Intensive Blood Glucose Control Research Articles

Insulin therapy in insulin resistance: Could it be part of a lethal pathway?

Insulin therapy in insulin resistance: Could it be part of a lethal pathway?

A Practitioner's Simple Mnemonic for Managing Diabetes: “GLUCOSE BAD”

Diabetes is a chronic disease resulting from defects in insulin production, insulin action, or both, which ultimately can lead to elevated blood glucose levels, causing serious health complications and premature death. Diabetes is the seventh leading cause of death in the US and contributes to many complications, including eye, kidney, and heart disease, and lower limb amputation. The Diabetes Control and Complications and the Epidemiology of Diabetes Interventions and Complications trials have shown that, with intensive therapy and optimal blood glucose control, there is a reduction in complications, leading to the development of clinical guidelines for the management of diabetic patients. The “GLUCOSE BAD” mnemonic can assist the practitioner in remembering those guidelines.

The research progress of astragalus in regulating blood glucose steady state of diabetes patients

In recent decades, the mortality and morbidity of diabetes have increased such that it is becoming a major worldwide public health problem. Intensive blood glucose control could significantly raise the patients life and their survival quality nevertheless it develops hypoglycaemia. Repeated hypoglycemia leads to glucose conterregulate deficiencyand hamper reaching glucose target goals. Astragalus, a traditional Chinese herb used in diabetic therapy for thousands years, has also proven its glucose counterregulationeffect on preventing hypoglycemia. Here, we summarize its glycemic regulation mechanism in different extracts. It is projected that the efficacy and safety of astragalus extracts will be proven in clinical trials and animal experiments in future, and this herb extract might be known as a new class of anti-diabetic drug without hypolycemia danger. Key words: Diabetic Mellitus; Hypoglycemia; Astragalus

Exome sequencing identifies novel ApoB loss-of-function mutations causing hypobetalipoproteinemia in type 1 diabetes

Diabetic patients commonly suffer from disturbances in production and clearance of plasma lipoproteins, known as diabetic dyslipidemia, resulting in an increased risk of coronary heart disease. The study aimed to examine the cause of hypobetalipoproteinemia in two patients with type 1 diabetes. The Diabetes Control and Complications Trial (DCCT) is a study demonstrating that intensive blood glucose control delays the onset and progression of type 1 diabetes complications. Hypobetalipoproteinemia was present in two DCCT subjects, IDs 1427 and 1078, whose LDL-C levels were 36 and 28 mg/dL, respectively, and triglyceride levels were 20 and 28 mg/dL, respectively. We performed exome sequencing on genomic DNA from the two patients with hypobetalipoproteinemia. The subjects 1427 and 1078 had heterozygous loss-of-function mutations in the gene apolipoprotein B (ApoB), and these mutations resulted in premature stop codons at amino acid 1333 (ApoB-29) and 3680 (ApoB-81), respectively. Indeed, the plasma ApoB level of subject 1427 (19 mg/dL) was the lowest and that of subject 1078 (26 mg/dL) was the second to the lowest among all the 1,441 DCCT participants. Sequencing genomic DNA of family members showed that probands 1427 and 1078 inherited the mutations from the father and the mother, respectively. The identification of ApoB loss-of-function mutations in type 1 diabetic patients presents innovative cases to study the interaction between hypobetalipoproteinemia and insulin deficiency.

Spatial patterns of structural brain changes in type 2 diabetic patients and their longitudinal progression with intensive control of blood glucose.

OBJECTIVEUnderstanding the effect of diabetes as well as of alternative treatment strategies on cerebral structure is critical for the development of targeted interventions against accelerated neurodegeneration in type 2 diabetes. We investigated whether diabetes characteristics were associated with spatially specific patterns of brain changes and whether those patterns were affected by intensive versus standard glycemic treatment.RESEARCH DESIGN AND METHODSUsing baseline MRIs of 488 participants with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) study, we applied a new voxel-based analysis methodology to identify spatially specific patterns of gray matter and white matter volume loss related to diabetes duration and HbA1c. The longitudinal analysis used 40-month follow-up data to evaluate differences in progression of volume loss between intensive and standard glycemic treatment arms.RESULTSParticipants with longer diabetes duration had significantly lower gray matter volumes, primarily in certain regions in the frontal and temporal lobes. The longitudinal analysis of treatment effects revealed a heterogeneous pattern of decelerated loss of gray matter volume associated with intensive glycemic treatment. Intensive treatment decelerated volume loss, particularly in regions adjacent to those cross-sectionally associated with diabetes duration. No significant relationship between low versus high baseline HbA1c levels and brain changes was found. Finally, regions in which cognitive change was associated with longitudinal volume loss had only small overlap with regions related to diabetes duration and to treatment effects.CONCLUSIONSApplying advanced quantitative image pattern analysis methods on longitudinal MRI data of a large sample of patients with type 2 diabetes, we demonstrate that there are spatially specific patterns of brain changes that vary by diabetes characteristics and that the progression of gray matter volume loss is slowed by intensive glycemic treatment, particularly in regions adjacent to areas affected by diabetes.

