Maintain Blood Glucose Levels Research Articles

Effects of allopurinol on renal function in patients with diabetes: a systematic review and meta-analysis

Background/Objective Diabetes mellitus is a common “non-gout” disease with high incidence. Several studies have shown that serum uric acid level in patients with diabetes is higher than that in healthy individuals, and is accompanied by severe albuminuria and high serum creatinine (Scr). Recent clinical studies have found that uric acid-lowering therapy (such as allopurinol) could reduce urinary albumin excretion rates (UAER) and Scr, increase eGFR, and thus reduce kidney damage in patients with diabetes. Therefore, this meta-analysis [PROSPERO CRD42021274465] intended to evaluate the efficacy and safety of allopurinol in patients with diabetes mellitus. Methods We thoroughly searched five electronic resource databases for randomized controlled trials (RCTs) that compared the efficacy and safety of allopurinol versus conventional treatment or placebo for the treatment of patients with diabetes mellitus. Predetermined outcomes were considered continuous variables, mean difference (MD) was used for the determination of effect size (standardized mean difference [SMD] was used to determine the effect size when there were different evaluation criteria in different articles), and the corresponding 95% confidence interval (CI) was calculated. All outcome measures were analyzed using a random-effects model for data analysis. Results Ten eligible trials with a total of 866 participants were included in the meta-analysis. Allopurinol was more effective in decreasing serum uric acid (SUA) levels compared with conventional treatment (p = 0.0001) or placebo (p < 0.00001). Moreover, the levels of 24-hour urine protein were significantly lower in the allopurinol group (p < 0.00001). The subgroup analysis of Scr showed that the Scr of patients with an allopurinol treatment duration of fewer than six months was significantly lower than that of the control group (p = 0.03). No significant difference in adverse events (AEs) was identified between the treatment and control groups. Conclusions Our meta-analysis of RCTs showed that oral administration of allopurinol effectively reduced SUA levels in patients with diabetes, and patients’ renal function was protected. More RCTs with larger sample sizes and higher quality are needed to clarify the role of allopurinol use in decreasing blood pressure, maintaining blood glucose levels, and improving renal function in patients with diabetes.

Organ-Specific Glucose Uptake: Does Sex Matter?

Glucose uptake by peripheral organs is essential for maintaining blood glucose levels within normal range. Impaired glucose uptake is a hallmark of type 2 diabetes (T2D) and metabolic syndrome and is characterized by insulin resistance. Male sex is an independent risk factor for the development of T2D. We tested whether sex and diet are independent variables for differential glucose uptake by various organs. Here, in a longitudinal study, we used 18F-fluorodeoxyglucose (FDG) and positron emission tomography (PET) to determine baseline differences in whole-body glucose uptake in young male and female mice on chow and high-fat diets. We report that sex and diet are important independent variables that account for differential glucose uptake in brown fat, skeletal muscle, liver, heart, kidney, and the stomach, but not the brain, lungs, pancreas, small intestine, or perigonadal adipose. Of the seven organs analyzed, two organs, namely brown fat, and the heart had the highest concentrations of FDG, followed by the brain, kidneys, and skeletal muscle on chow diet. Young female mice had 47% greater FDG uptake in the brown fat compared to male mice, whereas skeletal muscle FDG uptake was 49% greater in male mice. The high-fat diet inhibited FDG uptake in brown fat, skeletal muscle, and the heart, three major organs involved in uptake, whereas brain uptake was enhanced in both sexes. These foundational and groundbreaking findings suggest that mechanisms of glucose homeostasis are context- and organ-dependent and highlight the need to study sex-specific outcomes and mechanisms for diseases such as T2D, obesity, and metabolic syndrome.

Identification and Isolation of Biosurfactant Producing Bacteria from Oil Spill Contaminated Soil of Ennore

