Hyperglycemia In Patients Research Articles

Successful correction of hyperglycemia is critical for weight loss and a decrease in cardiovascular risk in obese patients

Weight loss is recommended for obese patients with cardiovascular risk; however, it remains questionable how hyperglycemia affects this process. To address this problem, we aimed to determine the association between weight loss, lipid profile, and body mass parameters in obese normoglycemic and hyperglycemic patients. Obese (body mass index30 kg/m2) normoglycemic and hyperglycemic volunteers were placed on a weight reduction program that included a balanced, low-calorie diet and moderate exercise for 6 months. Participants were assessed for serum glucose, β-cell functions, insulin resistance, lipid metabolism, lipoprotein profile, and body mass parameters. This weight reduction program fully normalized serum glucose levels only in a subpopulation of patients. These individuals also exhibited a significant reduction in body weight, and significant improvement in serum lipid profile and insulin resistance. In contrast, the patients that remained hyperglycemic were characterized by persistent insulin resistance, increased levels of atherogenic fractions of LDL and HDL lipoproteins, and elevated values of a modified Atherogenic Index of Plasma. Correlation analysis indicated a strong positive association between the modified Atherogenic Index of Plasma with atherogenic lipid profile, insulin resistance, and body mass parameters, indicating its usefulness in clinical studies in obese patients. Overall, our data indicate that successful treatment of hyperglycemia facilitates weight loss and improves the composition of blood lipids, while persisting hyperglycemia negatively affects the weight loss process and maintains an atherogenic lipid profile. Because hyperglycemia predisposes to cardiovascular disorders, its correction should be the primary goal during weight reduction therapy.

Continuous Glucose Monitoring-Assisted Insulin Dose Titration in the Indian Outpatient Setting

Context: Monitoring blood glucose levels is an important aspect in the overall management of an individual with diabetes mellitus. Continuous glucose monitoring (CGM) system is an effective tool that enables physicians to do so by way of regular automated checks of sensor glucose (SG). Aims: In this article, we discuss in detail on how CGM technology works, practical aspects of its application and how CGM data are interpreted. We describe the different glucose sensors available in India and suggest when and whom to use them. We also evaluate the effectiveness of CGM-assisted titration of insulin dose in our hyperglycemic patients and discuss the results. Settings and Design: This is a single-center retrospective observational study of insulin-treated patients with diabetes attending the endocrinology outpatient department, who opted for a CGM-assisted insulin dose titration. Subjects and Methods: Monitoring was done using the Freestyle libre pro™ CGM system and insulin doses were titrated on regular follow-ups every 3–4 days for a total of 2 weeks. Patients who had an average SG level of more than 250 mg/dl on day 1 of monitoring, and had CGM data for a minimum of 12 days were included (n = 73). Data were analyzed using CGM-specific glucometrics including average SG and estimated A1c (eA1c) reduction, and changes in the percentage time in range (TIR), time below range (TBR), and time above range (TAR). Statistical Analysis Used: Not applicable. Results: When compared to day 1, the last day (D12–14) of CGM-assisted insulin dose titration showed: 1. An average SG reduction of 164.1 mg/dl (321.34 mg/dl → 157.24 mg/dl). 2. An eA1c reduction of 4.98% (12.08% → 7.1%). 3. An average TIR improvement of 51.21% (3.8% → 55.01%). 4. An average TAR reduction of 62.06% (96.12% → 34.06%). 5. An average increase in TBR from 0% to 10.21%. Target TIR >70% was achieved by 31/73 patients on D12-14, compared to 0/73 on day 1. Target TAR <25% was achieved by 43/73 patients on D12-14, compared to 0/73 on day 1. Target TBR <5% was not achieved by 21/73 patients on D12-14 when compared to 0/73 on day 1. Conclusions: CGM is a novel, easy-to-use, useful technology easily available in India for all patients with diabetes. We have demonstrated that quick and effective glycemic reduction is possible with CGM-assisted insulin dose titration within a short period of 2 weeks.

