Hyperglycemia In Patients Research Articles

Systematic review of the effect of <em>Phyllanthus emblica</em> in glycaemic control

Introduction: Diabetes mellitus which is characterized by chronic hyperglycaemia accounts for 1.6 million deaths per year globally. In Sri Lanka, 7.4% of adults are with raised fasting blood glucose. Phyllanthus emblica, some fruit, which is also called by Nelli, Amla or Indian Gooseberry, is traditionally believed to facilitate control of hyperglycaemia.Objectives: To systematically review the glycaemic control effect of Phyllanthus emblica.Methods: PubMed, EMBASE, Cochrane Library, CINAHL and AGRICOLA databases were searched to select relevant studies. Studies were selected in two rounds. Three screening questions consisted of; whether study was a human study with Phyllanthus emblica included as a fruit or an ingredient, outcomes were related to glycaemic control and outcomes being reported quantitatively. Following the review of titles and abstracts, full articles were reviewed with screening questions such as, study design, participants, intervention, and findings of outcome. Two reviewers independently screened articles with the third intervening in resolving the conflicts. Meta-analysis was not performed following the heterogeneity assessments and narrative review of the findings was done.Results: Eighteen studies were selected, having respectively excluding 81, 106 and 22 studies with reference to three screening questions. Six studies were done among healthy individuals and 12 were done among patients with diabetes. The studies were conducted among the age group of 18-75 years. Sample sizes of studies ranged from 10 to 150 participants, with 951 participants in total. In three studies, Phyllanthus emblica was used as a single entity and in 15, it was one component of a combined product. Fifteen selected studies described the mean fasting blood sugar (FBS) levels and 13 of them showed statistically what Phyllanthus emblica or products containing it had on glycaemic control, compared to control group (p<0.001). Out of those 13 studies with significant findings on glycaemic control, 10 studies were done among hyperglycaemic patients. In eight studies, a significant reduction in HbA1c results (p <0.05) was observed and nine studies showed a significant reduction in post prandial blood sugar (PPBS) levels (p<0.05). None of the selected studies showed any negative impact of Phyllanthus emblica on blood glucose levels among either healthy or diabetics individuals.Conclusions & Recommendations: Phyllanthus emblica is found to be with favourable effects in facilitating blood sugar control. Further research on the potential application of it as a glycaemic controller, must be encouraged.

Blood Glucose Control on Diabetic Patient Type I using Sliding Mode Adaptive Control

Diabetes is a metabolic disorder due to insufficient insulin synthesis or inadequate insulin sensitivity. The Bergman’s minimal model describes the dynamics of blood glucose levels in type 1 diabetics. The model has control inputs in the form of insulin injections and covers external disturbance factors in the form of meal disturbances. This research developed a control design using an sliding mode adaptive control to reduce blood glucose levels in hyperglycemic patients and keep it within normal glucose levels. Sliding mode adaptive control is an adaptive controller updates the model based on measured performance while in operation. A numerical simulation of the proposed controller is carried out by giving eating disorders three times, namely at breakfast, lunch, and dinner. Based on the numerical simulation, to lower the high blood glucose in the hyperglicemic patient, the insulin injection should be given starting at 30 minutes before breakfast for the next four hour, with a maximal dose of injection is 13 mU/min. It can decrease the high blood pressure until 54.83%.

Galvanostatic method assembled ZIFs nanostructure as novel nanozyme for the glucose oxidation and biosensing

Recently, the composite of soft conductive substrates, such as carbon fiber (CF), with metal-organic frameworks (MOFs) has been employed in a myriad of applications. The composite material has demonstrated exceptional potential in the realm of electrochemical sensing platforms. However, the rapid growth of MOFs on the surface of CF remains a challenge. Herein, we propose a simple galvanostatic method as an effective strategy for rapidly growing zeolitic imidazolate frameworks (ZIFs) on CF, and obtain nano-caltrop-like ZIFs modified CF (NC-ZIFs/CF) glucose (Glu) sensor platform with distinctive morphology. The prepared NC-ZIFs/CF demonstrated significant electrocatalytic activity towards the oxidation of Glu in alkaline media, characterized by a pronounced augmentation in oxidation current density. At an applied potential of 0.4 V, NC-ZIFs/CF exhibited a remarkably broad detection range (3–30,000 µmol/L) and demonstrated outstanding selectivity, repeatability and reproducibility. Additionally, the NC-ZIFs/CF was efficaciously employed for the detection of blood Glu levels in the serum of both normoglycemic and hyperglycemic patients, obtaining highly reliable results. This work demonstrates the feasibility of using galvanostatic method assembly to induce the growth of MOFs on conductive substrates, providing new ideas for electrocatalysis sensors and other electrochemical applications.

