sufficient blood 25(OH)D concentrations and prevent 25(OH)D insufficiency in order to extend the lifespan of KSD patients.

Establishment and validation of a risk predictive model of preoperative drug-induced limitation of pupil dilation in type 2 diabetes mellitus patients with concomitant cataract

Objective: To establish and validate a risk predictive model of preoperative drug-induced limitation of pupil dilation (PD) in type 2 diabetes mellitus (T2DM) patients with concomitant cataract. Methods: A cross-sectional study was performed, in which 376 T2DM patients with concomitant cataract who received cataract operation in the Second Affiliated Hospital of Zhejiang University School of Medicine from October 2022 to March 2023 were randomly selected as the study subjects. Of the 376 patients, 268 who were admitted to the hospital from October to December 2022 served as the modeling group, and were divided into PD limited group (n=187) and PD unlimited group (n=81) based on whether they had drug-induced limitation of PD. Logistic regression was used to establish a risk predictive model, R software was used to draw the nomogram, Hosmer-Lemeshow test was utilized to judge the model's goodness of fit, and receiver operating characteristic (ROC) curve was adopted to validate the predicting efficacy of the model. Another 108 T2DM patients who received cataract operation in the same hospital from January to March 2023 served as the validation group, and Hosmer-Lemeshow test and ROC curve were used for the external validation of the model. Results: In the modeling group (n=268), there were 124 males and 144 females, with the mean age of (66.6±6.8) years, while in the validation group (n=108), there were 51 males and 57 females, with the mean age of (64.9±9.1) years. The incidence of preoperative drug-induced limitation of PD was 69.8% (187/268) in T2DM patients with concomitant cataract. T2DM disease course (OR=1.134, 95%CI: 1.074-1.198, P<0.001), body mass index (BMI) (OR=0.863, 95%CI: 0.767-0.972, P=0.015), glycohemoglobin (HbA1c) level (OR=1.397, 95%CI: 1.055-1.849, P=0.019) and baseline pupil dimeter (OR=0.089, 95%CI: 0.045-0.179, P<0.001) were the risk factors of drug-induced limitation of PD. Hosmer-Lemeshow test showed χ2=6.231 and P=0.621, the area under curve (AUC) of ROC curve was 0.897 (95%CI: 0.857-0.937, P<0.001), and when the Youden index was the maximum (0.655), the model's sensitivity and specificity was 0.877 and 0.778, respectively. The external validation results demonstrated that the AUC of ROC curve was 0.928 (95%CI: 0.875-0.981, P<0.001), the maximum Youden index was 0.761, the sensitivity was 0.932, the specificity was 0.829, and the overall accuracy was 89.8%. Conclusion: The risk predictive model established in the current study can provide reference for the clinical assessment of the risk of preoperative drug-induced limitation of PD in T2DM patients with concomitant cataract.

Association of serum 25-hydroxyvitamin D levels with all-cause and cause-specific mortality among postmenopausal females: results from NHANES

BackgroundVitamin D deficiency is common among the population, but its relationship with mortality of postmenopausal females is unclear. The aim of this study is to explore the association between serum 25-Hydroxyvitamin D (25(OH)D) and all-cause and cause-specific mortality among postmenopausal women in the United States.Methods6812 participants of postmenopausal females from the National Health and Nutrition Examination Survey (2001–2018) were included in this study. The mortality status of the follow-up was ascertained by linkage to National Death Index (NDI) records through 31 December 2019. We used cox proportional hazards models to estimate the association of serum 25(OH)D concentrations and mortality of postmenopausal females.ResultsThe mean level of serum 25(OH)D was 72.57 ± 29.93 nmol/L, and 65.34% had insufficient vitamin D. In postmenopausal females, low serum 25(OH)D concentrations were significantly associated with higher levels of glycohemoglobin, glucose, and lower levels of HDL. During follow-up, 1448 all-cause deaths occurred, including 393 cardiovascular disease (CVD)-related deaths and 263 cancer deaths. After multivariate adjustment, higher serum 25(OH)D levels were significantly related with lower all-cause and CVD mortality. In addition, serum 25(OH)D presented a L-shaped relationship with all-cause mortality, while appeared a U-shaped with CVD mortality, and the cut-off value is 73.89 nmol/L and 46.75 nmol/L respectively.ConclusionsLow serum 25(OH)D levels are associated with the higher risk of all-cause and CVD mortality in postmenopausal females. These findings provide new ideas and targets for the health management of postmenopausal women.

Interval walking training in type 2 diabetes: A pilot study to evaluate the applicability as exercise therapy.

