Maximum Glucose Levels Research Articles

Effect of antenatal betamethasone on blood glucose levels in women with and without diabetes

ObjectiveTo characterize the maternal glycemic response to betamethasone in subjects without diabetes compared to subjects with diabetes. Study designBlood glucose levels in 22 gravidae without diabetes and 11 gravidae with diabetes were recorded for 48h following betamethasone administration for threatened preterm delivery. Maximum blood glucose value and time to maximum value were compared. Area under the curve calculations were used to express the duration and degree of significant hyperglycemia for individual subjects. These summary measures were then correlated to subject characteristics and laboratory values to determine a risk profile of those subjects without diabetes at risk for significant hyperglycemia. ResultsAll subjects with diabetes and the majority of those without diabetes had significant hyperglycemia during the study period. Mean maximum blood glucose was higher for those with diabetes (205mg/dL vs. 173mg/dL, p⩽0.01). Mean time to reach the maximum glucose level was similar for both groups. Result of a glucose tolerance test given immediately prior to betamethasone correlated strongly with amount of time spent with hyperglycemia for subjects without diabetes (rho=0.59, p⩽0.01). Morbidly obese subjects spent less time with hyperglycemia than those with lower body mass indices (p=0.03). ConclusionBoth subjects with and without diabetes demonstrate significant hyperglycemia after receipt of antenatal betamethasone.

Glycated albumin is a better indicator of the glucose excursion than predialysis glucose and hemoglobin A1c in hemodialysis patients

Glycated albumin (GA) has been reported to be a better indicator of glycemic control than hemoglobin A1c (HbA1c) in diabetic hemodialysis (HD) patients. We performed a cross-sectional study to evaluate associations between daily glucose profiles based on blood glucose measurements at seven different times a day and their GA, HbA1c, and pre-dialysis glucose levels in 90 HD patients with (n = 46) and without (n = 44) diabetes. The results of a univariate analysis showed that the GA, HbA1c, and pre-dialaysis glucose levels were significantly correlated with the daily glucose profiles. In a multivariate analysis, the GA levels were found to be independently correlated with maximum glucose levels (F = 9.448, P = 0.0028) and mean amplitude of glucose excursion (MAGE, F = 5.169, P = 0.0255), but no significant correlation was found between the HbA1c levels and daily glucose profiles. The pre-dialysis glucose levels were independently correlated with minimum glucose levels (F = 8.336, P = 0.0049). In a stratified analysis, the identical trend was seen in the diabetic HD patients, but an independent correlation was found only between HbA1c values and mean glucose levels in nondiabetic HD patients. GA levels may be a better indicator of glycemic control than HbA1c and pre-dialysis glucose levels, especially as a means of evaluating the glucose excursions in diabetic HD patients.

Diabetes and the Association of Postoperative Hyperglycemia With Clinical and Economic Outcomes in Cardiac Surgery

The management of postoperative hyperglycemia is controversial and generally does not take into account pre-existing diabetes. We analyzed clinical and economic outcomes associated with postoperative hyperglycemia in cardiac surgery patients, stratifying by diabetes status. Multicenter cohort study in 4,316 cardiac surgery patients operated on in 2010. Glucose was measured at 6-h intervals for 48 h postoperatively. Outcomes included cost, hospital length of stay (LOS), cardiac and respiratory complications, major infections, and death. Associations between maximum glucose levels and outcomes were assessed with multivariable regression and recycled prediction analyses. In patients without diabetes, increasing glucose levels were associated with a gradual worsening of outcomes. In these patients, hyperglycemia (≥180 mg/dL) was associated with an additional cost of $3,192 (95% CI 1,972 to 4,456), an additional hospital LOS of 0.8 days (0.4 to 1.3), an increase in infections of 1.6% (0.5 to 2.8), and an increase in respiratory complications of 2.6% (0.0 to 5.3). However, among patients with insulin-treated diabetes, optimal outcomes were associated with glucose levels considered to be hyperglycemic (180 to 240 mg/dL). This level of hyperglycemia was associated with cost reductions of $6,225 (-12,886 to -222), hospital LOS reductions of 1.6 days (-3.7 to 0.4), infection reductions of 4.1% (-9.1 to 0.0), and reductions in respiratory complication of 12.5% (-22.4 to -3.0). In patients with non-insulin-treated diabetes, outcomes did not differ significantly when hyperglycemia was present. Glucose levels <180 mg/dL are associated with better outcomes in most patients, but worse outcomes in patients with diabetes with a history of prior insulin use. These findings support further investigation of a stratified approach to the management of patients with stress-induced postoperative hyperglycemia based on prior diabetes status.

