Higher Plasma Glucose Levels Research Articles

Deletion of platelet-derived growth factor receptor-β improves diabetic nephropathy in Ca2+/calmodulin-dependent protein kinase IIα (Thr286Asp) transgenic mice

The activation of platelet-derived growth factor receptor-β (PDGFR-β) signalling is increased in the glomeruli and tubules of diabetic animals. In this study, we examined the role of PDGFR-β signalling during the development of diabetic nephropathy. We recently generated pancreatic beta cell-specific Ca(2+)/calmodulin-dependent protein kinase IIα (Thr286Asp) transgenic mice (CaMKIIα mice), which show very high plasma glucose levels up to 55.5 mmol/l and exhibit the features of diabetic nephropathy. These mice were crossed with conditional knockout mice in which Pdgfr-β (also known as Pdgfrb) was deleted postnatally. The effect of the deletion of the Pdgfr-β gene on diabetic nephropathy in CaMKIIα mice was evaluated at 10 and 16 weeks of age. The plasma glucose concentrations and HbA(1c) levels were elevated in the CaMKIIα mice from 4 weeks of age. Variables indicative of diabetic nephropathy, such as an increased urinary albumin/creatinine ratio, kidney weight/body weight ratio and mesangial area/glomerular area ratio, were observed at 16 weeks of age. The postnatal deletion of the Pdgfr-β gene significantly decreased the urinary albumin/creatinine ratio and mesangial area/glomerular area ratio without affecting the plasma glucose concentration. Furthermore, the increased oxidative stress in the kidneys of the CaMKIIα mice as shown by the increased urinary 8-hydroxydeoxyguanosine (8-OHdG) excretion and the increased expression of NAD(P)H oxidase 4 (NOX4), glutathione peroxidase 1 (GPX1) and manganese superoxide dismutase (MnSOD) was decreased by Pdgfr-β gene deletion. The activation of PDGFR-β signalling contributes to the progress of diabetic nephropathy, with an increase in oxidative stress and mesangial expansion in CaMKIIα mice.

Beneficial Effect of Traditional Chinese Medicinal Formula Danggui-Shaoyao-San on Advanced Glycation End-Product-Mediated Renal Injury in Streptozotocin-Diabetic Rats

The present study was undertaken to characterize the effects of Danggui-Shaoyao-San (DSS), a famous traditional Chinese medicine formula consisting of six herbal medicines, on diabetic nephropathy. Streptozotocin-induced diabetic rats were orally administrated DSS (2.8 g kg−1 per day) for 12 consecutive weeks. DSS partially decreased the high plasma glucose level in diabetic rats. Diabetic-dependent alterations in urinary albumin, 24-hour urinary albumin excretion rate, and creatinine clearance as well as the kidney hypertrophy (kidney weight/body weight ratio) and glomerular mesangial matrix expansion were ameliorated after 12 weeks of DSS treatment. The increased expression of nuclear factor-κB as well as transforming growth factor-β 1 and the progressive accumulation of type IV collagen in kidney of diabetic rats were also attenuated by DSS. Not only the elevated levels of advanced glycation end products (AGEs) and N ε-(carboxymethyl)lysine but also the higher levels of lipid peroxidation products in kidney of diabetic rats were ameliorated by DSS. Decreased activity of superoxide diamutase and glutathione peroxidase in kidney of diabetic rats was enhanced by DSS. These data demonstrated that the renoprotective effects of DSS in STZ-diabetic rats not only were attributable to regulate plasma glucose to attenuate AGEs expression in diabetic glomeruli but also likely reflected its antioxidant activity.

Association of SUMO4 Met55Val variation with increased insulin resistance in newly diagnosed type 2 diabetes in a Chinese population

