Plasma Glucose Levels Research Articles

Viral interactions with host factors (TIM-1, TAM -receptors, Glut-1) are related to the disruption of glucose and ascorbate transport and homeostasis, causing the haemorrhagic manifestations of viral haemorrhagic fevers.

The haemorrhagic features of viral haemorrhagic fevers may be caused by common patterns of metabolic disturbances of the glucose and ascorbate homeostasis. Haemorrhages and vasculature disfunctions are a clinical feature not only of viral haemorrhagic fevers, but also in scurvy, diabetes and thrombotic microangiopathic haemolytic anaemia. Interestingly, the expression of glucose and ascorbate transporter Glut-1 on the erythrocyte membrane is associated with the inability to synthesize ascorbate and is restricted to that very species that are susceptible to filoviruses (primates, humans and fruit bats). Glut-1 may play a pivotal role in haemorrhagic fever pathogenesis. TIM-1 and TAM receptors have been recognized to enhance entry of Ebola, Lassa and Dengue viruses and viral interferences with TIM-1 could disturb its function, disturbing the expression of Glut-1. In those species not able to synthesize ascorbate and expressing Glut-1 on erythrocytes virus could interact with Glut-1 or other functionally related protein, and the influx of glucose into the cells would be severely impaired. As a consequence, transient hyperglycemia and a marked oxidative stress coupled with the high levels of glucose in plasma would be established, and then promote the activation of NF–κB transcription, exacerbating a pro-inflammatory response mediated by cytokines and chemokines: The inability to synthesize ascorbate is an Achilles Heel when trying to counteract the oxidative stress.

Health Benefits of Yerba Mate Consumption on Cardiovascular Health

Background: Yerba mate is a Paraguayan kind of herbal tea prepared from the dried and roasted leaves of trees called Ilex paraguariensis St. Hill. It is known for high content of polyphenols, methylxanthines and saponins. According to the studies products rich in those nutrients may have a positive influence on the humans cardiovascular health. Materials and methods: We reviewed publications obtained from PubMed and Google Scholar. Articles were selected based on keywords such “yerba mate’’, “Ilex paraguariensis’’, “cardiovascular diseases’’. For the final analysis, qualified articles were published from 2005 to 2024. Results: Confirming positive impact on serum lipid levels individuals using mate tea. Long – term positive influence on blood pressure. Moreover subjects with obesity took advantages of Yerba beverage by decreasing waist-to-hip ratio. Patients with diabetes were observed to have a significant reduction in fasting plasma glucose level and HbA1c concentration. Conclusions: Most of the cited researches support the hypothesis of benefits coming from drinking mate infusions for patients with elevated lipid serum levels, obesity, high blood pressure and type 2 diabetes mellitus. All of mentioned health issues can lead to the cardiovascular problems therefore using mate infusions can prevent CVDs. Taking everything into consideration, medical professionals might recommend Yerba mate tea for their patients especially as a replacement of a coffee.

The Contribution of Postprandial Glucose Levels to Hyperglycemia in Type 2 Diabetes Calculated from Continuous Glucose Monitoring Data: Real World Evidence from the DIALECT-2 Cohort.

Traditional glycemic monitoring in type 2 diabetes is limited, whereas continuous glucose monitoring (CGM) offers better insights into glucose fluctuations. This study aimed to determine the correlations and relative contributions of fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) levels to hyperglycemia. We utilized CGM and recorded carbohydrate intake data from lifestyle diaries of 59 patients enrolled in the Diabetes and Lifestyle Cohort Twente (DIALECT-2). Correlations between FPG and the glucose management indicator (GMI), FPG and Time Above Range (TAR), PPG and GMI, and PPG and TAR were conducted. Daily and mealtime relative contributions of PPG and FPG to glycated hemoglobin (HbA1c) and GMI were determined, considering two ranges: on target (<7.0%, 53 mmol/mol) and not on target (≥7.0%, 53 mmol/mol). Correlations between mealtime PPG and carbohydrate consumption were examined. FPG and PPG correlated with GMI (r = 0.82 and 0.41, respectively, p < 0.05). The relative contribution of PPG in patients with HbA1c, GMI, and TAR values not on target was lower than in patients with HbA1c, GMI, and TAR values on target. When analyzing different mealtimes, patients with target GMI values had a higher PPG (73 ± 21%) than FPG after breakfast (27 ± 21%, p < 0.001). Individuals with elevated GMI levels had lower PPG after lunch (30 ± 20%), dinner (36 ± 23%), and snacks (34 ± 23%) than FPG. PPG after breakfast positively correlated (r = 0.41, p < 0.01) with breakfast carbohydrate intake. Both PPG and FPG contribute to hyperglycemia, with PPG playing a larger role in patients with better glycemic control, especially after breakfast. Targeting PPG may be crucial for optimizing glucose management.