There are few established easy-to-perform exercise protocols with evidence-based effects for individuals with type 2 diabetes (T2D). A unique exercise regimen, interval walking training (IWT), has been reported to be beneficial for improving metabolic function, physical fitness and muscle strength in adults of overall health. This pilot study aims to demonstrate descriptive statistics of IWT adherence and changes in various data before and after the intervention of IWT in adults with T2D, perform statistical hypothesis testing, and calculate effect sizes. We performed a single-arm interventional pilot study with IWT for 20 weeks. We enrolled 51 participants with T2D aged 20-80 years with glycohemoglobin (HbA1c) levels of 6.5-10.0% (48-86 mmol/mol) and a body mass index of 20-34 kg/m2, respectively. The target was 60 min/week of fast walking for 20 weeks. The participants visited the hospital and were examined at 4-week intervals during this period. Between the start of IWT and after 20 weeks, we measured and evaluated changes in glucose and lipid metabolism data, body composition, physical fitness, muscle strength, dietary calorie intake, and daily exercise calories. All included participants completed IWT, with 39% of them reaching the target length of fast walking over 1,200 minutes in 20 weeks. In the primary outcome, HbA1c levels, and in the secondary, lipid metabolism and body composition, no significant changes were observed except for high-density lipoprotein cholesterol (HDL-C) (from 1.4 mmol/L to 1.5 mmol/L, p = 0.0093, t-test). However, in the target achievement group, a significant increase in VO2 peak by 10% (from 1,682 mL/min to 1,827 mL/min, p = 0.037, t-test) was observed. Effect sizes were Cohen's d = 0.25 of HDL-C, -0.55 of triglyceride, and 0.24 of VO2 peak in the target achievement group, which were considered to be of small to medium clinical significance. These results could be solely attributed to IWT since there were no significant differences in dietary intake and daily life energy consumption before and after the study. IWT could be highly versatile and was suggested to have a positive effect on lipid metabolism and physical fitness. In future randomized controlled trial (RCT) studies, the detailed effects of IWT, focusing on these parameters, will be examined. Trial registration: This trial was registered with the Japanese University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR: Usefulness on interval walking training in patients with type 2 diabetes. 000037303).

A Novel Approach for Glycosylated Hemoglobin Testing Using Microchip Affinity Electrophoresis.

Effective management of diabetes largely benefits from early diagnosis followed by intensive long-term regulation of blood glucose. The levels of glycohemoglobin (HbA1 and HbA1c) have been used as standard biomarkers to assess long-term blood glucose concentrations for diabetes diagnosis and management. Gold standard laboratory methods for HbA1 and HbA1c testing are often costly and not widely available. Moreover, currently available point-of-care (POC) immunoassay-based glycohemoglobin tests may produce inaccurate test results for patients with co-existing diseases such as hemoglobin disorders and anemia. Here, we report a POC platform, HemeChip-GHb, for quantitative HbA1 detection leveraging paper-based affinity electrophoresis. We describe the design and development of the HemeChip-GHb test. Feasibility and accuracy of the HemeChip-GHb system were demonstrated by testing blood samples collected from healthy donors, patients with prediabetes, and patients with diabetes. HbA1 levels measured with HemeChip-GHb show 0.96 correlation to the levels reported from the clinical standard HPLC tests, and with a bias of -0.72% based on Bland-Altman analysis. 99.6% of the HbA1 levels for paired HemeChip-GHb and HPLC fell within A and B zones of no difference in clinical outcome based on error grid analysis. Using HemeChip-GHb we achieved accurate diabetes status detection with sensitivity and specificity of 100%. We presented a novel POC paper-based affinity electrophoresis platform that has the potential for accurately diagnosing diabetes, and addressing an unmet need for accurate and affordable diagnostics in resource-challenged environments.

Diabetic coma in the mortality of patients with diabetes mellitus

BACKGROUND: Statistics on the causes of death of patients with diabetes mellitus do not correspond to real indicators because of the insufficient level of diagnosis at the post-mortem stage of research in most regions of the country.&#x0D; AIM: This study aimed to statistically analyze the mortality of patients with diabetes as a result of diabetic coma in the period from 2017 to 2020.&#x0D; MATERIALS AND METHODS: The study examined blood and vitreous body of the eyes from 4444 patients with diabetes mellitus. The levels of glycohemoglobin in the blood and glucose, lactate, and acetoacetate in the vitreous body of the eyes were determined. The diagnosis of diabetic coma was made taking into account previously developed criteria.&#x0D; RESULTS: A total of 692 (15.6%) patients with diabetes mellitus died of diabetic coma. Diabetic coma-related deaths occupy a much larger percentage of cases than is available in statistical data because of the insufficient implementation of laboratory tests at the post-mortem stage of diagnosis and restricted coding of the cause of diabetic coma-related death of patients with diabetes mellitus. Methods for diagnosing diabetic comas are easy to perform, guarantee high accuracy and reliability of results, and are available for any specialized laboratory.&#x0D; CONCLUSION: The most common precomatous state (the beginning of the development of hyperosmolar non-ketoacidotic coma), which in combination with coma itself, leads to the highest rates of diabetic coma-related death. In recent years, diabetic coma-related death tended to reduce.