Blood glucose concentration for predicting poor outcomes in patients with and without impaired glucose metabolism undergoing off-pump coronary artery bypass surgery - long-term observational study.

IntroductionStrict glucose control is an everyday practice in the perioperative period. Elevated glucose level has a deleterious impact on clinical results, but a therapeutic target has not been stated yet.AimTo determine a glucose concentration range affecting long-term outcomes after coronary artery bypass surgery (CABG).Material and methodsThis study is a retrospective evaluation of consecutive patients treated in a university hospital in Poland from 2004 to 2008. Patients were divided into 2 groups: an impaired glucose metabolism group (IGM) if they had 1) known DM or 2) perioperative hyperglycaemia defined as ≥ 200 mg/dl; and a non-IGM group. The end point (EP) was all-cause mortality.ResultsOne thousand two hundred and eleven patients were covered by the analysis. The observation time was from 01.01.2004 until 01.08.2012. Patients who had maximal glucose concentrations < 242 mg/dl had the lowest mortality risk (EP in 21.1%); a higher risk was noted in the group with glucose concentrations 242–324 mg/dl (EP in 30.8%); and a very high risk was found for the group where glucose concentration was > 324 mg/dl (EP in 44.2%) (p = 0.041). Patients with IGM had a shorter survival at the end of the study (p < 0.001). The longest survival was observed in patients whose maximal glucose level was ≤ 242 mg/dl (p < 0.001) and the minimal glucose concentration was in the range 61–110 mg/dl (p < 0.001).ConclusionsTight glucose concentration control should be performed irrespective of a diabetes diagnosis and proper treatment introduced when necessary. Maximal glucose concentration should be kept < 242 mg/dl, while the minimum should be in the range 60–110 mg/dl.

Insulin resistance, β-cell dysfunction and differences in curves of plasma glucose and insulin in the intermediate points of the standard glucose tolerance test in adults with cystic fibrosis

Abstract Background Diabetes has become a co-morbidity with a negative impact on nutritional status, lung function and survival in cystic fibrosis. Objective To identify any changes in intermediate points after a 2-h oral glucose tolerance test (OGTT), pancreatic β-cell dysfunction, and insulin resistance in cystic fibrosis-related diabetes. Methods It was carried out a retrospective analysis in a cohort of 64 patients affected of cystic fibrosis, older than 14 years, using the first pathological OGTT. Peripheral insulin resistance was measured using the homeostasis model assessment for insulin resistance (HOMA-IR), and pancreatic β-cell function was calculated according to Wareham. Time to maximum plasma insulin and glucose levels and area under the curve (AUC0–120) were also measured. Results Twenty-eight women and 36 men with a mean age of 26.8 years were enrolled, of whom 26.7% had normal glucose tolerance (NGT), 18.3% cystic fibrosis-related diabetes without fasting hyperglycemia (CFRD w/o FPG), 10% indeterminate (INDET), and 45% impaired glucose tolerance (IGT). HOMA-IR values were not significantly different between the diagnostic categories. Patients with any pathological change had worse β-cell function, with a significant delay in insulin secretion, although there were no differences in total insulin production (AUC0–120). Time to maximum glucose levels was significantly shorter in NGT patients as compared to other categories, with glucose AUC0–120 being higher in the different diagnostic categories as compared to NGT. Conclusions In over half the cases, peak blood glucose levels during a standard OGTT are reached in the intermediate time points, rather than at the usual time of 120 min. Patients with cystic fibrosis and impaired glucose metabolism have a delayed insulin secretion during the standard OGTT due to loss of first-phase insulin secretion, with no differences in total insulin production. Absence of significant changes in HOMA-IR suggests that β-cell dysfunction is the main pathogenetic mechanism.

