Insulin Group Research Articles

Clinical benefits of empagliflozin in very old patients with type 2 diabetes hospitalized for acute heart failure.

There is little evidence on the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors in older patients with heart failure. This work analyzed the clinical efficacy and safety of empagliflozin continuation in very old patients with type 2 diabetes hospitalized for acute decompensated heart failure. We conducted a real-world observational study between September 2015 and June 2021. Patients ≥80 years were grouped by antihyperglycemic regimen: (1) continuation of preadmission empagliflozin combined with basal insulin regimen and (2) conventional basal-bolus insulin regimen. A propensity score matching analysis matched patients in both groups in a 1:1 manner. The primary outcome was differences in clinical efficacy measured by the visual analogue scale dyspnea score, NT-proBNP levels, diuretic response, and cumulative urine output. Safety endpoints such as adverse events, worsening heart failure, discontinuation of empagliflozin, length of hospital stay, and in-hospital deaths were also analyzed. After propensity score matching, 79 patients were included in each group. At discharge, the N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were lower in the empagliflozin continuation group than in the insulin group (1699 ± 522 vs. 2303 ± 598 pg/ml, p= 0.021). Both the diuretic response and cumulative urine output were greater in patients treated with empagliflozin than in patients with basal-bolus insulin during the hospitalization (at discharge: -0.14 ± -0.06 vs. -0.24 ± -0.10, p= 0.044; and 16,100 ± 1510 vs. 13,900 ± 1220 ml, p= 0.037, respectively). No differences were observed in safety outcomes. In very old patients with type 2 diabetes hospitalized for acute heart failure, continuing preadmission empagliflozin reduced NT-proBNP levels and increased diuretic response and urine output compared to a basal-bolus insulin regimen. The empagliflozin regimen also showed a good safety profile.

Metformin versus insulin therapy for gestational diabetes: Effects on offspring anthropometrics and metabolism at the age of 9 years: A follow-up study of two open-label, randomized controlled trials.

AimsTo compare anthropometrics, and lipid and glucose metabolism in the 9‐year‐old offspring of mothers treated with metformin or insulin for gestational diabetes mellitus (GDM).Materials and MethodsThis was a Finnish two‐centre, 9‐year follow‐up study of two open‐label, randomized controlled trials comparing the effects observed in the offspring of mothers who received metformin and insulin treatment for GDM. Measurements included anthropometrics, blood pressure, lipoproteins, and oral glucose tolerance tests. This study was registered with ClinicalTrials.gov, number NCT02417090.ResultsAt the age of 9 years 172 children (55% of the original study cohort, 82 from the metformin and 90 from the insulin group) participated in the study. No differences were found between the 9‐year‐old offspring groups in anthropometric variables, including body mass index and waist‐to‐height ratio. The offspring in the metformin group had higher high‐density lipoprotein (HDL) cholesterol concentrations (1.72 vs. 1.54 mmol/L; P = 0.039) but lower low‐density lipoprotein cholesterol (2.39 vs. 2.58 mmol/L; P = 0.046) and apolipoprotein B concentrations (0.63 vs. 0.67 g/L; P = 0.043) than the offspring in the insulin group. The difference in HDL cholesterol concentration was found to be significant only in boys (P = 0.003). The 2‐hour glucose value in the oral glucose tolerance test was 0.6‐mmol/L lower in boys from the metformin group than in those from the insulin group (P = 0.015).ConclusionsMetformin treatment for GDM is associated with similar offspring growth and glucose metabolism but a more favourable lipid profile at the age of 9 years as compared to insulin treatment.

Effects of 18-months metformin versus placebo in combination with three insulin regimens on RNA and DNA oxidation in individuals with type 2 diabetes: A post-hoc analysis of a randomized clinical trial

Formation of reactive oxygen species has been linked to the development of diabetes complications. Treatment with metformin has been associated with a lower risk of developing diabetes complications, including when used in combination with insulin. Metformin inhibits Complex 1 in isolated mitochondria and thereby decreases the formation of reactive oxygen species. Thus, we post-hoc investigated the effect of metformin in combination with different insulin regimens on RNA and DNA oxidation in individuals with type 2 diabetes. Four hundred and fifteen individuals with type 2 diabetes were randomized (1:1) to blinded treatment with metformin (1,000 mg twice daily) versus placebo and to (1:1:1) open-label biphasic insulin, basal-bolus insulin, or basal insulin therapy in a 2 × 3 factorial design. RNA and DNA oxidation were determined at baseline and after 18 months measured as urinary excretions of 8-oxo-7,8-dihydroguanosine (8-oxoGuo) and 8-oxo-7,8-dihydro-2′-deoxyguanosine (8-oxodG), respectively. Urinary excretion of 8-oxoGuo changed by +7.1% (95% CI: 0.5% to 14.0%, P = 0.03) following metformin versus placebo, whereas changes in 8-oxodG were comparable between intervention groups. Biphasic insulin decreased urinary excretion of 8-oxoGuo (within-group: −9.6% (95% CI: −14.4% to −4.4%)) more than basal-bolus insulin (within-group: 5.2% (95% CI: −0.5% to 11.2%)), P = 0.0002 between groups, and basal insulin (within-group: 3.7% (95% CI: −2.0% to 9.7%)), P = 0.0007 between groups. Urinary excretion of 8-oxodG decreased more in the biphasic insulin group (within-group: −9.9% (95% CI: −14.4% to −5.2%)) than basal-bolus insulin (within group effect: −1.2% (95% CI: −6.1% to 3.9%)), P = 0.01 between groups, whereas no difference was observed compared with basal insulin. In conclusion, eighteen months of metformin treatment in addition to different insulin regimens increased RNA oxidation, but not DNA oxidation. Biphasic insulin decreased both RNA and DNA oxidation compared with other insulin regimens.

