Increase In Glycemia Research Articles

The level of reactive oxygen species production by adipocytes of epicardial adipose tissue is associated with an increase in postprandial glycemia in patients with severe coronary atherosclerosis

The mechanisms of oxidative stress in adipocytes of local fat depots in patients with cardiometabolic diseases have been studied insufficiently.Purpose. To study the levels of reactive oxygen species (ROS) production in adipocytes of epicardial (EAT) and subcutaneous adipose tissue (SAT) in patients with stable coronary artery disease (CAD) and severe coronary atherosclerosis who underwent coronary artery bypass grafting; to investigate the potential relationships between the levels of ROS production by EAT and SAT adipocytes and obesity parameters, EAT accumulation, basal and postprandial glycemia, and blood lipid transport function.Material and Methods. The study included 19 patients (12 men and 7 women including 6 patients (31.5%) with type 2 diabetes mellitus) aged 53–72 years with stable CAD and severe coronary atherosclerosis. The material for the study was EAT and SAT adipocytes obtained by the enzymatic method from intraoperative explants. The ROS level in adipocytes was determined using the fluorimetry with 2,3-dihydrodichlorofluorescein diacetate. Anthropometric parameters of obesity and EAT thickness were studied using echocardiography. The blood lipid transport function and the levels of basal and postprandial glucose were assessed.Results. The levels of ROS production by EAT and SAT adipocytes in the overall group of patients did not differ significantly and amounted to 1710 (1608; 2079) and 1876 (1374; 2215) arbitrary units, respectively. The level of ROS production by SAT adipocytes did not correlate with the parameters of obesity, EAT thickness, or biomarker levels. The level of ROS production by EAT adipocytes directly correlated with the level of postprandial glycemia (rs = 0.62, p < 0.05), but did not correlate with measures of general and abdominal obesity, EAT thickness, and dyslipidemia. The level of ROS production by EAT adipocytes in patients with postprandial glycemia ≥ 7.7 mmol/L (n = 9) exceeded the corresponding value in patients with lower level of postprandial glycemia (n = 10): 2079 (1710; 2458) against 1625.5 (1332; 1699) arbitrary units (p = 0.015), respectively.Conclusion. We showed for the first time that the level of ROS production by EAT adipocytes in CAD patients with severe coronary atherosclerosis was directly associated with the level of postprandial glycemia. The highest level of ROS production in EAT adipocytes occurred in these patients when the level of postprandial glycemia exceeds 7.7 mmol/L.

Determination of autoantibodies in dogs with diabetes mellitus.

Background and Aim:The classification of diabetes mellitus (DM) in dogs has been controversial as currently canine insulin-dependent DM is classified together with absolute insulin deficiency, non-insulin-dependent DM, and relative insulin deficiency. Studies on human autoantibodies evaluated in canines with DM, such as anti-glutamic acid decarboxylase (GAD65), anti-islet antigen 2 (IA2), and anti-zinc transporter isoform 8 (ZnT8), have been inconclusive. Thus, this study was designed to establish the serological profile of anti-GAD65, anti-IA2, and anti-ZnT8 antibodies in a group of dogs with and without DM.Materials and Methods:Sixty-one dogs, including 31 patients with DM (with and without insulin treatment) and 30 patients without DM (normal weight and obese), were included for determining autoantibodies using a human enzyme-linked immunosorbent assay (ELISA) detection system for type 1 DM.Results:This study found the presence of anti-IA2 antibodies in 58% of the sample (18/31 patients with DM); however, the presence of anti-GAD65 was not detected, and anti-ZnT8 was found in 3 (9.6%) patients with DM.Conclusion:This study showed a higher positive frequency of anti-IA2 antibodies in a sample of canine with DM, indicating that alterations in the signaling vesicle tyrosine phosphatase 2 lead to lower insulin release and thus to an increase in patients’ glycemia. These preliminary results should be taken with caution and corroborated by a canine-specific assay when an ELISA is available for such determination.

Prevalence of carbohydrate metabolism disorders in patients with new coronavirus infection