An Observational Study of Glycemic Status in New Onset Acute Stroke and Their Clinical Outcome in a Tertiary Care Teaching Hospital

Abstract Objective The study was aimed to test the blood glucose level in acute stroke patients to find out any correlation with types and prognosis of different glycaemic groups. Method It was a prospective observational study of patients admitted to hospital in Nizamabad due to an acute ischemic or hemorrhagic stroke (<24Hrs after the onset). Clinical parameters including history and clinical examination findings were recorded. CT scan of brain, blood glucose level, HbA1c, and other laboratory tests were taken in all the patients. 2D echocardiography (2D-ECHO) and X-Ray chest picture were also performed. According to glycaemia, the patients were classified into four groups such as Nondiabetic/euglycemic, known Diabetics on glycemic control therapy with or without glycemic control, Newly detected diabetics, and Stress hyperglycemia patients. On the day 1 and 15 National Institutes of Health Stroke Scale (NIHSS) was calculated to evaluate the severity of stroke and its outcome. Good prognosis was considered when NIHSS 5, moderate prognosis when NIHSS was 6–15, and poor prognosis when NIHSS was 16–20. Patients with NIHSS 20 died within 3 days of admission. Results Finally, 158 patients with acute stroke were included. Hemorrhagic stroke was seen in 43 (27.2%) and ischaemic stroke in 115 (72.8%) patients. Maximum cases were found in 51–60 years age group (37.9%) followed by 41–50 (20.3%) and 61–70 years age group (20.3%). Majority of study subjects were males, 65.8 % (n=104). Maximum cases were Euglycemics (44.3%), followed by stress hyperglycemic (27.8%), known diabetes (15.9%), and newly diagnosed diabetes (12%) presenting with acute stroke. Higher NIHSS score was found in stress hyperglycemic patients (19.4%) followed by known diabetics (17.3%), newly detected diabetics (16.3%), and euglycemics (9.5%). Maximum proportion (81.8%) of ischaemic stroke cases were found with stress hyperglycemia compared to other glycemic conditions but in hemorrhagic stroke maximum proportion (47.3%) were newly diagnosed diabetics. Maximum proportion of large size of lesion (47.4%) was found in newly diagnosed diabetes followed by stress hyperglycemia (45.55). Medium size of the lesions was found more in newly diagnosed diabetes (52.6%) followed by known diabetes cases (52%). Good outcome was found in 51 cases (32.2%), moderate outcome in 34 (21.5%), and poor outcome was in 30 (18.9%). 43 patients with NIHSS score >20 died within 3 days of admission (27.2%). Maximum proportion of death cases in ischemic group those belongs to newly diagnosed diabetes cases (8/9=88.8%). Higher deaths were found in blood sugar <110 mg/dl and blood sugar >199 mg/dl with an incidence rates of 41.2% and 53.4%. Conclusion Hyperglycaemia in non-diabetic patients after acute stroke is a stress response reflecting more severe neurological damage. Elevated HbA1c presenting stroke glycaemia status has a significant trend in increasing the risk of cause mortality. The management of hyperglycaemia in patients with diabetes and non-diabetes is an important aspect of the emergency management of stroke.

Biochemical Alterations Associated With the Severity of COVID-19 in Sub-Saharan Black African Individuals.

Biochemical markers are essential in the monitoring and the clinical care of patients as they inform clinicians. Here, we characterized biochemical alterations in sub-Saharan Black African individuals with COVID-19. The study includes COVID-19 patients cared for at the Akanda Army Hospital in Libreville (Gabon). A total of 2237 patient records were extracted and reviewed. Patients were classified based on hospital admission (intensive care unit [ICU], internal medicine ward, and outpatient). One thousand six hundred seventy-one were included in the study. ICU patients were significantly older than non-ICU hospitalized patients (P < 0.001) and outpatients (P < 0.0001). Hyperglycemic patients had 6.4 odds of being in ICU (P < 0.0001). Patients with abnormally high urea had 54.7 odds of being in ICU (P < 0.0001). Patients with abnormally high aspartate aminotransferase (AST) (>33 IU/L) had 3.5 odds of being in ICU (P < 0.0001). Hyperlactatemia (>246 IU/L) odds in ICU patients were 14 (P < 0.0001). The odds of abnormally high alkaline phosphatase (ALP) (>147 IU/L) in ICU patients were 4.6 (P < 0.0001). Odds for hypochloremia (<98 mmol/L) were 1.6 in ICU (P < 0.05). Dysnatremia patients (<135 or >145 mmol/L) had 9.5 odds of being found in ICU patients (P < 0.0001). The odds of potassium imbalance (<3.6 or >5 mmol/L) in ICU patients were 12.2 (P < 0.0001). COVID-19-associated biochemical alterations observed in the Black African population are similar to those observed in other populations, and the association between COVID-19 severity, hyperglycemia, and multi-organ affection is confirmed.

