Risk Of Hyperglycemia Research Articles

The effect of bedtime snacks on morning fasting blood glucose in gestational diabetes mellitus: a randomized controlled trial.

While guidelines recommend bedtime snacks for women with gestational diabetes mellitus (GDM), there is insufficient evidence championed those recommendation. To evaluate if bedtime snacking is effective in preventing high fasting blood glucose incidence among women with GDM. An open-label, parallel-group, randomized controlled trial was conducted from December 2023 to July 2024 at Ma'anshan Maternal and Child Health Care Center, Anhui, China. A total of 62 GDM cases at the nutrition clinics were enrolled, and were randomly and equally allocated to groups of bedtime snacks (25g nuts, intervention group) and no bedtime snacks (control group). The intervention was lasted for 8 weeks, during which fasting blood glucose was measured 3 times per week, 1-hour postprandial glucose and 2-hour postprandial glucose 2 times per week with a home glucometer. In the late pregnancy (approximately at 34 weeks), the glycated haemoglobin, high-density lipoprotein, low-density lipoprotein, triglycerides, total cholesterol were measured in the laboratory and birth outcomes information (birth weight, gestational weeks at delivery, delivery mode) were collected. The primary outcomes were the level of fasting blood glucose and the hyper-fasting blood glucose incidence during 8-week duration. The secondary outcomes were the level of the glycated haemoglobin, high-density lipoprotein, low-density lipoprotein, triglycerides and total cholesterol in the late pregnancy. Generalized estimating equations and analysis of covariates were conducted for the analysis of the primary outcomes. The multivariate linear regression was conducted for the analysis of the secondary outcomes. Post-hoc analysis was also conducted for the indicators of 1-hour postprandial glucose, 2-hour postprandial glucose and perinatal outcomes applying generalized estimating equations, analysis of covariates, the multivariate linear regression and logistics regression. After adjusting for maternal age, pre-pregnancy body mass index, mid-pregnancy glucose, mid-pregnancy blood lipids and diet in late pregnancy, neither the average fasting blood glucose (control group: 4.90 mmol l-1, intervention group: 4.96 mmol l-1) (β = 0.05, [95%CI-0.22 to 0.31], P = 0.720) nor hyper-fasting blood glucose incidence (control group: 0.19, intervention group:0.26) (β = 0.07, [95%CI-0.07 to 0.20], P = 0.335) were significant different between the two groups. And we found low-density lipoprotein level were higher in the intervention group (3.21 mmol l-1) compared to the control group (2.52 mmol l-1) (β = 0.70, [95%CI0.07 to 1.34], P = 0.031). Additionally, post-hoc analysis showed that the incidence of elevated 1-hour postprandial glucose was significantly higher in the intervention group (0.42) than in the control group (0.28) (β = 0.14, [95%CI0.01 to 0.27], P = 0.036). No difference was found regarding any perinatal outcomes between the two groups. Bedtime snack did not reduce the risk of morning hyperglycaemia and adverse perinatal outcomes in women with gestational diabetes mellitus, but exacerbated lipid markers and the 1-hour postprandial glucose profile. Our study did not support clinicians and relevant guidelines to recommend bedtime snacking as a form of glycaemic control in women with GDM. Clinical trial identification number: ChiCTR2300078399. URL of the registration site: https://www.chictr.org.cn/bin/project/edit?pid=210400 .

Incidence and risk of endocrine and metabolic abnormalities linked to PARP inhibitors in solid tumors: a meta-analysis.

Poly (ADP-ribose) polymerase inhibitors (PARPi) serve as crucial therapeutic agents in solid tumor treatment. Preclinical investigations suggest a potential protective function of PARPi against endocrine and metabolic impairments. Nevertheless, the existing body of evidence remains inconclusive on this aspect. Our aim was to evaluate the potential impact of PARPi on endocrine and metabolic disruptions in clinical trials. We conducted a comprehensive search across the Medline, EMBASE, PubMed, and Web of Science databases, along with the ClinicalTrials.gov registry. Phase II/III randomized controlled trials (RCTs) investigating the effects of PARPi in metabolic and endocrine processes were selected for inclusion in patients with solid tumors. The primary outcomes of interest encompassed metabolic and endocrine dysfunctions. A total of 26 trials (n = 9,590 patients) were included in our meta-analysis. Niraparib demonstrated an increased risk of any-grade hyperglycemia (OR = 2.15, 95% CI 1.28-3.62), with patients receiving PARPi for metastatic pancreatic cancer showing a higher susceptibility to any-grade hyperglycemia (OR = 1.78, 95% CI 1.04-3.04). Conversely, rucaparib exhibited a potential ameliorative effect on hyperglycemia (OR = 0.54, 95% CI 0.30-0.97). No statistically significant disparities were observed for other outcomes associated with PARPi utilization. Among these RCTs included, 50% were assessed as low qualities due to high risk of bias. Our meta-analysis demonstrated that PARPi may exert adverse effects on endocrine and metabolic pathways. Close monitoring of hyperglycemia is recommended for patients undergoing niraparib therapy, especially those with pancreatic cancer. This meta-Analysis was prospectively registered in the PROSPERO database with ID CRD42023457959.

