Index Of Blood Glucose Control Research Articles

Epidemiology of Diabetic Foot Infections in an Eastern Caribbean Population: A Prospective Study

This study evaluates the epidemiology of diabetic foot infections in an Eastern Caribbean nation in order to direct public health preventive measures. We prospectively identified all patients with diabetic foot infections who were admitted to tertiary care hospitals across Trinidad and Tobago from July 2011 to June 2012. A questionnaire was used to collect data on demographics, patient knowledge, avoidance of risk factors for chronic diseases (a proxy to unhealthy lifestyles), and glycosylated hemoglobin measurements on admission as an index of blood glucose control. The data were analyzed with statistical software. There were 446 patients with diabetic foot infections (mean age = 56.9 years, standard deviation = 12.4 years). Most patients had Type 2 diabetes (93.3%) and were of Indo-Trinidadian (49.1%) or Afro-Trinidadian (41.7%) descent. There were preexisting complications of diabetes in 82.9% of patients with Type 2 diabetes: foot infections requiring hospitalization (70.2%), ischemic heart disease (32.5%), renal impairment (13.7%), and retinopathy (22.1%). Despite most patients claiming compliance with treatment, 75% had glycosylated hemoglobin levels above 7.1% at presentation, and 49.3% continued unhealthy lifestyles. Despite the high prevalence of diabetic complications at admission, and despite 70% having had previous hospitalization for treatment of foot infections, only 57.4% of patients reported ever being counseled or taught about foot care by medical personnel. There is room for improvement in public health strategies to prevent diabetic foot complications in this setting. Such strategies should focus on patient education with emphasis on lifestyle modification and compliance with medical therapy.

How to compare adequacy of algorithms to control blood glucose in the intensive care unit?

Vogelzang et al. retrospectively assessed a derivative marker of blood glucose control over time in the intensive care unit (ICU), "the hyperglycemic index" (HGI), in relation to outcome. The HGI predicted mortality better than other indices of blood glucose control that do not take the duration of hyperglycemia into account. This provided further support to the concept of maintaining normoglycemia with insulin throughout intensive care in order to improve outcome. The HGI was also proposed as a tool to assess performance of glucose control algorithms. This, however, implies similar sampling frequency for the compared algorithms. Just as we prefer continuous, online display of blood pressure and/or cardiac output for optimal titration of inotropes and vasopressors, a continuous display of blood glucose levels is mandatory for optimal titration of insulin therapy in ICU. We anxiously await the development and validation of such devices.

Evaluation of serum fructosamine concentration as an index of blood glucose control in cats with diabetes mellitus

SUMMARY Fructosamine, a glycated serum protein, was evaluated as an index of glycemic control in normal and diabetic cats. Fructosamine was determined manually by use of a modification of an automated method. The within-run precision was 2.4 to 3.2%, and the day-to-day precision was 2.7 to 3.1%. Fructosamine was found to be stable in serum samples stored for 1 week at 4 C and for 2 weeks at − 20 C. The reference range for serum fructosamine concentration in 31 clinically normal colony cats was 2.19 to 3.47 mmol/L (mean, 2.83 ± 0.32 mmol/L). In 27 samples from 16 cats with poorly controlled diabetes mellitus, the range for fructosamine concentration was 3.04 to 8.83 mmol/L (mean, 5.93 ± 1.35 mmol/L). Fructosamine concentration was directly and highly correlated to blood glucose concentration. Fructosamine concentration also remained high in consort with increased blood glucose concentration in cats with poorly controlled diabetes mellitus over extended periods. It is concluded that measurement of serum fructosamine concentration can be a valuable adjunct to blood glucose monitoring to evaluate glycemic control in diabetic cats. The question of whether fructosamine can replace glucose for monitoring control of diabetes mellitus requires further study.