The effects of aerobic exercise plus spirulina polysaccharide supplement on learning and memory function of diabetes rats and its mechanism

Objective: To investigate the effects of aerobic exercise plus spirulina polysaccharide(SP) supplement on the related protein expressions of p75NTR signal in hippocampal and the improvement of learning and memory of type 2 diabetes rats. Methods: The model of type 2 diabetic rats was established by fed high-fat diet for four weeks together with intraperitoneal injecting a low dose of STZ. The model rats were randomly divided into diabetic model group(B),diabetic exercise group(C),diabetic+SP group(D)and diabetic exercise+SP group(E), another normal control group(A)without any intervention was set up,12 rats in each group. The rats in Group C and E were treated with intervention of swimming training for six weeks. The rats in Group D and E were treated with SP intragastrically for 6 weeks. Learning and memory abilities were observed by Morris water maze test. The hippocampus cell apoptosis was observed by Tunnel staining, and BDNF content and the expressions of p75NTR, cleaved caspase-3 of hippocampus were tested by ELISA, Western blot and immunohistochemistry, respectively. At the same time, the changes of blood glucose and levels of serum insulin were examined. Results: ①Compared with Group A at different time points, the body weight of Group B was decreased significantly(P＜0.01). Compared with Group B at different time points, the body weight of Group C,D and E had no difference (P＞0.05). Compared with Group A, levels of the blood glucose and serum insulin Group B were increased significantly(P＜0.01).Compared with Group B, the levels in the intervention groups were decreased significantly (P＜0.01); ②Compared with Group A, the escape latencies of Group B were prolonged significantly(P＜0.01), platform quadrant residence duration and the times of crossing platform were decreased (P＜0.01). Compared with Group B, the escape latencies of the intervention groups were shortened (P＜0.05 or P＜0.01), and the times of crossing platform were increased (P＜0.05 or P＜0.01). ③Compared with Group B, the neural cells apoptosis of the intervention rats was decreased, and the protein expressions of p75NTR and cleaved caspase-3 were decreased (P＜0.05 or P＜0.01), however the expression of BDNF was increased significantly (P＜0.05 or P＜0.01). Conclusion: Aerobic exercise and SP supplement can improve the learning-memory ability of type 2 diabetes rats, and the improvement effect of exercise combined with SP is markedly better than that of exercise and SP alone, the mechanism might be related to better regulating p75NTR signal related protein expressions and then inhibiting apoptosis in hippocampus of rats with type 2 diabetes.

Glycemic control and neonatal outcomes in women with gestational diabetes mellitus treated using glyburide, metformin, or insulin: a pairwise and network meta-analysis

AimsWe aimed to assess the comparative efficiency and safety of the use of glyburide, metformin, and insulin in gestational diabetes mellitus (GDM).MethodsWe searched for randomized controlled trials that compared glyburide, metformin, and insulin in GDM. Data regarding glycemic control and neonatal safety were collected and analyzed in pairwise and network meta-analyses.ResultsA total of 4533 individuals from 23 trials were included. Compared with glyburide, metformin reduced 2-h postprandial blood glucose (2HPG) to a greater extent (standard mean difference (SMD) 0.18; 95% credible interval (CI) 0.01, 0.34). There were significantly lower prevalence of neonatal hypoglycemia (risk difference (RD) − 0.07; 95%CI − 0.11, − 0.02) and preeclampsia (RD − 0.03; 95%CI − 0.06, 0) in the metformin group than in the insulin group. The metformin group had significantly lower birth weight (SMD − 0.17; 95%CI − 0.25, − 0.08) and maternal weight gain (SMD − 0.61; 95%CI − 0.86,− 0.35) compared with the insulin group. Network meta-analysis suggested that metformin had the highest probability of successfully controlling glycemia and preventing neonatal complications.ConclusionsThe present meta-analysis suggests that metformin may be as effective as insulin for glycemic control and is the most promising drug for the prevention of neonatal and maternal complications.