The Synergistic Effects of Pioglitazone on the Glucose-Lowering Action of Metformin in Relation to OCT1 and Gluts m-RNA Expression in Healthy Volunteer

Objective: Organic Cation Transporter 1 (OCT1) plays a key role in the disposition of metformin in hepatocytes; a recent non-clinical study reported that the peroxisome-proliferator activated receptor γ agonist pioglitazone increased the expression of Slc22a1 (Oct1) by 3.1-fold as well as its transporting function. We therefore evaluated the effect of pioglitazone on the glucose-lowering effect of metformin in 15 human participants using the Oral Glucose Tolerance Test (OGTT) and measuring the mRNA levels of OCT1, as well as those of Glucose Transporter 1 (GLUT 1) and GLUT4, which are also important in glucose utilization, in peripheral blood cells. Research design and methods: The glucose-lowering effects of metformin were evaluated by the OGTT before and after metformin treatment on Days 1 and 2 of the study and again on Days 18 and 19 after a 14-day course of pioglitazone 30 mg/day. Differences in maximum glucose levels (ΔGmax) and the areas under the glucose-time curve during the first 60 min after glucose ingestion (ΔAUCgluc60) and the entire 180-min test (ΔAUCgluc) caused by metformin treatment were determined before and after pioglitazone administration. Results: Pioglitazone increased ΔGmax by 50.0% (P=0.021), ΔAUCgluc60 by 88.1% (P=0.020), and ΔAUCgluc by 266%. Pioglitazone did not increase OCT1 and GLUT1 mRNA levels in peripheral blood cells. Conclusion: OCT1 induction plays a limited role in the synergistic effect of pioglitazone on the glucose-lowering activity of metformin. However, this synergistic effect lasted 3 days after pioglitazone treatment ended, which warrants further clinical investigation.

The impact of a pure protein load on the glucose levels in type 1 diabetes patients treated with insulin pumps.

We aimed to estimate the impact of ingestion of a pure protein load on the glucose levels in T1DM patients treated with insulin pumps. We examined 10 T1DM patients (6 females, mean age—32.3 years, mean HbA1c—6.8%) treated with insulin pumps equipped with a continuous glucose monitoring system (CGMS). In Phase I, baseline insulin infusion was optimized to minimize the differences in fasting glucose levels to less than 30 mg/dL between any two time points between 9 a.m. and 3 p.m. In Phase II, the patients were exposed to single pure protein load. CGMS record was performed and the glucose pattern was defined for 6 hours of each phase. The maximal glucose level increment was similar for the entire duration of the fasting and the protein load test (26.6 versus 27.6 mg/dL, resp., P < 0.78). There was only a borderline difference in change between baseline versus 6th hour glucose (12.5 and 19.0 mg/dL, P = 0.04). Glucose variability, assessed by standard deviation of mean glucose levels, was 36.4 and 37.9 mg/dL, respectively (P = 0.01). The administration of a pure protein load does not seem to have a clinically significant impact on glucose levels in T1DM patients treated with insulin pumps.