SUMO4 Met55Val variation was shown to be related to type 2 diabetes susceptibility and the vascular complications in Asian people. To further examine the related mechanisms, this study was designed to evaluate the association of SUMO4 Met55Val polymorphism with insulin resistance and β cell function in newly diagnosed type 2 diabetic patients in a Chinese population. Four hundred and twenty seven newly diagnosed type 2 diabetic patients were selected for SUMO4 Met55Val polymorphism genotype analysis. All subjects underwent a 75-g oral glucose tolerance test (OGTT) to estimate the insulin sensitivity and β cell function. Anthropometrics and a metabolic profile were used for phenotyping analysis. The results showed that the SUMO4 Met55Val polymorphism was associated with higher insulin resistance (P<0.001) and lower insulin sensitivity (P<0.001). Patients with GG genotype had higher levels of plasma glucose, insulin and C peptide. Insulin sensitivity index (ISI) was closely correlated with body mass index (BMI) in patients with GG genotype in comparison to the counterparts with AG or AA genotype (r= -0.504 vs. r= -0.430 vs. r= -0.340). Multiple regression linear analysis showed that SUMO4 Met55Val polymorphism was an independent determinant for insulin sensitivity (P=0.001), which, along with triglyceride, BMI and sex, could account for 20.1% of the variation in ISI. The result remained the same after adjusting for BMI and sex. No association was found between SUMO4 Met55Val polymorphism and β cell function (all P>0.05). It was concluded that SUMO4 Met55Val variant was associated with increased insulin resistance in Chinese patients with newly diagnosed type 2 diabetes.

Naturally high plasma glucose levels in mourning doves ( Zenaida macroura) do not lead to high levels of reactive oxygen species in the vasculature

Plasma glucose (P Glu) concentrations in birds are 1.5–2 times higher than those of mammals of similar body mass. In mammals, sustained elevations of P Glu lead to oxidative stress and free radical-mediated scavenging of endogenous vasodilators (e.g., nitric oxide), contributing to elevated blood pressure. Despite the relatively high P Glu levels in birds, they appear resistant to the development of oxidative stress in tissues such as the heart, brain and kidneys. To our knowledge no information exists on oxidative stress susceptibility in the resistance vasculature of birds. Therefore, we compared endogenous antioxidant mechanisms in the resistance vasculature of mourning doves (MODO; Zenaida macroura) and rats ( Rattus norvegicus). Reactive oxygen species (ROS) were assessed with the fluorescent indicator 7′-dichlorodihydrofluorescein diacetate, acetyl ester in mesenteric arteries from rats and wild-caught MODO. Despite having significantly higher P Glu than rats, there were no significant differences in ROS levels between mesenteric arteries from rats or doves. Although superoxide dismutase and catalase activities were lower in the plasma, total antioxidant capacity, uric acid, vitamin E (α-tocopherol), and carotenoids (lutein and zeaxanthin) were significantly higher in MODO than in rats. Thus, compared to rats, MODO have multiple circulating antioxidants that may prevent the development of oxidative stress in the vasculature.

High-intensity Exercise Training Attenuates Diabetes-induced Muscle Capillary Regression In Non-obese NIDDM Rats

Exercise has been shown to be an effective non-pharmacological treatment in the prevention of some disease complications due to type 2 diabetes mellitus (T2DM). PURPOSE: The purpose of this study was to explore the effects of high-intensity running exercise on the 3-D microangiopathic structural changes of the capillary networks and associated angiogenic factors in the soleus muscle of non-obese T2DM rats. METHODS: Male Goto-Kakizaki (6 weeks old) spontaneously non-obese diabetic rats were used as a model of non-insulin dependent diabetes mellitus (NIDDM). Three groups of rats were studied: sedentary diabetic (T2DM), exercised diabetic (T2DM+Ex), and age-matched sedentary non-diabetic control (Con, wild-type Wistar) rats. The exercised rats were run at a relatively high-intensity (lactate > 9 mmol/L) on a treadmill. This protocol consisted of running at 20 m/min at a 20° incline for 30 min /session, 5 sessions /week for 3 weeks. The capillary network of the soleus muscle was visualized using confocal laser microscopy. The mRNA expression levels of several angiogenic factors (VEGF, KDR, Flt-1, Ang-1, Ang-2, Tie-2, and HIF-1 alpha) were determined in the soleus by TaqMan probe-based real-time PCR. RESULTS: Both T2DM and T2DM+Ex rats had higher levels of plasma glucose and glycohemoglobin compared to Con rats. The level of reactive oxygen species was higher in T2DM+Ex than Con and T2DM rats. The capillary volume of the soleus was lower in T2DM than Con rats. In contrast, the capillary volume was higher in T2DM+Ex than Con and T2DM rats. In addition the expression levels of all angiogenic factors in the soleus were lower in T2DM than Con and T2DM+Ex rats, except for VEGF and Ang-1 which were similar to Con rats. Furthermore, all values were higher in the T2DM+Ex than Con and T2DM rats. CONCLUSIONS:The present results indicate that high-intensity running exercise training reduces muscle circulatory complications associated with NIDDM in rats.