Euglycemic Diabetic Ketoacidosis: Experience with 44 Patients and Comparison to Hyperglycemic Diabetic Ketoacidosis.

Euglycemic diabetic ketoacidosis (DKA) (glucose <250milligrams per deciliter (mg/dL) has increased in recognition since introduction of sodium-glucose co-transporter 2 (SGLT2) inhibitors but remains challenging to diagnose and manage without the hyperglycemia that is otherwise central to diagnosing DKA, and with increased risk for hypoglycemia with insulin use. Our objective was to compare key resource utilization and safety outcomes between patients with euglycemic and hyperglycemic DKA from the same period. This is a retrospective review of adult emergency department patients in DKA at an academic medical center. Patients were included if they were >18years old, met criteria for DKA on initial laboratories (pH ≤7.30, serum bicarbonate ≤18millimoles per liter [mmol/L], anion gap ≥10), and were managed via a standardized DKA order set. Patients were divided into euglycemic (<250milligrams per deciliter [mg/dL]) vs hyperglycemic (≥250mg/dL) cohorts by presenting glucose. We extracted and analyzed patient demographics, resource utilization, and safety outcomes. Etiologies of euglycemia were obtained by manual chart review. For comparisons between groups we used independent-group t-tests for continuous variables and chi-squared tests for binary variables, with alpha 0.05. We identified 629 patients with DKA: 44 euglycemic and 585 hyperglycemic. Euglycemic patients had milder DKA on presentation (higher pH and bicarbonate, lower anion gap; P < 0.05) and lower initial glucose (195 vs 561mg/dL, P < 0.001) and potassium (4.3 vs 5.3mmol/L, P < 0.001). Etiologies of euglycemia were insulin use prior to arrival (57%), poor oral intake with baseline insulin use (29%), and SGLT2 inhibitor use (14%). Mean time on insulin infusion was shorter for those with euglycemic DKA: 13.5 vs 19.4 hours, P = 0.003. Mean times to first bicarbonate >18mmol/L and first long-acting insulin were similar. Incidence of hypoglycemia (<70mg/dL) while on insulin infusion was significantly higher for those with euglycemic DKA (18.2 vs 4.8%, P = 0.02); incidence of hypokalemia (<3.3mmol/L) was 27.3 vs 19.1% (P = 0.23). Compared to hyperglycemic DKA patients managed in the same protocolized fashion, euglycemic DKA patients were on insulin infusions 5.9 hours less, yet experienced hypoglycemia over three times more frequently. Future work can investigate treatment strategies for euglycemic DKA to minimize adverse events, especially iatrogenic hypoglycemia.

Salivary and crevicular fluid proinflammatory cytokines and advanced glycation end products in patients with different glycemic levels undergoing fixed orthodontic treatment.

To examine whether patients with different blood glycemic levels undergoing fixed orthodontic therapy demonstrate changes in the biochemical profiles of crevicular fluid and salivary advanced glycation end products (AGEs) and proinflammatory cytokine levels in comparison with nondiabetic healthy subjects. Prediabetic subjects, subjects with type 2 diabetes mellitus (T2DM), and subjects without a diabetes mellitus diagnosis undergoing fixed orthodontic therapy with MBT prescription brackets (0.022-inch brackets and 0.019 × 0.025-inch stainless steel archwires) were included in the study. The following clinical periodontal parameters were evaluated: (1) plaque score (PS), (2) probing depth (PD), (3) bleeding on probing (BOP), and (4) clinical attachment loss. Crevicular fluid and saliva specimens were collected during regular orthodontic visits. Salivary and crevicular fluid tumor necrosis factor alpha, interleukin-6, ghrelin, resistin, AGEs, and receptor activator of nuclear factor κΒ ligand were evaluated using a human magnetic Luminex multiplex assay. BOP scores were significantly higher among T2DM subjects (19.2%) than among nondiabetic subjects (11.2%) and prediabetic subjects (15.9%). Comparable values were demonstrated by all three study groups regarding PD scores and PSs. T2DM subjects demonstrated higher scores for gingival crevicular fluid (GCF) chemokines than nondiabetic and prediabetic subjects. A statistically significant difference was found in the levels of AGEs and resistin among the three study groups. The scores revealed for the levels of GCF resistin and AGEs versus periodontal BOP demonstrated a significant positive association by the Pearson correlation test. T2DM patients demonstrated significantly higher levels of GCF resistin and AGEs during fixed orthodontic therapy. Chronic hyperglycemic patients undergoing orthodontic therapy demonstrated a proinflammatory response.

