Mean Blood Glucose Research Articles

Systematic Literature Review and Indirect Treatment Comparison of Three Ready-to-Use Glucagon Treatments for Severe Hypoglycemia.

Ready-to-use glucagon represents a significant advancement in the management of severe hypoglycemia for people with diabetes and their caregivers. This indirect treatment comparison (ITC) evaluated the efficacy and safety differences among the three ready-to-use glucagon treatments, Baqsimi® (nasal glucagon), Gvoke® (glucagon injection) and Zegalogue® (dasiglucagon injection), in adults and children with type 1 diabetes (T1D) or type 2 diabetes (T2D). A systematic literature review was conducted to identify randomized clinical trials assessing the efficacy and safety of Baqsimi, Gvoke or Zegalogue versus reconstituted, injectable glucagon (IG) in reversing insulin-induced hypoglycemia. Bayesian fixed-effect network meta-analysis was used to perform the ITC. Study endpoints included proportion of participants achieving treatment success, maximum blood glucose achieved, time to achieve treatment success and maximum blood glucose and treatment-emergent adverse events (TEAE). Ten clinical trials were included in the ITC (four for Baqsimi, three for Gvoke, and three for Zegalogue). All three treatments achieved high proportions of treatment success (> 98%). In adults, the efficacy results from combined T1D and T2D analysis were consistent with the T1D analysis, except statistically significantly faster in achieving treatment success for Baqsimi vs Gvoke in the combined analysis (13.96 vs 14.66min). The mean maximum blood glucose values were also statistically significantly lower for Baqsimi (168mg/dl) vs Gvoke (220mg/dl) and Zegalogue (190mg/dl). There was a trend towards a lower number of adults experiencing ≥ 1 TEAE with Baqsimi compared to Gvoke or Zegalogue, but no statistical significance was reached. Baqsimi, Gvoke and Zegalogue had comparable high proportions of treatment success in reversing insulin-induced hypoglycemia. Baqsimi achieved a lower mean maximum blood glucose value, which may have implications for the re-establishment of euglycemia. These findings may help support patients, caregivers and health care providers in their decision-making process when discussing various ready-to-use glucagon treatment options.

Determination of Glucose-Independent Racial Disparity in HbA1c for Youth With Type 1 Diabetes in the Era of Continuous Glucose Monitoring.

The magnitude and importance of higher HbA1c levels not due to mean blood glucose (MBG) in non-Hispanic black (B) versus non-Hispanic white (W) individuals is controversial. We sought to clarify the relationship of HbA1c with glucose data from continuous glucose monitoring (CGM) in a young biracial population. Glycemic data of 33 B and 85 W, healthy youth with type 1 diabetes (age 14.7 ± 4.8 years, M/F = 51/67, duration of diabetes 5.4 ± 4.7 years) from a factory-calibrated CGM was compared with HbA1c. Hemoglobin glycation index (HGI) = assayed HbA1c - glucose management index (GMI). B patients had higher unadjusted levels of HbA1c, MBG, MBGSD, GMI, and HGI than W patients. Percent glucose time in range (TIR) and percent sensor use (PSU) were lower for B patients. Average HbA1c in B patients 8.3% was higher than 7.7% for W (P < .0001) after statistical adjustment for MBG, age, gender, insulin delivery method, and accounting for a race by PSU interaction effect. Higher HbA1c persisted in B patients when TIR was substituted for MBG. Predicted MBG was higher in B patients at any level of PSU. The 95th percentile for HGI was 0.47 in W patients, and 52% of B patients had HGI ≥ 0.5. Time below range was similar for both. Young B patients have clinically relevant higher average HbA1c at any given level of MBG or TIR than W patients, which may pose an additional risk for diabetes complications development. HGI ≥ 0.5 may be an easy way to identify high-risk patients.

Early neonatal hypoglycemia in term and late preterm small for gestational age newborns.