Resistencia insulínica, disfunción de la célula β pancreática y diferencias en los puntos intermedios de las curvas de glucemia e insulina tras una sobrecarga oral estándar de glucosa en adultos con fibrosis quística

Backgrounddiabetes has become a co-morbidity with a negative impact on nutritional status, lung function and survival in cystic fibrosis. ObjectiveTo identify any changes in intermediate points after a 2-hour oral glucose tolerance test (OGTT), pancreatic β-cell dysfunction, and insulin resistance in cystic fibrosis-related diabetes. MethodsIt was carried out a retrospective analysis in a cohort of 64 patients affected of cystic fibrosis, older than 14 years, using the first pathological OGTT. Peripheral insulin resistance was measured using the homeostasis model assessment for insulin resistance (HOMA- IR), and pancreatic β-cell function was calculated according to Wareham. Time to maximum plasma insulin and glucose levels and area under the curve (AUC0-120) were also measured. ResultsTwenty-eight women and 36 men with a mean age of 26.8 years were enrolled, of whom 26.7% had normal glucose tolerance (NGT), 18.3% cystic fibrosis-related diabetes without fasting hyperglycemia (CFRD w/o FPG), 10% indeterminate (INDET), and 45% impaired glucose tolerance (IGT). HOMA-IR values were not significantly different between the diagnostic categories. Patients with any pathological change had worse β cell function, with a significant delay in insulin secretion, although there were no differences in total insulin production (AUC0-120). Time to maximum glucose levels was significantly shorter in NGT patients as compared to other categories, with glucose AUC0-120 being higher in the different diagnostic categories as compared to NGT. ConclusionsIn over half the cases, peak blood glucose levels during a standard OGTT are reached in the intermediate time points, rather than at the usual time of 120minutes. Patients with cystic fibrosis and impaired glucose metabolism have a delayed insulin secretion during the standard OGTT due to loss of first-phase insulin secretion, with no differences in total insulin production. Absence of significant changes in HOMA-IR suggests that β-cell dysfunction is the main pathogenetic mechanism.

Antidiabetic effects of the Cimicifuga racemosa extract Ze 450 in vitro and in vivo in ob/ob mice

IntroductionIt was the aim of the present experiments to examine potential antidiabetic effects of the Cimicifuga racemosa extract Ze 450. MethodsZe 450 and some of its components (23-epi-26-deoxyactein, protopine and cimiracemoside C) were investigated in vitro for their effects on AMP-activated protein kinase (AMPK) compared to metformin in HepaRG cells. Ze 450 (given orally (PO) and intraperitonally (IP)), metformin (PO) and controls were given over 7 days to 68 male ob/ob mice. Glucose and insulin concentrations were measured at baseline and during an oral glucose tolerance test (OGTT). ResultsZe 450 and its components activated AMPK to the same extent as metformin. In mice, Ze 450 (PO/IP) decreased significantly average daily and cumulative weight gain, average daily food and water intake, while metformin had no effect. In contrast to metformin, PO Ze 450 virtually did not change maximum glucose levels during OGTT, however, prolonged elimination. Ze 450 administered PO and IP decreased significantly post-stimulated insulin, whereas metformin did not. HOMA-IR index of insulin resistance improved significantly after IP and PO Ze 450 and slightly after metformin. In summary, the results demonstrate that Ze 450 reduced significantly body weight, plasma glucose, improved glucose metabolism and insulin sensitivity in diabetic ob/ob mice. In vitro experiments suggest that part of the effects may be related to AMPK activation. ConclusionsZe 450 may have utility in the treatment of type 2 diabetes. However, longer term studies in additional animal models or patients with disturbed glucose tolerance or diabetes may be of use to investigate this further.

Postprandial plasma glucose response and gastrointestinal symptom severity in patients with diabetic gastroparesis.