Metabolically healthy overweight/obesity with no metabolic abnormalities and incident hyperglycaemia in Chinese adults: analysis of a retrospective cohort study

ObjectivesTo explore whether metabolically healthy overweight (MHOW) and/or metabolically healthy obesity (MHO) increase hyperglycaemia risk in a Chinese population with a broad age range.DesignRetrospective cohort study.SettingSecondary analysis of data from...

A safe-enhanced fully closed-loop artificial pancreas controller based on deep reinforcement learning.

Patients with type 1 diabetes and their physicians have long desired a fully closed-loop artificial pancreas (AP) system that can alleviate the burden of blood glucose regulation. Although deep reinforcement learning (DRL) methods theoretically enable adaptive insulin dosing control, they face numerous challenges, including safety and training efficiency, which have hindered their clinical application. This paper proposes a safe and efficient adaptive insulin delivery controller based on DRL. It employed ten tricks to enhance the proximal policy optimization (PPO) algorithm, improving training efficiency. Additionally, a dual safety mechanism of 'proactive guidance + reactive correction' was introduced to reduce the risks of hyperglycemia and hypoglycemia and to prevent emergencies. Performance evaluations in the Simglucose simulator demonstrate that the proposed controller achieved an 87.45% time in range (TIR) median, superior to baseline methods, with a lower incidence of hypoglycemia, notably eliminating severe hypoglycemia and treatment failures. These encouraging results indicate that the DRL-based fully closed-loop AP controller has taken an essential step toward clinical implementation.

GlucoGenes®, a database of genes and proteins associated with glucose metabolism disorders, its description and applications in bioinformatics research

Data on the genetics and molecular biology of diabetes are accumulating rapidly. This poses the challenge of creating research tools for a rapid search for, structuring and analysis of information in this field. We have developed a web resource, GlucoGenes®, which includes a database and an Internet portal of genes and proteins associated with high glucose (hyperglycemia), low glucose (hypoglycemia), and both metabolic disorders. The data were collected using text mining of the publications indexed in PubMed and PubMed Central and analysis of gene networks associated with hyperglycemia, hypoglycemia and glucose variability performed with ANDSystems, a bioinformatics tool. GlucoGenes® is freely available at: https://glucogenes.sysbio.ru/genes/main. GlucoGenes® enables users to access and download information about genes and proteins associated with the risk of hyperglycemia and hypoglycemia, molecular regulators with hyperglycemic and antihyperglycemic activity, genes up-regulated by high glucose and/or low glucose, genes down-regulated by high glucose and/or low glucose, and molecules otherwise associated with the glucose metabolism disorders. With GlucoGenes®, an evolutionary analysis of genes associated with glucose metabolism disorders was performed. The results of the analysis revealed a significant increase (up to 40 %) in the proportion of genes with phylostratigraphic age index (PAI) values corresponding to the time of origin of multicellular organisms. Analysis of sequence conservation using the divergence index (DI) showed that most of the corresponding genes are highly conserved (DI < 0.6) or conservative (DI < 1). When analyzing single nucleotide polymorphism (SNP) in the proximal regions of promoters affecting the affinity of the TATA-binding protein, 181 SNP markers were found in the GlucoGenes® database, which can reduce (45 SNP markers) or increase (136 SNP markers) the expression of 52 genes. We believe that this resource will be a useful tool for further research in the field of molecular biology of diabetes.

Mixed Methods RCT comparing quality of life for pregnant women with type 1 diabetes using Hybrid Closed-Loop (HCL) to Sensor-Augmented Pump Therapy (SAPT).