Glycemic Characteristics and Clinical Outcomes in Patients with COVID-19 Admitted to Referral Shahid Sayad Shirazi Hospital in Gorgan, North of Iran.

Diabetes mellitus (DM) is one of the most common chronic diseases, the main manifestation of which is hyperglycemia, and is accompanied by many complications. Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, several studies have reported the occurrence of various complications associated with different degrees of hyperglycemia in COVID-19 patients. The aim of the present study was to investigate the glycemic characteristics and clinical outcomes in patients with COVID-19. In this cross-sectional study, 418 patients with COVID-19 were evaluated in terms of hyperglycemia and its related factors, as well as the relationship between hyperglycemia and the outcome of the disease. Data were statistically analyzed using SPSS software. In the present study, 350 (83.7%) out of 418 hospitalized patients with COVID-19 had hyperglycemia and 193 (55.1%) of the patients with hyperglycemia were women. 169 (48.4%) of patients with hyperglycemia during hospitalization were already diabetic. The mean age was higher in COVID-19 patients with hyperglycemia (P < 0.001), and systolic blood pressure and respiratory rate were also higher in them (P = 0.005 and P = 0.013, respectively). In patients with hyperglycemia, oxygen saturation (SpO2) at the time of admission and discharge was lower than other patients (P < 0.001). The frequency of hypertension in the patients with hyperglycemia was significantly higher than in nonhyperglycemic patients (P < 0.001 vs. 0.014). The estimated glomerular filtration rate (eGFR) of hyperglycemic patients was significantly lower than other patients (P < 0.001). Also, there was a significant inverse relationship between eGFR values and fasting (FBS) and random blood sugar (BS) (r = 0.328 and r = 0.310, P < 0.001). On the other hand, there was a direct relationship between FBS and random BS in patients with hyperglycemia with the dose of corticosteroids (r = 0.146 and r = 0.158, P < 0.01). In total, 8.2% of the patients died, although the FBS and random BS and a history of DM were not risk factors for the death of patients (P < 0.05). The findings of our study showed that hyperglycemia is highly prevalent in hospitalized patients with COVID-19. Hyperglycemia in previously nondiabetics appears to be associated with decreased eGFR in COVID-19 patients.

Serum Oxidative Status in People with Obesity: Relation to Tissue Losses, Glucose Levels, and Weight Reduction.

This work aims to study the effect of reductions in various body mass components on the oxidative, glycemic, and lipid parameters of people with obesity (PWO). A total of 53 PWO underwent a six-month individualized low-calorie diet combined with moderate exercise, during which anthropometric, biochemical, and oxidative parameters were measured. Probands were divided into groups based on weight, visceral fat area (VFA), total body water (TBW), and skeletal muscle mass (SMM) losses. Weight reduction normalizes glycemia, but VFA reduction is less pronounced, while SMM and TBW reductions are more pronounced in patients with higher initial concentrations of glucose and fructosamine. Moreover, changes in oxidative parameters correlate with changes in glucose. Weight loss, regardless of the reduced tissue, decreases cardiovascular risk. We observed a significant change in almost all parameters related to the redox state. In general, parameters responsible for antioxidant action improved, and markers of oxidative damage decreased. Malondialdehyde, lipid peroxides, and total oxidative status levels can be considered biomarkers reflecting only the current severity of reactive oxygen species genesis processes. When considering the glycemic state, the results are not as clear due to the substantial differences between normoglycemic and hyperglycemic patients. Glycemic status is a factor playing a crucial role in weight reduction.

Comprehensive Evaluation of the Clinical Efficacy of an Anti-Diabetic Polyherbal Formulation