Differential effect of novel antidiabetic agents on the arterial stiffness and endothelial function in patients with type 2 diabetes mellitus

Abstract Background Arterial stiffness and endothelial function markers flag increased cardiovascular disease risk in patients with type 2 Diabetes Mellitus (T2DM). Purpose To investigate the effects of novel antidiabaetic agents on arterial stiffness and endothelial function in T2DM patients. Patients and methods We enrolled 80 consecutive patients under stable antidiabetic therapy who did not reach therapeutic targets. Subjects were assessed to receive an additional antidiabetic agent to optimize glucose control; dipeptidyl peptidase-4 inhibitor (DPP-4i, n=24), glucagon like peptide-1 receptor agonist (GLP-1RA, n=26), sodium/glucose cotransporter-2 inhibitor (SGLT-2i, n=21) or long lasting insulin (n=9). Glycosylated hemoglobin (Hba1c) along with carotid-femoral pulse wave velocity (PWV), augmentation index (Alx) and flow-mediated dialatation (FMD), as biomarkers of arterial stiffness and endothelial function accordingly, were measured at baseline and 3 months after treatment intensification. Results There were no differences between the study groups in traditional risk factors, or baseline HbA1c, PWV, Alx and FMD levels (ps=NS for all). All groups achieved better glycemic control in terms of HbA1c values between baseline and follow-up, as seen in the paired differences of these values (for DPP4i: 0.7±0.3%, for GLP-1RA: 1.3±0.7%, for SGLT-2i: 0.8±0.5% and for insulin 2.0±0.8%, p<0.001 for all). PWV showed a decrease from 10.0±0.84 to 9.1±0.43 m/sec (p=0.092) in the DPP4-i group, from 11.7±0.72 to 10.2±0.74 m/sec (p<0.001) in the GLP-1RA group, from 10.3±0.54 to 9.6±0.59 m/sec (p=0.001) in the SGLT-2i group and from 11.6±1.04 to 11.1±1.02 m/sec (p=0.219) in the insoulin group, as presented in Figure 1. Alx was also decreased from 34.2±1.89 to 31.5±2.7% (p=0.023) in the DPP-4i group, from 29.1±1.52 to 25.6±2.09% (p<0.001) in the GLP-1RA group, from 29.9±1.44 to 24.2±1.48% (p<0.001) in the SGLT-2i group and from 28.2±2.33 to 26.2±1.64% (p=0.153) in the insulin group, as presented in Figure 1, as well. Regarding FMD, a reduction in the values between groups from baseline to follow-up was also observed; from 5.33±1.3 to 5.50±1.1% (p=0.004) for the DPP-4i group, from 5.54±0.8 to 5.99±0.8% (p=0,001) for the GLP-1RA group, from 5.59±0.9 to 5.77±1.2% (p=0.005) for the SGLT-2i group and from 5.76±0.8 to 5.83±0.9% for the insulin group, as demonstrated in Figure 2. Limitations: Our results should be examined under the scope of limited data pool and its subsequent restrictions. Conclusion These preliminary data provide evidence that treatment intesification- particularly with GLP1-RA and SGLT-2i, benefits vascular properties, a finding which could partly explain the positive cardiovascular outcomes of recent randomized clinical trials in this field. Funding Acknowledgement Type of funding sources: None.

The effect of one year treatment with GLP1-RA, SGLT2i and their combination on plasma levels of oxidative and antioxidative biomarkers

Abstract Background/Introduction Biomarkers of oxidative stress burden are found increased in Type-2 diabetes mellitus (T2DM) patients. An imbalance between oxidative and antioxidative plasma factors is implicated in the pathway of cardiovascular disease in diabetics. Novel antidiabetic agents with cardioprotective effects are glucagon like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). Purpose We investigated the effect of liraglutide (GLP1-RA),empagliflozin (SGLT-2i) and their combination on plasma levels of oxidative and antioxidative factors. Methods A hundred-sixty T2DM patients were randomly assigned and received: a) insulin (n=40), b) liraglutide (n=40), c) empagliflozin (n=40) and d) the combination liraglutide and empagliflozin (n=40) for 1 year. We measured at baseline and after 1 year of treatment the following antioxidative markers: a) Reducing Power (RP), b) 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid (ABTS), c) Total Antioxidant Capacity (TAC) and also Thiobarbituric acid reactive substances (TBARS) as a marker of oxidative burden. Results After 1 year of treatment all subjects achieved successful glycemic regulation, as estimated by Hemoglobin A1c (HbA1c) levels (8±0.5 vs 6.65±0.5, p<0.05). Patients on the combination GLP1-RA + SGLT2i displayed greater reduction of TBARS (8.66±0.42 μmol/l vs 7.92±0.35 μmol/l, p<0.05) and increase of ABTS (17.49 ±0.63 mmol/l vs 19.14 ±0.64 mmol/l, p<0.05) compared with insulin-treated participants (8.85±0.41 μmol/l vs 8.83±0.44 μmol/l and 17.07 ±0.58 mmol/l vs 17.22 ±0.49 mmol/l, p=NS respectively). Patients treated on GLP1-RA or SGLT2i separately showed the same improving trend with the combination group in the abovementioned biomarkers but the changes were not so prominent. In the insulin group worsening of TAC was also noticed (0.92±0.02 mmol/l vs 0.89±0.01 mmol/l, p<0.05). In the other biomarkers nonsignificant changes were observed for all groups. Furthermore the absolute change of HbA1c was correlated with the relative change of TBARS (r=0.419, p<0.05) Conclusion One year treatment with the GLP1-RA liraglutide and SGLT2i empagliflozin resulted in improvement of plasma levels of oxidative and antioxidative biomarkers compared to administration of insulin and the changes were more outstanding in patients that received the combination of GLP1-RA and SGLT2i, despite similar glycemic regulation in all participants. Thus the favorable cardiovascular effects of these novel factors may be partly explained by alterations in equilibrium between oxidative and antioxidative circulating biomarkers. Funding Acknowledgement Type of funding sources: None.

