Higher Initial Glucose Levels Research Articles

Multi-Objective Optimal Regulation of Glucose Concentration in Type I Diabetes Mellitus

Abstract Type I, or insulin-dependent diabetes mellitus, is a chronic disease in which insulin is not adequately produced by the pancreatic β-cells, which leads to a high glucose concentration. In practice, external insulin delivery is the only method to deal with this disease. To this end, a multi-objective optimal control for insulin delivery is introduced in this paper. Three conflicting objectives, including minimizing the risk of hypoglycemia and hyperglycemia, and reducing the amount of injected insulin, are considered. These objectives are minimized simultaneously while tuning the closed-loop system parameters that include the design details of the linear-quadratic regulator (LQR) and estimator speed of convergence. The lower and upper bounds of the LQR setup parameters are determined by Bryson’s rule taking into account the nominal glucose range (70−160 mg/dL) and maximum and minimum pump infusion rates (0.0024−15 mU/min). The lower and upper bounds of the estimator convergence speed are chosen such that the estimator is faster than the fastest mode of the closed-loop system. For computer simulations, Bergman’s minimal model, which is one of the commonly used models, is employed to simulate glucose-insulin dynamics in Type-I diabetic patients. The optimization problem is solved by the nondominated sorting genetic algorithm (NSGA-II), one of the widely used algorithms in solving multi-objective optimization problems (MOPs). The optimal solutions in terms of the Pareto set and its image, the Pareto front, are obtained and analyzed. The results show that the MOP solution introduces many optimal options from which the decision-maker can choose to implement. Furthermore, under high initial glucose levels, parametric variations of Bergman’s model, and external disturbance, the optimal control performance are tested to show that the system can bring glucose levels quickly to the desired value regardless of high initial glucose concentrations, can efficiently work for different patients, and is robust against irregular snacks or meals.

Inpatient Hypoglycemia in Patients With Chronic Kidney Disease

Background: Inpatient hypoglycemia has been shown to be associated with increased mortality, more complications, and greater length of stay [1]. Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) are at greater risks for hypoglycemia due to their decreased degradation of insulin, reduced glycogen stores, and decreased renal gluconeogenesis. With the association between inpatient hypoglycemia and increased morbidity and mortality, it is valuable to determine other risks factors that may contribute to hypoglycemia in the hospital setting. Objective: Determine the rates of hypoglycemia (glucose <70 mg/dl) and severe hypoglycemia (glucose <54 mg/dl) along with risk factors, such as type of insulin used and initial hyperglycemia at admission, for patients with diabetes mellitus (DM) and CKD/ESRD. Methods: A retrospective cohort analysis was conducted on 74,266 hospitalized patients who had DM and CKD/ESRD or DM alone, within 155 HCA Healthcare hospitals from January 2019 through June 2019. Results: Among hospitalized patients with DM, hypoglycemia was more common in patients with ESRD (n=5234) compared to patients with CKD without ESRD (n=18659) and patients without CKD/ESRD (n=52373) (34.37% vs. 23.66% vs. 12.91%, respectively, p<0.01). Similarly, severe hypoglycemia was more common in patients with ESRD compared to patients with CKD without ESRD, and patients without CKD/ESRD (18.09% vs. 11.19% vs. 5.28%, respectively, p<0.01).When evaluating patients with ESRD, a higher point of care (POC) glucose at time of admission was associated with an increased risk of subsequent hypoglycemia. Within the first 24 hours of hospital admission, hypoglycemia was more common if the patient’s initial POC glucose was greater than 300 with an incidence of 13.67% compared to 11.21% (n=955, p=0.033). Among patients with ESRD and an admission glucose > 300, having an order for dialysis within the first 24 hours of admission was associated with increased risk of hypoglycemia (OR= 1.2181, p=0.0014). Diabetics with subsequent hypoglycemia had higher initial glucose levels on admission when compared to diabetics who did not experience hypoglycemia during their hospital stay. Mean = 221.61±82.32 vs 205.54±74.51 (p=0.000002). Conclusion: In hospitalized patients with DM, CKD and ESRD are associated with increased risk of hypoglycemia. Amongst diabetics, patients with ESRD and CKD account for over 50% of cases of severe hypoglycemia. Severe hypoglycemia occurred in 18% of patients who had both diabetes and ESRD. An elevated glucose at admission is associated with a subsequent hypoglycemia in patients with ESRD. It is important to manage DM in patients with CKD and ESRD carefully as they may be more likely to experience hypoglycemia due to overcorrection and decreased clearance of insulin.1.Hulkower et al., Diabetes Manag 2014 Mar;4(2):165–176.