Variation in blood glucose, cholesterol, urea and calcium levels according to the physiological stage in Ouled-Djellal ewes in Algerian arid zone. Technical note

Sheep farming in arid and semi-arid regions of Algeria is confronted with large fluctuations in the availability of fodder, which is all the more restrictive for pregnant ewes whose needs are at a maximum and constitute a major obstacle to the development of this sector. This study aims to evaluate the influence of the physiological stage on the energy, nitrogen and mineral status of Ouled-Djellal ewes living in arid zones (Biskra), by determining the plasma levels of glucose, cholesterol, urea and calcium. Blood samples were taken from 40 ewes divided into two groups according to their physiological stage (pregnant and empty). The obtained results showed that the physiological stage had a significant influence only on blood glucose, being higher in empty sheep than in pregnant sheep (P&lt;0.05), whereas for the other blood parameters: cholesterol, urea, and the plasma concentrations of calcium do not seem to be influenced by the physiological stage.

Efficacy of Alogliptin/Metformin Fixed-Dose Combination Tablets and Vildagliptin/Metformin Fixed-Dose Combination Tablets on Glycemic Control in Real-World Clinical Practice for the Patients with Type 2 Diabetes: A Multicenter, Open-Label, Randomized, Parallel Group, Comparative Trial.

Background: This study was aimed to compare the efficacy of two combination tablets of dipeptidyl peptidase-4 (DPP-4) inhibitors and metformin with different dosages, alogliptin/metformin (AM) and vildagliptin/metformin (VM), on glycemic control in patients with type 2 diabetes (T2D). Methods: This was a prospective, multicenter, open-label, randomized, parallel group, comparative trial. After a run-in period of treatment with metformin alone, a total of 59 Japanese outpatients with T2D, aged 20-79 years with glycated hemoglobin (HbA1c) levels of 6.5%-10% were randomly assigned to 12-week AM treatment, alogliptin 25 mg/metformin 500 mg combination tablet orally once a day, or VM treatment, vildagliptin 50 mg/metformin 250 mg combination tablet orally twice a day. The primary endpoints were the changes in HbA1c and fasting plasma glucose (FPG) levels from baseline to week 12 between the two groups. Blinded intermittently scanned continuous glucose monitoring (isCGM) was performed between weeks 10 and 12. The incidence of adverse events during the study was also evaluated. Results: In all, 52 participants were analyzed. Significant decreases in HbA1c and FPG levels from baseline to week 12 were observed in both treatment groups. However, there were no significant differences between the AM and VM groups in the change in HbA1c level (-0.3% and -0.4%, P = 0.309) or the FPG level (-9.0 and -15.0 mg/dL, P = 0.789). The isCGM revealed that both treatments achieved the recommended glycemic target range. No adverse events, such as severe hypoglycemia, were observed in either group. Conclusions: We concluded that there were no significant differences in the efficacy of two combination tablets of DPP-4 inhibitors and metformin with different dosages on glycemic control in patients with T2D.

Intestinal-Target and Glucose-Responsive Smart Hydrogel toward Oral Delivery System of Drug with Improved Insulin Utilization.

An intelligent insulin delivery system targeting intestinal absorption and glucose responsiveness can enhance the bioavailability through oral insulin therapy, offering promising diabetes treatment. In this paper, a glucose and pH dual-response polymer hydrogel using carboxymethyl agarose modified with 3-amino-phenylboronic acid and l-valine (CPL) was developed as an insulin delivery carrier, exhibiting excellent biocompatibility and effective insulin encapsulation. The insulin encapsulated in the hydrogel (Ins-CPL) was released in a controlled manner in response to the in vivo stimulation of blood glucose and pH levels with higher levels of intracellular uptake and utilization of insulin in the intestinal environment simultaneously. Notably, the Ins-CPL hydrogel effectively regulated blood sugar in diabetic rats over a long period by simulating endogenous insulin, responding to changes in plasma pH and glucose levels, and overcoming the intestinal epithelium barrier. This indicates a significant boost in oral insulin bioavailability and broadens its application prospects.

Screening of Pre-Diabetes and Type-II Diabetes Mellitus Among the Personnel of Bangladesh Air Force