Comparison of Glycosylated Fibrinogen, Albumin, and Haemoglobin as Indices of Blood Glucose Control in Diabetic Patients

The value of glycosylated fibrinogen as an index of short-term diabetic control was compared with indices of long-term (glycosylated haemoglobin) and intermediate-term (glycosylated albumin) diabetic control, respectively. In this study, percentages of these glycosylated proteins and fasting plasma glucose concentration were determined in 95 healthy non-diabetic subjects and 48 diabetic patients (22 well-controlled and 26 poorly-controlled) after an overnight fast. The differences in the percentages of glycosylated fibrinogen, haemoglobin, and albumin between non-diabetic subjects (4.7, 6.4, and 2.0), well-controlled diabetic patients (6.9, 9.5 and 2.9), and poorly-controlled diabetic patients (11.3, 15.8, and 5.1) were statistically significant (p less than 0.05). The percent glycosylated fibrinogen exhibited significant association with severity of hyperglycaemia when diabetic patients were divided by 2, 4, and 6 standard deviations above the mean of fasting plasma glucose of non-diabetic subjects. There were significant correlations between glycosylated fibrinogen and fasting plasma glucose (r = 0.83, p less than 0.001), glycosylated haemoglobin (r = 0.94, p less than 0.001) and glycosylated albumin (r = 0.92, p less than 0.001) for all subjects studied. In ten newly diagnosed diabetic patients after 6 days of treatment, only the decrease in glycosylated fibrinogen (33.4%) was significant (p less than 0.05), but not that of glycosylated haemoglobin (4.8%) or albumin (8.0%). It is suggested that glycosylated fibrinogen provides the clinician with earlier objective evidence of the metabolic response to therapeutic intervention, and might be regarded as a short-term (2-3 days) index of blood glucose control.

Application of high-performance liquid chromatography in establishing an accurate index of blood glucose control

A chromatographic method utilizing a carboxymethylated poly(vinyl alcohol) resin for a more accurate determination of stable haemoglobin A 1c (St-A 1c) has been developed. The complete separation between St-A 1c, labile HbA 1c (L-A 1c) and HbF was achieved by gradient elution with sodium chloride in phosphate buffer. This high resolution permits accurate quantitation of St-A 1c, even in the presence of high levels of HbF or L-A 1c. In 142 subjects with normal fasting plasma glucose and normal response to a 75-g oral glucose tolerance test, the reference interval of St-A 1c was 2.80–3.98%.

Impaired fibrinolytic response to exercise in type II diabetes: Effects of exercise and physical training

We studied the effects of exercise and physical training on coagulation parameters and fibrinolytic activity in 16 sedentary non-insulin-dependent diabetics and nine control subjects matched for prior physical activity. Parameters were measured at rest and after 30 minutes of bicycle exercise at 70% to 75% of maximal oxygen uptake before and after 6 weeks of thrice-weekly physical training. In the untrained state, fibrinolytic activity was impaired in diabetics compared with controls (1.26 ± 0.19 v 2.20 ± 0.34 U; P < 0.3), and resting levels of plasma fibrinogen (329 ± 21 v 266 ± 17 mg/dL; P < .01) and the prothrombin time (PT) maximal velocity (Vmax) (4.9 ± 0.5 v 2.9 ± 0.5; P < .05) were increased. The activated partial thromboplastin time (APTT) Vmax was also increased but this did not reach statistical significance (3.6 ± 0.2 v 2.3 ± 0.5; P < 0.10). Activation of fibrinolysis occurred following exercise in both groups but the peak activity and increment were less in diabetics. Physical training for 6 weeks had no effect on plasma fibrinogen levels but significantly improved the resting and postexercise APTT Vmax and resting fibrinolytic activity in diabetics. The exercise-induced increment in fibrinolytic activity following training remained depressed compared with normal controls. The changes in APTT Vmax correlated with changes in the indices of blood glucose control. The relevance of these findings to possible antiatherogenic effects of exercise and the mechanism by which exercise produces these effects remain to be established.

Quality assessment of determinations of serum fructosamine in 33 clinical chemistry laboratories.

We investigated the analytical performance of fructosamine measurement in 33 routine clinical chemistry laboratories. We prepared 12 human control sera spanning a range of nondiabetic and diabetic fructosamine concentrations and assigned target values by using commercial reagents and a Cobas Bio centrifugal analyzer. Each control serum was analyzed by participating laboratories on two separate occasions. Averaged results were compared with target values, and systematic error was determined from slope and intercept regression coefficients. Overall, we found no significant (p greater than 0.05) slope or intercept bias, although slight nonlinearity was found with bichromatic instruments. Random error was determined from the standard error of estimate and from duplicate measurements. We found a median interlaboratory CV of 5.36% and similar analytical performance with all automated instruments used. The median random error with manual techniques was 18.1%. We conclude that fructosamine measurement as currently performed in routine laboratories is sufficiently accurate and reliable to function as an index of blood glucose control in diabetic patients.