Optimizing clinical outcomes resulting from glucose‐lowering therapies in type 2 diabetes: increased confidence about the DPP‐4 inhibitors and continued concerns regarding sulphonylureas and exogenous insulin

Optimizing clinical outcomes resulting from glucose‐lowering therapies in type 2 diabetes: increased confidence about the <scp>DPP</scp>‐4 inhibitors and continued concerns regarding sulphonylureas and exogenous insulin

Celebrating 30 years of research accomplishments of the diabetes control and complications trial/epidemiology of diabetes interventions and complications study.

The landmark Diabetes Control and Complications Trial (DCCT) and its follow-up study, the Epidemiology of Diabetes Interventions and Complications (EDIC), have changed the way that type 1 diabetes is treated, and have led to improvements in the health and quality of life of people with the disease. In this Perspective, we look back at the 30 years since the start of DCCT to celebrate the scientific achievements of the DCCT/EDIC study group and patient volunteers—achievements that have had far-reaching benefits for type 1 diabetes and beyond. The insights that continue to emerge from DCCT/EDIC underscore the importance of supporting long-term research on chronic diseases such as type 1 diabetes. We also describe factors that contributed to the success of DCCT/EDIC, its public health implications, and how results continue to inform current-day research directions supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH). A complementary Perspective from the DCCT/EDIC investigators summarizes the methods, and results, and clinical implications of these seminal studies (1). In the late 1970s to the early 1980s, there was considerable debate about whether the potential benefits of intensive glycemic control in reducing the development of diabetes complications outweighed the risks of hypoglycemia (2–4). The studies done before the DCCT were small and short in duration and had enrolled subjects with preexisting retinopathy, thus failing to resolve the controversy about the risks and benefits of intensive treatment or to address primary prevention. Moreover, some studies in individuals with established eye disease showed an early worsening of retinopathy with intensive blood glucose control (5–7). Delineation of the natural history of the preproliferative phases of diabetic retinopathy in conventionally treated type 1 diabetes and validation of retinal photography as an outcome measure provided the …

Are concomitant treatments confounding factors in randomized controlled trials on intensive blood-glucose control in type 2 diabetes? a systematic review.

BackgroundOpen-label, randomized controlled trials (RCTs) are subject to observer bias. If patient management is conducted without blinding, a difference between groups may be explained by other factors than study treatment. One factor may come from taking concomitant treatments with an efficacy on the studied outcomes. In type 2 diabetes, some antihypertensive or lipid-lowering drugs are effective against diabetic complications. We wanted to determine if these concomitant treatments were correctly reported in articles of RCTs on type 2 diabetes and if they might have influenced the outcome.MethodsWe performed a systematic review using Medline, Embase, and the Cochrane Library (from January 1950 to July 2010). Open-label RCTs assessing the effectiveness of intensive blood-glucose control in type 2 diabetes were included. We chose five therapeutic classes with proven efficacy against diabetes complications: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor antagonists (AIIRAs), fibrates, statins, and aspirin. Differences between concomitant treatments were considered statistically significant when p < 0.05.ResultsA total of eight open-label RCTs were included, but only three (37.5%) of them published concomitant treatments. In two studies (ACCORD and ADVANCE), a statistically significant difference was observed between the two groups for aspirin (p = 0.02) and ACEIs (p = 0.02).ConclusionsFew concomitant treatments were published in this sample of open-label RCTs. We cannot completely eliminate an observer bias for these studies. This bias probably influenced the results to an extent that has yet to be determined.

Effects of intensive control of blood glucose and blood pressure on microvascular complications in patients with type II diabetes mellitus.