The bacteria were isolated from the soil samples that were collected in oil spill-contaminated sites located at Kamarajar port in Ennore, Chennai, Tamil Nadu, India. The main aim of this study was to isolate the bacteria that produce biosurfactants from the oil spill contaminated soil in Ennore, Chennai and to produce a growth medium for the bacteria to enrich the growth of the bacteria. For the growth of bacteria, Minimal Medium (MM) and Mineral Salt Medium (MSM) were the two types of growth enrichment medium used and serial dilutions of the bacterial cultures were done for the production of colonies. The objective of the study was to perform tests to identify whether the bacteria can be able to produce the bio-surfactant or not. Tests like Drop collapse method and oil displacement method were done to check for the production of biosurfactant. The bacteria which produce the surface active substances were the one which produces the bio-surfactant. As a result, gram staining was done for identifying the nature of bacteria. Most of the gram positive bacteria are known to have the properties of bio-surfactant. These bacteria has peptidoglycan outer layer that are easier to kill - their thick peptidoglycan layer which absorbs antibiotics and cleaning products easily. Hereby we conclude that the bacteria which produces the biosurfactant is Bacillus and further studies should be done on identifying the bacteria at the species level. Therefore, this study was done to eradicate the oil spill contaminated areas with the help of bacteria in a natural way without harming the environment. Bacillus sp. is a gram-positive bacteria which helps in, liver and renal function, and act as an inflammatory markers and in maintaining blood glucose levels. It does not have an outer cell wall and only has a membrane of peptidoglycan which makes the Bacillus more absorbent and eco-friendly.

Preclinical Studies of Natural Products Targeting the Gut Microbiota: Beneficial Effects on Diabetes.

Diabetes mellitus (DM) is a serious metabolic disease characterized by persistent hyperglycemia, with a continuously increasing morbidity and mortality. Although traditional treatments including insulin and oral hypoglycemic drugs maintain blood glucose levels within the normal range to a certain extent, there is an urgent need to develop new drugs that can effectively improve glucose metabolism and diabetes-related complications. Notably, accumulated evidence implicates that the gut microbiota is unbalanced in DM individuals and is involved in the physiological and pathological processes of this metabolic disease. In this review, we introduce the molecular mechanisms by which the gut microbiota contributes to the development of DM. Furthermore, we summarize the preclinical studies of bioactive natural products that exert antidiabetic effects by modulating the gut microbiota, aiming to expand the novel therapeutic strategies for DM prevention and management.

Cargo receptor Surf4 regulates endoplasmic reticulum export of proinsulin in pancreatic β-cells

Insulin is an essential peptide hormone that maintains blood glucose levels. Although the mechanisms underlying insulin exocytosis have been investigated, the mechanism of proinsulin export from the endoplasmic reticulum (ER) remains unclear. Here, we demonstrated that Surf4, a cargo receptor homolog, regulates the ER export of proinsulin via its recruitment to ER exit sites (ERES). Under high-glucose conditions, Surf4 expression was upregulated, and Surf4 proteins mainly localized to the ER at a steady state and accumulated in the ERES, along with proinsulin in rat insulinoma INS-1 cells. Surf4-knockdown resulted in proinsulin retention in the ER and decreased the levels of mature insulin in secretory granules, thereby significantly reducing insulin secretion. Surf4 forms an oligomer and can physically interact with proinsulin and Sec12, essential for COPII vesicle formation. Our findings suggest that Surf4 interacts with proinsulin and delivers it into COPII vesicles for ER export in co-operation with Sec12 and COPII.

Type‐2 Diabetes and Identification of Major Genetic Determinants of Glycemic Index in Rice – A Review

AbstractRice consumers of different parts of the world always face the risk of diabetes and related health complications. Dietary intervention is the best adapted measure to maintain blood glucose levels and manage the diseases in rice consuming populations. The glycemic index of rice varieties is negatively correlated to the amylose content. Research studies have proven that the consumption of rice varieties with low glycemic index has beneficial effects in controlling diabetes. The genetic basis for the diversity observed for amylose content in different rice varieties is well elucidated. Waxy gene (Wx) is known to encode Granule–Bound Starch Synthase I (GBSS I) enzyme, which determines the amylose content in rice. Different allelic variations of Wx gene exist, which can be correlated to varying amylose content in rice. The PCR‐based markers for detecting single nucleotide polymorphism mutation at Wx locus provides a cost‐effective alternative to genotype rice varieties. This review outlines the anti‐diabetic properties of rice and strategies to identify rice varieties with a low glycemic index at the molecular level. The molecular basis of the glycemic index allows breeders to successfully identify rice germplasms with low glycemic index and engineer rice varieties with high grain yield and low glycemic index.

Acute Changes in Heart Rate Variability to Glucose and Fructose Supplementation in Healthy Individuals: A Double-Blind Randomized Crossover Placebo-Controlled Trial.