Gastroparesis is a well-known diabetic complication. The pathogenesis is not fully understood. However, it is important to early diagnose these patients. This study evaluated the plasma glucose response after a test meal, and gastrointestinal (GI) symptom severity in patients with clinical suspicion of diabetic gastroparesis, and assessed its usefulness to predict gastroparesis. In all, 83 subjects with insulin-treated diabetes mellitus (DM) type 1 and 2 were included; 53 subjects had gastroparesis and 30 had normal gastric emptying determined by gastric scintigraphy. GI symptom severity during the preceding 2 weeks was evaluated with a validated questionnaire. The test meal consisted of 100 g meat, 40 g pasta, 150 g carrot, and 5 g oil. The subjects ingested the meal under fasting conditions, and plasma glucose was followed during 180 minutes. Patients with gastroparesis demonstrated a blunted plasma glucose response after a test meal versus patients with normal gastric emptying (P < .005), reflected by lower maximum increase in plasma glucose response and incremental area under the curve of the plasma glucose, but a similar time to the maximum plasma glucose level. All GI symptoms were more severe in patients with gastroparesis. GI symptom severity had the best discriminative value to identify patients with gastroparesis with an area under the receiver operating curve of 0.83 (optimal cutoff: sensitivity 87%, specificity 80%). Patients with diabetic gastroparesis have a blunted postprandial plasma glucose response. Combining this information with the presence of GI symptoms can help clinicians identify diabetic patients with gastroparesis.

Clinically Relevant Assessment of the Variability of Glycemic Response and Its Affect on Surgical Site Infection Rates?

Purpose: Despite growing interest in perioperative glycemic control, little data existdefining the optimal value(s) to use to define appropriate glycemic management and the impact on the incidence of surgical site infection (SSI). The aim of this study was to assess variation in glycemic response and risk of SSI and hospital stay as defined by themaximum, minimum, and area under the curve for perioperative glucose in patients undergoing colectomy. We specifically used standard of care obtained glucose levels to reflect limitations of observations typically used to assess quality of care. Methods: All patients undergoing colectomy from 7/2007 to 6/2008 were assessed for the maximum and minimum levels of standard of care glucose levels, as well as area under the curve (AUC) for elevated glucose perioperatively. These were assessed for patients with and without SSI (SSI vs nSSI). Results: 183 consecutive patients were evaluated (22 diabetics). The incidence of SSI for the entire population was 17/183 (9.3%) without significant difference between the groups with respect to mean blood glucose level (SSI-136; nSSI-136). However, the SSI group had a higher maximum glucose level (SSI-194; nSSI 162; p 110 mg/dl (SSI-59%; nSSI-62%) or glucose > 150 mg/dl (SSI 6%; nSSI 18%). Conclusions: The data demonstrate that patients with SSI have wider fluctuations inglycemic response compared to non-SSI when standard of care serum glucose levels wasreviewed. Therefore, quality program monitoring of glucose impact on SSI should focus on both maximum and minimum levels during the perioperative period to better define process improvement in colectomy patients.

Impact of glucose excursion and mean glucose concentration in oral glucose-tolerance test on oxidative stress among Japanese Americans

AimTo evaluate the impact of glucose excursion (GE) and mean glucose concentration (MGC) on oxidative stress among persons with or without diabetes.Materials and methodsWe examined 775 Japanese Americans who had normal glucose tolerance (NGT), impaired glucose tolerance, or diabetes according to the 75 g oral glucose-tolerance test, using fasting, 1-hour, and 2-hour glucose data. We calculated GE by subtracting the minimum from the maximum glucose level among three points and calculated MGC using these measurements. We investigated the relationship between GE or MGC and urinary isoprostane as a marker of oxidative stress.ResultsAccording to tertiles of GE or MGC, GE was associated with isoprostane levels among subjects with NGT as well as those with diabetes (P=0.004 and 0.033 for trend, respectively). However, MGC was associated with isoprostane only among NGT subjects (P=0.001 for trend). Association between GE and isoprostane was significant when adjustment was made for age, sex, smoking status, body mass index, C-reactive protein, glucose tolerance status, and homeostatic model assessment (P=0.029), but the association with MGC was not significant.ConclusionOur results suggest the possibility that GE might result in oxidative stress, and the relationship is stronger than that for MGC.