Type 1 diabetes (T1D) in pregnancy is challenging. This study explores how assisted hybrid closed-loop (HCL) therapy versus sensor-augmented pump therapy (SAPT) impacts quality of life (QoL) in pregnancy. We interviewed 22 of 24 participants randomized to HCL therapy or SAPT in the Pregnancy Intervention with a Closed-Loop System study. Participants completed questionnaires about hypoglycemia fear and device satisfaction and trust. QoL was similar among women with T1D using HCL (n=12) and SAPT (n=12) throughout pregnancy and early postpartum. Hypoglycemia fear was not statistically different between groups but improved in the HCL group in the 2nd trimester vs baseline. Glucose monitoring satisfaction and trust increased during pregnancy in the HCL group but decreased in the SAPT group. Women trusted their mode of insulin delivery despite stress and frustration with fluctuating glucose and risks of hyperglycemia to their fetuses. Women who preferred less involvement with their management preferred HCL, while those desiring more involvement preferred SAPT. These similarities demonstrate that open communication is needed between provider and patient to determine perceived benefits versus burdens of HCL use in pregnancy, especially in the United States where available HCL systems lack pregnancy-specific algorithms and FDA approval for pregnancy use.

Systematic Review and Meta-Analysis of Risk Factors Associated with Postoperative Stress Hyperglycemia in Patients without Diabetes Following Cardiac Surgery.

To systematically evaluate risk factors for stress-induced hyperglycemia in patients without diabetes after cardiac surgery. Databases including CNKI, WanFang data, VIP, SinoMed, PubMed, Web of Science, Embase, and the Cochrane Library were searched using computer retrieval. The data were subjected to an in-depth meta-analysis using RevMan 5.4 and Stata 15.0 software. This study involved 11,645 postoperative cardiac surgery patients, including 8 case-control studies and 3 cohort studies, over which 18 risk factors were identified. The results of the meta-analysis indicated that statistically significant risk factors included age >65 years [odds ratios (OR) (95% CI ) = 3.47 (2.61-4.32)], female gender [OR (95%) = 1.54 (1.34-1.76)], combined heart valve and coronary artery bypass surgery [OR (95%) = 1.82 (1.23-2.70)], ejection fraction <40% [OR (95%) = 1.38 (1.17-1.63)], history of heart surgery [OR (95%) = 1.30 (1.06-1.59)], myocardial infarction [OR (95%) = 1.17 (1.05-1.31)], hyperlipidemia [OR (95%) = 0.76 (0.67-0.86)], hypertension [OR (95%) = 1.12 (1.03-1.22)], anticoagulant medication [OR (95%) = 0.77 (0.65-0.90)], cardiopulmonary bypass time >2 hours [OR (95%) = 20.26 (17.03-23.48)] and history of cardiopulmonary bypass [OR (95%) = 1.24 (1.09-1.41)]. Current evidence suggests that there are key risk factors for postoperative stress hyperglycemia in patients without diabetes who have undergone cardiac surgery. These factors can help identify patients at a high risk of perioperative stress hyperglycemia during cardiac surgery. This evidence provides a basis for healthcare professionals to develop predictive management strategies for perioperative stress hyperglycemia in patients without diabetes. However, more high-quality studies are required to address the limitations of the current research. CRD42024479215, https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=479215.

Combined effect of healthy lifestyles and obesity on cardiometabolic risks in Chinese rural adults

BackgroundCombined effect of healthy lifestyles and obesity on cardiometabolic risks were unclear in Chinese rural adults. We aimed to assess the above-mentioned issue.MethodsThis study included 25,123 adults from baseline survey of Henan rural cohort study. We collected information regarding current not smoking, current not drinking, healthy diet, adequate exercise, and healthy sleep. We calculated the number of healthy lifestyle factors for each participant or used the latent class analysis to identify clustering classes of healthy lifestyle. Body mass index (BMI), waist circumference (WC), blood pressure, blood lipid, and fasting blood glucose were measured. Logistic models were applied to assess the combined associations of healthy lifestyles and obesity with cardiometabolic risks.Results3.8%, 45.8%, and 50.4% of all participants had 0–1, 2–3, and 4–5 healthy factors. The prevalence of obesity defined by BMI and WC was 17.1% and 38.1%, respectively. Compared with participants with obesity who met 0–1 healthy factor, those with obesity who met 4–5 healthy factors have a lower risk of hypertension (odds ratio [OR], 0.41; 95% confidence intervals [95%CI], 0.29–0.58) and dyslipidemia (OR, 0.49; 95%CI, 0.35–0.68) except hyperglycemia (OR, 0.87; 95%CI, 0.53–1.43). Irrespective of the healthy lifestyle scores, compared with participants with normal weight, those with obesity were at higher risk of hypertension, dyslipidemia and hyperglycemia. We obtained similar results when using the latent class analysis or WC to define obesity.ConclusionOur findings indicated that healthy lifestyle did not entirely offset the obesity-related cardiometabolic risks although it brought some benefits.