Part I: the influence of serial repitching ofSaccharomyces pastorianuson the uptake dynamics of metal ions and fermentable carbohydrates during the fermentation of barley and gluten-free buckwheat and quinoa wort

Recently, research has been focusing on the use of alternative raw materials for brewing purposes and gluten-free beer-like beverages from malted buckwheat and quinoa are of commercial interest. A common commercial process involves the serial repitching of the yeast biomass, but this has not been described using buckwheat and quinoa wort fermentations. Our research studies (Parts I–III) explored the serial repitching of the yeast strain Saccharomyces pastorianus TUM 34/70 on the composition of a barley, buckwheat and quinoa fermentation medium. The present paper focuses on the fermentation performance and the uptake dynamics of metal ions and fermentable carbohydrates. Both pseudocereals showed high variations in all of the attributes examined during successive fermentations. In buckwheat the differences between successive fermentations were similar to those observed with barley, whereas differences in quinoa varied quite significantly from those observed with barley and showed a directional trend, suggesting a general weakening of the yeast from the sixth successive fermentation onward. In particular, the assimilation of the fermentable carbohydrates lessened and metal ion uptake appeared poorly controlled. It was concluded that buckwheat showed good potential for serial repitching of S. pastorianus TUM 34/70, whereas serial repitching of a quinoa wort appeared to be limited to five or six fermentations. Copyright © 2015 The Institute of Brewing & Distilling

Epidemiologic Features of Type 1 Diabetic Patients between 0 and 18 Years of Age in İstanbul City.

Objective:To evaluate the epidemiologic, clinical and laboratory characteristics of a group of children with type 1 diabetes mellitus (T1DM) living in a Turkish city. Methods:The records of 395 (boys/girls: 199/196) children with newly diagnosed T1DM hospitalized in the years 1985-2004 were evaluated retrospectively. The data were assessed by gender and age subgroups (≤5, 6-10 and ≥11 years).Results:Mean age of children at diagnosis was 8.1±4.1 years. At T1DM onset, the number of children ≤5, between 6-10 and ≥11 years old was 110 (27.9%), 147 (37.2%) and 138 (34.9%), respectively. The patients were mostly diagnosed at ages 6-8 years (24.1%), followed by cases aged 3-5 years (22.0%). Polyuria and polydipsia were the most common symptoms (94.7%). Mean duration of symptoms was 21.5±18.6 days. Although the patients mostly presented in autumn (30.7%), no season-related significant differences were found. The frequency of ketoacidosis was relatively high (48.5%). When compared to boys, the girls experienced higher rates of ketoacidosis (55.1% vs. 41.7%, p=0.042); had a higher frequency of anti-thyroid peroxidase antibodies (11.7% vs. 4.2%, p=0.049) and higher insulin requirement (0.89±0.41 vs. 0.77±0.36 IU/kg, p=0.005). Cases with a family history of T1DM were more likely to have anti-endomysial antibodies (42.9% vs. 8.1%, p=0.027) and higher initial blood glucose levels (510.5±145.0 vs. 436.1±156.5 mg/dL, p=0.005).Conclusion:The findings possibly indicate a decreasing age of T1DM onset. The high frequency of ketoacidosis at presentation is noteworthy. Girls had higher rates of ketoacidosis, higher frequency of anti-thyroid antibodies and higher insulin requirements as compared to boys. Patients with a family history of T1DM had higher initial glucose levels and higher frequency of anti-endomysial antibodies.

Diabetes Is Not Associated With Increased Mortality in Emergency Department Patients With Sepsis

Despite its high prevalence, the influence of diabetes on outcomes of emergency department (ED) patients with sepsis remains undefined. Our aim is to investigate the association of diabetes and initial glucose level with mortality in patients with suspected infection from the ED. Three independent, observational, prospective cohorts from 2 large US tertiary care centers were studied. We included patients admitted to the hospital from the ED with suspected infection. We investigated the association of diabetes and inhospital mortality within each cohort separately and then overall with logistic regression and generalized estimating equations adjusted for age, sex, disease severity, and sepsis syndrome. We also tested for an interaction between diabetes and hyperglycemia/hypoglycemia. A total of 7,754 patients were included. The mortality rate was 4.3% (95% confidence interval [CI] 3.9% to 4.8%) and similar in diabetic and nondiabetic patients (4.1% versus 4.4%; absolute risk difference 0.4%; 95% CI -0.7% to 1.4%). There was no significant association between diabetes and mortality in adjusted analysis (odds ratio [OR] overall 0.85; 95% CI 0.71 to 1.01). Diabetes significantly modified the effect of hyperglycemia and hypoglycemia with mortality; initial glucose levels greater than 200 mg/dL were associated with higher mortality in nondiabetic patients (OR 2.1; 95% CI 1.4 to 3.0) but not in diabetic patients (OR 1.0; 95% CI 0.2 to 4.7), whereas glucose levels less than 100 mg/dL were associated with higher mortality mainly in the diabetic population (OR 2.3; 95% CI 1.6 to 3.3) and to a lesser extent in nondiabetic patients (OR 1.1; 95% CI 1.03 to 1.14). We found no evidence for a harmful association of diabetes and mortality in patients across different sepsis severities. High initial glucose levels were associated with adverse outcomes in the nondiabetic population only. Further investigation is warranted to determine the mechanism for these effects.