Neonatal hypoglycemia is a common metabolic occurrence among small for gestational age (SGA) neonates. This study aims to determine the incidence of early neonatal hypoglycemia and confirms the potential risk factors among term and late preterm SGA neonates in a well-baby newborn nursery of a tertiary medical center in Southern Taiwan. We performed a retrospective medical record review of term and late preterm SGA (birth weight <10 percentile) neonates, born between January 1, 2012 and December 31, 2020, in the well-baby newborn nursery, of a tertiary medical center in Southern Taiwan. Blood glucose monitoring was routinely performed at 0.5, 1, 2, and 4h of life. Antenatal and postnatal risk factors were recorded. Mean blood glucose level, age of occurrence, symptomatic hypoglycemia, and need for intravenous glucose treatment of early hypoglycemia in SGA neonates were documented. 690 SGA neonates in the nursery met the criteria and were retrospectively enrolled in the study, 358 of whom (51.80%) were male and 332 (48.10%) female. Of 690 enrolled SGA neonates, 134(19.42%) SGA neonates developed hypoglycemia during a well-baby nursery stay. Among these neonates, 97% of early hypoglycemic episodes occur during the first 2h of life. The lowest blood glucose level was 46.78±11.13mg/dL, recorded in the first hour of life. Among the hypoglycemic 134 neonates, 26 (19.40%) neonates had to be transferred from the nursery to the neonatal ward and they required intravenous glucose treatment to achieve euglycemia. 14 (10.40%) neonates had symptomatic hypoglycemia. A multivariate logistic regression analysis revealed that cesarean delivery, small head circumference, small chest circumference, and low 1-min Apgar score were significant risk factors for early hypoglycemia in these neonates. Periodic routine blood glucose level monitoring within the first 4h of life in term and late preterm SGA neonates is required, especially those with cesarean delivery and low Apgar score.

Levels of leptin, irisin, oxytocin and insulin in obese and normal weight Iraqi young men

Introduction and Aim: Obesity is a serious, life-threatening health condition that is prevalent in Iraq and the world as a whole. Since Leptin, irisin, oxytocin and insulin are proposed to play main roles in energy expenditure, glucose homeostasis, regulating body weight, reducing obesity and improving life expectancy so the aim of this study was to evaluate the concentrations of these anti-obesity hormones plus insulin resistance Materials and Methods: The study was conducted on 100 obese young men with a mean age of 29.95 years and fifty normal weight young men with a mean age of 28.44. Results: In obese men, the mean leptin concentration was 24.08±9.91 ng/ml which was significantly higher than in normal weight men 5.48 ng/ml. Serum irisin levels in obese men and normal weight were 8.9 ng/ml, 2.4 ng/ml respectively, and it was significantly higher in obese group in comparison to the normal weight group. The mean serum oxytocin concentration was significantly lower in obese group 6.41pg/ml in comparison to normal weight 29.55 pg/ml. Serum insulin levels in obese and normal weight were 19.55±5.56 and 3.64 micro lU/ml respectively and it was significantly higher in obese men. The mean fasting blood glucose concentration in obese men was 98.67mg/dl and it was significantly higher than in normal weight 84±9.85 mg/ml. Insulin resistance (HOMA IR) was significantly higher in obese men 6.6 than in normal weight 0.68. Conclusion: Serum levels of leptin, irisin, insulin, and insulin resistance are higher in obese young men, while oxytocin levels were noticeably low. Our study also shows that obesity increases the likelihood of insulin resistance.