Glucose-Responsive Insulin Delivery via Surface-Functionalized Titanium Dioxide Nanoparticles: A Promising Theragnostic against Diabetes Mellitus.

Glucose-dependent insulin delivery systems have been recognized as a promising approach for controlling blood sugar levels in individuals with diabetes mellitus (DM). Recently, titanium dioxide nanoparticles have garnered huge attention in scientific research for their small size and effective drug delivery capabilities. In this study, we developed alizarin (AL)-capped phenylboronic acid (PBA)-functionalized titanium dioxide nanoparticles (TiO2) for glucose-sensitive insulin delivery (TiO2-PBA-INS-AL) aiming to manage both blood sugar levels and its associated organ pathology in DM. The synthesized nanoparticles demonstrated favorable loading capacity as well as high insulin encapsulation efficiency. Initial studies demonstrated glucose-responsive insulin release from TiO2-PBA-INS-AL in a cell-free environment upon exposure to different glucose concentrations. Notably, in vitro experiments revealed that insulin release from TiO2-PBA-INS-AL was more effective in muscle cells (primary glucose storage cells) compared to lung cells when subjected to different glucose concentrations (5.5-25 mM), indicating a glucose-sensitive intracellular insulin delivery mechanism. Furthermore, treatment with TiO2-PBA-INS-AL significantly enhanced GLUT4 translocation and glucose utilization in muscle cells treated with sodium palmitate (PA, 0.75 mM), compared to treatments with TiO2 or insulin alone. In diabetic animal models, a single oral dose of TiO2-PBA-INS-AL maintained normoglycemia for up to 12 h, indicating a significant improvement over subcutaneous or oral insulin treatment. Oral administration of TiO2-PBA-INS-AL also increased insulin bioavailability in both serum and muscle tissue compared to other administration methods. Besides, TiO2-PBA-INS-AL treatment showed no toxicity against both in vitro and in vivo models. Taken together, this nanocarrier-based drug delivery system mimics the natural regulation of insulin secretion in a noninvasive manner, enhancing patient adherence, reducing the risk of hyperglycemia, and improving diabetes management.

The impact of hyperglycemia on mortality in the emergency department: a comparison of diabetic and non-diabetic patients

Aims: Hyperglycemia is a common cause of emergency department visits and can be life-threatening. Chronic hyperglycemia results in complications including neuropathy, cardiovascular diseases, and kidney failure that are commonly found among diabetic patients while acute stress hyperglycemia induced by trauma, infection, and cardiovascular events is more often seen in non-diabetic individuals. They need to be managed in unique ways. We attempt to quantify the mortality risks of hyperglycemia in diabetic and non-diabetic emergency department patients respectively, and then use these data as a basis for management strategies. Methods: A retrospective analysis of 1,000 patients who were admitted to Esenyurt Necmi Kadıoğlu State Hospital between January 1, 2024, and June 30, 2024. Biochemical parameters and mortality were compared between diabetic and non-diabetic patients. Results: Diabetic patients had high mortality. Elevated CRP and glucose levels increase mortality risk, stress hyperglycemia was found to predict short-term risk in non-diabetic patients. The findings suggest that emergency departments should integrate hyperglycemia-related mortality risk assessment into triage protocols and consider tailored treatment strategies for diabetic and non-diabetic patients. Conclusion: This research highlights that diabetes significantly influences mortality among patients with hyperglycemia, necessitating tailored management strategies for diabetic and non-diabetic groups.

Systematic Review of Interventions in Early Pregnancy Among Pregnant Individuals at Risk for Hyperglycemia.