A study of the sodium‐glucose co‐transports of the avian kidney

Given animals of similar body mass, birds have been shown to have much higher plasma glucose concentrations than that of mammals. However, birds appear not to show the pathological symptoms associated with high plasma glucose levels as seen in mammals. As the glomerular filtration rates (on a mass specific basis) of birds and mammals are not significantly different and with higher plasma glucose levels, birds must have a larger filtered load of glucose. Despite this there is little or no detectable glucose in the ureteral urine of birds. This suggests that the mechanisms for glucose reabsorption by the bird kidney must be significantly up-regulated. In mammals glucose reabsorption is achieved through the sodium-glucose co-transport proteins (SGLTs) located in the apical cell membrane of the proximal renal tubule. The putative SGLTs within the avian kidney have not been isolated or characterized. Using SDS-PAGE and Western blots, we have been able to demonstrate the present of an immuno-reactive protein in the kidneys from mourning doves albeit not at the same intensity as that the rat kidney used as control.

Relationship between nonalcoholic fatty liver disease and metabolic syndrome

The aim of this study was to investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MS) in subjects who underwent a routine health checkup. We intended to establish a clinical association between NAFLD and MS as well as to compare the diagnostic criteria of MS based on the definitions set forth by the International Diabetes Federation (IDF), the US National Cholesterol Education Program Adult Treatment Panel III (2001) (NCEP/ATP-III) and the Metabolic Syndrome Study Group of Chinese Diabetes Society (CDS). Weight, height, waist circumference, hip circumference, percentage of body fat, blood pressure and ultrasound of liver were performed on subjects undergoing routine health checkup. Serum triglyceride, total cholesterol, high density lipoprotein cholesterol and fasting plasma glucose level were measured. A total of 2394 subjects were included in this analysis and 437 had NAFLD. The prevalence of MS in the whole sample according to IDF, NCEP/ATP-III and CDS definitions was 11.11%, 8.48% and 5.30%, respectively. The total degree of agreement between IDF, NCEP/ATP-III and CDS definition was 87.76%. The prevalence of MS in NAFLD subjects is much higher than that in non-NAFLD subjects. The prevalence of NAFLD in MS subjects is also much higher than that in non-MS subjects. The prevalence of MS varied depending on the diagnostic criteria used. NAFLD was strongly associated with the MS, although it remains unknown whether NAFLD is a cause or effect of MS.

Influence of plasma glucagon levels on glycemic control in children with type 1 diabetes

The aim of this study was to investigate the association between plasma glucose (PG), HbA1c and plasma glucagons levels in children with type 1 diabetes to determine the influence of plasma glucagon on their glycemic control. The study was conducted in 60 Japanese children, aged 13.3 ± 4.6 years, with type 1 diabetes for at least 3 years of diabetes. Most of the subjects had absent pancreatic β-cell function. We compared the glucagon levels among patient groups stratified according to the 2-hour postprandial levels (<50, 50-99, 100-199, 200-299, and ≥ 300 mg/dL), and the HbA1c levels (<7.0, 7.0-7.9, 8.0-8.9, and ≥ 9%). The mean 2-hour postprandial PG, HbA1c and plasma glucagon levels were 174 ± 97 mg/dL, 7.7 ± 1.3% and 84.0 ± 32.6 pg/mL, respectively. The glucagon levels were highly correlated with the PG levels (r=0.553, P<0.0001) and mildly correlated with the HbA1c levels (r=0.301, P=0.0192). Patients with high PG levels had significantly higher levels of glucagon as compared with those with lower PG levels (139.4 ± 47.2, 78.4 ± 17.3, 82.4 ± 21.0, 98.3 ± 29.2 and 93.8 ± 18.3 pg/mL, P=0.0009). On the other hand, there were no significant differences in plasma glucagon levels among patient groups stratified according to HbA1c levels (P=0.1566), however, patients with HbA1c levels ≥ 9% had significantly higher levels of glucagon than those with HbA1c levels < 7% (113.3 ± 53.4 vs 80.8 ± 18.4 pg/mL, P=0.0291). These results suggest that patients with high PG are likely to have high concentrations of plasma glucagon, which may aggravate glycemic control progressively, leading to elevation of HbA1c levels.