Role of Circulating Endocan as a Biomarker in Non-Alcoholic Fatty Liver Disease

Abstract Background Nonalcoholic fatty liver disease (NAFLD) has a prevalence of 25% worldwide and is described as the leading cause of chronic liver disease. Liver disease was found to be the third leading cause of death among persons with NAFLD. Its prevalence is increasing in conjunction with metabolic syndrome due to engaged risk factors, which include high body mass index and abdominal obesity, type 2 diabetes, dyslipidemia (high triglycerides and/or low high-densitylipoproteins), age, male sex, and alcohol consumption. Aim of the Work The aim of this study is to study serum level of Endocan in patients with nonalcoholic Fatty Liver disease (NAFLD) to detect its relation to the incidence and severity of nonalcoholic Fatty Liver Disease (NAFLD). Patients and Methods This study was conducted at Ain Shams University hospitals to evaluate the role of serum endocan as a diagnostic biomarker for NAFLD. We included a total of 100 subjects who were divided into two equal groups; Group 1 included 50 patients with NAFLD, and Group 2 included 50 healthy controls. Results Both BMI and waist circumference showed a significant increase in cases compared to controls. The prevalence of DM in the NAFLD group was 36% which was statistically significantly higher as compared with the control group. The mean SBP was statistically significantly higher in the NAFLD group, while DBP showed comparable findings. The mean liver size as detected by US was statistically significantly higher in the NAFLD group as compared with the control group, while spleen size didn’t reveal a statistically significant difference between the two groups. The mean fasting blood glucose, mean HbA1C, mean post-prandial glucose, mean cholesterol level, mean TGs, mean LDL, mean ALT and mean AST, mean ALP, mean GGT and mean ferritin level were statistically significantly higher in the NAFLD group as compared with the control group. The mean HDL level was statistically significantly lower in the NAFLD group as compared with the control group. Other laboratory variables were comparable between the two groups. The mean serum endocan level was statistically significantly higher in the NAFLD group as compared with the control group (54.58 ± 18.61 and 30.69 ± 6.49 respectively). Each of APRI, FIB-4 and NAFLD scores showed significant difference between the two groups. Conclusion Based on the previous findings, one can conclude that: Serum endocan may act as a surrogate marker for the diagnosis of NAFLD as it was significantly elevated in cases compared to controls. As well as detection of disease severity as it has a positive correlation with APRI, FIB-4 score yet still further studies on larger scales are required. This confirms the state of endothelial dysfunction associated with this disease NAFLD is associated with impaired lipid profile, impaired liver functions, and higher incidence of diabetes compared to controls.

Impact of Age on HbA1c Level of Diabetic Patients Attending Ahmadu Bello University Teaching Hospital Zaria, Nigeria

The present study looked into the possibility of impact of age on HbA1c level of diabetic patients attending Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria, as there have been reports of correlation between age and HbA1c in some other parts of the world. Three hundred and fifty (350) diabetic patients were initially recruited over a period of 10 months, from March 2018 to December 2018. Subjects consisted of 200 female and 150 male diabetic patients. After 10-12 hours fast, 5mL of blood was drawn from volunteer patients. About 3mL was centrifuged in order to separate the serum after which the serum was then analysed for glucose. Two hundred and fifteen (215) subjects, comprising of 110 female and 105 male diabetic patients, with ages between 46 years and 84 years (mean age = 65±19 years) and mean blood glucose of 200±20 mg/dL were then selected for the study. The remaining 2mL whole blood was analysed immediately for HbA1c. Information about patient’s age was obtained via a well-designed questionnaire and matched with hospital record. There was no significant difference in the mean HbA1c levels of male and female participants. For the given blood glucose range, the HbA1c level increased by 0.2%, proportionally, with every decade (10 years) increase in age. It was concluded that HbA1c increases consistently – independent of blood glucose and gender – with increase in age of diabetic patients.

Real-World Adherence and Effectiveness of Remote Patient Monitoring Among Medicaid Patients With Diabetes: Retrospective Cohort Study.