IDF21-0243 Clinical characteristics and outcomes in adult patients with hyperglycemic crises based on WHO classification 2019

Background: Hyperglycemic crises composed of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are metabolic catastrophes and could occur in any type of diabetes. Recently, the World Health Organization (WHO) revised the classification of diabetes and established the hybrid forms of diabetes mellitus, latent autoimmune diabetes in adults (LADA) and ketosis-prone type 2 diabetes (KPD). Although many clinical trials demonstrated the clinical characteristics and outcomes of hyperglycemic crises, few studies investigated the outcome of care in patients with hyperglycemic crises using the new WHO diabetic classification. Aim: To examine the clinical characteristics, outcomes of hyperglycemic crisis treatment, and post-discharged diabetic complications in the referral hospital in Bangkok, Thailand, of which diabetic subtypes were re-classified by the WHO diabetic classification 2019. Method: A retrospective study of patients with hyperglycemic crisis over 5 years (2015-2019) was done. Patients were re-classified into new DM subtypes according to the WHO diabetic classification 2019. The clinical characteristics, laboratory data, in-hospital outcomes, and long-term macrovascular and microvascular diabetic complications were collected and analyzed. Results: A total of 185 hyperglycemic crisis episodes in 138 patients with diabetes were included. DKA occurred more frequently than HHS and overlapped DKA and HHS (88.4%, 5.1%, and 6.1%, respectively). The mean age was 50.7±18.3 years old (51.4% female). The baseline A1c was 11.9±3.4%. Subjects were classified as follows: T1DM 15.9%, T2DM 68.8%, LADA 2.2%, KPD 10.9%, and pancreatic DM 2.2%. The most common precipitating causes of hyperglycemic crises were different among subtypes, i.e. medication noncompliance for T1DM, first diagnosis of DM for KPD, and infection for T2DM, LADA, and pancreatic DM (p=0.013). Forty-seven percent of all subjects developed hypokalemia during hyperglycemic crisis management, which was no different among DM subtypes. Five T2DM patients expired due to infection, the precipitating cause, which accounted for a mortality rate of 3.62% in our study. By the median follow-up of 25 months, insulin therapy had successfully been discontinued up to 71.4% in KPM and 24.4% in T2DM. The median time at insulin discontinuation was 7.2±4.3 months after hospital discharge. The last follow-up A1c was lowest in KPM, 6.5±1.4% (p=0.02). The new-onset macrovascular diabetic complications occurred in only T2DM and KPD, of which 55.5% occurred beyond 12 months. The microvascular complication occurred in all subtypes, of which 67.4% occurred within 12 months. Discussion: The KPD and LADA, the new hybrid subtypes of DM, accounted for 13% of hyperglycemic crisis patients in our center. Among diabetic subtypes, the acute outcomes of care were comparable but the long-term consequences were different. The KPD patients were more successful in discontinuing insulin therapy and had better glycemic control than other diabetic types. However, all DM subtypes were not different in developing macrovascular and microvascular complications. We encourage using the WHO diabetic classification 2019 to predict long-term clinical outcomes and insulin management in patients presenting with hyperglycemic crises.

IDF21-0439 Type 2 Diabetes Mellitus History in the Prognosis of Hospitalized COVID-19 Patients – A Prospective Observational Study

Background: COVID-19 is found to affect Type 2 Diabetes Patients drastically. Aim: To evaluate the association between a known history of diabetes mellitus (DM) and its clinical outcomes in hospitalized COVID-19 diabetic patients. Method: This prospective cohort study categorized COVID-19 positive patients admitted to a secondary care hospital in South India into DM patients and Non-DM patients. Data regarding the past medical and medication history was collected on the day of admission and the patients were regularly followed up till discharge or death. The outcome measures including duration of hospital stay, mortality, need for ICU care/mechanical ventilation were compared between the two groups. Data is extracted and statistically analyzed using Pearson correlation. Results: A total of 118 patients were observed, 53 patients were diabetic and 65 were non-diabetic. Out of the 53 hyperglycemic patients, 39 patients were on metformin therapy while 15 patients were on insulin before admission due to COVID-19. A higher mortality rate was observed in the DM group when compared with the Non-DM group [26.4% (14) vs 9.23% (6)]. An increased random blood glucose level at the time of admission had a positive correlation with mortality (p = 0.003). While insulin administration prior to admission had negative correlation with mortality [R value is -0.282 (p = 0.02)], increased insulin requirement during hospitalization is associated with poor outcomes [R value is 0.327 (p = 0.002)]. Discussion: People with diabetes when infected with COVID-19 are at a greater risk of morbidity and mortality. The study highlights the need of rational management of hyperglycemia in COVID patients with a history of diabetes mellitus.