METABOLIC SYNDROME IN THE CHRONIC KIDNEY DISEASE PATIENTS AT THE CANTHO CENTRAL GENERAL HOSPITAL

Objective: to study the Metabolic syndrome (MS) in the chronic kidney disease (CKD) patients with conservative treatment. Patients and methods: 123 CKD patients with conservative treatment at The Cantho Central General Hospital from 05/2009 to 08/2010 are investigated the component of MS basing on the NCEP-ATP III criteria for Asian. Results: - The overall prevalence of MS is 65.9% and increase significantly according to the insufficiency renal stage with 46.7% at the first stage group; 64.5% come to 67.7% at the second and the third stage group, and 83.9% at the final stage group. - The prevalence number of MS component are 99.2%, 94.3%, 65.9%, 37.4% and 10.6% respectively 1, 2, 3, 4 and 5 component of MS. - The prevalence of abdominal obesity, high triglyceride levels, low HDL-cholesterol, elevated blood pressure and high plasma glucose levels are respectively 50.4%, 54.5%, 78.9% 73.2% and 50.4%. - The prevalence of MS increase direct proportion with the level and duration of CKD significantly.

Diabetes mellitus and gastric carcinoma: Is there an association?

Diabetes mellitus (DM) has been associated with the risk of several gastrointestinal cancers including liver, pancreas, colon and rectum. However, the evidence is inconclusive for gastric adenocarcinoma (GC). In the current review, we summarize 20 population-based cohort studies that compared GC incidence and mortality between diabetic and non-diabetic population. We discuss the shared risk factors and provide qualitative and quantitative (meta-analytic) summary of the current evidence evaluating the association by high-risk subgroups. The overall risk-estimate based on all studies did not show an increased risk of GC in diabetics. However, 2 cohort studies conducted in East Asian countries, where Helicobacter pylori infection and GC rates are higher, showed a higher risk of GC in diabetics. Additionally, high plasma glucose levels in the presence of Helicobacter pylori infection increased the risk of GC by over four times, suggesting a multiplicative effect. Results from the meta-analysis show that, the risk of GC was also higher in populations with greater prevalence of type 1 DM (relative risk = 1.60), suggesting an insulin-independent carcinogenic process in this subgroup. The risk of mortality due to GC was higher in diabetics compared to non-diabetics (relative risk = 1.62). Although the overall risk estimates do not show an association between DM and GC, complex interactions between infectious, molecular, demographic and host factors may convey a higher risk in certain subgroups. Future studies should be sufficiently powered for detailed subgroup analysis to elucidate the causative and mechanistic association between DM and GC.

Relationship between Plasma Glucose Levels and Malignant Uterine Cervical Neoplasias

Background:There is a direct correlation between glycemic load and the risk of developing many malignant neoplasms.Aims:The aim of this study was to determine the plasma glucose levels in women with cervical cancer.Methods:The study included 177 women with anatomopathologically diagnosed uterine cervical cancer (stages 0–IV) treated between 1980 and 2008 at the Gynecology and Obstetrics outpatient service of the UFTM, Brazil. The plasma glucose levels of all patients were assayed at the time of diagnosis and correlated with tumor staging.Results:We statistically compared the plasma glucose levels of group 1 (cervical intraepithelial neoplasia 2–3), group 2 (stage I–II), group 3 (stage III–IV), and group 4 (control group: leiomyomas). Patient groups with poor prognosis (groups 2 and 3) showed significantly higher plasma glucose levels (P < 0.05) than those with less aggressive lesions (group 1). Plasma glucose levels were significantly higher in groups 2 and 3 than in group 4 (P < 0.05). The comparison of number of patients with plasma glucose level >90 mg/dl showed CIN versus I/II: P = 0.0753; OR = 2.018; (95% CI: 0.9236 to 4.410) and CIN versus III/IV: P = 0.0975; OR = 2.400; (95% CI: 0.8335 to 6.911).Conclusion:We observed an association between high plasma glucose levels and cervical cancer cases with poor prognoses. Plasma glucose tests should be routinely used as additional prognostic parameters in patients with cervical neoplasias.