Serum fructosamine concentration as measure of blood glucose control in type I (insulin dependent) diabetes mellitus.

Serum fructosamine activity was studied in 42 patients with type I (insulin dependent) diabetes mellitus and 30 non-diabetic volunteers as an index of blood glucose control. There was a significant correlation both between fructosamine and glycosylated haemoglobin values (r = 0.82) and between fructosamine and the fasting C peptide concentration (r = -0.81). Test results in 14 of the diabetics reflected the mean plasma glucose concentration calculated from 25 serial estimations in a single 24 hour period (r = 0.75; p less than 0.01) but not the mean amplitude of glycaemic excursion (r = 0.23; p greater than 0.05). Fructosamine concentrations measured in these multiple blood specimens did not change significantly throughout the day (mean coefficient of variation 4.1%) despite wide variability of the respective plasma glucose concentrations (mean coefficient of variation 36.2%). It is concluded that a single random serum sample analysed for fructosamine concentration provides a simple and reliable assessment of glucose homoeostasis in patients with type I diabetes mellitus.

Analysis of short-term changes in reversibly and irreversibly glycosylated haemoglobin AI: relevance to diabetes mellitus.

We have determined the stable (irreversibly glycosylated) fraction of haemoglobin AI (HbAI) on Bio-Rex 70 after incubation of red blood cells in 0.9 % saline solution for 6 h at 37 degrees C. The total (reversibly + irreversibly glycosylated fractions) HbAI was determined before each incubation. Labile (reversibly glycosylated) HbAI represented the difference between total and stable HbAI fractions. Total and stable HbAI fractions were determined during insulin- or meal-induced blood glucose fluctuations in 24 insulin-dependent diabetics and in seven subjects with impaired glucose tolerance. In the diabetics, the maximal fluctuation of total HbAI was 1.47% over 2-12 h, while the simultaneous plasma glucose variation was 21.5 mmol/l. The stable HbAI fraction did not change significantly. In diabetics the differences between the maximal and minimal values of plasma glucose and total HbAI were significantly correlated. Plasma glucose correlated with simultaneously determined total and labile HbAI fractions, but not with stable HbAI. In subjects with impaired glucose tolerance, similar changes in total but not in stable HbAI were observed during an oral glucose tolerance test. We conclude that, although rapid changes in chromatographically determined HbAI are relatively small, the determination of stable HbAI should be performed to circumvent this problem and to ensure a more accurate index of blood glucose control.

Temporal relationship of glycosylated haemoglobin concentrations to glucose control in diabetics

To examine the temporal relationship between Hb AIc values and various indices of blood glucose control, 38 diabetic and 28 nondiabetic youth counsellors employed at two summer camps for diabetic children took part in an eight-week study. Each week fasting determinations were made of Hb AI, Hb AIc, serum cholesterol, triglyceride and growth hormone and plasma glucose. Total daily urine glucose excretion was measured approximately two times per week, capillary glucose values were measured fasting and at 11 a. m. and 3 p. m. on two days per week, and urine glucose was measured semi-quantitatively four times per day. As Hb AI was correlated highly with Hb AIc (r = 0.997), it was used as the primary index of glycosylated haemoglobin. The mean values of Hb AI, serum cholesterol and triglycerides and fasting plasma glucose were all significantly elevated in the diabetic group but only Hb AI values provided total separation of the two groups. Within the diabetic group the Week 8 Hb AI values showed a significant correlation with the Week 8 mean capillary glucose concentrations, the proportion of urine tests showing 2% and 0% glycosuria, and mean serum triglycerides. Correlations of Week 8 Hb AI with the mean values of these glycaemic parameters for each week of the study demonstrated low order correlations with the glycaemic measures of Week 1, and a progressive increase in the degree of correlation reaching a plateau with the glycaemic measures of Week 4 to 8. Similar correlation analysis using the Hb AI values from Week 4 confirmed these findings. Therefore, while Hb AI provides an index of the control of diabetes, it appears to be more acutely responsive to blood glucose alteration than generally recognized.