Blood glucose level on admission as potential indicator of in-hospital mortality in non-diabetic patients presenting with acute stroke

Background: A stroke or cerebrovascular accident is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Stress hyperglycemia has been defined as hyperglycemia in previously euglycemic patients that corrects once the acute process resolves.Methods: The present study was conducted in the medicine department, Guru Nanak Dev hospital attached to government medical college, Amritsar from April 2021-December 2021 after taking approval from institutional ethics committee. This was a prospective observational study. A total of 50 non-diabetic patients of acute stroke with age group >18 to <75 of either sex were enrolled in this study. Comparison of mortality was done in hyperglycemic and non hypergylcemic non-diabetic patients on 1st day of admission and up to 10th day during hospital stay.Results: Mortality percentage on day 1 was higher among those who had high blood glucose levels but there was no significant association between glucose levels and day 1 outcome (survival or death) observed in our study (p=0.078). Mortality percentage on day 10 was higher among those who had high blood glucose levels and there was significant association between glucose levels and day 10 outcome (survival or death) observed in our study (p=0.001). A significant association was observed between glucose levels and overall outcome in our study (p<0.001).Conclusions: We conclude that even in non-diabetic patients, hyperglycemia on admission is independently associated with a higher risk of in-hospital mortality.

Per-operative evaluation of destructive pattern of COVID associated rhinocerebral mucormycosis

<p><strong>Background:</strong> The rapid global spread of Coronavirus disease led to declaration of COVID-19 as a pandemic on March 11,2020. Secondary infections are reportedly common in hospitalized, severely ill COVID-19 patients, encompassing between 10 and 30% of cases, fungal being 10 times more common. Mucormycosis is amongst the most fulminant form of zygomycosis caused by mucorales species of the phylum zygomycota and currently referred as COVID associated mucormycosis (CAM). The aim of this study is to evaluate the extend and pattern of destruction in nose, paranasal sinus and orbit found during the surgical debridement of post COVID hyperglycemic patients of mucormycosis.</p><p><strong>Methods:</strong> This prospective observational study was done on a random sample of 86 patients who came to ENT OPD of a tertiary care centre of middle India with clinical, radiological or histological findings suggestive of CAM. These patients underwent aggressive surgical debridement followed by antifungals and strict control of diabetic mellitus. The extend and pattern of destruction caused by CAM in nose, paranasal sinus and orbit noticed peroperatively were analysed.</p><p><strong>Results:</strong> Out of the 86 patients who got operated, there are 62 males and 24 females patients aged from 28 to 86 years. The left side was involved in 41 patients, and the right side in 66 patients. Among the nasal involvement, middle turbinate (56) was maximally involved followed by inferior turbinate (52), superior turbinate (1), septum (17) with posterior septum mostly involved, floor of nose was involved in (4) patients. The orbit was involved in 28 cases in which lamina papyracea was eroded in all cases followed by inferior orbital wall, orbital muscles, optic nerve. Cribriform plate was eroded in 3 patients. The overall extent of involvement of mucormycosis is as follows maxilla (86), ethmoid (71), frontal (29), sphenoid (30), septum (17), orbit (28), alveolus (5), palate (10), intracranial (9), subcutaneous phycomycosis (10).</p><p><strong>Conclusions:</strong> Management of CAM is really challenging which needs a multidisciplinary approach that includes aggressive surgical debridement, aggressive medical therapy with Amphotericin B and correction of the predisposing factors primarily diabetics mellitus</p>

Hyperglycemia in hospitalized patients of a tertiary care hospital: prevalence and treatment in two cross-sectional evaluations (2011-2020).

A study at Centro Hospitalar Universitário do Porto in 2011 revealed suboptimal control of inpatient hyperglycemia and a similar one was carried out in 2020. This study compares the results of 2011 and 2020 regarding prevalence of hyperglycemia, metabolic control, treatment and glycemic profile by infection/non-infection diagnosis. We performed two cross-sectional studies on 13th December 2011 and 9th October 2020 that included all non-critical adults with at least 24 hours of hospitalization, with no specific intervention between them. Glycemic control evaluated by minimum and maximum capillary blood glucose (CBG) in the previous day categorized as hypoglycemia (<70 mg/dL), normoglycemia (70-179 mg/dL) and hyperglycemia (≥180 mg/dL) (SPSS v.20). A total of 418 and 445 patients were respectively included in 2011 and 2020 studies and the prevalence of hyperglycemia was similar. Glycemic control improved numerically although not significantly in 2020: increase in normoglycemia, reduction in hyperglycemia and reduction in hypoglycemia. There was an increase in the use of basal-bolus regimens (19.6% vs. 7.3%, p = 0.009) and a decrease in human basal (p < 0.01) and rapid-acting insulin use (p = 0.001) with a proportional increase in long-acting (p = 0.002) and rapid-acting analogs (p < 0.001) use. There was a higher prevalence of infection (39.8% vs. 23.1%, p = 0.006) in 2020 and, in the infection subgroup, there were higher insulinization rates (37.3% vs. 10.7%, p = 0.017) and a trend to glycemic control improvement. Despite the higher insulinization rates, the preference for new insulin analogs and a trend to better glycemic control, we have not yet reached targets, so education still remains necessary.