Background: Medical Squadron (Med Sqn) of Bangladesh Air Force (BAF) Base Bashar (BSR) has been providing medical support for BAF Base BSR, Air Headquarters, most of the retired officers and their families. It has been observed that the number of Diabetes Mellitus (DM) patient is increasing day by day, and now it becomes a major health problem among the members of BAF, even among the young age group. In view of above, a study was conducted among the BAF uniform members who reported for laboratory investigation to Med Sqn BAF Base BSR. Assessing prevalence of DM among BAF personnel will also help for overall assessment of health problem of BAF personnel to make a preventive guideline. Methods: A descriptive type of cross-sectional study was conducted with available data in the pathological laboratory of Med Sqn BAF Base BSR during the period from 01 July 2021 to 30 Jun 2022. Within this period a total 9269 Air Force uniform members reported for routine as well as diagnostic purpose of checking blood sugar. Associated risk factor like overweight or obesity was also assessed by latest data from personal documents. Age and job pattern wise data were also analyzed. Statistical Package for Social Sciences (SPSS) version 29.0 was used to analyze data. Results: Out of 9269 BAF members a total 683 persons (7.36%) had high (above normal) plasma glucose. Of these 413(60.46%) were diabetic and 270(39.53%) were pre-diabetic (IFG/IGT). Among the 413 diabetic patients 292(42.75%) had fasting plasma glucose (FPG) ≥7 mmol/L as well as post prandial plasma glucose (PPPG) level ≥11.1 mmol/L. Among the 270 pre-diabetic patients 205(30.01%) had FPG level between 6.1-6.9 mmol/L with PPPG level &lt;7.8 mmol/L (Impaired Fasting Glucose/IFG) and 65(9.51%) had FPG level &lt;7 mmol/L with PPPG level between 7.8-11 mmol/L (Impaired Glucose Tolerance/IGT). Conclusion: DM has become a major health concern all over the world. This study attempted to identify the prevalence of age-related factors for DM among BAF uniform members between the ages 30 to 60 years. It has been observed that the prevalence of pre-diabetes is more among the 41 to 45 years age group and Type-II DM among the 46-50 years age group. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 22-27

Delayed treatment of diabetic foot ulcer in patients with type 2 diabetes and its prediction model

BACKGROUND Diabetic foot (DF) is a serious complication of type 2 diabetes. This study aimed to investigate the factors associated with DF occurrence and the role of delayed medical care in a cohort of patients with type 2 diabetes. AIM To reveal the impact of delayed medical treatment on the development of DF in patients with type 2 diabetes and to establish a predictive model for DF. METHODS In this retrospective cohort study, 292 patients with type 2 diabetes who underwent examination at our hospital from January 2023 to December 2023 were selected and divided into the DF group (n = 82, DF) and nondiabetic foot group (n = 210, NDF). Differential and correlation analyses of demographic indicators, laboratory parameters, and delayed medical treatment were conducted for the two groups. Logistic regression was applied to determine influencing factors. Receiver operating characteristic (ROC) analysis was performed, and indicators with good predictive value were selected to establish a combined predictive model. RESULTS The DF group had significantly higher body mass index (BMI) (P &lt; 0.001), disease duration (P = 0.012), plasma glucose levels (P &lt; 0.001), and HbA1c (P &lt; 0.001) than the NDF group. The NDF group had significantly higher Acute Thrombosis and Myocardial Infarction Health Service System (ATMHSS) scores (P &lt; 0.001) and a significantly lower delayed medical treatment rate (72.38% vs 13.41%, P &lt; 0.001). BMI, duration of diabetes, plasma glucose levels, HbA1c, diabetic peripheral neuropathy, and nephropathy were all positively correlated with DF occurrence. ATMHSS scores were negatively correlated with delayed time to seek medical treatment. The logistic regression model revealed that BMI, duration of diabetes, plasma glucose levels, HbA1c, presence of diabetic peripheral neuropathy and nephropathy, ATMHSS scores, and delayed time to seek medical treatment were influencing factors for DF. ROC analysis indicated that plasma glucose levels, HbA1c, and delayed medical treatment had good predictive value with an area under the curve of 0.933 for the combined predictive model. CONCLUSION Delayed medical treatment significantly affects the probability of DF occurrence in patients with diabetes. Plasma glucose levels, HbA1c levels, and the combined predictive model of delayed medical treatment demonstrate good predictive value.

Prediabetes persistence or remission and subsequent risk of gallbladder cancer: A nationwide cohort study

Background & aimsHyperglycemia is associated with an increased risk of gallbladder cancer (GBC), potentially by inhibiting gallbladder motility and inducing prolonged cholestasis. Although intermediate hyperglycemia (or prediabetes) is highly reversible, evidence is lacking about whether prediabetes persistence or remission is associated with an altered GBC risk. MethodsThis nationwide cohort study included 6058,662 adults without diabetes or cancer who underwent national health examinations twice in 2-year intervals between 2009 (S1) and 2011 (S2) and were followed-up until 2018. Prediabetes was defined as a fasting plasma glucose level of 100–125 mg/dL. We categorized changes in prediabetes status into: stable normoglycemia, new-onset prediabetes, prediabetes remission, and persistent prediabetes groups. GBC risk was estimated using Cox proportional hazards models, after adjusting for potential confounders. ResultsDuring 38.6 million person-years (median 6.4 years) of follow-up, 1349 new GBC cases were identified. Among 1409,474 individuals with prediabetes at S1, 768,515 achieved prediabetes remission at S2, outnumbering the 640,959 individuals with persistent prediabetes. GBC incidence probability was consistently higher among individuals with persistent prediabetes than in individuals with stable normoglycemia or prediabetes remission (all log-rank P < 0.01). Compared with stable normoglycemia, persistent prediabetes was associated with increased GBC risk (adjusted hazard ratio [aHR], 95 % CI: 1.21, 1.04 to 1.41). The aHRs of GBC were 1.14 (95 % CI, 0.99 to 1.33) and 1.03 (95 % CI, 0.88 to 1.21) for new-onset prediabetes and prediabetes remission, respectively. ConclusionsIndividuals with persistent prediabetes had a significantly increased risk of GBC, whereas those with prediabetes remission had no increased risk. Achieving prediabetes remission has a significant potential to reduce the risk of GBC.