BACKGRAUND: There is evidence of a multifactorial effect of SARS-CoV2 on carbohydrate metabolism with the development of hyperglycemia and the weighting of COVID19 even in people without DM.AIMS: Assess the prevalence of disorders carbohydrate metabolism (DCM) in hospitalized patients with a new coronavirus infection without a history of DM.MATERIALS AND METHODS: Patients with PCR-confirmed diagnosis of COVID19 aged 18-75 years (n=72) without a history of diabetes were examined. Observation was carried out from the moment of hospitalization to discharge. Patients were collected anamnesis data, laboratory and instrumental studies, HbA1c, fasting plasma glucose (FPG), postprandial glycemia.RESULTS: The prevalence of DCM (HbA1c≥6%) in 72 patients with COVID19 without a history of diabetes admitted to the hospital was 41,7%, while HbA1c ≥6,5% had 8,3%. The median HbA1c in the moderate-flow group was 5,7% [5,3–6,0], and in the severe-flow group it was 6,0% [5,8–6,2] (p=0,008). Participants were divided into groups according to the level of HbA1c≥6% and < 6%. The examined patients showed a high prevalence of risk factors for developing DM: age over 45 years — 83,3%, cardiovascular diseases — 46,3%, obesity — 50%. The study groups didn’t differ statistically in terms of risk factors for DM. In the group with HbA1c≥6%, FPG≥6,1 mmol / l on the second day and postprandial glycemia ≥7,8 mmol/l were observed in more cases than in the group with HbA1c<6% (39,1% vs 12,9%, p=0,051 and 47,8% vs 3,2%, p=0,0001, respectively). The prevalence of DCM in HbA1c was higher than in FPG (41,7% vs 29,2%, p=0,006). On the seventh day, the number of patients with FPG ≥ 6,1 mmol / l in the first group decreased from 39,1% to 4,4% (p=0,01), and in the second group-from 12,9% to 9,7% (p=1,0). There was a direct correlation between the level of HbA1c and C-reactive protein (r=0,271; p=0,048), and an inverse correlation with the content of lymphocytes in the blood (r=-0,25; p=0,068).CONCLUSIONS: In patients with a new coronavirus infection without a history of DM, a high prevalence of DCM was detected — 41,7%. Against the background of comparability of the studied groups by risk factors for DM, an increase in HbA1c, FPG and postprandial glycemia is a manifestation of transient hyperglycemia. Given the high prevalence of DCM, it can be assumed that SARS-CoV2 has diabetogenic properties.

Сучасні дані щодо напрямів терапії есенціальної гіпертензії у хворих із метаболічним синдромом і COVID-19 та визначення можливостей запобігання розвитку віддалених ускладнень

The review article includes information on data on the treatment of patients with essential hypertension and manifestations of metabolic syndrome and their effectiveness in preventing the development of long-term complications of COVID-19. The pandemic of acute respiratory syndrome caused by SARS-CoV-2 requires changes in the approach to the treatment and prevention of metabolic syndrome and essential hypertension, as the presence of these comorbidities worsens the course and prognosis of infectious disease. Some pathogenetic links have been identified that affect these pathological conditions. Emphasis is placed on the key role of a balanced and healthy diet, as a component of a healthy lifestyle, in maintaining the optimal functional state of the cardiovascular system. It is also noted that the course of infectious disease caused by SARS-CoV-2 in patients with metabolic syndrome is more severe and more often leads to complications. Since COVID-19 is recognized as a multi-organ disease with a wide range of manifestations and long-term symptoms, data on the course of this disease in patients with hypertension and metabolic syndrome were analyzed. Endothelial dysfunction is highlighted as one of the pathogenetic links that combines essential hypertension, insulin resistance and atherosclerosis, and options for its correction are considered. Standards for the treatment of essential hypertension and metabolic syndrome in view of the COVID-19 pandemic are presented. Information on the ability of statins to increase glycemia with long-term use, especially in patients with metabolic syndrome, is given. Conclusion. A number of drugs that have antioxidant, vasodilator and anti-inflammatory properties that do not cause an increase in glycemia, including quercetin, have been proposed. Its positive effect on the level of blood pressure has been revealed, which implies its use as an adjunct to antihypertensive therapy. The combination of quercetin and vitamin C is considered as an adjunct to basic therapy for COVID-19 disease and its long-term complications. Further studies are planned to determine the clinical value of quercetin supplements in therapy of essential hypertension, rehabilitation of patients after COVID-19, stabilization of dyslipidemia and insulin resistance, as well as dose adjustment and study of possible drug interactions between quercetin and antihypertensive drugs

Brain perfusion in type 1 diabetes and cognitive dysfunction

The purpose. To evaluate brain microcirculation using contrast and non-contrast magnetic resonance perfusion in patients with type 1 diabetes and cognitive dysfunction.Material and methods. The study complies with generally accepted ethical rules. The study included 45 patients with type 1 diabetes and cognitive dysfunction and 20 patients without. Every patient included in the study was continuously monitoring glycemia with evaluation of variability coefficients. MRI was performed using a magnetic resonance imaging scanner Signa Creator “E”, GE Healthcare, 1.5 Tl, China: methods – dynamic contrast (“Gadovist”, w/w, bolusno, 5 ml) and arterial spin marks. SPSS Statistic software package was used for statistical analysis.Results. Blood flow decreased in patients with type 1 type and cognitive dysfunction in the areas of white and gray matter of frontal, occipital and temporal lobes, and shells (p ≤ 0.05). According to perfusion data, hyperglycemia and the following glycemic variability indices have the greatest influence on cortical structures: glycemic index of prolonged glycemia increase, risk of hyperglycemia and hypoglycemia, glycemic rate of change, glycemic control quality indicator, and in case of non-contrast glycemic control quality and glycemic rate of change, risks of hypo and hyperglycemia. The main factors of changes in brain microcirculation are episodes of severe hypoglycemia in the anamnesis, duration of the disease, arterial hypertension, high cholesterol levels. No separate markers for the evaluation of cognitive disturbances in type 1 diabetes were revealed.Conclusions. The basis of microcirculatory brain disorders in type 1 diabetes is the level of HbA1c and variability of glycemia as well as acute complications, duration of diabetes and associated conditions (arterial hypertension and hypercholesterolemia). The most important data were obtained during contrast perfusion.