To evaluate the effects of intensive control of blood glucose and blood pressure on microvascular complications in patients with type II diabetes by comparing the therapeutic effects of intensive and standard treatment in patients with type II diabetes. A total of 107 patients with type II diabetes were randomly assigned into intensive and standard treatment groups. Patients in the intensive treatment group received preterax (perindopril/ indapamide) to control blood pressure, and gliclazide (diamicron) MR to control blood glucose. Patients in the standard treatment group received routine medications or placebo. Urinary microalbumin (UMA), urinary creatinine (UCR), the UMA/UCR ratio, and visual acuity were monitored according to the study design of the ADVANCE trial. Direct ophthalmoscopy and seven-field stereoscopic retinal photography were used to examine the fundi at baseline, and repeated after 5 years of treatment. The characteristics of patients in both groups were well balanced at baseline. After 5 years of treatment, visual acuity was found to be decreased in the standard group (P=0.04), but remained stable in the intensive group. The severity of diabetic retinopathy had not progressed in patients in the intensive group, but had deteriorated in the standard group (P=0.0006). The UMA/UCR ratio was not obviously changed in patients in the intensive group, whereas it was significantly increased in the standard group (P=0.00). Intensive control of blood glucose and blood pressure can decrease the incidence or slow the progression of microvascular complications in patients with type II diabetes, and maintain stable vision.

Targets for Glycemic Control

Targets for Glycemic Control

Mechanism-based antioxidant therapies promise to prevent diabetic complications?

Intensive blood glucose control can prevent the initiation and progression of diabetic complications. However, the impacts of intensive therapy against diabetic complications might be limited, because of difficulty in maintaining blood glucose concentrations close to the normal range or other unknown reasons. Thus, another approach based on the elucidation of mechanisms of diabetic complications might be required to prevent the progression of the complications.

Effects of the Endpoint Adjudication Process on the Results of a Randomised Controlled Trial: The ADVANCE Trial

BackgroundEndpoint adjudication committees (EPAC) are widely used in clinical trials. The aim of the present analysis is to assess the effects of the endpoint adjudication process on the main findings of the ADVANCE trial (Trial registration: ClinicalTrials.gov NCT00145925).Methods and FindingsThe ADVANCE trial was a multicentre, 2×2 factorial randomised controlled trial of blood pressure lowering and intensive blood glucose control in 11140 patients with type 2 diabetes. Primary outcomes were major macrovascular (nonfatal myocardial infarction, nonfatal stroke and cardiovascular death) and microvascular (new or worsening nephropathy and retinopathy) events. Suspected primary outcomes were initially reported by the investigators at the 215 sites with subsequent adjudication by the EPAC. The EPAC also adjudicated upon potential events identified directly by ongoing screening of all reported events. Over a median follow-up of 5 years, the site investigators reported one or more primary outcomes among 2443 participants. After adjudication these events were confirmed for 2077 (85%) with 48 further events added through the EPAC-led database screening process. The estimated relative risk reductions (95% confidence intervals) in the primary outcome for the blood pressure lowering comparison were 8% (−1 to 15%) based on the investigator-reported events and 9% (0 to 17%) based on the EPAC-based events (P for homogeneity = 0.70). The corresponding findings for the glucose comparison were 8% (1 to 15%) and 10% (2% to 18%) (P for homogeneity = 0.60). The effect estimates were also highly comparable when studied separately for macrovascular events and microvascular events for both comparisons (all P for homogeneity>0.6).ConclusionsThe endpoint adjudication process had no discernible impact on the main findings in ADVANCE. These data highlight the need for careful consideration of the likely impact of an EPAC on the findings and conclusions of clinical trials prior to their establishment.

Nonalcoholic fatty liver disease and microvascular complications in type 2 diabetes

To evaluate the correlation between nonalcoholic fatty liver disease (NAFLD) and microvascular complications in type 2 diabetes mellitus (T2DM). Data were obtained from 1217 inpatients with T2DM (757 females, 460 males; aged 63.39 ± 12.28 years). NAFLD was diagnosed by hepatic ultrasonography. Diabetic nephropathy (DN), diabetic peripheral neuropathy (DPN), and diabetic retinopathy (DR) were diagnosed according to their respective criteria. The prevalence of NAFLD and the independent correlations of clinical characteristics with NAFLD were determined by cross-tabulation and logistic regression, respectively. Approximately 61% of inpatients with T2DM in Qingdao, China had NAFLD, which decreased significantly with increase in age and prolonged course of diabetes. The prevalence of NAFLD in patients presenting with DN, DPN and DR was 49.4%, 57.2% and 54.9%, respectively. These rates were significantly lower than those of patients without DN, DPN and DR (65.9%, 65.6% and 66.1%, respectively, P < 0.05). Participants with NAFLD had greater body weight, waist circumference (WC), body mass index (BMI), fasting blood glucose (FBG), hemoglobin A1c, alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, blood pressure, as well as triglyceride (TG) levels and lower high-density lipoprotein (HDL) concentration than those without NAFLD (P < 0.05). NAFLD was positively correlated with BMI, WC, TG, FBG, diastolic blood pressure, and systolic blood pressure but negatively correlated with the duration of diabetes, DR, DPN, DN, and HDL. Despite the benign nature of NAFLD, efforts should be directed toward early diagnosis, intensive blood glucose and blood pressure control, and effective dyslipidemia correction.