Efficacy of a High-Protein Diet to Lower Glycemic Levels in Type 2 Diabetes Mellitus: A Systematic Review.

Diabetes is a metabolic disease with a high worldwide prevalence and an important factor in mortality and disability in the population. Complications can be reduced or prevented with lifestyle changes in physical activity, dietary habits, and smoking cessation. High-protein diets (HPDs, >30% or >1.0 g/Kg/day) decrease hyperglycemia in part due to their content of branched-chain amino acids (BCAAs), mainly leucine. Leucine (and other BCAAs) improve glucose metabolism by directly signaling in the medio-basal hypothalamus (MBH), increasing liver insulin sensitivity. To determine the effectiveness of an HPD to lower hyperglycemia, we analyzed the results of published clinical studies focusing on the levels of fasting plasma glucose and/or glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes mellitus (T2DM). We carried out a systematic search for clinical studies using HPDs. We searched five databases (Scopus, Web of Science, PubMed, Epistemonikos, and Cochrane), collecting 179 articles and finally selecting 8 articles to analyze their results. In conclusion, HPDs are an effective alternative to reduce hyperglycemia in patients with T2DM, especially so-called Paleolithic diets, due to their higher-quality protein from animal and vegetal sources and their exclusion of grains, dairy products, salt, refined fats, and added sugars.

Great debate: pre-diabetes is not an evidence-based treatment target for cardiovascular risk reduction.

With the increasing burden of diabetes as a cause of macro- and microvascular disease linked to the epidemics of obesity, attention is being paid to dysglycaemic states that predict and precede the development of type 2 diabetes. Such conditions, termed pre-diabetes, are characterized by fasting plasma glucose, or plasma glucose levels on an oral glucose tolerance test, or values of glycated haemoglobin intermediate between 'normal' values and those characterizing diabetes. These last are by definition associated, in epidemiological terms, with a higher incidence of microvascular disease-mostly retinopathy. Pre-diabetes overlaps with the components of the 'metabolic syndrome'-among which are excess visceral adiposity; hypertension; hypertriglyceridaemia; high levels of small, dense low-density lipoproteins; and metabolic-associated fatty liver disease. There is little doubt that pre-diabetes has important prognostic implications, especially for the occurrence of myocardial infarction, ischaemic stroke, and peripheral arterial disease. It is disputed, however, whether pre-diabetes is itself an actionable disease entity, in addition to the risk factors characterizing it. Because of this uncertainty, the latest European Society of Cardiology guidelines chose not to include pre-diabetes as a treatment target for atherosclerotic cardiovascular disease, at variance from the three previous editions of such guidelines. This is spurring a debate, the Pro and Contra arguments featured in the present debate article.

Predictive value of IGF-1/IGFBP-3 ratio for thyroid nodules in type 2 diabetic mellitus.

To explore the predictive value of the IGF-1/IGFBP-3 ratio for the presence of thyroid nodules in patients with type 2 diabetes mellitus (T2DM). This observational study prospectively enrolled patients with T2DM at the Second Hospital of Jilin University between May 2021 and January 2022. Thyroid nodule (TN) status was determined by ultrasonography. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive value of the serum IGF-1/IGFBP-3 molar ratio for TNs. Multivariable logistic regression analysis was conducted to identify risk factors for thyroid nodules in patients with T2DM. A total of 122 patients (mean age ± standard deviation: 52.57 ± 11.71 years; 74 males) were enrolled. 37.7% (n=46) of patients did not have TNs, while 62.3% (n=76) had TNs. The duration of diabetes, age, and HDL-C level were significantly higher in the T2DM group with TNs compared to the group without TNs (all P < 0.05). The area under the ROC curve (AUC) for the combination of IGF-1, IGFBP-3, and the serum IGF-1/IGFBP-3 molar ratio in predicting TNs in T2DM patients was 0.619 (P < 0.001). Additionally, multivariable logistic regression analysis revealed that the duration of diabetes, age, fasting plasma glucose (FPG), fasting insulin (FINS), thyroid-stimulating hormone (TSH), IGF-1, and IGFBP-3 levels were independent risk factors for thyroid nodules, while the serum IGF-1/IGFBP-3 molar ratio level was an independent protective factor for thyroid nodules in patients with T2DM (all P < 0.05). The combination of IGF-1, IGFBP-3, and the serum IGF-1/IGFBP-3 molar ratio may have a better predictive value for TNs in T2DM patients than using any single marker alone. The duration of diabetes, age, FPG, FINS, TSH, IGF-1, IGFBP-3, and the serum IGF-1/IGFBP-3 molar ratio levels were independently associated with thyroid nodules in patients with T2DM.