Comparative study of serum biochemical parameters between diabetic patients using medicinal plants and those using only conventional treatment in the rural region of the province of Tlemcen (North-western Algeria)

A survey is carried out on 148 diabetic patients from rural Fellaoucene, Tlemcen Province (North-Western Algeria). The main interest of this study is to determine the frequency of diabetic patients using medicinal plants with their conventional medication to relieve their diabetes mellitus and to compare their serum biochemical parameters with patients do not use these plants in combination with drugs. A questionnaire is used to collect information about patients (age, sex), diabetes (duration, type, treatments, and complications), antidiabetic plants use (vernacular, scientific names) and variation of some serum biochemical parameters (glycemia, triglyceride, cholesterol, urea, creatinine, glycated hemoglobin (HbA1c)). 72% of diabetic patients are type 2 diabetes mellitus and 77% of them are women with a mean age of 53 years. More than 26% of the cases are suffering from diabetes for more than 10 years. 96% of the patients are affected by at least one chronic complication. The results show that 21% of diabetics use medicinal plants without any significant effects on the balance of the biochemical parameters tested. We notice a slight increase in glycemia (1.39±0.48 g/l) and HbA1c (7.27±0.69 %) of both populations when compared to the values recommended by WHO (1.26 g/l and 6.5%, respectively). The medicinal plants still have a place in the treatment of diabetes mellitus in the rural region of Fellaoucene, Tlemcen (Algeria)

Prevalence of hypertension and diabetes in the population of Kosovo

Abstract Objectives To observe the prevalence of arterial pressure and glycemia in Kosovo and to provide free screening service through health promotion. Methods This prospective study was conducted over a 3-year period, during 2017–2019. All data were collected by AAB College staff in 11 Kosovo cities prior to a random sample with 7254 observations. Data included demographic information as well as blood pressure and glycemic level measurements. Results The overall prevalence of arterial pressure was registered at 27.6% and diabetes mellitus at 9.2%. Arterial pressure in females had a tendency to increase with age (r = 0.3552, P < 0.001), as well as the glycemic index (r = 0.1997, P < 0.001). Nevertheless, age had a stronger impact on males than in females, with regard to higher arterial pressure in the year 2017 (P < 0.001). In the following years, 2018 and 2019, the ratio had reversed. Glycemia had strong correlation with systolic arterial pressure value (P < 0.001). For a 1 mmol/L increase in glycemia, the diastolic value increased by 0.19 mmHg on average. Conclusions This study concluded that at younger ages the values of arterial pressure and glycemia remain within the commonly observed range, but over the years the probability for higher blood pressure or glicemia increases. Through continuous control of arterial pressure and glycemia at an early age, it is possible to identify abnormal diagnostics, in order to address them in time. Educational initiatives and screenings should take place in order to increase awareness of the citizens for checking themselves regularly.

Efficacy and safety of 28-day treatment with oral insulin (ORMD-0801) in patients with type 2 diabetes: A randomized, placebo-controlled trial.

To assess the safety and efficacy of oral insulin (ORMD-0801) in patients with type 2 diabetes (T2D). After a 2-week washout of other medications, adult metformin-treated patients with T2D were randomized to receive placebo or 16 or 24 mg ORMD-0801, once daily, at bedtime, for 28 days. The mean change from baseline weighted mean night-time glucose levels was determined from 2 nights of continuous glucose monitoring (CGM) recordings during the placebo run-in and last week of treatment. In total, 188 patients (HbA1c: 7.82% ± 0.88% [placebo] and 8.08% ± 1.11% [pooled ORMD-0801 group]) were enrolled. In the placebo group, mean night-time CGM increased from baseline by 13.7 ± 26.1mg/dL, whereas the increase was significantly smaller in the pooled ORMD-0801 group (1.7 ± 23.5mg/dL, P=.0120). Glycaemic control variables (24-hour, fasting and daytime CGM glucose) also displayed smaller increases with ORMD-0801 versus placebo. Change from baseline HbA1c was -0.01% in the pooled ORMD-0801 group versus +0.20% in the placebo group (P=.0149). ORMD-0801 was well tolerated, with similar adverse event and hypoglycaemia rates as placebo. In patients with T2D, bedtime ORMD-0801 curbed increases in night-time glycaemia, 24-hour glycaemia and HbA1c, without increasing the risk of hypoglycaemia or safety events compared with the control arm.