Simple SummaryIn this study, we investigated the cardio-autonomic stress responses to the ingestion of liquid glucose, fructose, a combination thereof and a placebo in healthy individuals at rest. The cardio-autonomic response was more pronounced in all groups with carbohydrates compared to placebo indicating an increased cardio-autonomic stress response resulting in a reduced heart-rate variability. When investigating different levels of blood glucose, the findings showed a significant decline in heart-rate variability with increasing blood glucose levels. This was also seen with severely low levels of blood glucose. The speed of how quick blood glucose increased and decreased also impacted the cardio-autonomic response which further deteriorated heart-rate variability. These findings indicate that healthy human’s autonomic system responds quickly to changes in their blood glucose.Background: It is unknown how different types of carbohydrates alter the cardio-autonomic system in healthy individuals. Therefore, the aim of this study was to investigate how heart-rate variability changes to single dose ingestion of glucose, fructose, glucose and fructose, and an artificial sweetener (sucralose). Methods: In a double-blind randomized crossover placebo-controlled setting, 15 participants received all study-specific substances in liquid form. During each 2-h visit, venous blood glucose was measured in a 5-min interval while heart-rate variability was measured continuously via Holter-electrocardiograph. Results: Ingestion of different types of carbohydrates and sucralose showed significant differences for heart rate (p < 0.001), SDNN (p < 0.008), RMSSD (p < 0.001), pNN50 (p < 0.001) and blood pressure (p < 0.001). Different glucose levels significantly altered parameters of heart-rate variability and blood pressure (all p < 0.001), while the rate of change in blood glucose led to changes in heart rate variability, but not in heart rate (p = 0.25) or blood pressure (p = 0.99). Conclusions: Ingestion of different types of carbohydrates lead to reductions in heart-rate variability compared to a placebo. Blood glucose values above or below 70–90 mg/dL decreased heart rate variability while this was also seen for rapid glucose changes, yet not as pronounced. Healthy individuals should be conscious about carbohydrate intake while maintaining blood glucose levels between 70–90 mg/dL.

Study of rise in cases of mucormycosis during covid-19 pandemic

There are reports of the rise of Rhino-orbital mucormycosis in COVID-19 patients during the second wave of the COVID-19 pandemic in India. Mucormycosis developed in patients who had the history of COVID-19 infection, uncontrolled diabetes mellitus with associated co-morbidities like hypertension, bilateral pneumonia, ischemic heart disease and concurrent use of steroids and oxygen therapy. So, to understand the association of mucormycosis with COVID-19 and other co-morbidities, we conducted a systemic study of mucormycosis in people with COVID-19.Tissue samples of patients, clinically and radiologically suspected of mucormycosis, received in microbiology department were examined by KOH mount microscopically and cultured on SDA. The culture isolates were then subjected to lactophenol cotton blue for identification.A total of 35(72.91%) samples were positive for fungal filaments in either KOH mount or fungal growth on SDA. spp. was most commonly isolated in culture, followed by spp. Mucormycosis was predominantly seen in males, 37(77.08%), than in females, 11(22.91%). The commonest risk factors associated with mucormycosis were COVID-19 positivity 42(87.5%) and diabetes mellitus 41(85.41%).: To reduce the risk of fungal infection, all efforts should be made to maintain blood glucose levels under control and judicious use of corticosteroids in patients with COVID-19.

RECENT APPROACHES IN GLUCOSE RESPONSIVE INSULIN DELIVERY SYSTEM

Diabetes mellitus is a chronic medical condition currently affecting 382 million people across the globe, caused due to increased blood glucose levels due to less insulin production or insulin resistance. Subcutaneous insulin administration for diabetes is the only most accepted therapy for maintaining blood glucose levels in diabetic patients. Many patients with advanced type II diabetes mellitus need to regularly monitor their blood glucose level to keep their blood glucose level in the target range. However long-term insulin therapy through an invasive route of administration causes problems with patient compliance and a sudden decrease in blood glucose levels. An artificial closed-loop insulin release system that mimics the glucose-responsive insulin secretion by β-cells of pancreas is one of the ways to overcome the problem faced with the conventional method of insulin administration. Many polymeric formulations showed an improved glucose-responsive release of insulin when incorporated with glucose-responsive catalysts such as glucose oxidase, phenylboronic acid, and glucose binding proteins, the release rate can be controlled by optimizing the concentration of glucose-responsive catalysts. This article is been focused on different mechanisms of glucose-responsive release by incorporation with glucose-responsive catalysts.