Cardiac function in fetal and infants born to mothers with gestational diabetes

Abstract Background The intraventricular pressure differences (IVPD) IVPD using color M-mode is a specific marker in infants of mothers with gestational diabetes mellitus (GDM). (Circulation R 2019, 378–388). Purpose This study investigated the myocardial performance of fetuses in mothers with GDM under the new GDM definition. Method The study population comprised of 27 mothers with GDM and the fetus. Women with GDM were defined as those with a glucose metabolism abnormality that existed before or began during the current pregnancy and was diagnosed using OGTTs. The 5 mothers with type 1 or type 2 DM were receiving insulin before their pregnancy. Fetal echo measurements were performed about median gestational age 35 weeks. The primary outcomes were comparisons of the fetal myocardial performance of GDM with insulin administration and without administration using echocardiography with IVPD, and IVPG. The secondary outcome has investigated the relationships between echocardiography parameters, IVPD, and IVPG, and maternal factors. For all statistical analyses, P<0.05 was considered significant. Result In the insulin group was higher RV output (Fig. 2A). Maternal max HbA1c was observed to have a positive correlation with fetal RV output, significantly (Fig. 2B). Maternal max fasting blood glucose was observed to have a negative correlation with the Total, Basal and Mid to apical IVPD, significantly, respectively. Serial change of LV Total IVPD from fetal to after birth shown in Slide. In both groups, LV Total IVPD was increasing from fetal and after birth significantly. Conclusion The mechanism associated with the favorable systolic and diastolic performances in IGDMs is suggested to involve metabolic adaptations in the heart. In diabetic mice, these adaptations seem to prevent the heart from failing during conditions of pressure overload, suggesting a restoration of the balance between glucose and fatty acid utilization is beneficial for cardiac function. In fetal LV and RV-IVPD might be interacted the mother's blood sugar control. These indexes can predict the sensitive fetal and infant's cardiac dysfunction for GDM. Funding Acknowledgement Type of funding sources: None.

Effects of insulin on sperm cell quality in ram semen cooled at 5°C

Insulin is present in the seminal plasma and is involved in sperm activities like motility and capacitation. However, the effects of insulin on the viability of cooled ram sperm are not fully understood. Therefore, the objective of the current study was to evaluate the effect of insulin addition on ram sperm maintained at 5ºC. Sperm samples were collected from six healthy, mature Santa Inês rams. The ejaculates were divided into two aliquots with (insulin group) or without (control group) insulin (3 IU mL-1) in the semen extender, and then cooled at 5°C for 48 hours. Subsequently, the sperm cells were evaluated for motility and kinetics using computer-assisted semen analysis. The samples were evaluated for acrosomal integrity by fluorescein using isothiocyanate combined with peanut agglutinin (FITC-PNA) and membrane functionality by the hypoosmotic swelling test. The semen analysis was performed after 24 or 48 hours of cooling. There was an increased percentage of progressive sperm motility (%), straightness (%), linearity (%) and beat caudal frequency (Hz) in the insulin group after 24 and 48 hours of cooling (p < 0.05). However, insulin did not affect total sperm motility, sperm velocities (VSL, VAP and VCL) (μm seg-1), acrosomal integrity and membrane functionality during cooling (p > 0.05). In conclusion, the addition of 3 IU mL-1 insulin to ram semen extender improved the quality of sperm motility after cooling.

A comparative study between topical short and long-acting insulin preparations in management of wounds in diabetic patients

Wounds of diabetic patients often require weeks of adequate and appropriate care for full recovery. The use of systemic insulin in diabetic patients was reported to enhance wound healing. Thus, the present study was conducted to evaluate the effect of topical insulin on diabetic wounds. Our objective was to compare the effectiveness of topical short and long acting insulin combined with standard wound dressings in healing of wounds in diabetic patients. Thirty adult patients of both sexes from the outpatient settings of the General and Plastic surgery wards at Minia University Hospital were included in the study. Patients were assigned into three groups; control, patients applying short acting insulin and those applying long-acting insulin. The wounds were compared for healing time, inflammation and pain at days 0, 14, and 21. The mean age of patients included in the study was 58.9±5.3 years. The unit healing time for diabetic control group was 25.1±22.9 which was significantly higher than the two other groups (10.02±5.4 and 5.1±2.4, respectively) with no significant difference between topical short and long-acting insulin applying groups. Upon scoring of wounds, the long acting score of the short acting insulin was significantly lower than the control group at day 14 (p=0.001) while both topical insulin groups showed significantly reduced scores at day 21 compared to the control group (p=0.001 and p=0.009 for short and long-acting insulin, respectively). Both topical insulin treatments resulted in an acceleration of the wound healing process with no significant difference between short and long-acting insulin.