Background: There are several clinical studies examining the health advantages of several single medicinal herbs utilized in traditional blood glucose-lowering treatments. But very few or no studies on herbal formulations were made as Polyherbal for the same goal. As a result, it is now necessary to confirm that patients with hyperglycemia can benefit from such Polyherbal medicines as Dolabi. Methods: This prospective open-label, herbal coded test drug-controlled, randomized trial was conducted at the Munshiganj and Dhaka area in Bangladesh. We enrolled 108 male and 104 female patients of 30-70 years with primary and moderate hyperglycemia. They were recruited from the OPD of an Unani &amp; Ayurvedic hospital in Munshiganj and different Unani clinics in Dhaka, Bangladesh after fulfilling the inclusion criteria. Patients were randomly assigned to receive metformin hydrochloride 500 mg two times daily and 2 tablets of Dolabi two times daily by using a random numbers table with the help of an assistant. Blood samples, height, weight, blood pressure, and personal data were recorded—laboratory results were obtained at the study baseline, after 1.5 months and after 3 months of intervention. Results: In the case of the test drug, results showed a significant decrease in blood glucose level between the baseline and after 3 months, in males, it was from 9.83±1.17 to 7.72±1.06 mg/dL for fasting glucose, from 16.60±2.35 to 8.23±1.17 mg/dL for 2 hours PP glucose, from 9.33±1.17 to 7.45±2.03 percent for HbA1c and for Insulin it reduces from 183.10±27.59 to 168.10±29.59 pmol/ L. The control drug metformin hydrochloride also showed a significant decrease in blood glucose level between baseline and after 3 months, in the case of males it was from 9.99±2.52 to 6.97±1.76 mg/dL for fasting glucose, from 17.43±5.05 to 7.89±2.42 mg/dL for 2 hours PP glucose, from 10.43±2.36 to 6.87±1.18 percent for HbA1c and for Insulin it reduces from 198.75±30.61 to 183.75±30.61p mol/L. In the case of females the test drug showed a significant reduction in fasting glucose, 2 hours PP glucose, HbA1c and Insulin between the baseline and after 3 months, it was from 10.02±1.11 to 7.78±0.93 mg/dL, from 16.88±2.21 to 8.16±1.11 mg/dL, from 9.84±1.04 to 7.45±1.03 percent and from 199.47±30.90 to 173.47±30.90 mg/dL respectively. In the case of females, the control drug showed a significant reduction in fasting glucose, 2 hours PP glucose, HbA1c and Insulin between baseline and after 3 months, it was from 10.18±1.92 to 6.71±1.59 mg/dL, from 18.70±3.88 to 7.60±3.74 mg/dL, from 10.58±1.08 to 6.98±1.08 percent and from 200.00±31.83 to 188.00±31.83 mg/dL respectively. Conclusions: We can infer the following from the present study’s findings: The polyherbal formulation Dolabi is able to reduce the blood glucose level. It can be an effective drug for primary hyperglycemic patients.

Stem Cell-Based Tissue Engineering Approaches for Diabetic Foot Ulcer: a Review from Mechanism to Clinical Trial.

Diabetic foot ulcer (DFU) is a complication from incomplete or prolonged wound healing, at times requires amputation, putting substantial health and socioeconomic burden. Wound healing is a dynamic overlapping process that can be regulated by arrays of molecular factors showing redundancy in function. However, dysregulation in the mechanism of angiogenesis, extra cellular matrix (ECM) formation and immune modulation are the major causes for impair wound healing in hyperglycaemic patients. Despite development of wound care research, there is a lack of well-accepted targeted therapy with multidisciplinary approach for DFU treatment. Stem cell therapy holds a promising outcome both in preclinical and clinical trials because of its ability to promote healing via regeneration and specialized tissue differentiation. Among different types of stem cells, regenerative potential of mesenchymal stem cell (MSC) is well demonstrated in both experimental and clinical trial. Still there is a huge knowledge gap among medical practitioners for deciding the best stem cell source, administration route, and safety. This review strengthens the fact that why stem cell therapy is a promising candidate to treat DFU and cited multiple tissue engineering and biomaterial-based approaches for delivering stem cells and their aftermath paracrine events. Based on the pre-clinical and clinical studies, the review tried to come up with optimum stem cell source and delivery route for the treatment of DFU.At last, the review glances on possible direction to enhance therapeutics strategy for the same, including different approaches like: phytocompounds, exosomes,scaffold geometry, cell preconditioning and licensing etc.

OR24-03 Triglyceride Clearance In Hypertriglyceridemic Pancreatitis: Time-course And Implications For Management