Relation between Serum Leptin, Lipid Profiles and other biomarkers levels in patients with type 2 diabetic nephropathy

Background: In advanced diabetes mellitus, serum levels of the most hormones are altered due to several interplaying mechanisms. Objective: To assess the relation of serum leptin and lipid profile in type 2 diabetic nephropathy. Patients and Method: Serum leptin levels and its relation to lipid profile were estimated in 62 patients with type 2 diabetic nephropathy attending the National Diabetes Center in Al- Mustansiriya University, and (26) healthy individuals considered as control group. The diabetic patients were classified into three groups, (24) pathients with normoalbuminuria (21) patients with microalbuminuria and (17) patients with macroalbuminuria. Fasting plasma glucose, serum creatinine, Hb A1c %, lipid profile (Total cholesterol, LDL- Cholesterol, HDL- Cholesterol and Triglyceride) and urinary albumin, were measured to establish the possibility of using these biomarkers as a supplementary to serum leptin to be a diagnostic test for type 2 diabetic nephropathy. Results: Serum leptin levels showed a significant elevation in microalbuminuria (20.08± 4.50 ng/ml) and macroalbuminuria groups (22.35± 6.89 ng/ml) as compared to nondiabetic normal control group (10.64 ± 3.17 ng/ml). There was no significant differences observed in serum leptin levels between the normoalbuminuria group (13.96 ± 5.73 ng/ml) and healthy controls, but a significant positive differences were noticed in the levels of fasting plasma glucose, serum creatinine, Hb A1c% and lipid profile in the three patient groups in comparison with the control group. While no significant correlation was observed between these biomarkers levels and serum leptin values. Conclusion: It might be concluded that serum leptin levels were elevated in type 2 diabetic patients with microalbuminuria and macroalbuminuria, suggesting that renal leptin degradation is impaired in early stage of kidney damage and this impairment increase with the progression of this disease. Leptin hormone may consider according to these results as a risk factor for progression of kidney disease in diabetic patients.

Plasma glucose, HbA1c, insulin and lipid profile in Sudanese type 2 diabetic patients with cardiovascular disease: a case control study

Background: Type 2 diabetes mellitus (T2DM) and its consequences are a serious global public health issue. By 2030, the number of people with type 2 diabetes is predicted to reach 439 million. The purpose of this study is to evaluate the plasma levels of glucose, HbA1c, insulin, and lipid profile in Sudanese T2DM patients. Methods: This case control study included 165 Sudanese patients with diabetic type 2 and a cardiovascular condition as cases and 165 diabetic type 2 volunteers without a cardiovascular disorder as controls. The concentrations of plasma glucose, HbA1c, and lipid profile were assessed using a Mindray BS-480 auto-chemistry analyzer, and insulin was analyzed using a Cobase 411 auto analyzer. The collected data were analyzed using statistical tools for social science computer programs (SPSS version 21). Results: According to the findings, (59.4%) of patients between the ages of (50-69). Females made up 50.9%. (38.2%) of patients had an illness duration of between (8-15 years). (41.8%) of individuals did not have hypertension. There was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin among diabetics with cardiovascular disease compared to diabetics without cardiovascular disease (p-value = 0.001, 0.000, 0.018, and 0.000). Females had significantly higher blood TC, LDL-C, HDL-C, and BMI than males (p-values = 0.000, 0,001, and 0.000, respectively). There were significant positive correlation between FBS, HBA1c, insulin and duration of disease (r=0.155, p, value=0.005) (r=0.160, p, value=0.004)(r=0.103, p. value=0.061)respectively, while there were significant negative correlation between TC, TG,LDL-C, HDL-C and duration of disease (r=-0.152, p, value= 0.006)(r=-0.023, p, value=0.678)(r=-0.113, p, value= 0.040)(r=-0.145, p, value=0.008)respectively. Conclusion: When comparing diabetics with cardiovascular disease to diabetics without cardiovascular disease, there was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin. FBS, HBA1c, insulin, and illness duration all had a strong positive connection.