The effects of insulin therapy on maternal blood pressure and weight in women with gestational diabetes mellitus

BackgroundAlthough insulin therapy achieves effective glycemic control, it may aggravate hyperinsulinemia. Nonetheless the benefits of insulin as first-line treatment for women with GDM are controversial. This work aimed to investigate the effect of insulin on maternal GDM.MethodsThis retrospective cohort study recruited 708 women with GDM of whom 616 underwent lifestyle intervention and 92 were prescribed insulin therapy. Differences in variables between the two groups were analyzed by univariate analysis and multivariate analysis. Propensity score matching was used to control for age, pre-pregnancy BMI, time and BP at GDM diagnosis, and family history of diabetes and hypertension. Paired sample test was applied to evaluate the changes in BP after intervention in the two groups of women.ResultsThere was no significant difference in mode of delivery, newborn weight or incidence of macrosomia between women prescribed insulin and those who adopted lifestyle modifications. Insulin therapy was associated with a slight increase in maternal weight compared with the lifestyle intervention group and was attributed to short-term treatment (about 12 weeks). In addition, insulin therapy remarkably increased maternal blood pressure, an effect that persisted after matching age, pre-pregnancy BMI, time and BP at GDM diagnosis, and family history of diabetes and hypertension. Between commencing insulin therapy and delivery, systolic blood pressure significantly increased by 6mmHg (P = 0.015) and diastolic blood pressure by 9 mmHg (P < 0.001). Increase in BP was significantly higher in the insulin group compared with the lifestyle intervention group (P < 0.001). Logistic regression analysis with enter selection confirmed that insulin therapy was closely correlated with development of gestational hypertension (GH).ConclusionsThis work suggested that short-term insulin therapy for GDM was associated with a slight increase in maternal weight but a significant risk of increasing maternal blood pressure.

Comparative study of neonatal and maternal adverse outcomes in women with gestational diabetes mellitus followed or treated with insulin versus dietary regimen

Aim: Primary aim of this study is to compare the neonatal and maternal complications of women with Gestational Diabetes Mellitus (GDM) treated with insulin or followed by diet. Secondary aim is to evaluate the rate of cesarean section and indications of that.&#x0D; Methods: Women with GDM were divided into two groups as insulin (n=110) and diet (n=200). Demographic data, antenatal follow-up measurements, gestational week at birth and type of delivery were recorded. Neonatal complications (neonatal intensive care admission, shoulder dystocia, hypoglycemia, low apgar score) and maternal complications (thrombosis, hypoglycemia and cellulitis) were recorded. Total and primary cesarean section rates were calculated by dividing them according to indications. Statistical analysis between groups was performed.&#x0D; Results:&#x0D; Age and body mass index were not statistically significant in both groups. Low apgar score, admission to neonatal intensive care, postpartum maternal complications and primary cesarean section rate were statistically significantly higher in the insulin group compared to the diet group (p

Вплив тяжкості стеатозу підшлункової залози на перебіг неалкогольної жирової хвороби підшлункової залози в дiтей