Prenatal air pollution exposure to diesel exhaust induces cardiometabolic disorders in adulthood in a sex-specific manner

BackgroundResults from observational and experimental studies indicate that exposure to air pollutants during gestation reduces birth weight, whereas little is known on potential cardiometabolic consequences for the offspring at adulthood. ObjectivesOur aim was to evaluate the long-term effects of gestational exposure to diesel engine exhaust (DE) on adult offspring phenotype in a rabbit model. MethodsThe protocol was designed to mimic human exposure in large European cities. Females rabbits were exposed to diluted (1 mg/m3) DE (exposed, n = 9) or clean air (controls, n = 7), from 3 days after mating, 2 h/d and 5 d/wk in a nose-only inhalation system throughout gestation (gestation days 3–27). After birth and weaning, 72 offspring (47 exposed and 25 controls) were raised until adulthood (7.5 months) to evaluate their cardio-metabolic status, including the monitoring of body weight and food intake, fasting biochemistry, body composition (iDXA), cardiovascular parameters and glucose tolerance. After a metabolic challenge (high fat diet in males and gestation in females), animals were euthanized for postmortem phenotyping. ResultsSex-specific responses to maternal exposure were observed in adult offspring. Age-related increases in blood pressure (p = 0.058), glycaemia (p = 0.029), and perirenal fat mass (p = 0.026) as well as reductions in HDL-cholesterol (p = 0.025) and fat-to-body weight ratio (p = 0.011) were observed in exposed males, suggesting a metabolic syndrome. Almost only trends were observed in exposed females with higher triglycerides and decreased bone density compared to control females. Metabolic challenges triggered or amplified some biological responses, especially in females. ConclusionsIn utero exposure to air pollution predisposed rabbit offspring to cardiometabolic disorders in a sex-specific manner.

The Investigation of the Effect of Hyperglycemic Changes on Psychophysical Measurements of Visual Function in Pseudophakic People Living with Diabetes Mellitus.

PurposeThe purpose of this study was to show the effect of increasing blood glucose level (BGL) on psychophysical visual function represents by visual acuity and contrast sensitivity in pseudophakic people living with diabetes (PDM).Study DesignThis was quasi-experimental, quantitative study using a pretest–posttest approach.MethodsThe study was conducted at Gamalakhe community health centre located in Gamalakhe township and included a sample of 50 pseudophakic people living without diabetes mellitus (PWDM) and 50 pseudophakic PDM. BGL as well as psychophysical measurements of visual function were measured preprandial and postprandial. Visual acuity (VA) was measured at distance (4 m) and near (40 cm) using logMAR VA charts, and contrast sensitivity (CS) was measured at 50 cm using a Mars chart. The data collected were captured and subsequently analyzed using SPSS version 25.ResultsGlycemic changes measured preprandial and postprandial observed a mean increase of 2.06±1.35 mmol/L (p=0.350) and 1.08±0.47 mmol/L (p=0.291) in pseudophakia PDM and pseudophakic PWDM, respectively. CS showed a mean increase of 0.01±0.10 (p=0.23) and 0.002±0.02 (p=0.19) log units in PDM and PWDM, respectively; however, the independent t-test showed this was insignificant between PDM and PWDM (p=0.27). A insignificant mean increase of 0.01±0.04 log units (p=0.25) and 0.001±0.01 (p=0.32) in distance VA of pseudophakic PDM and PWDM was found, respectively. A mean increase of 0.001±0.01 log units (p=0.32) and 0.01±0.03 (p=0.06) near logMAR VA of pseudophakic PDM and PWDM was found, respectively.ConclusionAcute hyperglycemic changes do not result in overall significant changes in visual acuity and contrast sensitivity in pseudophakic PDM and PWDM for an increase in glycemia of 2 mmol/L. We recommend studies investigate if changes occur for glycemic increases exceeding 2 mmol/L.

Effect of strength training on people with HIV and immunometabolic disorders

The introduction of highly active antiretroviral therapy (HAART) was able to help to control viral condition in patients living with HIV/AIDS, diminishing virus concentration and increasing T CD4 + cells. However, adverse effects follow the treatment, like lipodystrophy syndrome, characterized by morphological changes in body fat distribution and changes serum lipids and glycides levels, increasing the risk for chronical diseases with cardiovascular effects. Thus, complimentary non-drug practices, as strength training, are essential to treat these patients, helping to improve their immunometabolic condition, leading to a better coping with the disease. The aim of this study was to investigate the influence of a 12-week strength training protocol on immunometabolic system of people living with HIV/AIDS. It is a quasi-experimental study, conducted on 20 patients (16 men), all living with HIV/AIDS using HAART. T CD4 + cell numbers, serum triglycerides, cholesterol (total and fractions) and glycemia were measured before and after training. The data underwent to descriptive statistics using a paired T test, with the significance level set at p <0.05.There was a significant increase of 15.4% (p=0.009) on T CD4 + cells and, although not statistically significant, reduction on glycemia, total cholesterol and triglycerides and increase on HDL-cholesterol fraction. So, it is suggested that strength training may be effective on immunometabolic condition of people living with HIV / AIDS, increasing T CD4+ cells and controlling serum levels of lipids and glycides.