Weight Gain and Risk of Impaired Fasting Glucose After Smoking Cessation

BackgroundObservation of early changes in fasting plasma glucose level induced by post-smoking cessation weight gain is useful in predicting the risks of diabetes mellitus (DM) and impaired fasting glucose (IFG). We investigated the effect of post-smoking cessation weight gain on early changes in the risk of a high fasting plasma glucose (IFG) level (≥100 mg/dL).MethodsIn 946 subjects who underwent repeated health examinations after smoking cessation, changes in body mass index (BMI) and the odds ratio (OR) for IFG risk (adjusted for sex, age, BMI, fasting plasma glucose at year 1, and alcohol consumption) were calculated every year for 3 years after smoking cessation.ResultsAfter smoking cessation, the rate of BMI increase significantly increased in quitters: 2.36% at year 2 (never smokers: 0.22%, current smokers: 0.39%) and 0.46% at year 3 (never smokers: 0.14%, current smokers: 0.32%). However, it decreased by 0.15% at year 4 (never smokers: 0.12%, current smokers: 0.26%). The ORs for quitters did not significantly increase at any time during the follow-up period. However, among quitters who had smoked at least 20 cigarettes per day, it was significantly higher (OR 1.51, 95% confidence interval 1.1–2.01 at year 1 and 1.71, 1.23–2.38 at year 2).ConclusionsThe time course of the risk of IFG after smoking cessation was similar to that for the rate of BMI increase. In contrast to the findings of previous reports, the increase in IFG risk after smoking cessation was brief and disappeared in the absence of a significant increase in BMI.

α-glucosidase inhibitors from plants: A natural approach to treat diabetes

Diabetes is a common metabolic disease characterized by abnormally high plasma glucose levels, leading to major complications, such as diabetic neuropathy, retinopathy, and cardiovascular diseases. One of the effective managements of diabetes mellitus, in particular, non–insulin-dependent diabetes mellitus (NIDDM) to decrease postprandial hyperglycemia, is to retard the absorption of glucose by inhibition of carbohydrate hydrolyzing enzymes, such as α-glucosidase and α-amylase, in the digestive organs. α-Glucosidase is the key enzyme catalyzing the final step in the digestive process of carbohydrates. Hence, α-glucosidase inhibitors can retard the liberation of d-glucose from dietary complex carbohydrates and delay glucose absorption, resulting in reduced postprandial plasma glucose levels and suppression of postprandial hyperglycemia. In recent years, many efforts have been made to identify effective α-glucosidase inhibitors from natural sources in order to develop a physiologic functional food or lead compounds for use against diabetes. Many α-glucosidase inhibitors that are phytoconstituents, such as flavonoids, alkaloids, terpenoids,anthocyanins, glycosides, phenolic compounds, and so on, have been isolated from plants. In the present review, we focus on the constituents isolated from different plants having α-glucosidase inhibitory potency along with IC50 values.

Recomendaciones para el adecuado control glucémico durante el ingreso después de un accidente vascular cerebral

Hyperglycemia in the acute phase of stroke is a common problem. When present it's associated with a poor outcome of patients with both ischemic and hemorrhagic stroke, and equally in diabetic and non-diabetic patients. High levels of plasma glucose are associated with the infarct volume growth, higher rates of disability and increased mortality. In addition, hyperglycemia decreases effectiveness of intravenous fibrinolysis, resulting in lower rates of recanalization, and increasing its most feared complication, the hemorrhagic transformation. So far, randomized clinical studies aimed at lowering glycemia in the acute phase of stroke have not demonstrated clinical benefits. Currently, we recommend monitoring of blood glucose during hospitalization to achieve normoglycemic levels, avoiding elevations higher than 155mg/dL, a cut-off point beyond complications may occur.

Glut4 is upregulated despite decreased insulin signaling during prolonged fasting in northern elephant seal pups