The effect of lansoprazole, an OCT inhibitor, on metformin pharmacokinetics in healthy subjects

Gastro-esophageal reflux disease is common in patients with type 2 diabetes. A common treatment is the co-administration of proton-pump inhibitors (PPIs) and metformin. To date, however, the effects of co-administration of PPIs, which inhibit organic cation transporter (OCT) activity, on the action of metformin (a well-known substrate of OCTs) have not been clearly demonstrated. This was a randomized, double-blind, two-way crossover, placebo-controlled trial. Healthy male volunteers (n = 20) received metformin (single dose 1,000 mg on day 1 and single dose 750 mg on day 2, with a 12-h interval) co-administered with placebo or with lansoprazole (30 mg). Plasma concentrations of metformin were measured up to 24 h after the second dose. The glucose-lowering effects of metformin were evaluated by the oral glucose tolerance test before and after each single dose of metformin within the 2-day period. Lansoprazole increased the mean metformin maximum plasma concentration and area under the plasma concentration-time curve from zero to 24 h after the second dosing by 15 and 17 %, respectively (P < 0.05). Moreover, lansoprazole prolonged the metformin elimination half-life from 3.9 to 4.5 h and decreased its renal clearance by 13 % (P < 0.05). However, lansoprazole had no effect on the maximum glucose level and the area under the serum glucose concentration-time curve of metformin. Collectively, we found a modest pharmacokinetic drug interaction between lansoprazole and metformin, which suggests that the concomitant use of these drugs should be appropriately monitored. Further studies are warranted to assess changes in metformin pharmacokinetics in patients with diabetes receiving long-term lansoprazole therapy.

Effects of glucose injection on biochemical parameters, insulin, and glycolytic enzymes in GIFT (Oreochromis niloticus)

We evaluated the effect of glucose injection on a range of biochemical parameters,insulin,and glyco-lytic enzymes in GIFT(Oreochromis niloticus).Fish(n=150,mean weight 80±5 g) were randomly assigned to one of two groups,a control group that was injected with sterile 0.7% saline and a treatment group that was injected intraperitoneally with glucose(30 mg/100 g wet weight).The fish in both groups were euthanized 1–12 h after injection.Glucose injection resulted in hyperglycemia with maximum glucose levels observed 1 h after injection(P0.05) and a return to normal levels after 3 h.Cholesterol content also increased significantly(P0.05) after glucose injection.Conversely,triglycerides,plasma protein,and glutamic-pyruvic transaminase(GPT) levels were unaffected by glucose injection.The level of glutamic-oxalacetic transaminase(GOT) decreased significantly(P0.05) after injection.Liver glycogen peaked 6 h after injection with glucose,then decreased significantly(P0.05).Glucose injection had no effect on muscle glycogen levels.Insulin levels increased significantly(P0.05) in the plasma and muscle,but not in the liver,following glucose injection.Pyruvate kinase levels peaked 6 h after glucose injection(P0.05).Conversely,there was no change in hexokinase activity after injection.Our results suggest that metabolic adjustment caused by glucose administration is reflective of the regulatory action of insulin and pyruvate kinase.The levels of insulin and pyruvate kinase(PK) were unable to maintain pace with the absorption speed of carbohydrates in fish and a shortage in hexokinase(HK) activity limited glucose utilization,leading to higher concentrations of cholesterol.

Patch Pump Versus Conventional Pump: Postprandial Glycemic Excursions and the Influence of Wear Time