Abstract Disclosure: S.K. Majumdar: None. Introduction: Uncertainty exists for how to optimally manage severely elevated triglyceride (Tg) levels in patients with hypertriglyceridemic (HTg) pancreatitis. Standard recommendations include NPO (nil per os) status and intravenous (iv) insulin for most patients, yet information is lacking in regards to the natural time-course of Tg lowering, the degree of benefit insulin provides and for whom it may be indicated, and for the Tg level at which transition to feeding would be appropriate. Underlying Questions: (1) What is the natural time-course of triglyceride (Tg) lowering when nutritional intake is held and (2) does it differ according to etiology of hypertriglyceridemia? (3) What is the role of intravenous insulin in acute Tg lowering, and (4) at what threshold of Tg can nutritional intake safely resume? Methods: A retrospective study of patients hospitalized from October 2013 through December of 2018 with a diagnosis of pancreatitis associated with hypertriglyceridemia Tg ≥ 5.65 mM (500 mg/dL), in absence of other causes, was performed by medical record review. The time-course of Tg lowering was assessed for differences in relation to initial Tg values, use of iv insulin, ethanol vs. non ethanol associated causes, and time to Tg values of &amp;lt; 5.65 mM (500 mg/dL) vs &amp;lt; 11.29 (1000 mg/dL). Results: Sixty-six cases were identified and 45 had multiple measurements for time-course evaluation. Those with initial Tg values &amp;lt; 45.16 mM (4000 mg/dL) achieved Tg levels &amp;lt; 11.29 mM in &amp;lt; 3 days, while 18.8% with higher values took 5-9 days. Insulin therapy was associated with a longer duration, and ethanol with a shorter duration, of hypertriglyceridemia. Tg clearance in ethanol associated hypertriglyceridemia appeared independent of insulin treatment. Time to Tg &amp;lt; 5.65 mM vs &amp;lt; 11.29 mM was significantly longer when initial Tg levels were &amp;gt; 22.58 mM (2000 mg/dL). Conclusion: An arbitrary threshold of 45.16 mM (4000 mg/dL) for initial Tg’s in HTg pancreatitis appears to separate those likely to achieve Tg’s &amp;lt; 11.29 mM in &amp;lt; 3 vs. &amp;gt; 3 days, independent of cause or treatment in absence of known genetic defects in Tg clearance. Insulin therapy remains appropriate for hyperglycemic patients but appears unnecessary for isolated ethanol associated hypertriglyceridemia. A threshold Tg of &amp;lt;11.29 mM appears more practical than &amp;lt;5.65 mM for resuming nutritional intake. A randomized trial is necessary to confirm these findings. Presentation: Saturday, June 17, 2023

Inpatient glycemic management in noncritically ill patients: Updated guidelines.

Hyperglycemia is common in hospitalized patients and is traditionally managed with scheduled and correctional doses of insulin. The authors present an overview of the latest (2022) guidelines from the Endocrine Society on inpatient hyperglycemia management in noncritically ill patients, which includes a role for newer diabetes technologies and nontraditional insulin and noninsulin therapies.

A PKPD interaction between Momordica charantia and oral hypoglycemic drug –dapagliflozin in STZ induced hyperglycemic rats

Traditional medications obtained from the medicated herbal plants are used by about maximum percentage of world population for different chronic disease condition. Diabetes (Hyperglycemia- high blood sugar level) is a very important metabolic disorder in different developed, developing countries including India. It providing to very serious complications on health of human beings, especially in the rural and subruralareas. Hence, the research studies required to be subjected to pharmacodynamic and pharmacokinetic studies in order to determine effect of Momordica charantia herb on the hyperglycaemic patients who are taking the therapy with synthetic drugs. This study was to discover the influence of Momordica charantia on the pharmacokinetics and pharmacodynamics of Dapagliflozinand in rats. Results have proved the negative (decrease) effect of Momordica charantia on pharmacokinetics but positive (increase) effect on pharmacodynamics of Dapagliflozin.

Relationship between Dietary habits, lifestyle risk factors and dysglycemia among patients with type 2 diabetes mellitus in Al Madinah Al Munawara, Saudi Arabia

Background and Aim : Type 2 Diabetes Mellitus is a chronic global health condition that affects people of all ages at an alarming rate. It's more widespread in Middle Eastern countries, especially Saudi Arabia which has the second-highest rate of diabetes in the Middle East, according to the World Health Organization. The purpose of the study is to investigate the relationship between dietary habits, lifestyle factors, and dysglycemia among type 2 diabetic patients in Al-Madinah Al-Munawara, Saudi Arabia. Subjects and methods: This cross-sectional study was conducted on 281 type 2 diabetic patients aged between 20 and 65 years old via an online survey. Sociodemographic, anthropometric, dietary habits, physical activity, and other lifestyle data were collected from patients of Al Madinah's King Fahad Hospital in Al Madinah Al Munawara. Results: The highest age group of those surveyed was 41-65 years old. The majority (65.1%) were female. More than half of the surveyed population had university or college-level education. There was no association between family history and gender (p=0.631). There was a significant association between gender and intake of sweets (p= 0.001), red meat (p= 0.002), red tea (p= 0.013), green tea (p= 0.031), and consumption of grains (p= 0.027). Male patients were more active compared to the female group (14.3% vs. 4.9%), (p=0.043). Conclusion: Food habits influenced hyperglycemia. Female hyperglycemic patients had considerably greater rates of insufficient physical activity and sweet consumption. Male dysglycemic patients consumed considerably more red meat and poultry. Future consideration should be given to increasing awareness and knowledge of dietary intake and lifestyle factors and their importance to prevent future complications.