Postprandial cellular glucose uptake is dependent on an insulin-signaling cascade in muscle and adipose tissue, resulting in the translocation of the insulin-dependent glucose transporter 4 (Glut4) into the plasma membrane. Additionally, extended food deprivation is characterized by suppressed insulin signaling and decreased Glut4 expression. Northern elephant seals are adapted to prolonged fasts characterized by high levels of plasma glucose. To address the hypothesis that the fasting-induced decrease in insulin is associated with reduced insulin signaling in prolonged fasted seals, we compared the adipose protein levels of the cellular insulin-signaling pathway, Glut4 and plasma glucose, insulin, cortisol, and adiponectin concentrations between Early (n = 9; 2-3 wks postweaning) and Late (n = 8; 6-8 wks postweaning) fasted seals. Plasma adiponectin (230 ± 13 vs. 177 ± 11 ng/ml), insulin (2.7 ± 0.4 vs. 1.0 ± 0.1 μU/ml), and glucose (9.8 ± 0.5 vs. 8.0 ± 0.3 mM) decreased, while cortisol (124 ± 6 vs. 257 ± 30 nM) doubled with fasting. Glut4 increased (31%) with fasting despite the significant decreases in the cellular content of phosphatidylinositol 3-kinase as well as phosphorylated insulin receptor, insulin receptor substrate-1, and Akt2. Increased Glut4 may have contributed to the decrease in plasma glucose, but the decrease in insulin and insulin signaling suggests that Glut4 is not insulin-dependent in adipose tissue during prolonged fasting in elephant seals. The reduction of plasma glucose independent of insulin may make these animals an ideal model for the study of insulin resistance.

Surrogate index for insulin sensitivity composed of factors not using glucose and insulin in Japanese patients with diabetes.

The aim of the present study is to propose a novel index of insulin sensitivity instead of homeostasis model assessment of insulin resistance (HOMA-IR), which has a fundamental limitation of validity when applied to subjects with lower insulin secretions or high fasting plasma glucose (FPG) levels. A total of 25 apparently healthy subjects and 24 patients with type 2 diabetes participated in the study. We assessed relationships of glucose infusion rate (GIR), obtained by using the euglycemic hyperinsulinemic glucose clamp technique, with other measurements of metabolic and anthropometric parameters. In multiple regression analysis, a model including log-transformed (log) triglyceride/log high-density lipoprotein cholesterol and waist circumference as predictive variables showed the strongest contribution rate to explain GIR as an outcome variable (R (2) = 0.710). The validity of estimated GIR (EGIR) calculated from the regression equation composed of these factors was further tested in another group of patients including type 1, type 2 and pancreatic diabetes in whom HOMA-IR could not be used as a result of either high FPG or low fasting insulin level, or both. Even in those patients, EGIR showed a good positive relationship with measured GIR (r = 0.681, P < 0.0001). The proposed index without HOMA-IR can adequately show insulin sensitivity in Japanese diabetic patients, even in cases with the limitation of HOMA-IR application. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00076.x, 2010).

The importance of combined glycemic control in patients with type 2 diabetes mellitus

The contribution of intensive control of glycemia to the reduction of the risk of microvascular complications of type 2 diabetes mellitus is known perfectly well whereas its influence on the development of macrovascular complications remains to be clarified and remains a subject of debates. Bearing in mind that hyperglycemia is a key pathogenetic factor triggering formation of diabetic complications, it is necessary to identify characteristics of carbohydrate metabolism to be taken into account when choosing therapeutic strategies and to determine their target values. Control of the HbA1c level remains the most accessible and informative tool for the assessment of the efficiency of long-term compensation of type 2 diabetes mellitus. However, this method is not altogether free from limitations that can hamper its clinical application. The fasting glycemia level does not completely reflect the quality of DM2 treatment. There is potential relationship between high postprandial plasma glucose levels and the development of vascular complications. Also, it has been shown that variability of glucose concentration may be an important risk factor of diabetic complications. Measurement of the full range of glycemic parameters including fasting plasma glucose level, HbA1c and postprandial glycemia gives an idea of the general picture of the course of the disease necessary for the choice of the treatment strategy.

The prevalence of undiagnosed diabetes in non-cardiac surgery patients, an observational study