The prevalence of diabetes in the United States is high and increasing, and it is also the most expensive chronic condition in the United States. Self-monitoring of blood glucose or continuous glucose monitoring are potential solutions, but there are barriers to their use. Remote patient monitoring (RPM) with appropriate support has the potential to provide solutions. We aim to investigate the adherence of Medicaid patients with diabetes to daily RPM protocols, the relationship between adherence and changes in blood glucose levels, and the impact of daily testing time on blood glucose changes. This retrospective cohort study analyzed real-world data from an RPM company that provides services to Texas Medicaid patients with diabetes. Overall, 180 days of blood glucose data from an RPM company were collected to assess transmission rates and blood glucose changes, after the first 30 days of data were excluded due to startup effects. Patients were separated into adherent and nonadherent cohorts, where adherent patients transmitted data on at least 120 of the 150 days. z tests and t tests were performed to compare transmission rates and blood glucose changes between 2 cohorts. In addition, we analyzed blood glucose changes based on their testing time-between 1 AM and 10 AM, 10 AM and 6 PM, and 6 PM and 1 AM. Mean patient age was 70.5 (SD 11.8) years, with 66.8% (n=255) of them being female, 91.9% (n=351) urban, and 89% (n=340) from south Texas (n=382). The adherent cohort (n=186, 48.7%) had a mean transmission rate of 82.8% before the adherence call and 91.1% after. The nonadherent cohort (n=196, 51.3%) had a mean transmission rate of 45.9% before and 60.2% after. The mean blood glucose levels of the adherent cohort decreased by an average of 9 mg/dL (P=.002) over 5 months. We also found that variability of blood glucose level of the adherent cohort improved 3 mg/dL (P=.03) over the 5-month period. Both cohorts had the majority of their transmissions between 1 AM and 10 AM, with 70.5% and 53.2% for the adherent and nonadherent cohorts, respectively. The adherent cohort had decreasing mean blood glucose levels over 5 months, with the largest decrease during the 6 PM to 1 AM time period (30.9 mg/dL). Variability of blood glucose improved only for those tested from 10 AM to 6 PM, with improvements of 6.9 mg/dL (P=.02). Those in the nonadherent cohort did not report significant changes. RPM can help manage diabetes in Medicaid clients by improving adherence rates and glycemic control. Adherence calls helped improve adherence rates, but some patients still faced challenges in transmitting blood glucose levels. Nonetheless, RPM has the potential to reduce the risk of adverse outcomes associated with diabetes.

Hypoglycaemia management with a hypercaloric supplementation in neonatal puppies delivered by caesarean section.

There is a high perinatal mortality rate in dogs, estimated at 20%, and one of the leading causes of this rate is hypoglycaemia. Therefore, we aimed to evaluate the efficacy of a hypercaloric supplement containing vitamins and amino acids in newborn puppies presenting hypoglycaemia at birth. Ninety-nine pups were divided into four groups: normoglycaemic caesarean section (NORMOCS), hypoglycaemic caesarean section supplemented with the hypercaloric (SUPLCS), hypoglycaemic caesarean section supplemented with glucose (GLICCS) and eutocic delivery (EUT). We evaluated the following parameters glycaemia, Apgar score, neurological reflexes and rectal temperature of neonates at the following moments 5 min (M5), 30 min (M30) and 60 min (M60) after birth. Brachycephalic dogs were 73.3% (22/30) of caesarean sections (c-sections). The puppy's average glycaemia represented about 90% of the maternal glycaemia, while 15.1% (14/99) of the neonates had hypoglycaemia (<90 mg/dL) at M0 and 46.5% (44/99) at M60. Only four neonates had glycaemia below 40 mg/dL at M30 but without showing any clinical signs. The puppy's fasting while waiting for the intraoperative period and the dam's anaesthetic recovery was considered risk factors for hypoglycaemia. There was no difference in mean blood glucose levels or vitality parameters among puppies from the SUPLCS and GLICCS. In conclusion, the hypercaloric supplement can be used as a replacement for glucose in hypoglycaemic puppies and it can also bring nutritional benefits for the puppy. The prepartum glycaemia of the dam is an important parameter to be measured, and the appropriate management of it reduces the chances of the puppies being born with hypoglycaemia.

Effects of glucagon-like peptide-1 receptor agonists on glucose excursion and inflammation in overweight or obese type 2 diabetic patients.