A-202 Establishing of Lipid-Apolipoprotein Connectivity Map in Hyperglycemia

Abstract Background Hyperglycemia, a condition characterized by a significantly increased glucose level in the blood, can lead to insulin deficiency and pre-diabetes. Lack of insulin production also interferes with lipid metabolism and increases the risk for cardiovascular disease. Thus, diagnosis and treatment of hyperglycemic patients can benefit from advanced proteomics and lipidomics testing approaches. Methods Disease-focused serum samples from 50 specimens were collected and evaluated, including 29 specimens with a glucose level&amp;gt;180 mg/dL and 21 normal lipidemic specimens. The sample proteomics analysis was conducted with a Perfinity IDP workstation (Shimadzu Scientific, Columbia, MD, USA) using on-line protein digestion with an immobilized enzyme reactor (IMER) directly coupled to a HALO-C18 column (Advanced Materials Technology, Wilmington, DE, USA). Lipidomics data were collected with the Lipidyzer platform (AB SCIEX, Framingham, MA, USA). Statistical analysis was conducted using JMP software (SAS Institute, USA) and custom scripts. Results Using targeted lipidomics and proteomics platforms we identified 20 proteins and 575 lipid species across 10 lipid subclasses. We identified specific lipids and lipoproteins dysregulated in hyperglycemic specimens as compared to the normolipidemic samples and linked them to major metabolic pathways. Lipoprotein particles related-proteins apos A1/B/C2/C3/E and lecithin–cholesterol acyltransferase (LCAT) were significantly dysregulated and associated with changes in HDL-mediated lipid transport, very-low-density lipoprotein particle remodeling, acylglycerol homeostasis, and triglyceride homeostasis. Conclusion The conducted integrated analysis of lipid and protein concentrations in hyperglycemia specimens to provide new insights into molecular changes associated with hyperglycemia that may inform new diagnostic and therapeutic strategies. The network analysis can allow improved categorization of patients that can lead to more effective and individualized therapeutic intervention approaches. This study provides new experimental and informatics approaches to better assess underlying metabolic conditions and related diseases, including cardiovascular disease, diabetes, and metabolic syndrome. Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Use of trade names is for identification only and does not imply endorsement by the CDC.

Higher Prehospital Blood Glucose Levels Associated With Return of Spontaneous Circulation in Out-of-Hospital Non-traumatic Cardiac Arrests

ObjectiveCardiac arrest leads to an array of metabolic disturbances. We aimed to investigate the association between prehospital blood glucose levels (BGLs) and rates of return of spontaneous circulation (ROSC) in non-traumatic out-of-hospital cardiac arrests (OHCAs). MethodsA retrospective analysis of adult non-traumatic OHCAs within Kalamazoo County, MI, from January 2018 to May 2020 using the Michigan Emergency Medical Services Information System database was performed. Demographic data, Utstein variables, and BGLs (hypoglycemia < 70 mg/dL, euglycemia 70-120 mg/dL, and hyperglycemia >120 mg/dL) were abstracted. Chi-square and Wilcoxon rank sum tests were used to evaluate the relationship between BGL and ROSC. ResultsIn total, 314 patients met the inclusion criteria. The mean age was 62.9 years. ROSC was achieved in 147 (46.8%) patients. Fifty (15.9%), 75 (23.9%), and 189 (60.2%) patients were hypoglycemic, euglycemic, and hyperglycemic, respectively. An association was found between the glycemic group and ROSC (P < .0001), with an estimated odds of ROSC being 77% lower (95% confidence interval, 46%-90%) for hypoglycemic than euglycemic or hyperglycemic patients. The point difference between median ROSC-yes BGL (median [interquartile range] = 160 mg/dL [110-225 mg/dL]) was 33 mg/dL (95% CI, 13-51 mg/dL) greater than the ROSC-no group (median [interquartile range] = 127 mg/dL [75-190 mg/dL], P = .001). ConclusionNon-traumatic OHCA patients achieving ROSC had a significantly higher prehospital BGL than the ROSC-no group. Further study is warranted to investigate the role intra-arrest BGL may have as a prognostic marker for ROSC.

Hyperglycemia and insulin infusion in pancreatoduodenectomy: a prospective cohort study on feasibility and impact on complications.