The maternal metabolic environment in early pregnancy can influence fetal growth trajectories. Our objective was to identify interventions initiated in early pregnancy (<20 weeks gestation) in pregnant individuals with risk factors for hyperglycemia and report their impact on primary (neonatal adiposity, small for gestational age, large for gestational age, macrosomia) and secondary outcomes (gestational weight gain, maternal hypertensive disorder, birth injury, NICU admission, preterm delivery, emergency cesarean section). We searched Cochrane Central database, Medline, Embase, CINAHL databases, and clinicaltrials.gov (September 2024) for clinical trials published between 2009 - 2024. Search terms included the key words "early OR during" OR "first trimester OR second trimester" AND "gestation OR pregnancy" OR "prenatal care" AND "insulin resistance" OR "metabolic health" OR "diabet*" OR "body composition" OR "obes*" OR "weight gain" OR "gestational diabetes" OR "hyperglycemia" OR "metabolic syndrome" AND "clinical trial." Randomized controlled trials (RCTs) and other trials reporting interventions initiated before 20 weeks gestation in participants with singleton pregnancies at risk for hyperglycemia (overweight and/or obesity, history of type 2 diabetes, and/or history of GDM) that reported at least one primary outcome were included. Studies had to be conducted with humans in high income countries as defined by the World Bank, written in English. We used the Downs and Black checklist to evaluate the methodological quality and risk. Data was extracted independently and any questions were resolved through group discussion. Interventions were categorized and synthesized by type. 21,924 records were identified and 70 full-text articles met inclusion criteria. 65 articles were RCTs. Eight intervention categories were identified: diet only, physical activity or exercise only, diet and physical activity or exercise combined, lifestyle counseling, supplements, pharmaceuticals, early GDM screening, and mixed interventions. Only 12 studies reported statistically significant effects on primary neonatal outcomes. Interventions initiated in early pregnancy (<20 weeks) among pregnant individuals at risk for hyperglycemia that include one or more of the following strategies can reduce risk of excess neonatal adiposity, macrosomia, large for gestational age and small for gestational age neonates: goal-setting and motivational strategies to improve diet and increase physical activity through individual and group sessions; lifestyle coaching that included behavioral techniques designed to empower participants by fostering autonomy in a supportive environment; structured group exercise classes three times per week; and personalized dietary recommendations.

Predicting benefit from adjuvant therapy with corticosteroids in community-acquired pneumonia: a data-driven analysis of randomised trials.

Despite several randomised controlled trials (RCTs) on the use of adjuvant treatment with corticosteroids in patients with community-acquired pneumonia (CAP), the effect of this intervention on mortality remains controversial. We aimed to evaluate heterogeneity of treatment effect (HTE) of adjuvant treatment with corticosteroids on 30-day mortality in patients with CAP. In this individual patient data meta-analysis, we included RCTs published before July 1, 2024, comparing adjuvant treatment with corticosteroids versus placebo in patients hospitalised with CAP. The primary endpoint was 30-day all-cause mortality, collected across all trials, and analyses followed the intention-to-treat principle. We analysed HTE using risk and effect modelling. For risk modelling, patients were classified as having less severe or severe CAP based on the pneumonia severity index (PSI), comparing PSI class I-III versus class IV-V. For effect modelling, we trained a corticosteroid-effect model on six trials and externally validated it using data from two trials, received after model preregistration. This model classified patients into two groups: no predicted benefit and predicted benefit from adjuvant treatment with corticosteroids. The literature search was registered on PROSPERO, CRD42022380746. We included eight RCTs with 3224 patients. Across all eight trials, 246 (7·6%) patients died within 30 days (106 [6·6%] of 1618 in the corticosteroid group vs 140 [8·7%] of 1606 in the placebo group; odds ratio [OR] 0·72 [95% CI 0·56-0·94], p=0·017). The corticosteroid-effect model, which selected C-reactive protein (CRP), showed significant HTE during external validation in the two most recent trials. In these trials, 154 (11·4%) of 1355 patients died within 30 days (88 [13·1%] of 671 in the placebo group vs 66 [9·6%] of 684 in the corticosteroid group; OR 0·71 [95% CI 0·50-0·99], p=0·044). Among patients predicted to have no benefit (CRP ≤204 mg/L, n=725), no significant effect was observed (OR 0·98 [95% CI 0·63-1·50]), whereas for those with predicted benefit (CRP >204 mg/L, n=630), 39 (13·0%) of 301 patients died in the placebo group compared with 20 (6·1%) of 329 in the corticosteroid group (0·43 [0·25-0·76], pinteraction=0·026). No significant HTE was found between less severe CAP (PSI class I-III, n=229) and severe CAP (PSI class IV-V, n=1126). Corticosteroid therapy significantly increased hyperglycaemia risk (44 [12·8%] of 344 in the placebo group vs 84 [24·8%] of 339 in the corticosteroid group; OR 2·50 [95% CI 1·63-3·83], p<0·0001) and hospital re-admission risk (30 [3·7%] of 814 in the placebo group vs 57 [7·0%] of 819 in the corticosteroid group; 1·95 [1·24-3·07], p=0·0038). Overall, adjuvant therapy with corticosteroids significantly reduces 30-day mortality in patients hospitalised with CAP. The treatment effect varied significantly among subgroups based on CRP concentrations, with a substantial mortality reduction observed only in patients with high baseline CRP. None.