The aim of this study was to compare blood glucose and plasma insulin profiles after bolus insulin infusion by a patch pump (PP) versus a conventional pump (CP), directly after placement and after Day 3 of use. Twenty patients with type 1 diabetes came in for two blocks of visits: one block of two visits while wearing the OmniPod® (Insulet Corp., Bedford, MA) insulin pump (PP) and one block of two visits while wearing the Medtronic Diabetes (Northridge, CA) Paradigm® pump (CP). Patients administered an identical mealtime insulin bolus of at least 6 IU. For PP, maximum glucose levels were 28.7% lower on Day 3 (P=0.020), when maximum insulin levels were 30.3% higher (P=0.002). For CP, maximum glucose levels were 26.5% lower on Day 3 (P=0.015), when maximum insulin levels were 46.4% higher (P=0.003). Glucose levels (mean [interquartile range]) were significantly lower on Day 3 for PP (168.2 [145.8] mg/dL vs. 139.4 [77.8] mg/dL; P=0.013), but not significantly so for CP (159.0 [66.1] mg/dL vs. 139.5 [57.9] mg/dL; P=0.084). Mean insulin levels were significantly higher on Day 3 for CP (195 [120] pmol/L vs. 230 [90] pmol/L; P=0.01), but not significantly so for PP (178 [106] pmol/L vs. 194 [120] pmol/L; P=0.099). There were no significant differences between the two catheter lengths. Postprandial glycemic excursions were lower on Day 3 of catheter wear time, but there were no differences between PPs and CPs. These findings support the proposal that catheter wear time plays an important role in insulin absorption.

Blood Glucose Levels

The purpose of this study was to establish a mathematical model which can be used to estimate glucose levels in the blood over time. The equations governing this process were manipulated with the use of techniques such as separation of variables and integration of first order differential equations, which resulted in a function that described the glucose concentration in terms of time. This function was then plotted, which allowed us to find when glucose concentration was at its highest. The model was then used to analyze two cases where the maximum glucose level could not exceed a certain level while the amount of carbohydrates and glycemic index were varied, independently.

Hyperglycemia and its association with clinical outcomes for patients in the pediatric intensive care unit after abdominal surgery

PurposeWe investigated the incidence of hyperglycemia of patients in the pediatric intensive care unit (PICU) after receiving abdominal surgery and its association with clinical outcomes. MethodsA retrospective review was performed from November 1, 2010 to November 1, 2011 on all PICU admissions after abdominal surgery. Maximum serum glucose concentrations (Gmax) in PICU, PICU length of stay, total hospital length of stay, deep and systemic infection, wound infection and mortality rates were recorded and analyzed. ResultsA total of 193 children met the inclusion criteria of our research. Maximum glucose levels ranged from 55.7 mg/dL to 415.9 mg/dL (median: 132 mg/dL). Hyperglycemia in PICU was prevalent, with 125 (64.8%) patients having Gmax >110 mg/dL during their PICU stay and 35 (18.8%) having Gmax >200 mg/dL. Average PICU length of stay and total hospital length of stay grew as the maximum glucose levels rose among the four plasma glycemic ranges. The highest serum glucose range patient group also had the highest wound infection rates (14.3% and 11.4%). ConclusionsHyperglycemia was prevalent among patients after major abdominal surgery in PICU and was correlated with increased PICU length of stay, total hospital length of stay. Appropriate glycemic control may improve clinical outcomes for this group of patients.

Factors Associated with Increases in Glucose Levels in the Perioperative Period in Non-Diabetic Patients

Background: Blood glucose levels are elevated during the perioperative period as a result of the neuro-endocrine response to the stress of surgery. In nondiabetic patients, blood glucose levels are not a part of routine preoperative testing nor are they monitored during surgery or in the post anesthesia care unit (PACU). We measured blood glucose levels in nondiabetic patients during the perioperative period to identify how many patients had high glucose levels and what factors were associated with increases in blood glucose levels. Methods: This prospective observational study included two hundred and ninety five nondiabetic patients between the ages of 18 and 80 years, undergoing elective noncardiac surgery. Blood glucose levels were measured preoperatively and at frequent, predetermined intervals during surgery and in the PACU. Patient characteristics, surgical and anesthetic factors, and pain scores in the PACU were recorded, as were postoperative complications. Results: Forty nine percent (49%) of the patients had maximum intraoperative glucose levels of 126 mg/dl or higher and fifty three percent (53%) had maximum postoperative glucose levels of 126 mg/dl or higher. Preoperative glucose levels, family history of diabetes and amount of blood loss were statistically significantly associated with both max-intra-op and max-post-op glucose levels. Additionally, blood administration, surgery duration and race were significantly associated with max-intra-op glucose levels, while amount of intravenous fluids and sex were significantly associated with max-post-op glucose levels. Conclusion: A large number of nondiabetic patients in our study had maximum glucose levels >126 mg/dl in the perioperative period. Certain patient characteristics, as well as surgical/anesthetic factors, were associated with increases in the glucose levels. More studies are indicated to determine which patients may benefit from glucose monitoring in the perioperative period.