Glycation modulates alpha-synuclein fibrillization kinetics: A sweet spot for inhibition

Glycation is a nonenzymatic posttranslational modification (PTM) known to be increased in the brains of hyperglycemic patients. Alpha-synuclein (αSN), a central player in the etiology of Parkinson’s disease, can be glycated at lysine residues, thereby reducing αSN fibril formation in vitro and modulating αSN aggregation in cells. However, the molecular basis for these effects is unclear. To elucidate this, we investigated the aggregation of αSN modified by eight glycating agents, namely the dicarbonyl compound methylglyoxal (MGO) and the sugars ribose, fructose, mannose, glucose, galactose, sucrose, and lactose. We found that MGO and ribose modify αSN to the greatest extent, and these glycation products are the most efficient inhibitors of fibril formation. We show glycation primarily inhibits elongation rather than nucleation of αSN and has only a modest effect on the level of oligomerization. Furthermore, glycated αSN is not significantly incorporated into fibrils. For both MGO and ribose, we discovered that a level of ∼5 modifications per αSN is optimal for inhibition of elongation. The remaining sugars showed a weak but optimal inhibition at ∼2 modifications per αSN. We propose that this optimal level balances the affinity for the growing ends of the fibril (which decreases with the extent of modification) with the ability to block incorporation of subsequent αSN subunits (which increases with modification). Our results are not only relevant for other αSN PTMs but also for understanding PTMs affecting other fibrillogenic proteins and may thus open novel avenues for therapeutic intervention in protein aggregation disorders.

Diabetes Mellitus during the Pandemic Covid-19: Prevalence, Pathophysiology, Mechanism, and Management: An updated overview.

Diabetes mellitus (DM) is among the most frequently reported comorbidities in patients tainted with the pandemic coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With a high pervasiveness of diabetes mellitus, there is an urgency to understand the special aspects of COVID-19 in hyperglycemic patients. Diabetic patients are at higher risk than the general population of viral or bacterial infections, thus require special attention since diabetes is linked with severe, critical, and lethal modes of COVID-19. The objective of this study was to focus on epidemiology, pathophysiology, mechanism, and management of DM with COVID-19. The search was carried out on databases portals such as Pubmed, EMBASE, Google Scholar, and CINAHL with the keywords, i.e., COVID-19, coronavirus, SARS-CoV-2, diabetes, covid-19, etc. Result: DM and COVID-19 disease conditions can impact each other in terms of clinical progression and outcome. Available laboratory/clinical observations suggest that hyperglycemia-induced immune dysfunction, inflated lactate grades, and cytokines storm may play critical roles in the seriousness of COVID-19 in patients with diabetes; however, the exact mechanisms linking diabetes and COVID-19 remain to be further clarified. Standards to constrain the disease spread at the individual and community level are the key to extenuate the speedily rising pandemic, while definitive treatment, like plasma therapy, chemoprophylaxis, or vaccine for COVID-19, has yet to be discovered.

Hyperglycemia in nondiabetic adult trauma patients is associated with worse outcomes than diabetic patients: An analysis of 95,764 patients.

The adverse impact of acute hyperglycemia is well documented but its specific effects on nondiabetic trauma patients are unclear. The purpose of this study was to analyze the differential impact of hyperglycemia on outcomes between diabetic and nondiabetic trauma inpatients. Adults admitted 2018 to 2019 to 46 Level I/II trauma centers with two or more blood glucose tests were analyzed. Diabetes status was determined from International Classification of Diseases-10th Rev.-Clinical Modification, trauma registry, and/or hemoglobin A1c greater than 6.5. Patients with and without one or more hyperglycemic result >180 mg/dL were compared. Logistic regression examined the effects of hyperglycemia and diabetes on outcomes, adjusting for age, sex, Injury Severity Score, and body mass index. There were 95,764 patients: 54% male; mean age, 61 years; mean Injury Severity Score, 10; diabetic, 21%. Patients with hyperglycemia had higher mortality and worse outcomes compared with those without hyperglycemia. Nondiabetic hyperglycemic patients had the highest odds of mortality (diabetic: adjusted odds ratio, 3.11; 95% confidence interval, 2.8-3.5; nondiabetics: adjusted odds ratio, 7.5; 95% confidence interval, 6.8-8.4). Hyperglycemic nondiabetics experienced worse outcomes on every measure when compared with nonhyperglycemic nondiabetics, with higher rates of sepsis (1.1 vs. 0.1%, p < 0.001), more SSIs (1.0 vs. 0.1%, p < 0.001), longer mean hospital length of stay (11.4 vs. 5.0, p < 0.001), longer mean intensive care unit length of stay (8.5 vs. 4.0, p < 0.001), higher rates of intensive care unit use (68.6% vs. 35.1), and more ventilator use (42.4% vs. 7.3%). Hyperglycemia is associated with increased odds of mortality in both diabetic and nondiabetic patients. Hyperglycemia during hospitalization in nondiabetics was associated with the worst outcomes and represents a potential opportunity for intervention in this high-risk group. Therapeutic/care management; Level III.