MO933EFFECT OF PHYSICAL ACTIVITY AND LIFESTYLE CHANGES ON INSULIN RESISTANCE IN PATIENTS AFTER KIDNEY TRANSPLANTATION

Abstract Background and Aims The incidence of post-transplant diabetes mellitus (PTDM) after kidney transplantation (KT) is high and ranges from 15-30%. Insulin resistance (IR) at the time of KT is the most significant risk factor for the development of PTDM in patients after KT, as demonstrated by several analyzes. It is possible to reduce the high incidence of PTDM by influencing just modifiable risk factors, including obesity and the associated IR. The aim of this work is to determine the effect of precisely determined physical activity and lifestyle changes on IR and other risk factors for PTDM in patients after KT. Method This is a prospective controlled analysis, which included 44 patients after primary KT in the Martin Transplant Center. Half consisted of a study group (n = 22) whose patients were assigned to perform regular physical activity. The primary goal was to complete at least 150 minutes of moderate intensity physical exertion per week. They performed an aerobic or combined (aerobic + anaerobic) type of sports activity. Monitoring was provided by a sports tracker (Xiaomi Mi Band 3 compatible with Mi Fit mobile application). The other half was made up of a control group. The exclusion criterion at that time was already diagnosed with diabetes mellitus or a pre-diabetic condition. IR was assessed using the HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) index from fasting blood glucose and insulinemia values. Each patient underwent an oral glucose tolerance test (oGTT) at the end of follow-up. Patients in both groups have the same immunosuppressive protocol. The duration of follow-up was 6 months. Results In the observed group we univariately found in the 3rd and 6th month of monitoring significantly lower waist circumference (P = 0.0437, P = 0.0372), better graft function (P = 0.0036, P = 0.0137), lower value glycemia (P = 0.0016, P = 0.0003), C-peptide (P = 0.0447, P = 0014) and lower low-density lipoprotein (LDL) at 6 months (P = 0.0444) compared to the control group. We confirmed a statistically significantly lower IR at 6 months (P = 0.0202) and fasting blood glucose at 3 and 6 months (P = 0.0227) by multivariate analysis in the observed group. After the end of the follow-up, we identified statistically significantly fewer patients with a negative oGTT result in the control group (P < 0.0001), significantly more patients with impaired glucose tolerance, fasting hyperglycemia (P = 0.0078) and diagnosed with PTDM (P = 0.0212). In the control group, we found a statistically significant increase in glycemia at 30 (P = 0.0034) as well as at 120 minutes (P = 0.0011) during oGTT compared to the observed group. Conclusion In our study, we confirmed a significant effect of regular physical activity in preventing the development of IR and associated pre-diabetic conditions and PTDM.

Influence of androgen deprivation therapy on glucose metabolism and ambulatory glucose profile

Introduction. Androgen deprivation, used to treat prostate cancer, leads to metabolic disorders, including glucose metabolism disorders. The timing of development and the characteristics of these changes have not been sufficiently studied. The expansion of the possibilities for assessing glycemia makes it possible to obtain changes in glucose.Objective. To study the dynamics of the effect of long-term androgen-deprivation therapy with gonadotropin-releasing hormone agonists (GnRH agonists) on the parameters of glucose metabolism and ambulatory glucose profile in patients with locally advanced prostate cancer (La PCa).Materials and methods. The study included 99 patients with La PCa receiving androgendeprivation therapy (ADT) with (GnRH agonists) for at least 12 months. The study of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) levels was performed at baseline, after 3, 6 and 12 months of ADT, and constant self-monitoring of glycemia was recommended using portable glucometers. Flash glucose monitoring systems (FreeStyle Libre) were installed in ten patients with a detected increase in glycemia on the background of ADT, allowing them to obtain data on the ambulatory glucose profile (AGP).Results and discussion. Long-term ADT in patients with La PCa, regardless of baseline age, BMI, WC, was accompanied by an early, progressive deterioration in parameters of glucose metabolism. The proportion of patients with prediabetic FPG values after 12 months becames 66% according ADA criteria. We found that 12-month ADT changes the AGP: an increase area under the curve and postprandial glycemic levels, an increase in blood glucose variability with an increase in the CONGA index to 6.817 (p < 0.001).Conclusion. ADT by GnRH agonists in patients with La PCa is accompanied by a predisposition to early disorders of glucose metabolism with a high risk of rapid development of prediabetes regardless of baseline age, BMI, and WC. The AGP of patients is characterized by an increase in the total glycemic load, and glycemic variability.

Onset of Diabetes Pediatric Age and Comorbidly in the last 12 years and urgent Covid Vaccination in Sanitary Agency in Bergamo - Italy