Hypoglycemia-Induced Loss of Consciousness in an Immobilized Geriatric Patient: A Case Report

Introduction : Hypoglycemia in geriatric people is a less well recognized condition and have been correlated with acute outcomes such as seizure, coma, and cardiac arrhythmia. Symptoms of hypoglycemia tend to be less specific with ageing, where diagnosing these conditions in geriatric patient potentially becomes more difficult. Case Report : A 77-year-old man was brought to the ER due to unresponsive since 2 hours before admission. He was hypoglycemic with a plasma glucose level of 70 mg/dL, hypoalbuminemia (2,6 g/dL), and hyponatremia (121 mmol/L). After receiving intravenous dextrose, he regained consciousness and his plasma glucose level increased to 120 mg/dL. Electrolyte abnormalities were corrected, plasma glucose level monitored every 2 hours and titrated according to hypoglycemia standard procedure. He has been in total bed rest and immobilized for 5 years due to inferior paraparesis with decubitus ulcer, had a history of uncontrolled hypertension and diabetes mellitus. Physical examination showed reduced motor function in his lower extremities. The patient had significant recovery during the treatment course and was discharge 4 days after initial presentation. Discussion : Hypoglycemia is a low plasma glucose concentration state that could leads to defective glucose counter-regulation and hypoglycemia unawareness. The patient’s long immobilized state potentially leads to a catabolic state that results in muscle wasting. While his reduced intake leads to geriatric anorexia and become the potential cause of hypoglycemia. Mainstay of hypoglycemic treatment is the detection and treatment using interventions that rapidly increased blood sugar to a safe level, eliminating injury risks and quickly relived symptoms. Conclusion : Diabetes in geriatric has a higher risk for hypoglycemia and should be considered in treating an elderly patient presenting with unresponsiveness or loss of consciousness.

6905 The Necessity For New Criteria To Evaluate Overbasalization In East Asian Patients With Type 2 Diabetes Using Basal Insulin

Abstract Disclosure: H. Jang: None. Background: Overbasalization, which refers to adjusting the dose of basal insulin beyond an appropriate dose, should be avoided when using basal insulin in patients with type 2 diabetes. It is recommended to evaluate overbasalization when the basal insulin dose exceeds 0.5 units/kg/day or when post-meal glucose levels are &amp;gt; 180 mg/dL. However, this is an expert opinion, and specific criteria for East Asians have not been presented. Methods: Patients with type 2 diabetes using basal insulin (insulin glargine U-100, insulin glargine U-300, insulin degludec, NPH) at Seoul National University Bundang hospital from December 2020 to November 2023, with fasting plasma glucose (FPG) levels between 80 mg/dL and 130 mg/dL, were retrospectively analyzed. Patients with CKD ≤ grade 3b (estimated glomerular filtration rate &amp;lt; 45 mL/min/1.73m2), those taking medications such as steroids that may affect blood glucose levels, and patients undergoing cancer treatment were excluded. Results: A total of 548 patients were analyzed. The mean age of the subjects was 64.7 ± 12.4 years, with 299 (54.6%) being male, and the mean body mass index was 25.1 ± 6.6 kg/m2. The mean duration of diabetes was 18.1 ± 9.6 years. The mean HbA1c level was 7.7 ± 1.1%, while the mean fasting plasma glucose and median fasting C-peptide levels were 105.4 ± 13.9 mg/dL and 1.4 [0.8, 2.1] ng/mL, respectively. Insulin degludec being the most commonly administered (279 [50.9%]). The mean 2-hr postprandial glucose was 206.3 ± 64.8 mg/dL, with 350 (63.9%) having 2-hr postprandial glucose &amp;gt; 180 mg/dL. The administered insulin dose was 0.35 ± 0.17 units/kg/day, and 101 (18.4%) had an insulin dose &amp;gt; 0.5 units/kg/day. Conclusion: In East Asian patients with type 2 diabetes receiving basal insulin, although high 2-hr postprandial glucose levels suggest the possibility of overbasalization, the administered dosage of basal insulin was relatively low. Considering the lower insulin secretion capacity in East Asians, it is thought that new, specific criteria for overbasalization in East Asians are necessary. Presentation: 6/3/2024