Management of Hyperglycemia in Hospitalized Patients Receiving Parenteral Nutrition.

Almost half of inpatients on parenteral nutrition experience hyperglycemia, which increases the risk of complications and mortality. The blood glucose target for hospitalized patients on parenteral nutrition is 7.8 to 10.0 mmol/L (140 to 180 mg/dL). For patients with diabetes, the same parenteral nutrition formulae as for patients without diabetes can be used, as long as blood glucose levels can be adequately controlled using insulin. Insulin can be delivered via the subcutaneous or intravenous route or, alternatively, added to parenteral nutrition admixtures. Combining parenteral with enteral and oral nutrition can improve glycemic control in patients with sufficient endogenous insulin stores. Intravenous insulin infusion is the preferred route of insulin delivery in critical care as doses can be rapidly adjusted to altered requirements. For stable patients, insulin can be added directly to the parenteral nutrition bag. If parenteral nutrition is infused continuously over 24 hours, the subcutaneous injection of a long-acting insulin combined with correctional bolus insulin may be adequate. The aim of this review is to give an overview of the management of parenteral nutrition-associated hyperglycemia in inpatients with diabetes.

Newly diagnosed diabetes vs. pre-existing diabetes upon admission for COVID-19: Associated factors, short-term outcomes, and long-term glycemic phenotypes

AimsHigh rates of newly diagnosed diabetes mellitus (NDDM) have been reported in association with coronavirus disease-2019 (COVID-19). Factors associated with NDDM and long-term glycemic outcomes are not known. MethodsRetrospective review of individuals admitted with COVID-19 and diabetes mellitus (DM; based on labs, diagnoses, outpatient insulin use, or severe inpatient hyperglycemia) between March and September 2020, with follow-up through July 2021. ResultsOf 1902 individuals admitted with COVID-19, 594 (31.2%) had DM; 77 (13.0%) of these had NDDM. Compared to pre-existing DM, NDDM was more common in younger patients and less common in those of non-Hispanic White race/ethnicity. Glycemic parameters were lower and inflammatory markers higher in patients with NDDM. In adjusted models, NDDM was associated with lower insulin requirements, longer length of stay, and intensive care unit admission but not death. Of 64 survivors with NDDM, 36 (56.3%) continued to have DM, 26 (40.6%) regressed to normoglycemia or pre-diabetes, and 2 were unable to be classified at a median follow-up of 323 days. ConclusionsDiabetes diagnosed at COVID-19 presentation is associated with lower glucose but higher inflammatory markers and ICU admission, suggesting stress hyperglycemia as a major physiologic mechanism. Approximately half of such individuals experience regression of DM.

Elevated prehospital point-of-care glucose is associated with worse neurologic outcome after out-of-hospital cardiac arrest