Efficacy of preoperative oral glucose on blood glucose response and neutrophil–lymphocyte ratio in patient undergoing brain tumor resection: Randomized controlled trial study

Background: Hyperglycemia and inflammatory conditions due to surgical stress response in conventional brain tumor resection can increase the morbidity and mortality of neurosurgery patients. Enhanced recovery after surgery (ERAS) protocol has been widely used in various types of surgery, but data on the neurosurgery are still limited. The aim of this study was to analyze the role of preoperative oral glucose administration in attenuating surgical stress response in patients undergoing brain tumor resection. Materials and Methods: Thirty-four elective craniotomy brain tumor resection patients underwent a double-blind, randomized controlled trial. Patients were divided into two groups: one group that received oral carbohydrate (CHO; maltodextrin 12.5% 50 g in 400 ml water) 2 h preoperatively and a control group that only received water. Blood glucose level and neutrophil–lymphocyte ratio (NLR) were obtained preoperatively, before induction, and 6 h and 24 h postoperatively. Results: Blood glucose was better in the CHO group at 6 h (117.18 ± 16.25 mg/dl vs. 154.88 ± 28.22 mg/dl, P < .001) and 24 h (118.05 ± 13.89 mg/dl vs. 153.76 ± 34.81 mg/dl, P < .001) postoperatively compared to that in the control group. NLR in the CHO group showed a lower value compared to that in the control group at 6 h (8.21 ± 6.20 vs. 15.47 ± 6.76, P < .001) and 24 h (9.43 ± 7.35 vs. 20.04 ± 10.99, P < .001) postoperatively. Conclusion: Preoperative oral glucose administration can help reduce the stress response in brain tumor resection by maintaining blood glucose level and attenuating the increase of NLR postoperatively better than in routine preoperative fasting.

Secondary Cutaneous Mucormycosis Post-COVID-19: Case Series from a Tertiary Center.

Background:Mucormycosis is an angioinvasive mucorales fungal infection. Cutaneous type formed 10.5% of cases in India in precovid-19 era. Glucocorticoid-induced immunosuppression and hyperglycemia, reusable oxygen humidifiers in COVID-19 therapy, and preexisting uncontrolled diabetes mellitus contribute to post-COVID-19 mucormycosis. However, for post-COVID-19 cutaneous mucormycosis, sufficient data is not available.Aim:To study factors related to post-COVID-19 cutaneous mucormycosis.Methodology:Clinical and investigation details of six patients admitted in tertiary center with post-COVID-19 cutaneous mucormycosis.Results:Among six patients, three were males and three females; all in 45–60 years age group from districts under tertiary center. Site of eschar was face (four) and lips (two). All six were positive for COVID-19 10–12 days prior to admission for mucormycosis. All had intravenous steroids and supportive humidified oxygen therapy for minimum 1 week under COVID-19 treatment. They presented to emergency with ophthalmic/ENT complaints; subsequently, they developed cutaneous manifestations within 2–3 days. All six had diabetes mellitus, with above 400 mg/dL sugar levels at admission.Conclusion:This study's findings correlated with various studies across the country and elsewhere. Preexisting diabetes mellitus and steroid therapy for COVID-19 increase the risk of mucormycosis. Caution for early diagnosis, maintaining blood glucose levels, and judicious use of steroids for treatment of COVID-19 are indicated.

EFFECT OF HONEY ON HEALTHY AND ALLOXAN DIABETIC MALE SWISS-WEBSTER MICE (MUS MUSCULUS) WITH AND WITHOUT GLIBENCLAMIDE THERAPY

This study was conducted to know the effect of honey from Sumbawa on healthy and alloxan-induced diabetic mice. It consisted of honey quality test, glucose tolerance test (GTT) and alloxan-induced diabetes. On GTT, healthy animals were given pure honey, diluted honey 20% and 50%, blood glucose levels were measured every 30 minutes for 3 hours. Diabetic mice obtained by inducing alloxan at a dose of 50 mg/kg bw. Blood glucose levels of diabetic mice in range of 400-500 mg/dL. Honey and combination of glibenclamide with honey were given for 21 days. Glibenclamide dose of 0.65 mg/kg bw was used as standard drug. Blood glucose levels were measured on days 10, 17 and 24. On the next day, the animals were sacrificed and pancreas were isolated. Pure honey, 20%, and 50% honey showed to raise blood glucose levels. Blood glucose level in mice group that given pure honey stayed in the normal value of 140 mg/dL until 180 minute observation, significantly different from the group of glucose 20% (p&lt;0.05). Honey and combination of glibenclamide with honey in alloxan diabetic mice did not caused a decrease of blood glucose levels that significantly different compared to the sore group (p&gt;0.05). It can be concluded honey maintains blood glucose levels of healthy mice on a normal value of 140 mg/dL until 180 minutes. In alloxan diabetic test, neither honey nor the combination of glibenclamide and honey did not show a decrease in blood glucose levels that significantly different to the sore group.