The association between acute kidney injury and dysglycaemia in critically ill patients with and without diabetes mellitus: a retrospective single-center study

Background Critically ill patients in the intensive care unit (ICU) often experience dysglycaemia. However, studies investigating the link between acute kidney injury (AKI) and dysglycaemia, especially in those with and without diabetes mellitus (DM), are limited. Methods We used the Medical Information Mart for Intensive Care IV database to investigate the association between AKI within 7 days of admission and subsequent dysglycaemia. The primary outcome was the occurrence of dysglycaemia (both hypoglycemia and hyperglycemia) after 7 days of ICU admission. Logistic regression analyzed the relationship between AKI and dysglycaemia, while a Cox proportional hazards model estimated the long-term mortality risk linked to the AKI combined with dysglycaemia. Results A cohort of 20,008 critically ill patients were included. The AKI group demonstrated a higher prevalence of dysglycaemia, compared to the non-AKI group. AKI patients had an increased risk of dysglycaemia (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.41–1.65), hypoglycemia (aOR 1.56, 95% CI 1.41–1.73), and hyperglycemia (aOR 1.53, 95% CI 1.41–1.66). In subgroup analysis, compared to DM patients, AKI showed higher risk of dysglycaemia in non-DM patients (aOR: 1.93 vs. 1.33, P int<0.01). Additionally, the AKI with dysglycaemia group exhibited a higher risk of long-term mortality compared to the non-AKI without dysglycaemia group. Dysglycaemia also mediated the relationship between AKI and long-term mortality. Conclusion AKI was associated with a higher risk of dysglycaemia, especially in non-DM patients, and the combination of AKI and dysglycaemia was linked to higher long-term mortality. Further research is needed to develop optimal glycemic control strategies for AKI patients.

Hyperglycemia Risk Evaluation of Hydrocortisone Intermittent Boluses Vs Continuous Infusion in Diabetic Patients with Septic Shock: A Prospective Cohort Study

Background &amp; Objectives: Septic shock is a serious condition associated with a high mortality rate because of the multiorgan dysfunction caused by dysregulated host immune responses to infection. Giving low dose steroids in septic shock patients has been shown to hasten the reversal of shock and current Surviving Sepsis Guidelines (SSG) also suggest using low dose steroids for the same. Also, the use of steroids causes hyperglycaemia particularly in diabetic patients. The current SSG does not specify the method of administration. The primary objective of our study was to compare continuous infusion vs intermittent boluses of hydrocortisone to obtain a better glycaemic control. Methods: A prospective cohort study was conducted in diabetic patients with septic shock admitted in Multi Disciplinary Intensive Care Unit (MDICU) of PRS hospital from July 2022 to February2023. Hydrocortisone was given as continuous infusion in 55 subjects and the remaining 55 received intermittent boluses of hydrocortisone and average blood glucose values were measured in both the groups. Results: Among 110 patients, 55 patients each received continuous infusion and intermittent boluses of hydrocortisone respectively. The mean blood glucose values in continuous infusion group were 161.1 ± 22.7 and 172.5 ± 21.0 (mg/ dl) in intermittent boluses group which was statistically significant with a p value of 0.007. There was no statistically significant difference among the groups in 28-day mortality, ICU length of stay (LOS), hospital LOS, or other secondary safety outcomes. Conclusions: This study infers that giving hydrocortisone as continuous infusions in septic shock patients leads to better glycaemic control when compared to intermittent boluses of hydrocortisone, without any difference in 28-day mortality.

Screening fasting glucose before the OGTT: near-patient glucometer- or laboratory-based measurement?