ObjectivesHyperglycemia is associated with poor outcomes in critically-ill patients. This has implications for prognostication of patients with out-of-hospital cardiac arrest (OHCA) and for post-resuscitation care. We assessed the association of hyperglycemia, on field point-of-care (POC) testing, with survival and neurologic outcome in patients with return of spontaneous circulation (ROSC) after OHCA. MethodsThis was a retrospective analysis of data in a regional cardiac care system from April 2011 through December 2017 of adult patients with OHCA and ROSC who had a field POC glucose. Patients were excluded if they were hypoglycemic (glucose <60 mg/dl) or received empiric dextrose. We compared hyperglycemic (glucose >250 mg/dL) with euglycemic (glucose 60–250 mg/dL) patients. Primary outcome was survival to hospital discharge (SHD). Secondary outcome was survival with good neurologic outcome (cerebral performance category 1 or 2 at discharge). We determined the adjusted odds ratios (AORs) for SHD and survival with good neurologic outcome. ResultsOf 9008 patients with OHCA and ROSC, 6995 patients were included; 1941 (28%) were hyperglycemic and 5054 (72%) were euglycemic. Hyperglycemic patients were more likely to be female, of non-White race, and have an initial non-shockable rhythm compared to euglycemic patients (p < 0.0001 for all). Hyperglycemic patients were less likely to have SHD compared to euglycemic survivors, 24.4% vs 32.9%, risk difference (RD) −8.5% (95 %CI −10.8%, −6.2%), p < 0.0001. Hyperglycemic survivors were also less likely to have good neurologic outcome compared to euglycemic survivors, 57.0% vs 64.6%, RD −7.6% (95 %CI −12.9%, −2.4%), p = 0.004. The AOR for SHD was 0.72 (95 %CI 0.62, 0.85), p < 0.0001 and for good neurologic outcome, 0.70 (95 %CI 0.57, 0.86), p = 0.0005. ConclusionIn patients with OHCA, hyperglycemia on field POC glucose was associated with lower survival and worse neurologic outcome.

Assessment of glycaemic status in adult hospital patients for the detection of undiagnosed diabetes mellitus: A systematic review.

AimIn‐hospital blood glucose testing is commonplace, particularly in acute care. In‐hospital screening for hyperglycaemia may present a valuable opportunity for early diabetes diagnosis by identifying at‐risk individuals. This systematic review investigates the extent to which random blood glucose testing in acute and inpatient hospital settings predicts undiagnosed diabetes.MethodsTwo databases were systematically searched for studies in which adult patients received an in‐hospital random blood glucose test, followed by a diagnostic HbA1c test. The primary outcome was the proportion of hyperglycaemic individuals diagnosed with diabetes by HbA1c.ResultsA total of 3245 unique citations were identified, and 12 were eligible for inclusion. Ten different blood glucose thresholds, ranging from 5.5 to 11.1 mmol/L, were used to detect hyperglycaemia, indicating that there is no consistent clinical definition for hyperglycaemia. The proportion of participants with hyperglycaemia in each study ranged from 3.3% to 62.1%, with a median (Q1, Q3) of 34.5% (5.95%, 61.1%). The proportion of hyperglycaemic participants found to have a diabetes‐range HbA1c varied from 4.1% to 90%, with a median (Q1, Q3) of 18.9% (11.5%, 61.1%). Meta‐analysis was not possible due to substantial heterogeneity between study protocols.ConclusionsAll studies consistently identified a proportion of hyperglycaemic hospital patients as having a diabetes‐range HbA1c, showing that in‐hospital blood glucose screening can facilitate diabetes diagnosis. The proportion of hyperglycaemic participants with undiagnosed diabetes varied substantially, indicating a need for further research and consistency in defining in‐hospital hyperglycaemia. This may aid the development of a standardised screening protocol to identify people with possible undiagnosed diabetes.

Application of hyperglycemia/diabetes-derived polygenic risk scores on the risk of poor outcomes after an ischemic stroke.

Unfavorable prognoses are often accompanied for hyperglycemic stroke patients. This study aimed to construct a hyperglycemia/diabetes-derived polygenic risk score (PRS) to improve the predictive performance for poor outcome risks after a stroke and to evaluate its potential clinical application. A hospital-based cohort study was conducted including 1320 first-ever acute ischemic stroke (AIS) patients and 1210 patients who completed the follow-up at 3 months. PRSs were calculated for hyperglycemia/diabetes mellitus using results from genome-wide association studies in Asians. An unfavorable functional outcome was defined as a modified Rankin Scale score of ≥3 at 3, 6, and 12 months of follow-up. The prediction of a poor prognosis was evaluated using measures of model discrimination, calibration, and net reclassification improvement (NRI). The second to fourth PRS quartiles (≥Q2) were significantly associated with higher risks of unfavorable outcomes at 3 months compared with the first quartile as the reference group after adjusting for age, baseline stroke severity, hypertension, diabetes, dyslipidemia, smoking, heart disease, and ischemic stroke subtype (p for trend <0.0001). The addition of the PRS to traditional risk predictors of poor outcomes after an AIS significantly improved the model fit (likelihood ratio test p < 0.0001) and enhanced measures of reclassification (NRI, 0.245; 95% confidence interval [CI], 0.195-0.596). The corrected C-index for the PRS combining traditional risk factors at 3 months after a stroke was 0.899 (95% CI, 0.878-0.980). Among hyperglycemic AIS patients, those who did not take an antidiabetic drug and whose PRS was ≥Q2 had higher risks of an unfavorable outcome at 3 months compared with patients who took the medicine. The hyperglycemia/diabetes-derived PRS was associated with poor outcomes after an AIS, but further studies are needed to validate its use for clinical applications.