Актуальність. Неалкогольна жирова хвороба підшлункової залози — надлишкове накопичення жиру в підшлунковій залозі, асоційоване з ожирінням, при виключенні вторинної етіології стеатозу. Неалкогольна хвороба печінки може мати прогредієнтний перебіг. Чи супроводжується прогресування неалкогольної жирової хвороби підшлункової залози специфічними структурними та лабораторними змінами, залишається неясним. Мета: встановити особливості сонологічних та лабораторних змін у дітей iз неалкогольною жировою хворобою підшлункової залози залежно від ступеня стеатозу. Матеріали та методи. Ми спостерігали 93 дітей віком від 7 до 17 років, середній вік 11,87 ± 2,82 року. Ступінь стеатозу підшлункової залози оцінювали за допомогою ультрасонографії. Пацієнтам проводили зсувнохвильову еластографію і стеатометрію (кількісну оцінку ступеня загасання ультразвуку з визначенням середнього коефіцієнта загасання ультразвуку (КЗУ)) підшлункової залози за допомогою апарату Ultima PA Expert («Радмір», Україна). Фіброз та стеатоз печінки були діагностовані з використанням апарату FibroScan 502 Touch (Франція) з функцією контрольованого параметра ультразвукового загасання (КПУЗ). Діти були розділені на наступні групи: 1-ша група — 50 пацієнтів зi стеатозом підшлункової залози й ожирінням/надмірною вагою; ця група була розділена на підгрупи: S1 — 20 осіб iз 1-м ступенем стеатозу підшлункової залози; S2 — 22 пацієн­ти з 2-м ступенем стеатозу підшлункової залози, S3 — 8 хворих iз 3-м ступенем стеатозу підшлункової залози; 2-га група — 30 пацієнтів без стеатозу підшлункової залози з ожирінням/надмірною вагою, 3-тя (контрольна) група — 13 дітей iз нормальною вагою. Пацієнтам були проведенi загальноклінічний аналіз крові з визначенням швидкості осідання еритроцитів (ШОЕ), біохімічна гепатограма (аланінамінотрансфераза (AЛТ), аспартатамінотрансфераза (АСТ), гамма-глутамілтранспептидаза (ГГТП), амілаза крові). Рівень інсуліну визначали за допомогою імуноферментного аналізу з розрахунком індексу інсулінорезистентності HOMA. Статистичний аналіз проводився з використанням програмного забезпечення Statistica 7.0 за допомогою дисперсійного аналізу (ANOVA) з наступним post hoc аналізом. Результати. У дітей групи S3 порівняно з контрольною групою продемонстровано більш високий рівень ШОЕ — в 1,86 раза (р = 0,01), АЛТ — в 1,86 (р = 0,006), АСТ — в 1,96 (р = 0,00019), ГГТП — в 2,10 раза (р = 0,0001). Ми виявили, що пацієнти зi стеатозом підшлункової залози мали більш високий рівень інсуліну порівняно з контрольною групою (підгрупа S1 — 18,38 ± 5,07 мкОД/мл, S2 — 30,76 ± 3,92 мкОД/мл, S3 — 33,70 ± 5,37 мкОд/мл; 2-га група — 18,70 ± 2,98 мкОд/мл; 3-тя група — 9,480 ± 5,067 мкОд/мл (р = 0,00262)). Також у пацієнтiв зi стеатозом підшлункової залози відмічено більш високий індекс HOMA порівняно з конт­рольною групою (S1 — 4,04 ± 0,87, S2 — 7,11 ± 0,96, S3 — 7,99 ± 1,35; 2-га група — 3,81 ± 0,73; 3-тя група — 1,94 ± 0,92 (p = 0,00156)). КПУЗ був підвищеним у дітей зi стеатозом підшлункової залози порівняно з конт­рольною групою (підгрупа S1 — 234,50 ± 9,94 дБ/м, S2 — 239,05 ± 8,99 дБ/м, S3 — 245,33 ± 17,21 дБ/м; 2-га група — 197,87 ± 7,70 дБ/м; 3-тя група — 172,754 ± 12,170 дБ/м (p = 0,00156)). КЗУ сягав максимальних рівнів у дітей підгрупи S3 (S1 — 2,55 ± 0,08 дБ/см, S2 — 2,56 ± 0,09 дБ/см, S3 — 2,74 ± 0,14 дБ/см; 2-га група — 2,26 ± 0,08 дБ/см; 3-тя група — 1,72 ± 0,15 дБ/см (р = 0,00001)). Пацієнти зі стеатозом підшлункової залози мали вищий рівень жорсткості печінки та підшлункової залози, проте значущість відмінностей була недостатньою. Висновки. Дослідження показало, що неалкогольна жирова хвороба підшлункової залози в дітей супроводжується стеатозом печінки, зростанням рівня маркерів запалення та інсулінорезистентності, що збільшуються при зростанні ступеня ­стеатозу.

Association between diabetes status and subsequent onset of glaucoma in postmenopausal women

The purpose of this study was to analyze the risk of glaucoma based on diabetes status using a large nationwide longitudinal cohort of postmenopausal women. This study included 1,372,240 postmenopausal women aged ≥ 40 years who underwent National Health Screening Program in 2009. Subjects were classified into the following 5 categories based on diabetes status: no diabetes, impaired fasting glucose (IFG), new onset diabetes, diabetes treated with oral hypoglycemic medication, and diabetes treated with insulin. Subjects were followed from 2005 through 2018, and hazard ratios of glaucoma onset were calculated for each group. Subgroup analyses of subjects stratified by age, smoking, drinking, hypertension, and dyslipidemia were performed. During the follow up period, 42,058 subjects developed glaucoma. The adjusted hazard ratio was 1.061 (95% CI, 1.036–1.086) in the IFG group, 1.151 (95% CI, 1.086–1.220) in the new onset diabetes group, 1.449 (95% CI, 1.406–1.493) in the diabetes treated with oral hypoglycemic medication group, and 1.884(95% CI, 1.777–1.999) in the diabetes treated with insulin group compared to the no diabetes group. The results were consistent in subgroup analyses after stratifying by age, lifestyle factors (smoking and drinking), and comorbidities (hypertension and dyslipidemia). Diabetes status is associated with increased risk of glaucoma development in postmenopausal women.

Effects of Different Glucose-Lowering Measures on Maternal and Infant Outcomes in Pregnant Women with Gestational Diabetes: A Network Meta-analysis.