12450 Beyond the Surface: A Deep Dive into Pancreatic Insulinoma

Abstract Disclosure: S. Bhandari: None. R. Elhag: None. J. Singh: None. N. Rastogi: None. Background: Pancreatic neuroendocrine tumors (NET) are rare lesions that are typically sporadic, solitary and usually &amp;lt;2cm in diameter, with reported incidence of 4 cases per 1 million patients per year[1]. The most common hormone secreting NET are insulinomas. The hallmark of insulinomas is hypersecretion of insulin, leading to neuroglycopenic symptoms and uncontrolled sympathoadrenal activity. Clinical case: 51 years old female with no significant past medical history was referred to endocrine clinic by her primary care physician for hypoglycemia with a blood glucose level of 48 mg/dl. She reported an increased frequency of headaches and dizziness which began with intermittent fasting (10-12 hours) for past 6 months. These symptoms improved upon increasing meal frequency. Initial laboratory investigations revealed glucose of 54 mg/dl, normal HbA1c, and negative sulfonylurea panel. The patient had normal liver and kidney function with no malnutrition or malabsorption issues. Further work up showed C-peptide level 1.56 ng/ml (n 0.80-3.85ng/ml), insulin level 7.9 uIU/mL (n &amp;lt;18.4 uIU/mL), pro-insulin level significantly elevated at 77.6 pmol/L (n &amp;lt;/= 18.8pmol/L) and beta hydroxybutyrate of 0.12 mmol/l (n 0.02-0.27mmol/l). Insulin like growth factor was normal. Insulin antibodies were negative, and pituitary hormones were within normal limits. Pancreatic ultrasound was normal. CT abdomen/pelvis showed a 0.8x1.1 cm homogenously hypervascular anterior pancreatic body soft tissue lesion consistent with NET. Patient was started on diazoxide and continuous glucose monitoring (CGM). She was referred to general surgery and underwent successful tumor resection. Insulinoma is suggested by Whipple's triad, which is presence of hypoglycemic symptoms, documented hypoglycemia and resolution of hypoglycemic symptoms after glucose administration. As clinical manifestations are non-specific, diagnosing an insulinoma is challenging and depends on collateral history and a high index of suspicion. The gold standard of diagnosis is supervised 72-hour fasting test with plasma glucose, insulin, C-peptide, and proinsulin level measurements. Medical management of insulinoma includes the use of diazoxide, calcium channel blockers, propranolol, and glucocorticoids. Surgery is definitive treatment for insulinomas, with cure rates ranging from 77 to 100%. Conclusion: Insulinomas are benign and curable in most cases but can be fatal if misdiagnosed. Incidental findings of hypoglycemia should warrant thorough diagnostic workup to facilitate timely diagnosis and management.

7284 Ablation of hexose-6-phosphate dehydrogenase in mice causes skeletal muscle atrophy and dramatically impairs exercise capacity

Abstract Disclosure: M. Zogg: None. A.D. Grötsch: None. J. Birk: None. P. Pelczar: None. J. Bouitbir: None. A. Odermatt: None. Hexose-6-phosphate dehydrogenase (H6PD) catalyzes the first two steps of the pentose-phosphate pathway (PPP) within the endoplasmic reticulum (ER), generating the redox equivalent NADPH. It has been shown that mice lacking H6PD develop defects mainly in skeletal muscles [1]. Nevertheless, the mechanisms underlying the myopathy in H6PD KO mice is unknown. Here, we further assessed muscle responses to H6PD deficiency and aimed to uncover the mechanisms that may cause myopathy in mice. We conducted a detailed characterization of the muscle structure and function as well as energy metabolism in oxidative and glycolytic muscles of H6PD KO mice. At the age of 15 weeks, H6PD KO mice displayed lower body weight than WT mice, despite similar food and water intake. Grip strength was significantly lower in H6PD KO than in WT mice. This was associated with decreased weight of the mixed (gastrocnemius, quadriceps) and fast fiber type rich muscles of the hind leg (extensor digitorum longus, tibialis anterior) in H6PD KO animals. Atrogin1 and Murf1 mRNA expression, markers of atrophy, increased only in the white (glycolytic) quadriceps. In this context, fast-twitch fibers in WT mice displayed higher H6pd mRNA expression than slow-twitch fibers. Electron microscopy analysis of red and white gastrocnemius muscles displayed the presence of large intramyofibrillar vacuoles, and morphologic changes of the sarcoplasmic reticulum and mitochondria in H6PD KO muscle. Metabolically, H6PD KO muscles presented an accumulation of glycogen granules and significantly decreased mRNA expression of glucose transporter Glut4, glucose-6-phosphate transporter G6pt and glycogen phosphorylase Pygm. The exercise capacity, measured by maximal running distance, decreased by more than 50% in H6PD KO mice. Upon exercise, both WT and H6PD KO animals were able to mobilize the majority of glycogen stored in their muscles. However, immediately after exercise, there was a significant increase in plasma lactate and glucose levels in H6PD KO animals. Disturbances in glucose metabolism were further supported by in vitro experiments using stable C2C12 H6PD KO myoblasts, revealing a shift in basal state mitochondrial fuel oxidation usage from glucose to fatty acid and glutamine in metabolic dependency assays. In conclusion, our findings revealed that H6PD seems to play a key role in proper function and energy metabolism of skeletal muscles.