Currently, the lack of comparative studies between weekly and daily formulations of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for glucose excursion is worth investigation. To investigate the effects of weekly and daily formulations of GLP-1RA on glucose excursion and inflammation in overweight and obese patients with type 2 diabetes. Seventy patients with type 2 diabetes mellitus who were treated at our hospital between January 2019 and January 2022 were enrolled in this retrospective analysis. All patients were treated with metformin. We evaluated changes in blood glucose levels and a series of important indicators in patients before and after treatment with either a weekly or daily preparation of GLP-1RA (group A; n = 33 and group B; n = 37). The degree of decrease in the levels of fasting blood glucose, mean blood glucose, mean amplitude of glycemic excursions, total cholesterol, triglycerides, tumor necrosis factor-α, interleukin-6, and high-sensitivity C-reactive protein after treatment in group A was higher than that in group B (P < 0.05), whereas the 2-h postprandial blood glucose levels decreased more so in group B than in group A (P < 0.001). However, there were no statistically significant differences in the levels of glycated hemoglobin, standard deviation of blood glucose, coefficient of variation, absolute mean of daily differences, percentage of time with 3.9 mmol/L < glucose < 10 mmol/L, and high- and low-density lipoproteins between the two groups (P > 0.05). The incidence of adverse reactions was significantly lower in group A than in group B (P < 0.05). The effect of the weekly preparation of GLP-1RA in controlling blood glucose levels in the patients, suppressing inflammation, and reducing adverse reactions was significantly higher than that of the daily preparations, which is worthy of clinical promotion.

Efficacy and safety of closed-loop control system for type one diabetes in adolescents a meta analysis

This meta-analysis compares the efficacy and safety of Closed-Loop Control (CLC) to Sensor-Augmented Insulin Pump (SAP) for adolescent patients with Type 1 Diabetes Mellitus (T1DM). Eleven randomized-controlled trials were included with a total of 570 patients, from a total of 869 articles found adhering to PRISMA guidelines. The efficacy of the therapies were evaluated from the day, night and during physical activities monitoring of the of the mean blood glucose (BG), Time In Range (TIR), and Standard Deviation (SD) of the glucose variability. The safety measure of the therapies, was assessed from the day and night recording of the hypoglycemic and hyperglycemic events occurred. Pooled results of comparison of mean BG values for day, night and physical activities, − 4.33 [− 6.70, − 1.96] (P = 0.0003), − 16.61 [− 31.68, − 1.54] (P = 0.03) and − 8.27 [− 19.52, 2.99] (P = 0.15). The monitoring for day, night and physical activities for TIR − 13.18 [− 19.18, − 7.17] (P < 0.0001), − 15.36 [− 26.81, − 3.92] (P = 0.009) and − 7.39 [− 17.65, 2.87] (P = 0.16). The day and night results of SD of glucose variability was − 0.40 [− 0.79, − 0.00] (P = 0.05) and − 0.86 [− 2.67, 0.95] (P = 0.35). These values shows the superiority of CLC system in terms of efficacy. The safety evaluation, of the day, night and physical activities observations of average blood glucose goal hypoglycemic events − 0.54 [− 1.86, 0.79] (P = 0.43), 0.04 [− 0.20, 0.27] (P = 0.77) and 0.00 [− 0.25, 0.25] (P = 1.00) and hyperglycemic events − 0.04 [− 0.20, 0.27] (P = 0.77), − 7.11 [− 12.77, − 1.45] (P = 0.01) and − 0.00 [− 0.10, 0.10] (P = 0.97), highlights the commendable safety factor of CLC. The CLC systems can be considered as an ideal preference in the management of adolescents with type 1 diabetes to be used during a 24 h basis.

Efficacy and safety of different insulin infusion methods in the treatment of total parenteral nutrition-associated hyperglycemia: a systematic review and network meta-analysis.