The measurement of fasting glucose is a common practice for lowering the risk of hyperglycemia before an oral glucose tolerance test (OGTT). In this study we analyze advantages and limitations of near-patient measurement of capillary fasting glucose with a portable glucometer or blood sampling and measurement of plasma glucose with laboratory instrumentation. The final study population consisted of 241 subjects (mean age: 36±8 years; 97.9 % pregnant women) referred to our local phlebotomy center for an OGTT. Fasting glucose was measured in capillary blood using a near-patient glucometer (glucometer-based strategy) and in plasma with laboratory instrumentation using the hexokinase reference assay (laboratory-based strategy). The mean turnaround time from sample collection to obtaining the glucose value was longer with the laboratory-based strategy (32 min 8 vs. 8 s). The imprecision of the glucometer was higher than that of the laboratory assay (3.4 vs. 0.8 %). A negative bias of-3.3 % in fasting glucose was found with the glucometer compared to the laboratory measurement. The diagnostic accuracy, sensitivity and specificity of the glucometer for detecting fasting glucose values≥7.0 mmol/L were 99.2 , 50.0 and 100.0 % compared to the laboratory assay. The glucometer-based strategy had an incremental cost of 0.17€ per patient compared to the laboratory-based strategy. Screening fasting glucose in capillary blood with a near-patient glucometer instead of measuring fasting plasma glucose with laboratory instrumentation allows faster patient management in the phlebotomy center but is associated with higher imprecision, inaccuracy, costs and avoidable finger pricks.

Glucocorticoid treatment and new-onset hyperglycaemia and diabetes in people living with chronic obstructive pulmonary disease: A systematic review and meta-analysis.

In people living with chronic obstructive pulmonary disease (COPD), we aimed to estimate: (1) the prevalence of glucocorticoid-induced hyperglycaemia (GIH); (2) whether the prevalence of GIH varies by age, baseline diabetes status, treatment duration, ascertainment of glycaemia, definition of hyperglycaemia, study design and year of publication; and (3) the relative risk (RR) of new-onset hyperglycaemia in exposed vs non-exposed to systemic glucocorticoids. We searched electronic databases until 9 November 2023 for randomised controlled trials and observational studies including adults diagnosed with COPD, with or without diabetes at baseline, using systemic glucocorticoids equivalent to prednisolone ≥5 mg/day for ≥3 days if exposed. Hyperglycaemia was defined as a blood glucose above a study-specific cut-off. We extracted data on study and participant characteristics, exposure and outcome. We performed random-effects meta-analysis to calculate pooled prevalence estimate of GIH. Prevalence was expressed as the proportion of people who developed hyperglycaemia among all exposed to systemic glucocorticoids during follow-up. We calculated RR of new-onset hyperglycaemia in exposed vs non-exposed to systemic glucocorticoids from eight studies. Of 25,806 citations, we included 18 studies comprising 3642 people of whom 3125 received systemic glucocorticoids and 1189 developed hyperglycaemia. Pooled prevalence of GIH was 38.6% (95%CI 29.9%-47.9%) with significant heterogeneity, I2 = 96% (p < 0.010), which was partially explained by differences in study design. Pooled RR = 2.39 (95%CI 1.51-3.78). Publication bias was present. The prevalence of GIH was 38.6%. Being treated with systemic glucocorticoids for COPD was associated with 2.4 times higher risk of new-onset hyperglycaemia versus no glucocorticoid treatment.

The Impact of Pay-for-Performance Care on the Mortality and Cardiovascular Outcomes in Older Adults With Newly Diagnosed Type 2 Diabetes: A Nationwide Population-Based Cohort Study

ObjectivesTo evaluate the long-term effects of pay-for-performance (P4P) care in the geriatric population with newly diagnosed type 2 diabetes (T2D). DesignRetrospective longitudinal cohort study. Setting and ParticipantsA total of 6607 propensity score-matched pairs of patients with newly diagnosed T2D who received either P4P care or standard care as identified from the National Health Insurance Research Database in Taiwan between January 1, 2000, and December 31, 2019. MethodsCox regression models were used to assess differences in risk of outcomes between P4P and non-P4P care. Primary outcomes and measures include all-cause mortality, hospital admissions due to cardiovascular events, dialysis initiation, severe hyperglycemia, and severe hypoglycemia. Multivariable Cox regression models were performed to calculate hazard ratios among and within groups. ResultsThe multivariable-adjusted model showed that patients with P4P care had a significantly lower risk of all-cause mortality (adjusted hazard ratio [aHR], 0.37; 95% CI, 0.35–0.39), stroke (aHR, 0.80 95% CI, 0.72–0.88), myocardial infarction (aHR, 0.57; 95% CI, 0.48–0.67), heart failure (aHR, 0.75; 95% CI, 0.69–0.81), and dialysis (aHR, 0.66; 95% CI, 0.53–0.82) compared with those not receiving P4P care. However, there were no significant differences in the risk of severe hyperglycemia (aHR, 0.92; 95% CI, 0.82–1.03) and severe hypoglycemia (aHR, 1.04; 95% CI, 0.92–1.17) between the 2 groups. Conclusions and ImplicationsThis nationwide cohort study suggests that the P4P program may reduce the risk of cardiovascular events, dialysis needs, and mortality in older patients with T2D without increasing the risk of severe hypoglycemia. P4P may be an effective management strategy for older patients with T2D.