IntroductionA network meta-analysis was conducted to compare and rank the effects of different glucose-lowering measures on maternal and infant outcomes in pregnant women with gestational diabetes mellitus (GDM).MethodsWe searched the PubMed, CNKI, Embase, Cochrane Library, Wanfang, and Weipu databases for relevant studies published between database establishment and June 2021. Study retrieval involved subject-heading and keyword searches. Randomized controlled trials (RCTs) with different glucose-lowering treatments for GDM patients were included. The Cochrane tool was used to assess bias risk. Pairwise and network meta-analyses were used to compare and rank the effects of different hypoglycemic measures on maternal and infant outcomes in pregnant women with GDM.ResultsWe included 41 RCTs involving 6245 pregnant women with GDM. Patients treated with insulin had a higher incidence of neonatal intensive care unit (NICU) occupancy (1.3, 95% CI 1.0–1.7) than those treated with metformin. The insulin (1.5, 95% CI 1.1–2.1 and 1.8, 95% CI 1.0–3.3) and glyburide (2.0, 95% CI 1.2–3.2 and 2.5, 95% CI 1.1–8.4) groups exhibited higher incidences of neonatal hypoglycemia and large for gestational age (LGA) newborns than the metformin group. The glyburide group exhibited a lower probability of cesarean section than the metformin (0.76, 95% CI 0.55–1.0) and insulin (0.71, 95% CI 0.52–0.96) groups. Preeclampsia incidence in the diet and exercise groups was significantly lower than in the metformin (0.19, 95% CI 0.043–0.72) and insulin (0.15, 95% CI 0.032–0.52) groups. No intervention significantly reduced the incidences of macrosomia, preterm birth, gestational hypertension, or respiratory distress syndrome (RDS). The ranking results showed that the metformin group had the lowest rates of neonatal hypoglycemia, macrosomia, LGA, and NICU occupancy. The glyburide group had the lowest NICU occupancy and cesarean section rates and the highest neonatal hypoglycemia, LGA, preeclampsia, and gestational hypertension rates. The diet and exercise group had the lowest preterm delivery and preeclampsia rates and the highest NICU occupancy rate.ConclusionMetformin is a potentially superior choice for GDM treatment because it is associated with minimal incidences of multiple adverse pregnancy outcome indicators and does not lead to high values of certain adverse outcome indices. Other hypoglycemic agent or diet groups exhibit high incidences of certain adverse outcomes. Therefore, when selecting a GDM treatment strategy, the efficacies and risks of different treatment programs should be evaluated according to the scenario in hand.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01142-7.

Maternal serum sortilin levels in gestational diabetes mellitus

Objective To evaluate the serum sortilin levels in pregnant women with gestational diabetes mellitus (GDM) and to compare the results with normoglycemic healthy pregnant women and observe the relationship between serum sortilin levels and biochemical parameters. Methods This case–control study consisted of 55 pregnancies with GDM and 32 healthy singleton pregnancies matched for maternal and gestational age. The maternal serum levels of sortilin were measured with enzyme-linked immunosorbent assay and compared between groups. Results Sortilin levels were significantly higher in GDM group (5.52 ± 3.19 ng/mL versus 3.30 ± 1.47 ng/mL, p < .001). Pairwise comparisons showed that both the diet group and insulin group had significantly higher serum sortilin levels than the control group (p: .022 and p: .002, respectively). Maternal serum sortilin levels were significantly positively correlated with serum insulin levels, homeostasis model assessment of insulin resistance (HOMA-IR) and glycated hemoglobin values (r: 0.277, p: .012, r: 0.306, p: .005, r: 0.267, p: .012, respectively). Conclusions Serum sortilin levels were significantly higher in women with GDM compared to the control group and were positively correlated with insulin, HOMA-IR and glycated hemoglobin levels. The present results point to the role of sortilin in glucose homeostasis and suggest that it may be a novel marker for GDM.

12주간 복합운동이 성인 비만남성의 신체조성, 혈압, 인슐린저항성 및 CRP에 미치는 영향

The purpose of this study is to find out the effects of combined exercise on body composition, blood pressure, insulin resistance and CRP in adult obese men. For obese men in their 30s, a total of 20, experiments (n=10) and controls (n=10) For 12 weeks, 1-6 weeks (50-70% HRR) was set to a kinetic strength of (60-80% HRR) of 7-12 weeks. After calculating the mean value (M) and the standard deviation (M±SD) for the measurement variable, Verification of differences in the mean values of the pre and post in the group is based on the paired t-test, Test of main effects for differences between groups and intergroup and time-to-period interaction effects (repeated-measured ANOVA).<BR> Analysis of body composition, blood pressure, insulin resistance, and CRP after complex exercise resulted in the following conclusions. Body composition significantly reduced %BF in the exercise group and increased LBM. SBP and DBP significantly decreased in the exercise group, significantly decreased in the insulin, glucose, HOMA-IR, and CRP exercise group, and significantly increased HOMA-IR in the control group. As a result of this, participation in 12-week combined exercise has a positive effect on body composition, blood pressure, insulin resistance, and CRP, and it is believed that combined exercise has had a positive effect on obesity improvement and prevention of obese men in their 30s.