Approaches to Decrease Hyperglycemia by Targeting Impaired Hepatic Glucose Homeostasis Using Medicinal Plants.

Liver plays a pivotal role in maintaining blood glucose levels through complex processes which involve the disposal, storage, and endogenous production of this carbohydrate. Insulin is the hormone responsible for regulating hepatic glucose production and glucose storage as glycogen, thus abnormalities in its function lead to hyperglycemia in obese or diabetic patients because of higher production rates and lower capacity to store glucose. In this context, two different but complementary therapeutic approaches can be highlighted to avoid the hyperglycemia generated by the hepatic insulin resistance: 1) enhancing insulin function by inhibiting the protein tyrosine phosphatase 1B, one of the main enzymes that disrupt the insulin signal, and 2) direct regulation of key enzymes involved in hepatic glucose production and glycogen synthesis/breakdown. It is recognized that medicinal plants are a valuable source of molecules with special properties and a wide range of scaffolds that can improve hepatic glucose metabolism. Some molecules, especially phenolic compounds and terpenoids, exhibit a powerful inhibitory capacity on protein tyrosine phosphatase 1B and decrease the expression or activity of the key enzymes involved in the gluconeogenic pathway, such as phosphoenolpyruvate carboxykinase or glucose 6-phosphatase. This review shed light on the progress made in the past 7 years in medicinal plants capable of improving hepatic glucose homeostasis through the two proposed approaches. We suggest that Coreopsis tinctoria, Lithocarpus polystachyus, and Panax ginseng can be good candidates for developing herbal medicines or phytomedicines that target inhibition of hepatic glucose output as they can modulate the activity of PTP-1B, the expression of gluconeogenic enzymes, and the glycogen content.

The Gestational Diabetes Mellitus Approach in Clinical Practice – A Narrative Review

Abstract Gestational diabetes mellitus (GDM) is an increasingly condition in medical practice. In the absence of an effective therapeutic management, it can lead to significant maternal and neonatal complications with adverse health effects. Reducing the risk of morbidity is the goal achived by screening of all pregnant women and active involvement of health care staff and early medical intervention in case of detection of GDM. The aim of this review is to present the nowadays strategy of GDM approach. The management challenge is to maintain blood glucose levels within the targets recommended by current guidelines, which are in relatively narrow ranges. Nutritional intervention and lifestyle changes are of primary importance. If necessary insulin therapy is initiated, insulin analogues are preferable due to lower risk of hypoglycemia. Oral antidiabetics are not recommended in pregnancy, even if they are used in certain circumstances.

Pengaruh Aktivitas Fisik Jalan Kaki terhadap Kadar Gula Darah pada Pasien Diabetes Melitus di Wilayah Kerja Puskesmas Cianjur Kota

Introduction: Diabetes mellitus (DM) is a chronic disease that occurs because the pancreas cannot produce enough insulin or the body cannot effectively use the insulin produced by the pancreas. There are 4 ways to maintain blood glucose levels, namely; pharmacological therapy, nutritional therapy, diabetes self management education, and physical activity. Walking exercise is the most often described as the modalities of physical activity to improve health. Objective: The research objective was to determine the effect of walking physical activity on blood sugar levels in diabetes mellitus patients in the work area of ​​the Cianjur Kota Health Center in 2021. Method: This study used a design quasi-experimental with an approach one-group pretest-posttest design. The population of this study was all 620 people with diabetes mellitus who were taken using a simple random sampling technique, which was 17 respondents. Results: Analysis of data using test paired sample t-test. Statistical test results obtained a p-value of 0.000 &lt; 0.05 so that Ha is accepted, which means there is an effect of physical activity on foot on blood sugar levels in diabetes mellitus patients in the work area of ​​the Cianjur Kota Health Center in 2021. Conclusion: This study found that walking exercise as far as 2,5 km for 30 minutes can lower blood sugar levels significantly in patients with diabetes mellitus.