7799 Nesidioblastosis Concurrent with Anatomically Confirmed Metastatic Gastric Cancer

Abstract Disclosure: Y. Cho: None. K. Jo: None. J. Han: None. S. Moon: None. E. Kim: None. Background: Nesidioblastosis is a rare condition that should be considered in cases of pancreatogenic hyperinsulinemic hypoglycemia without evidence of insulinoma on imaging. We present the first case of nesidioblastosis concomitant with anatomically confirmed metastatic gastric cancer of the pancreas. Case Report A 57-year-old male presented with recurrent episodes of loss of consciousness and hypoglycemia, with a glucose level of 26 mg/dl upon arrival at the emergency room. Despite a history of advanced gastric cancer and previous chemotherapy, the patient had not been diagnosed with diabetes and was not taking medications associated with hypoglycemia. Four months prior, he underwent total gastrectomy. The fasting plasma glucose levels was 38 mg/dl, accompanied by C-peptide levels of 6.10 ng/mL, insulin levels exceeding 1000 uIU/ml, and proinsulin levels at 8.8 pmol/L. The insulin antibody level was more than 100%, and the highest cortisol level reached 15.60 ug/dL during the rapid ACTH stimulation test. The patient's postprandial 2-hour glucose level reached 233 mg/dl during the 75g glucose tolerance test. Imaging studies, including whole-body PET CT and abdominal CT, showed no evidence of suspected metastatic lesions, and the pancreas appeared normal on MRI. Endoscopic ultrasound could not be performed due to anatomical changes following the surgery. A selective arterial calcium stimulation test demonstrated a substantial over twofold increase in insulin concentrations in the gastroduodenal artery, splenic artery, and superior mesenteric artery. The patient received methylprednisolone 125 mg once daily but insulin levels remained elevated, exceeding 1000 uIU/ml, requiring continuous dextrose infusion. Octreotide therapy was initiated, resulting in an improvement in insulin levels to 589 uIU/ml, although discontinuation of dextrose fluid remained unfeasible. After consultation with the surgeon, a open subtotal pancreatectomy was performed, allowing discontinuation of dextrose on the second post-surgery day, with improved glucose and insulin levels. Histological examination showed three clusters of atypical cells with perineural infiltration. Immunostaining indicated negative synaptophysin and positive CK20, suggesting possible gastric cancer metastasis, consistent with prior gastrectomy findings. Moreover, an increased number of variable-sized Langerhans islets exhibited positive insulin and glucagon immunostaining within the islets, indicative of nesidioblastosis. Conclusion: Nesidioblastosis should be considered in cases of unexplained post-surgery hypoglycemia following metastatic gastric cancer treatment. Furthermore, given the potential link with metastatic gastric cancer, which may elude detection via imaging alone, aggressive surgical intervention should be contemplated as a nesidioblastosis treatment strategy. Presentation: 6/3/2024

8814 Concordance in Defining Diabetes Remission: A Comparative Analysis of HbA1c, eA1c, and FPG Criteria After One Year of Digital Twin (DT) Intervention

Abstract Disclosure: P. Shamanna: None. M. Dharmalingam: None. A. Vadavi: None. A. Keshavamurthy: None. S. Bhonsley: None. M. Thajudeen: None. A. Balasubramanian: None. S.R. Joshi: None. Introduction: This study investigates the concordance among HbA1c, estimated A1c (eA1c), and fasting plasma glucose (FPG) remission criteria following one year of Digital Twin (DT) intervention. Understanding the agreement of these criteria in a cohort of 209 patients is critical for evaluating diabetes treatment efficacy. Methods: Diabetes remission was assessed in 209 patients after one year of DT intervention, using HbA1c, eA1c, and FPG criteria. Kappa values, along with sensitivity, specificity, and p-values, were calculated for concordance. Mean, standard deviation, and p-values for age, duration of diabetes, HbA1c, fasting plasma glucose, and eA1c were also computed. Results: The study revealed substantial agreement between HbA1c and eA1c criteria (Kappa: 0.751, indicating 'substantial' agreement), HbA1c and FPG criteria (Kappa: 0.703, indicating 'substantial' agreement), and eA1c and FPG criteria (Kappa: 0.719, indicating 'substantial' agreement), post one year of DT intervention. The average age of participants was 43.89 years (±8.72), with a diabetes duration of 3.65 years (±2.66). The initial HbA1c was 9.02% (±1.90), reducing to 6.00% (±0.67) at the end of the study. Initial and final fasting plasma glucose levels averaged 170.75 mg/dL (±61.11) and 109.33 mg/dL (±30.60), respectively. Remission rates were 72.73% for HbA1c, 75.60% for eA1c, and 71.29% for FPG. Conclusion: Our findings suggest that remission using either eA1c or FPG criteria can be reliably compared to the gold standard HbA1c criteria, with all showing 'substantial' agreement post one year of DT intervention. This high concordance, reflected in the statistically significant kappa values, highlights the effectiveness of eA1c and FPG criteria as robust tools in assessing diabetes remission alongside the HbA1c criteria. These insights are crucial for clinical practice and diabetes research, offering flexibility in evaluating patient outcomes. Presentation: 6/1/2024