To systematically evaluate the efficacy and safety of different insulin infusion methods in the treatment of total parenteral nutrition (TPN)-associated hyperglycemia based on published literature and the data of completed clinical trials using a network meta-analysis. A comprehensive search of PubMed, Elsevier, Web of Science, EMBASE, Medline, clinicaltrials.gov, Cochrane Library, and three Chinese databases (Wanfang Data, China National Knowledge Infrastructure, and SINOMED) up to December 15, 2022, was performed to collect information on different insulin infusion methods used for the treatment of TPN-associated hyperglycemia, and the Cochrane systematic review method was used to screen the literature, evaluate the quality of the included literature, and extract clinical characteristics for a network meta-analysis. Clinical outcomes included mean blood glucose (MBG), hypoglycemia, hospital length of stay, hyperglycemia, surgical site infection (SSI) and mean total daily insulin. A total of 21 articles, including 1,459 patients, were included to analyze 6 different routes of insulin infusion, including continuous intravenous insulin infusion (CVII), continuous subcutaneous insulin infusion (CSII), subcutaneous glargine insulin (s.c. GI), the addition of regular insulin to the PN mixture (RI-in-PN), multiple subcutaneous insulin injections (MSII) and 50% of insulin administered as RI-in-PN + 50% of insulin administered as s.c. GI (50% RI-in-PN + 50% s.c. GI). The results of the network meta-analysis showed that MSII was the least effective in terms of MBG, followed by CVII. The 6 interventions were basically equivalent in terms of the hypoglycemia incidence. In terms of the length of hospital stay, patients in the CVII group had the shortest hospital stay, while the MSII group had the longest. CVII was the best intervention in reducing the incidence of hyperglycemia. The incidence of SSI was the lowest in the CSII and CVII groups, and the mean daily insulin dosage was the lowest in the CVII group. Current literature shows that for the treatment of TPN-associated hyperglycemia, CVII is the most effective, reducing the incidence of hyperglycemia and shortening the length of hospital stay without increasing the incidence of hypoglycemia. MSII has the worst efficacy, leading to a higher MBG and longer hospital stay, and RI-in-PN, CSII, s.c. GI and 50% RI-in-PN + 50% s.c. GI are better in terms of efficacy and safety and can be substituted for each other. https://www.crd.york.ac.uk/prospero/, identifier CRD42023439290.

Perioperative glycaemic control for people with diabetes undergoing surgery.

Perioperative glycaemic control for people with diabetes undergoing surgery.

Diabetes self-management education interventions and self-management in low-resource settings; a mixed methods study.

Diabetes is largely a self-managed disease; thus, care outcomes are closely linked to self-management behaviours. Structured self-management education (DSME) interventions are, however, largely unavailable in Africa. We sought to characterise DSME interventions in two urban low-resource primary settings; and to explore diabetes self-management knowledge and behaviours, of persons living with diabetes (PLD). A convergent parallel mixed-methods study was conducted between January and February 2021 in Accra, Ghana. The sampling methods used for selecting participants were total enumeration, consecutive sampling, purposive and judgemental sampling. Multivariable regression models were used to study the association between diabetes self-management knowledge and behaviours. We employed inductive content analysis of informants' experiences and context, to complement the quantitative findings. In total, 425 PLD (70.1% (n = 298) females, mean age 58 years (SD 12), with a mean blood glucose of 9.4 mmol/l (SD 6.4)) participated in the quantitative study. Two managers, five professionals, two diabetes experts and 16 PLD participated in in-depth interviews. Finally, 24 PLD were involved in four focus group discussions. The median diabetes self-management knowledge score was 40% ((IQR 20-60). For every one unit increase in diabetes self-management knowledge, there were corresponding increases in the diet (5%;[95% CI: 2%-9%, p<0.05]), exercise (5%; [95% CI:2%-8%, p<0.05]) and glucose monitoring (4%;[95% CI:2%-5%, p<0.05]) domains of the diabetes self-care activities scale respectively. The DSME interventions studied, were unstructured and limited by resources. Financial constraints, conflicting messages, beliefs, and stigma were the themes underpinning self-management behaviour. The DSME interventions studied were under-resourced, and unstructured. Diabetes self-management knowledge though limited, was associated with self-management behaviour. DSME interventions in low resource settings should be culturally tailored and should incorporate sessions on mitigating financial constraints. Future studies should focus on creating structured DSME interventions suited to resource-constrained settings.

A pregnancy-specific Glucose management indicator derived from continuous glucose monitoring in pregnant women with type 1 diabetes.