Introduction Diabetes is a chronic disease as a result of absent or low intake in internal production of Insulin or glucose tolerance in a large diffusion population of 3.27 million people in Italy. 5,4 thousand of Italian people for ISTAT in a future prospective and there will be an increase in the next years for high increase risk of new cases every year until now. We have Diabetes typo II (T2DM, older in 90%), and Diabetes typo I (T1DM, younger in 10%), both are Prevent with Auxological Screening and early Intervention with Nutritional Applied Behavior Analysis (A.B.A.). An early diagnosis determines a survival of 5,000 patients for year. In our patients affects by T1DM, during pandemic of Coronavirus disease (SARS-CoV type 2 and variants), we have noted an increase of glycemia during respiratory infections with more comorbidities and complications for them. Clinical Study We study 181 patients who have accessed in Treviglio-Caravaggio Hospital in these years since 1/1/2009 to 1/6/2020. we have 181 records divided for sex: 104 males and 77 females. With follow-up for 55 patients with severe comorbidities and 4 were transferred to HUB Center for risk of coma in severe compliances and during Covid lock down 44 patients were suggested to take care in HUB center of Bergamo or Milan to prevent their hospitalizations in security environment. The children’s accesses affected by Diabetes type 1 was in our Emergency and Pediatric Department of Treviglio Hospital in the last 12 years, since 1 January 2009 to 1 June 2021, are 129 total patients and 52 new patients during Auxological-Nutritional Ambulatory for Pediatric T1DM outpatients before and during 2020-2021 controls of metabolic diet therapy in fellow-up, now, with cellphone and in Meet. Materials and Methods We have records data in excel and Pivot graphic and analysis in Anova Statics Program with follow-up of 181 patients divided in 2 period of age: preschooler 23, and scholar e adolescent 157. 125 patients are divided in 123 Diabetes Mellitus (with Italian code 775.1 e 250.1 national record), 2 MOBY cases and 57 patients with one or more comorbidly. From date of casehistory, we need now analysis 3 groups with outset of diabetes during 2 years of life of which 19.2% with comorbidity 21.6% with many comorbidities and cases of Insulin-dependent Diabetes after 2 years of life are 77,7%, with severe comorbidity in 24%. With comorbidity outset in the 39.2% and during follow-up in 42.4%. From report 21% patients have for the major part “Celiac Disease” and 6,4% other infections (Helicobacter Pylori and enteritis). Whereas 28% have metabolic-auxological endocrinological diseases (acute/chronic evolution during up-growth). Underweight young with T1DM (BMI < 15 Kg/m2) or obesity (BMI>35 Kg/m2) have a high risk to be infected and dead for COVID-19 owing to complications of their status of health. Conclusions Until 1/31/2018, we allow to do a distinction: the first since 2009-2014 within 20.6% early diagnosis and discovered in later age the second since 2014-2019 with more 38.4%. In the last years since 2019-2021 about, the early neonatal respect to mellitus DMT1 of last period, presents a predictive index of 55.5% with a better stature-ponderal development, neurological-behavior, and nutritional-compliance monitoring in 12 years of periodic controls. Since 11 March 2020 with WhatsApp, Hangouts and Meet or Skype, our data of SARS-CoV-19 infection in T1DM patients showed more than 65% positive patients by serological test after a period of suspect disease in 12 patients (6,6%) against a few symptoms in 107 patients (59,11%) with positive nasalpharyngeal test during quarantine or observation in a second lockdown, since September 2020 to May 2021.

In vivo toxicities of the hospital effluent in Mahdia Tunisia.

Hospital effluent (HE) is one of the most important sources of pharmaceuticals released into the environment. This kind of pollution is a recognized problem for both human health and aquatic life. Consequently, in the present study, we assessed the effects of untreated hospital effluent on mice via biochemical and histopathological determinations. Female mice were given free access to water bottles containing untreated HE at different dilutions for 21 days. Then clinical biochemistry and histopathology evaluation were conducted. Serum biochemistry analysis showed the presence of significant increase in cholesterol, triglycerides, glycaemia and total bilirubin. However, phosphatase alkaline and urea activities have been significantly decreased compared to the control group. No significant variation was observed for the rest of the studied parameters (high-density lipoproteins; low-density lipoproteins and uric acid). Additionally, multiple alterations, including cellular necrosis, leucocyte infiltration and congestion, were observed in different tissues of mice exposed to the tested HE.

Real-World Experience With Pasireotide Lar in Acromegaly Resistant to First-Generation Somatostatin Analogs: A Single Center 1-Year Observation