Hyperglycemia is a risk factor for postoperative complications but its impact on outcome after pancreatoduodenectomy (PD) is scarcely studied. This prospective cohort study aimed to assess the effect of continuous insulin infusion on postoperative complications and blood glucose, as well as to evaluate the impact of hyperglycemia on complications, after PD. One hundred patients planned for PD at Skåne University Hospital, Sweden were prospectively included for perioperative continuous insulin infusion and a historic cohort of 100 patients was included retrospectively. Median blood glucose levels were calculated and data on complications were analyzed and compared between the historic cohort and the intervention group as well as between normo- and hyperglycemic patients. Median glucose levels were significantly lower in the intervention group compared to the historic cohort up to 30 days postoperatively (median glucose 8.5mmol/l (interquartile range 6.4-11) vs. 9.1mmol/l (interquartile range 6.8-17) ( P =0.007)). No significant differences in complication rates were recorded between these two groups. The incidence of complications classified as Clavien ≥3 was higher in hyperglycemic patients (100 vs. 27%, P =0.024). Among hyperglycemic patients the prevalence of preoperative diabetes was higher compared to normoglycemic patients (52 vs.12%, P <0.001). In patients with a known diagnosis of diabetes, a trend, although not statistically significant, towards a lower incidence of postoperative pancreatic fistula grade B and C, as well as postpancreatectomy hemorrhage grade B and C, was seen compared to those without preoperative diabetes (6.8 vs. 14%, P =0.231 and 2.3 vs. 7.0%, P =0.238, respectively). Insulin infusion in the early postoperative phase after PD is feasible in a non-ICU setting and significantly decreased blood glucose levels. The influence on complications was limited. Preoperative diabetes was a significant predictor of postoperative hyperglycemia and was associated with a lower incidence of clinically significant postoperative pancreatic fistula.

Association between admission hyperglycemia and postoperative pneumonia in geriatric patients with hip fractures

BackgroundAdmission hyperglycemia is a common phenomenon in the early stages of injury. This study aimed to determine the relationship between admission hyperglycemia and postoperative pneumonia in geriatric patients with hip fractures.MethodsA total of 600 geriatric patients admitted to Dandong Central Hospital with hip fractures were included. Patients were divided into four groups based on quartiles of admission blood glucose levels: Q1- Q4. Multivariable logistic regression and propensity score-matched analyses were conducted to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for postoperative pneumonia. Receiver operating characteristic (ROC) curves were used to determine the cut-off value of admission hyperglycemia for predicting postoperative pneumonia.ResultsThe incidence of postoperative pneumonia was significantly higher among hyperglycemic patients than those with normal glucose levels (OR = 2.090, 95% CI: 1.135–3.846, p = 0.016). Admission hyperglycemia showed moderate predictive power, with an area under the ROC curve of 0.803. Furthermore, propensity score-matched analyses demonstrated that patients in the Q3 (OR = 4.250, 95% CI: 1.361–13.272, p = 0.013) and Q4 (OR = 4.667, 95% CI: 1.251–17.405, p = 0.022) quartiles had a significantly higher risk of postoperative pneumonia compared to patients in the Q1 quartile.ConclusionsAdmission hyperglycemia in elderly hip fracture patients increases the risk of postoperative pneumonia. This biomarker can aid clinical assessment and perioperative management.

The Role of Zinc in Cancer Patients Suffering From Diabetic Disease or Hyperglycaemia and the Impacts in the New Immunotherapy Protocols

Diabetes is a harmful metabolic disease (fasting hyperglycemia, intense thirst, mainly nocturnal diuresis, etc.) which afflicts millions of people worldwide and is correlated with environmental pollution and poor diet. The hyperglycemia of diabetic disease, supported by insulin resistance and hyperinsulinemia, is closely related to an increase in oncological, cardiovascular and chronic-degenerative diseases and to a worsening of any responses to therapeutic protocols. Our work proposes an insight into the lack of therapeutic response to immunotherapy and/or chemotherapy protocols in diabetic or hyperglycemic cancer patients. Lack of therapeutic response, in fact, occurs when a patient does not respond to a certain pathology because the body is unable to produce or activate specific lymphocytes and antibodies towards that disease. We argue that the lack of therapeutic response can be caused by deficiencies of trace elements such as Zinc, Copper, Manganese and Cobalt etc. Which help our body to improve its health condition and aggravated by toxic substances such as heavy metals, PCBs and other environmental pollutants. It therefore becomes essential to dose these substances in the various biological matrices (blood, hair, urine, modified tissues, etc.) and in the tumor to adequately deal with the neoplastic disease and reduce the possibility of a lack of therapeutic response.