Adequate sleep duration accentuates the effect of glucagon-like peptide-1 receptor variant on HbA1c: A gene-environment interaction study

BackgroundBoth glucagon-like peptide-1 receptor (GLP1R) agonists and lifestyle modifications are widely adopted in managing glycemia. However, the joint effects of GLP1R agonists with lifestyle on glycemic traits have not been evaluated. MethodsThis gene-environment study tested the interaction between GLP1R-rs10305492 variant, consistent with the effect of GLP1R agonist therapies, and four lifestyle factors (diet, physical activity, sleep duration, and chronotype) for glucose and glycated hemoglobin (HbA1c) levels among 263,846 UK Biobank participants. Linear regression models were conducted to evaluate the effects of the rs10305492 and lifestyle factors on glucose and HbA1c levels. ResultsGLP1R-rs10305492-AA/AG genotype combined a healthy diet, regular physical activity, adequate sleep duration, or morning chronotype were associated with lower glucose and HbA1c levels (all P for trend < 0.001). A synergistic effect was found between rs10305492 and sleep duration on HbA1c, suggesting a recommended adequate sleep duration (7–8 h/day) may amplify the HbA1c lowering effect of GLP1R agonists. Joint effects of the rs10305492 and adequate sleep were associated with a 26 % reduced risk of hyperglycemia (>7.8 mmol/L) risk and a 22 % lower of high HbA1c (>39 mmol/mol or 5.7 %). ConclusionsCombining GLP1R agonists with adequate sleep may provide additional benefits for glycemic control in clinical practice.

Corticosteroids in Septic Shock Treatment: A Systematic Review of Efficacy and Side Effects

Septic shock (SS) is a critical condition with high mortality rates ranging from 27 to 54% in intensive care units (ICU). This systematic review aimed to evaluate the effects of corticosteroids on SS treatment, with a focus on mortality rates, ICU stay duration, shock reversal, and potential side effects. A comprehensive literature search was conducted using PubMed, Scopus, and the Web of Science, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six studies were selected for the systematic review, including meta-analyses of randomized controlled trials. The results showed that corticosteroids, particularly low-dose hydrocortisone, reduced 28-day mortality, ICU admissions, and hospital mortality. Corticosteroids also improved shock reversal, increased vasopressor-free days, and shortened the ICU stay. However, their use was associated with increased risks of hyperglycemia and hypernatremia. The optimal daily dose for mortality reduction was approximately 260 mg of hydrocortisone or its equivalent. While corticosteroids show promise in managing SS, their use remains controversial due to varied outcomes across studies. Personalized treatment, considering factors such as timing, dosage, and specific corticosteroids, is necessary to optimize the benefits and reduce risks. Further research is required to determine the optimal corticosteroid protocols and effectiveness of adjunct treatments.

Consensus Report on the Use of Continuous Glucose Monitoring in Chronic Kidney Disease and Diabetes.

This report represents the conclusions of 15 experts in nephrology and endocrinology, based on their knowledge of key studies and evidence in the field, on the role of continuous glucose monitors (CGMs) in patients with diabetes and chronic kidney disease (CKD), including those receiving dialysis. The experts discussed issues related to CGM accuracy, indications, education, clinical outcomes, quality of life, research gaps, and barriers to dissemination. Three main goals of management for patients with CKD and diabetes were identified: (1) greater use of CGMs for better glycemic monitoring and management, (2) further research evaluating the accuracy, feasibility, outcomes, and potential value of CGMs in patients with end-stage kidney disease (ESKD) on hemodialysis, and (3) equitable access to CGM technology for patients with CKD. The experts also developed 15 conclusions regarding the use of CGMs in this population related to CGMs' unique delivery of both real-time information that can guide monitoring and management of glycemia and continuous and predictive data in this population, which is at higher risk for hypoglycemia and hyperglycemia. The group noted three major clinical gaps: (1) CGMs are not routinely prescribed for patients with diabetes and CKD; (2) CGMs are not approved by the United States Food and Drug Administration (FDA) for patients with diabetes who are on dialysis; and (3) CGMs are not routinely available to all of those who need them because of structural barriers in the health care system. These gaps can be improved with greater stakeholder collaboration, education, and awareness brought to the use of CGM technology in CKD.