Study of serum lipid profile and serum lipo-protein (a) in type II diabetes mellitus patients compared to non-diabetics

Background: This study helps us in evaluating present Indian scenario of lipid and diabetic portfolio, and advices about how aggressive treatment should be for immediate control of blood sugars and lipids are to minimize the cardiovascular risks. The objective of this study was to evaluate the serum lipid profile and lipo-protein (a) levels in comparison to patients with type II diabetics with non-diabetics.Methods:It was a hospital-based case control study conducted on patients presenting with signs and symptoms of diabetes mellitus and confirmed on doing appropriate investigation. 200 patients of which 100 were non-diabetic (control) and 100 type II diabetic patients, of which fifty were type II diabetics were on oral hypoglycemic agents (OHA) and 50 were on insulin only, were selected after matching for age and sex. Lipid profile, serum lipoprotein (a), ECG, 2D echo was studied in these patients.Results: The males were more (74%) than females (26%) among the cases. Fasting blood sugar, post prandial blood sugar and HbA1c were significantly more in cases. Triglycerides, LDL, VLDL and lipoprotein (a) were significantly more in cases. ST shift (mm) and T wave inversions were significantly more in cases compared to controls (p&lt;0.05). Mean ejection fraction was significantly reduced in cases compared to controls. FBS and PPBS were not significantly different in two groups of OHA and insulin but HbA1c was significantly better controlled in insulin group than OHA group.Conclusions:Lipid profile and lipoprotein (a) as well as ECG and 2D echo parameters were significantly worse in diabetes patients. Hence appropriate management is important to prevent risk of complications.

Comparison of the efficacy of topical insulin with autologous serum eye drops in persistent epithelial defects of the cornea.

To investigate the effect of topical insulin on epithelization in persistent epithelial defects (PED) refractory to usual treatment compared to autologous serum. Retrospective, consecutive case-control series. The charts of 61 consecutive patients with PED treated with topical insulin (case group) and 23 treated with autologous serum (control group) were reviewed. Primary efficacy end points were the percentage of patients in which epithelization was achieved, as well as the rate and time until epithelization. Secondary efficacy point was need for amniotic membrane transplantation (AMT) or other surgeries. Mean time between PED diagnosis and start of topical insulin was 22.7 ± 18.5 days (range 13-115) and the mean area was 14.8 ± 16.2 mm2 (range 1.1-70.6). In the control group, mean time was 27.9 ± 16.8 days, mean epithelial defect area being 18.6 ± 15.0 mm2 (range 1.7-52.9). No differences in baseline characteristics were found between groups (p > 0.05). Epithelization was achieved in 51 patients (84%) on insulin and 11 patients (48%) on autologous serum (p = 0.002). In those patients, mean time until reepithelization was 32.6 ± 28.3 days (range 4-124) in the insulin group and 82.6 ± 82.4 days (range 13-231) in the autologous serum group (p = 0.011). The need for AMT was significantly lower in the insulin group (p = 0.005). PED recurrence was higher in patients treated on autologous serum (43%) compared with insulin (11%) (p = 0.002). Topical insulin is an effective treatment and safely promotes healing of PED. In our series, topical insulin presented better epithelization outcomes than autologous serum and could thus be considered as a first-line treatment.

Efficacy and Safety of Empagliflozin Continuation in Patients with Type 2 Diabetes Hospitalised for Acute Decompensated Heart Failure.

There is little evidence on the use of sodium−glucose cotransporter 2 inhibitors in hospitalised patients. This work aims to analyse the glycaemic and clinical efficacy and safety of empagliflozin continuation in patients with type 2 diabetes hospitalised for acute decompensated heart failure. This real-world observational study includes patients treated using our in-hospital antihyperglycaemic regimens (basal-bolus insulin vs. empagliflozin-basal insulin) between 2017 and 2020. A propensity matching analysis was used to match a patient on one regimen with a patient on the other regimen. Our primary endpoints were the differences in glycaemic control, as measured via mean daily blood glucose levels, and differences in the visual analogue scale dyspnoea score, NT-proBNP levels, diuretic response, and cumulative urine output. Safety endpoints were also analysed. After a propensity matching analysis, 91 patients were included in each group. There were no differences in mean blood glucose levels (152.1 ± 17.8 vs. 155.2 ± 19.7 mg/dL, p = 0.289). At discharge, NT-proBNP levels were lower and cumulative urine output greater in the empagliflozin group versus the basal-bolus insulin group (1652 ± 501 vs. 2101 ± 522 pg/mL, p = 0.032 and 16,100 ± 1510 vs. 13,900 ± 1220 mL, p = 0.037, respectively). Patients who continued empagliflozin had a lower total number of hypoglycaemic episodes (36 vs. 64, p < 0.001). No differences were observed in adverse events, length of hospital stay, or in-hospital deaths. For patients with acute heart failure, an in-hospital antihyperglycaemic regimen that includes continuation of empagliflozin achieved effective glycaemic control, lower NT-proBNP, and greater urine output. It was also safer, as it reduced hypoglycaemic episodes without increasing other safety endpoints.