Introduction: First generation somatostatin analogs (SSAs) are the treatment of choice in persistent acromegaly after transsphenoidal surgery. However, they are effective in 25% to 45 % of patients and a second generation SSA - pasireotide LAR may be a more effective alternative. Aim Our aim was to evaluate the impact of 1-year treatment with pasireotide LAR on disease control and on glucose metabolism in patients with acromegaly after debulking surgery resistant to first-generation SSAs. Material and methods In this single-center prospective study 29 consecutive patients with resistant acromegaly were treated with pasireotide LAR. The initial drug dose was 40 mg i.m. every 28 days. If patient did not achieve biochemical control (GH <2.5 ng/mL and IGF-1 ≤ULN for age and sex) at month 3, the dose was increased to 60 mg i.m. every 28 days. Assessment (GH, IGF-1, glucose, HbA1c) was performed at month 3, 6, 9 and 12. Results: In total, 22 patients (10 females, 12 males) completed a 1-year treatment. Mean age was 41.8±13.8 years. Twelve patients (54.5%) were ≤ 40 years old (including 6 (27.3%) patients of age ≤30 years). At baseline, mean IGF-1 level was 2.3 (SD 0.7) x ULN (age- and sex-specific) (583.9 ng/mL; SD 182.2) and mean GH concentration was 3.9 (SD 2.8) ng/mL. Both values decreased significantly after 1 year of treatment (P<0.001). Pasireotide LAR dose was increased to 60 mg in 16 (72.7%) patients and decreased to 20 mg in one patient patient due to worsening of diabetes control. The magnitude of mean GH level decrease was the largest within first 6 months (mean change from baseline: -1.75 ng/mL, 95% CI: -2.64, -0.85, P=0.0006). Mean IGF-1 level decreased rapidly within the first 3 months (mean change from baseline: -153.20 ng/mL, 95% CI: -203.20, -103.19, P<0.0001) and remained low during 12-month follow-up. GH level ≤ 1 ng/mL and ≤2.5 ng/mL was achieved by 7 (31.8%) and 17 (77.3%) patients, respectively. Six patients (27.3%) achieved normal IGF-1 level (IGF-1 ≤1 x ULN) (P=0.0275). IGF-1 ≤1.3 x ULN was observed in 11 (50.0%) of patients. Full biochemical control (GH ≤1 ng/mL and IGF-1 ≤1 x ULN) was achieved in 3 (13.6%) patients. Pasireotide LAR treatment resulted in significant increase of mean fasting glucose level: 119.2 (SD 17.3) vs. 107.5 (SD 13.9) mg/dL, P<0.001. The largest change was observed in first 3 months, and it remained stable until month 12. HbA1c level also increased significantly during first 3 months and stayed on similar level during follow-up (mean for month 12: 6.3 (SD 0.6) vs. 5.9 (SD 0.5) % at baseline, P<0.001). Conclusions: Pasireotide LAR is an effective treatment in most patients with persistent acromegaly after surgical debulking resistant to first generation SSAs. The largest increase of glycemia occurs during first 3 months of treatment and it remains stable afterwards.

Circadian Oscillatory Pattern of Glycemic Control in Patients With Diabetes Mellitus

Diabetes mellitus (DM) is one of the major public health problems. Glucose variability is of such relevance that vascular complications occurrences in DM patients has been attributed to hyperglycemia and dysglycemia event. Therefore, glycemia variability may be considered a health issue; however, whether glycemia variability is represented by a given pattern oscillation, is yet to be determined. Then, we sought to determine whether glycemic variability, assessed with continuous glucose monitoring (CGM), display a stationary pattern of oscillation with characteristics of circadian rhythm in patients with diabetes mellitus (DM) type I (DM-I) and type II (DM-II). The CGM data was assessed every 5 minutes x 24 hours x 6 days. Patients (n=196; age, 18-80 years) were assigned to DM-I (n=144, Males: 79), DM-II (n=24, Males 14) and Control (i.e., healthy; n=28, Males: 6) groups. Circadian rhythm of glycemia was assessed during day (08:00-20:00 h) and night (20:00-08:00 h) phases. Anthropometry, pharmacologic treatments, glycosylated hemoglobin (HbA1c), and years of evolution were determined. Participants with DM-I and DM-II had greater HbA1c and standard deviation of glycemia compared to Controls, independent of sex. CGM revealed a predominant stationary oscillatory pattern of glycemic control in all experimental groups. Moreover, maximum energy oscillation of glycemia revealed oscillations between 2-6 days. Between 10:00-14:00 h DM-I females displayed greater increase of glycemia compared to DM-I males and Control females (p<0.05). Females DM-II patients, between 13:00–19:00 h showed an increase (p<0.05) of glycemia vs. Control females. The DM-I and DM-II males, between 02:00-10:00 h and 22:00-24:00 h, increased glycemia compared to Control males. The magnitude of interindividual variability of hyperglycemia was similar during day and night phases in DM-I and DM-II patients, although in DM-I male patients hyperglycemia was greater at night compared to day phase (p<0.05). This study demonstrates that the DM-I and -II Female group has a stationary pattern that is characterized by having a circadian pattern. Therefore, the oscillatory pattern reveal that exist a sensitive daily time, which could help to develop new therapeutic strategies to improve the outcome of this critical population.

The Age-Dependent Increase of Metabolic Syndrome Requires More Extensive and Aggressive Non-Pharmacological and Pharmacological Interventions: A Cross-Sectional Study in an Italian Cohort of Obese Women.