Yoğun Bakım Hastalarında Yoğun İnsülin Tedavisi İle Kan Șekerinin Sıkı Kontrolünün Mortalite Ve Morbiditeye Etkileri

Amaç: Bu çalıșma, yoğun bakım (YB) hastalarında sürekli insülin infüzyonu ile kan șekerinin sıkı kontrolünün mortalite, morbidite ve immün paraliziye etkilerini araștırmak amacı ile planlandı. Materyal ve Metod: Bu prospektif, randomize ve kontrollü çalıșmaya YB’a kabul edilen hasta veya birinci derece yakınlarından onam alınan toplam 20 hasta dahil edildi. Hastalar YB’ye kabulden sonra randomize olarak, Yoğun İnsülin Tedavisi (YİT) veya Geleneksel İnsülin Tedavisi (GİT) gruplarından birine alındı. Her iki gruba 10’ar hasta dahil edildi. Sürekli insülin infüzyonu ile YİT grubunda kan șekeri 80-110 mg/dL, GİT grubunda 180-200 mg/dL arasında tutuldu. Hastalar YB’ye kabul edildikten sonra günlük APACHE II (Acute Physiology and Chronic Health Evaluation II, Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi) ve TISS 28 (Therapeutic Intervention Scoring System, Tedavi Amaçlı Girișim Skorlama Sistemi) skorlamaları yapıldı. Kabul, 5, 14 ve 28’inci günde tam kan ve biyokimyasal analizler yapıldı, C-reaktif protein (CRP) ve akım sitometri yöntemi ile monositik HLA-DR düzeyi saptandı. Yoğun bakım ve hastanede kalma süreleri ile olası mortalite nedeni ve zamanı kaydedildi. İstatiksel analizde Mann Whitney U Testi ve Chi-Square Testi kullanıldı ve p

A Placebo-Controlled, Single and Multiple Dose Study to Investigate the Appropriate Parameters for Evaluation of Pharmacodynamic Equivalence of Voglibose in Healthy Korean Volunteers

Background: Voglibose is an α-glucosidase inhibitor. The purpose of this study was to evaluate the pharmacodynamic characteristics of voglibose for determining the appropriate study design and parameters for a pharmacodynamic equivalence study of voglibose. Methods: This study consisted of two studies. The single dose study had an open and single sequence design. Nineteen subjects received placebo and then one tablet of voglibose on two consecutive days with sucrose. The multiple dose study was performed with the similar design, except that it was a multiple dose of the single dose study. Nine subjects who showed an effective response in the single dose study received placebo three times and then voglibose 4 times on two consecutive days. Serial blood samples for pharmacodynamic parameters were taken until 180 mins after each administration. The baseline adjusted maximum serum glucose level (Gmax) and area under the serum glucose level-time profiles were determined and compared. Results: In the single dose study, the difference in Gmax was -10.6 ± 28.7 mg/dL. The area under the serum glucose concentration-time curve (AUGC0-1h) of placebo and voglibose were 7825.0 ± 1145.3 mg? min/dL, 7907.5 ± 917.2 mg?min/dL, respectively. In the multiple dose study, the difference in Gmax was 46.6 ± 16.1 mg/dL. The AUGC0-1h of placebo and voglibose were 8138.6 ± 721.9 mg?min/dL and 6499.7 ± 447.2 mg?min/dL, respectively. The Gmax and AUGC0-1h of the multiple dose study was significantly different between placebo and voglibose in paired t-test. Conclusion: The differences in Gmax and AUGC0-1h are suitable for pharmacodynamic parameters to evaluate bioequivalence of voglibose.