Given that preoperative hyperglycemia is associated with poor outcomes and many non-diabetic patients have high plasma glucose (PG) levels, the purpose of our study was to estimate the prevalence of undiagnosed diabetes among non-cardiac surgery patients and to identify predictors of hyperglycemia in non-diabetics. We included all non-cardiac surgery patients with complete records in the Clinical Database of the Anesthesiology Institute at the Cleveland Clinic during January 2007 to April 2009, and we estimated the prevalence of undiagnosed diabetes and impaired fasting glucose (IFG) among the non-diabetic patients. The mean glucose levels for known diabetics and undiagnosed diabetics were compared using two-tailed Student's t tests, and we assessed the association between PG levels and demographic variables within the non-diabetics. Of the 39,434 patients analyzed, 5,511 (14%) were known diabetics. Of the 33,923 known non-diabetics, 3,426 (10 %) were undiagnosed diabetics and another 3,549 (11%) had IFG. Thus, 6,975 patients (21%) of the non-diabetic patients presented with abnormally high glucose. Previously undiagnosed diabetics had higher preoperative glucose levels compared with known diabetics, with a mean ± standard deviation (SD) of 161 ± 48 vs 146 ± 67 mg·dL⁻¹ (8.9 ± 2.7 vs 8.1 ± 3.7 mmoL·L⁻¹), respectively. The difference remained highly significant after adjusting for body mass index, age, sex, and American Society of Anesthesiologists (ASA) physical status (P < 0.001). Among non-diabetics, older age, obesity, male sex, and a higher ASA physical status were collectively significant predictors of hyperglycemia, with a c-statistic (95% confidence interval) of 0.67 (0.66-0.68). A significant proportion of non-cardiac surgery patients have previously undiagnosed diabetes and pre-diabetes. Previously undiagnosed patients have higher fasting glucose levels compared with diabetic patients. Further studies should be conducted to identify the implications of these findings on patient outcomes.

Análise de diferentes medidas antropométricas na identificação de síndrome metabólica, com ou sem alteração do metabolismo glicídico

This study compared anthropometric measurements and insulin resistance indexes of individuals with or without metabolic syndrome (MS), stratified by the presence of glycemic abnormalities. 454 individuals (66% women, 54% Caucasians) were included, being 155 allocated to group 1 (without MS, without glycemic abnormality), 32 to group 2 (without MS, with glycemic abnormality), 104 to group 3 (with MS, without glycemic abnormality), and 163 to group 4 (with MS, with glycemic abnormality). Groups were compared by ANOVA. Those with MS (3 and 4) showed the worst anthropometric and lipid profiles; in group 2, despite higher plasma glucose levels, the mean values of anthropometric variables and lipids did not differ from group 1. The highest mean values of HOMA-IR were found in the groups with MS, while group 2 showed the lowest HOMA-β. Triglyceride was the metabolic variable with the highest correlation coefficients with anthropometry. However, the strongest correlations were those of waist circumference (r = 0.503) and waist-to-height ratio (r = 0.513) with HOMA-IR (p < 0.01). Our findings indicate that, in a sample of the Brazilian population, any anthropometric measure identifies individuals with MS, but such measurements seem to be unable to differentiate those with glycemic disturbance. We reinforce the strongest relationship of measures of central adiposity with insulin resistance, suggesting utility for the waist-to-height. An autoimmune component may be contributing to the deterioration of glucose metabolism of individuals from group 2.

A twice-a-day feeding regimen optimizes performance in broiler breeder hens

To evaluate the effects of different methods of feed allocation on performance, plasma hormone concentration, and ovarian morphology, an experiment was conducted using 32 Cobb 500 broiler breeder hens. The experiment was started at 27 wk and lasted to 39 wk of age. Feeding regimens included: i) hens with an ad libitum feeding program, ii) hens that received their restricted feed once a day, iii) hens that received their restricted feed twice a day, and iv) hens that received their restricted feed 3 times a day. Each hen was assumed as an experimental unit and treatments were replicated 8 times. Daily egg production, BW, and egg and yolk weights were measured. Two blood samples were taken 3 and 6 h after the first feed allocation every 2 wk. Plasma samples were assayed for glucose, triacylglycerol (TAG), cholesterol, as well as leptin-like concentration, glucagon, triiodothyronine, thyroxine, progesterone, estradiol, and testosterone. Liver, abdominal fat pad, and ovary were collected at necropsy. Ovaries were weighed and follicles were characterized as large yellow follicles, small yellow follicles, and large white follicles. Results showed inferior egg production in ad libitum-fed birds along with high levels of plasma glucose, TAG, cholesterol, leptin-like concentration, and testosterone. Twice-a-day-fed birds produced more egg in the entire production period than once-a-day-fed birds. Better performance of twice-a-day-fed hens was associated with lower plasma glucose, TAG, and leptin-like concentration, whereas their estradiol and glucagon were higher than once-a-day-fed hens. Results obtained in our study suggest that allocation of restricted feed 2 times a day may alleviate or delay lipotoxicity development and improve reproductive performance in broiler breeder hens.