Background Metabolic syndrome is a combination of cardiovascular risk factors (i.e., visceral obesity, dyslipidaemia, glucose intolerance, and hypertension), which entails critical issues in terms of medical management and public health. Methods The aim of the present cross-sectional study was to investigate the age-related changes of the single IDF (International Diabetes Federation) diagnostic criteria for metabolic syndrome (waist circumference, WC; high-density lipoprotein cholesterol, HDL-C; triglycerides; glucose; systolic and diastolic blood pressure, SBP and DBP) in a large population of (Italian) obese women (n = 1.000; body mass index, BMI >30 kg/m2; age: 18–83 yrs), subdivided into two subgroups depending on the presence (n = 630) or absence (n = 370) of metabolic syndrome. Parallelly, the percentages of treatment with hypolipidaemic drugs, hypoglycaemics, and antihypertensives and, among the treated subjects, of control of the underlying condition in accordance with the cut-offs of IDF criteria for dyslipidaemia, hyperglycaemia, and hypertension were determined over six age ranges (i.e., 18–30, 31–40, 41–50, 51–60, 61–70, and > 70 yrs). Results The prevalence of metabolic syndrome increased with advancing age. In the subgroup with metabolic syndrome, an age-dependent increase in HDL-C, glycaemia, and SBP occurred, while the visceral adiposity was stable. In the same subgroup, triglycerides and DBP decreased age-dependently. In the subgroup without metabolic syndrome, an age-dependent increase in WC, HDL-C, glycaemia, SBP, and DBP was observed. A progressive age-dependent increase in the percentage of patients pharmacologically treated for the cardiometabolic abnormalities was detected in patients with metabolic syndrome, a similar trend being also observed in patients without metabolic syndrome only for the antihypertensives. A clear-cut disproportion between treated versus adequately controlled women (with pharmacotherapy) was detected in the whole population. Conclusions At least in an Italian context of obese females, the age-dependent worsening of glycaemia and BP exerts a fundamental pathophysiological role in the progressive increase of metabolic syndrome with advancing age, which appears to be not adequately treated in a large part of obese subjects. The results of the present study might be useful for public health decision-makers for programming future more extensive and aggressive non-pharmacological and pharmacological interventions in the obese population.

Relationship between hyperglycemia, insulin resistance and serum apoptosis marker m30- antigen in patients with type 2 diabetes mellitus

Objective: The amount of evidence suggests that the apoptosis marker M30-antigen (an antibody that recognizes the cytokeratin-18 fragment) has an association with hyperglycemia.&#x0D; Material and Methods: In this study, serum M30 levels of 145 patients diagnosed with prediabetes (n = 28) and type 2 diabetes, which was divided into four groups according to their HbA1c levels, were measured. The health control group (n = 24) was composed of healthy individuals. Serum concentrations of M30 antigen were measured using an enzyme-linked immunosorbent assay system and expressed as mean ± SD. HbA1c concentration was determined by boronate affinity technology according to NGSP standards.&#x0D; Results: M30 levels were comparable in the healthy control group (64,39±3,9 U/L) and prediabetes group (82,07±13,7). Type 2 diabetes Groups A, B, C, and D had levels of 109,38±16 U/L, 117,46±14,3 U/L, 173,69±48,1 U/L, and 163,40±37,3 U/L, respectively. The analysis of the data has shown that serum levels of M30 in the control and prediabetes groups were significantly lower than Type 2 diabetes Groups C and D (p=0.043). When all groups were taken into consideration, a significant relationship was found between HbA1c and serum M30 levels (r=0.231, p=0.002).&#x0D; Conclusion: Apparently, the increase in glycemia is followed by a rise in the serum levels of the, suggesting that apoptosis occurs as a secondary effect immediately after hyperglycemia.

The importance of the bacterial overgrowth syndrome in the development of disorders metabolic functions of the liver in non-alcoholic fatty liver disease

To study the basic metabolic functions of the liver in patients with non-alcoholic fatty liver disease and to assess the relationship of these disorders with the bacterial overgrowth syndrome. 50 patients with non-alcoholic fatty liver disease at the stage of steatosis were examined. In the verification of the diagnosis, hepatobiliary system ultrasound and FibroMax test data were used. A study was conducted of indicators of lipid, carbohydrate, protein, pigment, mineral metabolism and the exchange of enzymes in the blood. The bacterial overgrowth syndrome was studied by the results of a hydrogen breath test with lactulose using a LactofаH2 analyzer. Patients with non-alcoholic fatty liver disease showed a significant increase in total cholesterol (median 5.9 mmol/l vs 5.0 mmol/l, p=0.000013), triglycerides (1.35 g/l vs 0.9 g/l, p=0.014), glucose (5.65 mmol/l against 5.1 mmol/l, p=0.000001) of blood serum compared with the control group. An increase in total protein and a tendency to decrease in albumin, an increase in serum sodium and calcium were detected. In patients with non-alcoholic fatty liver disease there is a significant increase in the markers of cytolysis and cholestasis compared with the control group. The bacterial overgrowth syndrome was detected in 72% of cases, with ileocecal valve function impaired in 50% of patients, gastrointestinal motility slowed down, or colon dysbiosis occurred. A correlation analysis revealed positive relationships between the bacterial overgrowth syndrome on the one hand and glucose (r=0.83, p0.05), total protein (r=0.35, p0.05), calcium (r=0.5, p0.05) on the other hand; negative relationship between the bacterial overgrowth syndrome and albumin (r=-0.8, p0.05). In this case, a positive relationship between the bacterial overgrowth syndrome and the increase in glycemia after glucose loading, that is, absorption in the small intestine, was revealed. The established violations of the metabolic functions of the liver with non-alcoholic fatty liver disease are closely related to the bacterial overgrowth syndrome.