Killip classification and glucose level in patients with acute myocardial infarction

Objective Killip classification is a valuable prognostic stratification for patients with acute myocardial infarction. Patients with high initial glucose levels also have adverse outcomes. We hypothesize that an increase in the Killip classification rank of patients with acute myocardial infarction might be associated with increase in initial glucose levels. Methods In a retrospective cohort study, patients receiving percutaneous coronary angiography after an acute myocardial infarction were enrolled. Patients were accorded Killip classifications, and the data were compared using the χ 2 and 1-way analysis of variance tests. Results The study was conducted on 246 eligible subjects. Higher initial glucose levels were associated with higher rate of hospitalization within 1 year as well as mortality ( P < .05). Glucose levels among the 4 Killip classes were different ( P < .05). Conclusion Patients ranked in the higher Killip classes had higher glucose levels than those ranked in the lower classes.

Immediate and Delayed Cord Clamping in Infants Born Between 24 and 32 Weeks: A Pilot Randomized Controlled Trial

This pilot study's aim was to establish feasibility of a protocol for delayed cord clamping (DCC) versus immediate cord clamping (ICC) at preterm birth and to examine its effects on initial blood pressure and other outcomes. A randomized controlled trial recruited 32 infants between 24 and 32 weeks. Immediately before delivery, mothers were randomized to ICC (cord clamped at 5 to 10 seconds) or DCC (30- to 45-second delay in cord clamping) groups. Intention-to-treat analyses revealed that the DCC group were more likely to have higher initial mean blood pressures (adjusted OR 3.4) and less likely to be discharged on oxygen (adjusted OR 8.6). DCC group infants had higher initial glucose levels (ICC=36 mg/dl, DCC=73.1 mg/dl; p=0.02). The research design is feasible. The immediate benefit of improved blood pressure was confirmed and other findings deserve consideration for further study.

Immobilization of Zymomonas mobilis 2716, for the protection of cellular activity

Alginate-immobilized Zymomonas mobilis cells produced 17.8% (v/v) ethanol in less than 24 h, with an ethanol yield of 97%, compared with 88% for free cells, using a fed-batch cultivation technique. The substrate, glucose, was added intermittently in powder form to foster nucleation of the CO2 formed. Repeated-batch cultivation led to complete utilization of approximately 200 g glucose/l in 7.5 h with a 98% conversion efficiency to ethanol. Free cells used the glucose less efficiently (conversion efficiency of 78%), and even after 100 h the glucose was not fully consumed. Freeze-substitution electron microscopy studies showed that immobilized cells generally displayed lesser blebbing and membrane disruption than free cells. These studies further suggest that membrane blebbing may be due to an effect of high initial glucose levels, and not due to the accumulation of end-products ethanol and CO2.

Direct fermentation of starch to lactic acid byLactobacillus amylovorus

Fermentation production of lactic acid directly from starch was studied in a batch fermentor usingLactobacillus amylovorus. At an initial concentration of 120 g/L starch, 96.2 g/L of lactic acid was produced from liquefied starch in 20 hours while 92.5 g/L of lactate was produced from the raw starch in 39 hours. High initial glucose levels (100 g/L) in the medium inhibited the organism, unless it had been adapted by growing it in a low-glucose medium. The direct production of lactic acid from starch could reduce overall production costs significantly.

Poly- and disaccharidases in Vespa orientalis (Vespinae: Hymenoptera)

1. 1. Carbohydrate hydrolases (Group 3) of Vespa orientalis were quantitatively assayed. 2. 2. In most body tissue homogenates and fluids maltase and sucrase were the most active disaccharidases. 3. 3. Trehalase was the most active in all venom samples and in the gut of workers. 4. 4. Isomaltase activity was lower than the other three major disaccharidases and it was absent from the head of adult insects and from larval fat body. 5. 5. Lactase and cellobiase activity was only found in hemolymph, gut and gastric juice samples. 6. 6. Polysaccharidase activity was present in all of the examined samples. 7. 7. Stored hemolymph samples (−20°C) had high initial glucose levels, but no significant difference was found in the enzymatic activity between stored and fresh hemolymph. 8. 8. Anaerobic conditions did not prevent or delay glucogenesis in fresh hemolymph.

Effect of chlorpropamide treatment on insulin secretion in diabetics: Its relationship to the hypoglycemic effect

We have studied the effect of chronic chlorpropamide treatment on insulin secretion in response to intravenous glucose. With treatment, the mean insulin level 5 min after glucose infusion increased significantly in 1 wk and reached its highest level in 1 mo. The increment over the fasting level increased similarly. The mean levels 20, 30, and 60 min after infusion did not change with treatment. All the diabetics, except one, with a fasting blood glucose level greater than 160 mg 100 ml had little or no insulin secretion 5 min after glucose infusion either before or during chlorpropamide treatment. The mean blood glucose levels decreased during treatment more in those with higher initial glucose levels. The increase in early (5 min) insulin secretion was not related to the hypoglycemic effect. These data indicate that with chlorpropamide treatment early insulin secretion usually improves. Since a decrease in blood glucose may occur without any change in insulin secretion in some patients, it is suggested that the improvement in early insulin secretion may be secondary to a general improvement in carbohydrate metabolism.