English

BACKGROUND Hyperglycemia is a common finding during the admission of non-diabetic patients with acute coronary syndrome. It is very essential to differentiate this stress hyperglycemia from the hyperglycemia in latent diabetics whose diabetes may have been unmasked by the stress of acute coronary syndrome (ACS). We conducted this study to evaluate stress hyperglycemia in non-diabetic patients with ACS. METHODS We conducted this cross sectional study in the Department of Medicine, KIMS Hospital, Karad, over a period of one year. Non-diabetic patients with HbA1c &lt; 6.5 admitted in our hospital with ACS were included in the study. We included a total of 100 patients in our study, their detailed history, clinical examination and lab evaluation was done. We divided the patients into two groups, Group A were normoglycaemic patients and Group B were acute phase hyperglycemic patients with blood sugars more than 160. Correlation between the blood sugar levels and outcome of the patients was done. RESULTS Mean age was 65.23 ± 21.05 years. No significant difference in risk factor distribution in the two groups was seen. (p &gt; 0.05) We had 47 cases of unstable angina (UA – 47%) followed by 43 cases of STEMI (43 %) and 10 cases of NSTEMI (10 %). We observed a significant difference in the presence of complications in the two groups (p&lt;0.001), Group B patients with hyperglycemia had more complications. Significant difference was seen between the presence of heart failure, arrhythmias and shock in the two groups, with group B having more incidences of these (p&lt;0.05). Significant difference in the outcome of the two groups was seen (p = 0.012). We observed that out of 38 patients in Group B with hyperglycemia, there were 8 deaths (21.05%) as compared to 3 deaths (4.84%) in Group A patients. CONCLUSIONS We observed that the high prevalence (38%) of stress in non-diabetic ACS patients is responsible for significantly more complications, more chances of heart failure, arrhythmia, shock and more deaths. KEY WORDS Acute Coronary Syndrome, Stress Hyperglycemia, Non-Diabetic Patients, Outcome

Early Blood Glucose Level Post-Admission Correlates with the Outcomes and Oxidative Stress in Neonatal Hypoxic-Ischemic Encephalopathy.

The antioxidant defense system is involved in the pathogenesis of neonatal hypoxic-ischemic encephalopathy (HIE). To analyze the relationship between first serum blood glucose levels and outcomes in neonatal HIE, seventy-four patients were divided, based on the first glucose level, into group 1 (>0 mg/dL and <60 mg/dL, n =11), group 2 (≥60 mg/dL and <150 mg/dL, n = 49), and group 3 (≥150 mg/dL, n = 14). Abnormal glucose levels had poor outcomes among three groups in terms of the clinical stage (p = 0.001), brain parenchymal lesion (p = 0.004), and neurodevelopmental outcomes (p = 0.029). Hearing impairment was more common in group 3 than in group 1 (p = 0.062) and group 2 (p = 0.010). The MRI findings of group 3 exhibited more thalamus and basal ganglion lesions than those of group 1 (p = 0.012). The glucose level was significantly correlated with clinical staging (p < 0.001), parenchymal brain lesions (p = 0.044), hearing impairment (p = 0.003), and neurodevelopmental outcomes (p = 0.005) by Pearson’s test. The first blood glucose level in neonatal HIE is an important biomarker for clinical staging, MRI findings, as well as hearing and neurodevelopment outcomes. Hyperglycemic patients had a higher odds ratio for thalamus, basal ganglia, and brain stem lesions than hypoglycemic patients with white matter and focal ischemic injury. Hyperglycemia can be due to prolonged or intermittent hypoxia and can be associated with poor outcomes.

Inhibition of Advanced Glycation End Product Formation in Rat Tail Tendons by Polydatin and p-Coumaric acid: an In Vitro Study.