A nutraceutical combination of cinnamon, purple onion, and tea linked with key enzymes on treatment of type 2 diabetes.

Diabetes mellitus (DM) is concomitant with significant morbidity and mortality and its prevalence is accumulative worldwide. The conventional antidiabetic agents are known to mitigate the symptoms of diabetes; however, they may also cause adverse effects. This study was to explore the efficacy of polyherbal dietary supplement cinnamon, purple onion, and tea on the mediation of postprandial hyperglycemia in the search of combinations with a maximal response. A starch solution (3g/kg Bwt) of oral starch tolerance test (OSTT) and glucose solution (4g/kg Bwt) of oral glucose tolerance test (OGTT) with and without cinnamon, purple onion, tea extract (15mg/kg Bwt), and mixture (each 5mg/kg Bwt, 1:1:1), metformin (14mg/kg Bwt), or acarbose (50mg/kg Bwt) was administered to high fat plus high fructose-induced diabetic mice after an overnight fast. Postprandial plasma glucose levels were measured and changed areas under the response curve were calculated to find out the maximal efficacy of optimal polyherbal combinations. Compared with acarbose, the mixture of extracts (purple onion, cinnamon, and tea) indicated the decreasing blood glucose in OSTT. In OGTT, the mixture of extracts showed greater efficacy for hypoglycemia when compared with metformin. The molecular docking of α-amylase, α-glucosidase, and AMPK was further confirmed the putatively acting molecules from the extracts of purple onion, cinnamon, and tea. Overall, this investigation evidenced a beneficial mediation for the progression of lowering blood glucose with a combinatory extract of cinnamon, dietary onion, and tea, implicating their prospective as nutraceuticals that might ameliorate hyperglycemia in diabetes. PRACTICAL APPLICATIONS: Diabetes mellitus (DM), one of metabolic syndrome, attributes to risk factors like obesity, physical inactivity, ageing, life style, and genetic predisposition even with significant morbidity and mortality. DM is increasing and accounts for an estimated annual medical expenditure of US$ 827 billion worldwide. Therefore, maintaining blood glucose levels within the normal range is critical for preventing diabetes and its co-morbidities. The conventional antidiabetic agents are known to mitigate the symptoms of diabetes; nevertheless, they may also cause adverse or side effects. In an effort to design novel and well-tolerated solutions to halt the progression of DM, however evidence-base is extremely limited regarding the efficacy of polyherbal dietary supplement individual herbs for the management of glycemia. In this investigation evidenced a beneficial mediation for the progression of lowering blood glucose with a combinatory extract of cinnamon, dietary onion, and tea, implicating their prospective as nutraceuticals that might ameliorate hyperglycemia in diabetes.

The Effect of the Closed-Loop Control System on Blood Glucose Control With Exercise: A Critically Appraised Topic

Context: Exercise can cause fluctuations in blood glucose control in type 1 diabetics. For athletes with type 1 diabetes, maintenance of blood glucose within an ideal range may be difficult. Objective: To determine, in individuals with type 1 diabetes, the effectiveness of the closed loop control system versus the open loop control system in keeping blood glucose levels in the ideal range with exercise. Data Sources: A search of PubMed was conducted in June of 2020 using the Boolean phrases: (closed loop control system OR artificial pancreas) AND type 1 diabetes AND exercise AND ideal range AND adolescents, artificial pancreas AND glucose prediction AND exercise. Study Selection: Titles were reviewed for relevance, the abstract was then assessed for applicability, and finally the full text was examined. Articles were included that examined the percent of time in the ideal blood glucose range when exercise occurred during that day. Articles were excluded that didn’t compare the closed loop and open loop control systems and articles that did not involve exercise. Data Extraction: The PEDro scale was used to determine the methodological quality of the included studies. The measure addressed was the percent of time in the ideal blood glucose range of 70-180 mg/dL. 95% Confidence Intervals and Cohen’s D were calculated for each article. Data Synthesis: The search yielded 268 articles and 3 were selected for inclusion. The two randomized controlled trials scored 9/10 on the PEDro scale and the randomized two-arm crossover clinical trial scored 9/10 on the PEDro scale. Percent time spent in the ideal blood glucose range when exercise was performed was significantly higher in the closed loop group versus the open loop group in each of the three studies. In one randomized control trial, mean time in the ideal range was 71.3% (SD = 17.6, 95% CI = 62.5, 80.10) in the closed loop group versus 64.7% (SD = 13.3, 95% CI = 58.1–71.4) in the open loop group. Cohen’s D was 0.4. In the second randomized control trial, mean time in the ideal range was 73.5% (SD = 8.4, 95% CI = 70.1, 76.9) for the closed loop group versus 50% (SD = 26.8, 95% CI = 39.1, 60.9). Cohen’s D was 1.2. The two-arm crossover clinical trial resulted in a mean time in target range of 84.1% (SD = 11.5, 95% CI = 79.0, 89.2) in the closed loop group versus 68.7% (SD = 13.9, 95% CI = 62.5, 74.9) in the open loop group. Cohen’s D was 1.2. Conclusions: For adolescents with type 1 diabetes who exercise, the closed loop control system maintains blood glucose levels in the ideal range for a longer percent of time versus an open loop system. Each patient should be evaluated on a case-by-case basis with his/her healthcare team. Future research should examine the closed loop control system on specific energy systems.