Intensive Glucose Control in Diabetics with an Acute Myocardial Infarction Does not Improve Mortality and Increases Risk of Hypoglycemia-A Meta-Regression Analysis

Some early trials comparing intensive glucose control in type 2 diabetics with an acute myocardial infarction (MI) reported a decrease in mortality over a short period of follow up leading to a presumption of improved survival with intensive glucose control. Later data refuted this hypothesis. The 2009 ACC/AHA focused update on ST elevation MI gave a weak recommendation for the use of an insulin based regimen to achieve and maintain blood glucose less than 180 mg/dL. We decided to assess the validity of this recommendation.The authors searched the Pub- Med, Cochrane CENTRAL and EMBASE databases for randomized controlled trials from 1965 through 2011.Trials included were direct head-to-head comparisons of an intensive blood glucose control strategy using pharmacological means (insulin in most cases) with a less intensive regimen. The primary outcome assessed was the risk of all -cause mortality in the two groups at the end of follow up. Also assessed was the rate of hypoglycemia. The methodological quality of the studies was assessed. Event rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) using a random effects model (Mantel-Haenszel) assuming inter-study heterogeneity. Statistical analysis was done with Review Manager V5.1 and SYSTAT. Meta-regression was done with duration of therapy as covariate.Three studies (total N = 2113) met the inclusion exclusion criteria. Mortality was not different between the groups (RR 0.94, 95% CI of 0.66-1.34; p=0.73.). Rate of hypoglycemia was significantly higher in the intensive glucose control group (RR 13.40, 95% CI 3.69-48.61; p < 0.01), with a 12% absolute risk increase and a number needed to harm (NNH) of 9 (95% CI 6.8- 9.8)-even without achieving target glycemic control. Neither did intensive control improve CHF, arrhythmias and reinfarction rates. Meta regression revealed that mortality with intensive glycemic control was worse with increased duration of therapy (p=0.001, for trend).This systematic review suggests limited benefit of intensive glycemic control in type 2 diabetics with an MI, with a significant risk of serious hypoglycemia.

Intensive Glucose Control in Diabetics with an Acute Myocardial Infarction Does not Improve Mortality and Increases Risk of Hypoglycemia-A Meta-Regression Analysis

Some early trials comparing intensive glucose control in type 2 diabetics with an acute myocardial infarction (MI) reported a decrease in mortality over a short period of follow up leading to a presumption of improved survival with intensive glucose control. Later data refuted this hypothesis. The 2009 ACC/AHA focused update on ST elevation MI gave a weak recommendation for the use of an insulin based regimen to achieve and maintain blood glucose less than 180 mg/dL. We decided to assess the validity of this recommendation. The authors searched the Pub- Med, Cochrane CENTRAL and EMBASE databases for randomized controlled trials from 1965 through 2011.Trials included were direct head-to-head comparisons of an intensive blood glucose control strategy using pharmacological means (insulin in most cases) with a less intensive regimen. The primary outcome assessed was the risk of all -cause mortality in the two groups at the end of follow up. Also assessed was the rate of hypoglycemia. The methodological quality of the studies was assessed. Event rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) using a random effects model (Mantel-Haenszel) assuming inter-study heterogeneity. Statistical analysis was done with Review Manager V5.1 and SYSTAT. Meta-regression was done with duration of therapy as covariate. Three studies (total N = 2113) met the inclusion exclusion criteria. Mortality was not different between the groups (RR 0.94, 95% CI of 0.66-1.34; p=0.73.). Rate of hypoglycemia was significantly higher in the intensive glucose control group (RR 13.40, 95% CI 3.69-48.61; p < 0.01), with a 12% absolute risk increase and a number needed to harm (NNH) of 9 (95% CI 6.8- 9.8)-even without achieving target glycemic control. Neither did intensive control improve CHF, arrhythmias and reinfarction rates. Meta regression revealed that mortality with intensive glycemic control was worse with increased duration of therapy (p=0.001, for trend). This systematic review suggests limited benefit of intensive glycemic control in type 2 diabetics with an MI, with a significant risk of serious hypoglycemia.