Advanced glycation end products (AGEs) formed through non-enzymatic glycosylation between a protein and sugar molecule are highly harmful to the human body. In hyperglycemic patients, AGE formation is more due to high glucose circulating in the blood, causing inter and intra molecular cross-linking of collagen leading to reduction of collagen elasticity. This cross-linked collagen develops resistance to matrix metalloproteinases leading to impaired collagen turnover. The aim of this work is to determine the anti-glycation effects of polydatin and p-coumaric acid in preventing collagen cross-linking by incubating rat tail tendons (RTTs) as collagen source in high glucose concentration (50mM) for a week. The RTTs were then characterized for tensile strength, cross-linking efficiency, circular dichroism spectrometry, collagen, glucose, and aldehyde contents. Electrophoresis was carried out to evaluate the level of cross-linking in collagen and the results confirmed the ability of the drugs in preventing complex intermolecular cross-link formation induced by non-enzymatic glycosylation. CD data showed alteration in the secondary structure of collagen where AGE formation had occurred. More collagen was extracted by pepsin from RTTs treated with glucose alone (6.88mg/10mg tendon) when compared with drug-treated groups (4.25, 2.56mg/10mg tendon for polydatin and p-coumaric acid, respectively). Tensile strength (20.66% and 18.95%), cross-linking percentage (32.5% and 29.84%), and glucose content (2.3 and 1.8mg/100mg) of drug-treated groups were similar to the positive control (19.07%, 30.13%, and 2.61mg/100mg) thus proving the anti-glycation potential of the drugs. Hence, both polydatin and p-coumaric acid could play a pivotal role in preventing AGE formation.

Glucose metabolic disorder in Klinefelter syndrome: a retrospective analysis in a single Chinese hospital and literature review

BackgroundWe aimed to investigate the clinical characteristics and islet β-cell function in patients with Klinefelter syndrome (KS) and hyperglycemia.MethodsThis is a retrospective study. In total, 22 patients diagnosed with KS were identified from the electronic medical record system, including 9 patients with hyperglycemia (total patients with hyperglycemia, THG-KS group) and 5 hyperglycemic KS patients with oral glucose tolerance test (OGTT) results (HG-KS group). An additional 5 subjects with hyperglycemia and 5 normal glucose tolerance (NGT) subjects matched based on body mass index were included as the HG group and NGT group, respectively. Data from clinical and laboratory examinations were collected. We further performed a literature review of KS and hyperglycemia.ResultsWe found that KS patients developed abnormal glucose metabolism earlier in life than those without KS, and the median age was 17 years, ranging from 10 years to 19 years. Six of 17 (35.3%) patients were diagnosed with diabetes mellitus and 3 of 17 (17.6%) patients were diagnosed with prediabetes. Among 10 patients with both fasting blood glucose and insulin results recorded, there were 8 out of 17 (47.1%) KS patients had insulin resistance. The prevalence of hypertension and dyslipidemia was higher in patients with hyperglycemia and KS than in patients with NGT KS. Compared with the HG group, insulin sensitivity levels were lower in HG-KS group, whereas homeostasis model assessment of β-cell function levels (p = 0.047) were significantly, indicating higher insulin secretion levels in the HG-KS group.ConclusionsKS patients develop hyperglycemia earlier in life than those without KS and show lower insulin sensitivity and higher insulin secretion. These patients also have a higher prevalence of other metabolic diseases and may have different frequencies of developing KS-related symptoms.

Tumour necrosis factor-α −308G/A polymorphism is associated with insulin secretory defects in Bangladeshi prediabetic/diabetic subjects

ObjectivesTumour necrosis factor (TNF)-α, an adipocytokine, is closely linked to impaired glucose tolerance (IGT) and insulin resistance (IR) in type 2 diabetes (T2D) subjects. The relationship between the polymorphisms in the TNF-α gene and IR in Bangladeshi prediabetes and T2D subjects has not yet been fully identified. This study aims to reveal the association between TNF-α gene polymorphism and IR in hyperglycaemic patients of Bangladeshi origin. MethodsIn our study, 106 IGT, 100 T2D, and 109 healthy subjects of Bangladeshi origin were recruited to identify the impact of TNF-α gene polymorphism at position −308 with a G>A transition using PCR and subsequent restriction fragment length polymorphism (RFLP). ResultsThe −308G>A TNF-α genotype frequency distribution within the control, IGT, and T2D groups showed a significant association (χ2 = 21.077; P = 0.001), although allele frequency distribution within the groups showed a statistically non-significant difference (χ2 = 1.696; P = 0.091). β-cell functional deficiency (HOMA-B%) was observed to be significantly (P = 0.034) lower in subjects with a variant genotype. In addition, our results indicate that the study subjects’ body mass index (BMI) and residence status were positively correlated (P ≤ 0.05) with −308G>A TNF-α gene polymorphism. ConclusionsTherefore, it can be concluded that −308G>A TNF-α gene polymorphism may have a causative relationship with lower insulin secretory capacity and higher BMI in Bangladeshi IGT and T2D populations, while the urban population's lifestyle might be associated with this polymorphism.