Treatment for T1DM patients by a neuro-fuzzy inverse optimal controller including multi-step prediction

Diabetes Mellitus is a serious metabolic condition for global health associations. Recently, the number of adults, adolescents and children who have developed Type 1 Diabetes Mellitus (T1DM) has increased as well as the mortality statistics related to this disease. For this reason, the scientific community has directed research in developing technologies to reduce T1DM complications. This contribution is related to a feedback control strategy for blood glucose management in population samples of ten virtual adult subjects, adolescents and children. This scheme focuses on the development of an inverse optimal control (IOC) proposal which is integrated by neural identification, a multi-step prediction (MSP) strategy, and Takagi–Sugeno (T–S) fuzzy inference to shape the convenient insulin infusion in the treatment of T1DM patients. The MSP makes it possible to estimate the glucose dynamics 15 min in advance; therefore, this estimation allows the Neuro-Fuzzy-IOC (NF-IOC) controller to react in advance to prevent hypoglycemic and hyperglycemic events. The T–S fuzzy membership functions are defined in such a way that the respective inferences change basal infusion rates for each patient’s condition. The results achieved for scenarios simulated in Uva/Padova virtual software illustrate that this proposal is suitable to maintain blood glucose levels within normoglycemic values (70–115 mg/dL); furthermore, this level remains less than 250 mg/dL during the postprandial event. A comparison between a simple neural IOC (NIOC) and the proposed NF-IOC is carried out using the analysis for control variability named CVGA chart included in the Uva/Padova software. This analysis highlights the improvement of the NF-IOC treatment, proposed in this article, on the NIOC approach because each subject is located inside safe zones for the entire duration of the simulation.

Insulin protocol to control post-pancreatectomy diabetes

Diabetes is a disease by which blood glucose level is elevated by defects in insulin secretion or by resistance to insulin. As pancreatectomy inevitably results in the reduction of the total islet mass, the majority of clinicians tended to believe that pancreatectomy itself would immediately cause blood glucose elevation and subsequent diabetes development. In partial pancreatectomy surgery (distal pancreatectomy or PPPD), however, not all patients develop diabetes for at least a number of years after. This is because the remnant pancreatic islets can produce relatively enough amount of insulin to maintain blood glucose level. After this compensatory time period passes after partial pancreatectomy, the pancreas eventually undergoes atrophy after surgery and the insulin secretory function decreases in the remnant islet. This will lead to delayed development of diabetes after pancreatectomy. Under these situations, insulin injection together with oral anti-diabetic medication would be critical for controlling the blood glucose level. In contrast, patients who undergo total pancreatectomy will develop diabetes immediately after the surgery because of the absolute deficiency of insulin. In this situation, the patients will need a tightly-controlled, delicate insulin injection protocol with multiple subcutaneous insulin injections. Recently, with only a small patch applied to the body, continuous glucose monitoring system (CGMS) enables the reporting of the blood glucose level into the patient's smartphone every 1-5 minutes. The CGMS has gained popularity, is clinically helpful, and is even supported by the health insurance system for type 1 diabetes patients (the patients who undergoes total pancreatectomy can be categorized as type 1 diabetes by the Health Insurance Review System). In this lecture, I will be addressing the different glucose management protocols and/or methods in a variety of pancreatectomy cases and will also introduce the usefulness of CGMS for total pancreatectomy patients.

Traditional weight loss and dukan diets as to nutritional and laboratory results

Traditional weight loss and dukan diets as to nutritional and laboratory results