Intensive Glucose Control in Diabetics with an Acute Myocardial Infarction Does not Improve Mortality and Increases Risk of Hypoglycemia-A Meta-Regression Analysis

Objectives: Some early trials comparing intensive glucose control in type 2 diabetics with an acute myocardial infarction (MI) reported a decrease in mortality over a short period of follow up leading to a presumption of improved survival with intensive glucose control. Later data refuted this hypothesis. The 2009 ACC/AHA focused update on ST elevation MI gave a weak recommendation for the use of an insulin based regimen to achieve and maintain blood glucose less than 180 mg/dL. We decided to assess the validity of this recommendation. Methods: The authors searched the Pub- Med, Cochrane CENTRAL and EMBASE databases for randomized controlled trials from 1965 through 2011.Trials included were direct head-to-head comparisons of an intensive blood glucose control strategy using pharmacological means (insulin in most cases) with a less intensive regimen. The primary outcome assessed was the risk of all -cause mortality in the two groups at the end of follow up. Also assessed was the rate of hypoglycemia. The methodological quality of the studies was assessed. Event rates were compared using a forest plot of relative risk (RR; 95% confidence interval [CI]) using a random effects model (Mantel-Haenszel) assuming inter-study heterogeneity. Statistical analysis was done with Review Manager V5.1 and SYSTAT. Meta-regression was done with duration of therapy as covariate. Results: Three studies (total N = 2113) met the inclusion ⁄ exclusion criteria. Mortality was not different between the groups (RR 0.94, 95% CI of 0.66-1.34; p=0.73.). Rate of hypoglycemia was significantly higher in the intensive glucose control group (RR 13.40, 95% CI 3.69-48.61; p<0.01), with a 12% absolute risk increase and a number needed to harm (NNH) of 9 (95% CI 6.8- 9.8)-even without achieving target glycemic control. Neither did intensive control improve CHF, arrhythmias and reinfarction rates. Meta regression revealed that mortality with intensive glycemic control was worse with increased duration of therapy (p=0.001, for trend). Conclusions: This systematic review suggests limited benefit of intensive glycemic control in type 2 diabetics with an MI, with a significant risk of serious hypoglycemia. Keywords: Myocardial infarction, intensive glycemic control, meta-analysis, regression, hypoglycemia, mortality

Daily n-3 fatty acid supplements did not reduce CV events in high-risk patients with dysglycemia

ACP Journal Club18 September 2012Daily n-3 fatty acid supplements did not reduce CV events in high-risk patients with dysglycemiaEllis Lader, MDEllis Lader, MDMid Valley Cardiology, New York University School of Medicine, Kingston, New York, USA (E.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-6-201209180-02011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationORIGIN Trial Investigators, Bosch J, Gerstein HC, et al. n-3 fatty acids and cardiovascular outcomes in patients with dysglycemia. N Engl J Med. 2012;367:309-18. https://pubmed.ncbi.nlm.nih.gov/22686415Clinical Impact RatingsGIM/FP/GP: Cardiology: Endocrinology: References1 Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-86. [PMID: 8366922] Google Scholar2 Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545-59. [PMID: 18539917] Google Scholar3 ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358:2560-72. [PMID: 18539916] Google Scholar4 Duckworth W, Abraira C, Moritz T, et al; VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129-39. [PMID: 19092145] Google Scholar5 Sobel BE, Hardison RM, Genuth S, et al; BARI 2D Investigators. Profibrinolytic, antithrombotic, and antiinflammatory effects of an insulin-sensitizing strategy in patients in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. Circulation. 2011;124:695-703. [PMID: 21768545] Google Scholar6 Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. [PMID: 11832527] Google Scholar7 Daviglus ML, Stamler J, Orencia AJ, et al. Fish consumption and the 30-year risk of fatal myocardial infarction. N Engl J Med. 1997;336:1046-53. [PMID: 9091800] Google Scholar Author, Article, and Disclosure InformationAffiliations: Mid Valley Cardiology, New York University School of Medicine, Kingston, New York, USA (E.L.)This article was published at Annals.org on 4 September 2012. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoGlargine did not reduce CV events more than standard care in patients with dysglycemia Ellis Lader Metrics 18 September 2012Volume 157, Issue 6Page: JC3-11KeywordsArrhythmiaFatty acidsGlucoseHbA1cHypoglycemiaInsulinMyocardial infarctionOilsType 2 diabetes ePublished: 18 September 2012 Issue Published: 18 September 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Improving diabetes care in Sri Lankan children: the way forward

Type 1 diabetes mellitus (T1DM) is an autoimmune disease. The incidence of T1DM is on the increase worldwide. The incidence in Sri Lanka is yet to be determined but there has been a definite increase in its occurrence in the recent past. Uncontrolled diabetes gives rise to micro vascular and macrovascular complications. Various strategies are being implemented to improve care for children with T1DM worldwide. Intensive blood glucose control, regular blood glucose monitoring, screening for complications are prerequisites for better diabetes management. The diabetic care of Sri Lankan children needs to be optimised. Compared to the West we do encounter many practical difficulties. This article discusses the facilities that we have compared to other countries who have achieved good glycaemic control in children and the way forward for the Sri Lankan paediatric population. DOI: http://dx.doi.org/10.4038/sjdem.v2i1.4333 Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2012; 2 : 35-38

Rational control on postoperative blood glucose levels in infants with congenital heart disease

To investigate optimal level of post-operation blood glucose control in infants with congenital heart disease (CHD). One hundred and two infants ≤1 year old undergoing open-heart surgery were randomly divided into three groups: intensive blood glucose control group (group A, n = 35), active blood glucose control group (group B, n = 38), and common glucose control group (group C, n = 29). Insulin injection would be intravenously administrated when blood glucose levels up to 8.3, 15.0, and 18.0 mmol/L in group A, B, and C, respectively. Blood white blood count (WBC), C-reactive protein (CRP), lactic acid, alanine aminotransferase (ALT), creatinine (Cr), incidence of pulmonary infection, the length of intensive care unit (ICU) stay, incidence of hypoglycemia and mortality were compared at 72 hours after operation among three groups. WBC [×10(9)/L], CRP (mg/L) and incidence of pulmonary infection in group C were significantly higher than those in group A and group B (WBC: 18.2 ± 8.7 vs. 13.2 ± 5.1, 14.5 ± 5.7; CRP: 32.9 ± 10.9 vs. 20.8 ± 9.8, 18.6 ± 8.5; incidence of pulmonary infection: 27.6% vs. 8.6%, 10.5%, all P < 0.05), but there were no statistical differences between group A and group B. ALT (U/L) in group B was significantly lower than that in group A and group C (49.0 ± 17.8 vs. 68.4 ± 16.9, 69.9 ± 13.8, both P < 0.05), but there was no statistical difference between group A and group C. Incidence of hypoglycemia in group A was significantly higher than that in group B and group C (20.0% vs. 2.6%, 3.4%, both P < 0.05), but there was no statistical difference between group B and group C. There were no statistical differences in lactic acid (mmol/L), Cr (μmol/L) and the length of ICU stay (days) among group A, B, and C (lactic acid: 2.1 ± 0.8, 2.3 ± 0.5, 2.2 ± 0.7; Cr: 55.1 ± 13.4, 49.4 ± 15.7, 57.3 ± 11.6; the length of ICU stay: 3.5 ± 1.8, 3.2 ± 1.1, 3.6 ± 1.6, all P>0.05). There was no infant death in three groups. Severe hyperglycemia after open heart operation was associated with increasing WBC count, CRP level and incidence of pulmonary infection during the post operative period. However, it also demonstrated that intensive blood glucose control be link to increase risks of hypoglycemia and liver dysfunction.

Reducing renal failure: how low do glucose levels need to go?

SUMMARY Diabetic kidney disease is the commonest cause of end-stage kidney disease worldwide. One strategy to prevent the development and progression of diabetic kidney disease is intensive blood glucose control. Randomized controlled trials such as the UKPDS and DCCT have demonstrated that a target HbA1c level of 7% improves renal outcomes. More recently, ACCORD, ADVANCE and VADT have explored the effects of targeting even lower HbA1c levels of 6.0–6.5%. These contemporary trials have universally reported improvements in albuminuria but no clear effects on preventing end-stage kidney disease. Thus, the additional and likely long-term renal benefits of intensive glucose lowering to achieve HbA1c levels ≤7% need to be balanced against the potential risks of intensive therapy such as severe hypoglycemia. An individualized approach is required with the understanding that the greatest renal benefits are likely to be achieved at a HbA1c level of ≤7%. Other risk factors for renal impairment should also be addre...