Glucose management indicator (GMI) is a core metric derived from continuous glucose monitoring (CGM) and is widely used to evaluate glucose control in patients with diabetes. No study has explored the pregnancy-specific GMI. This study aimed to derive a best-fitting model to calculate GMI from mean blood glucose (MBG) obtained from CGM among pregnant women with type 1 diabetes mellitus (T1DM). A total of 272 CGM data and corresponding laboratory HbA1c from 98 pregnant women with T1DM in the CARNATION study were analysed in this study. Continuous glucose monitoring data were collected to calculate MBG, time-in-range (TIR), and glycaemic variability parameters. The relationships between the MBG and HbA1c during pregnancy and postpartum were explored. Mix-effect regression analysis with polynomial terms and cross-validation method was conducted to investigate the best-fitting model to calculate GMI from MBG obtained by CGM. The pregnant women had a mean age of 28.9±3.8years, with a diabetes duration of 8.8±6.2years and a mean body mass index (BMI) of 21.1±2.5kg/m2 . The HbA1c levels were 6.1±1.0% and 6.4±1.0% during pregnancy and at postpartum (p=0.024). The MBG levels were lower during pregnancy than those at postpartum (6.5±1.1mmol/L vs. 7.1±1.5mmol/L, p=0.008). After adjusting the confounders of haemoglobin (Hb), BMI, trimesters, disease duration, mean amplitude of glycaemic excursions and CV%, we developed a pregnancy-specific GMI-MBG equation: GMI for pregnancy (%)=0.84-0.28* [Trimester] + 0.08 * [ BMI in kg/m2 ] + 0.01 * [Hb in g/mL] + 0.50 * [MBG in mmol/L]. We derived a pregnancy-specific GMI equation, which should be recommended for antenatal clinical care. ChiCTR1900025955.

Efficacy of Perioperative Infusion of N(2)-L-alanyl-L-glutamine in Glycemic Control for Patients With Uncontrolled Diabetes Mellitus Presented for Urgent Coronary Artery Bypass Surgery: A Randomized Controlled Trial

To evaluate the efficacy of preoperative glutamine infusion in reducing insulin requirements in patients with uncontrolled type 2 diabetes, defined as glycated hemoglobin (HbA1c) >7%, undergoing urgent coronary artery bypass graft (CABG) surgery. A randomized controlled trial. At Ain Shams University Hospital, Cardiothoracic Academy. Ninety-three patients (of both sexes) with uncontrolled diabetes presenting for urgent CABG were categorized into 2 groups. The dipeptiven group (n=46) was given an infusion of dipeptiven 1.5 mL/kg body weight dissolved in normal saline (200 mL) over 3 hours before surgery. The control group (n=47) received a normal saline infusion (200 mL). The dipeptiven group demonstrated statistically significant lower intraoperative (173.74 ± 19.97 mg/dL v 198.22 ±14.64 mg/dL) and postoperative (162.36 ±13.11 mg/dL v 176.13 ±14.86 mg/dL) mean blood glucose levels. In addition, dipeptiven infusion was found to reduce mean total insulin requirements intraoperatively by 3.64 ± 0.56 units/h and postoperatively by 37.109 ± 4.30 units/24 h in comparison to placebo (50.98 ± 16.55 units/24 h and 5.10 ± 2.28 units/h, respectively). A preoperative infusion of dipeptiven can contribute to ameliorating stress hyperglycemia in uncontrolled diabetic patients undergoing urgent CABG.

Comparison of the Stress Responses Following TAP Block and Epidural Anesthesia in Patients Undergoing Elective Laparoscopic Cholecystectomy Under General Anesthesia: Randomized Clinical Trial.

Major surgeries and the accompanied acute stress response are associated with poor immune system function and extensive immunological changes. This study was done to compare post-surgery stress responses following TAP blocks and epidural anesthesia in patients undergoing laparoscopic cholecystectomy under general anesthesia. Sixty patients who were candidates for laparoscopic cholecystectomy were enrolled in this RCT. After randomly assigning patients into two groups (30 patients in epidural anesthesia and 30 patients in the TAP block group), the degree of pain and stress responses (serum level of blood glucose, CRP, IL-1, TNF-α, cortisol) of patients were measured preoperatively and at 6 and 24 hours after surgery. Mean blood glucose, serum cortisol, CRP, and WBC decreased significantly 6 and 24 hours after the intervention in both groups and differed significantly between the two groups (P-value <0.05). The proportion of patients with a pain score greater than 3 at 6 and 12 hours after surgery was significantly higher in the Epidural group compared with the TAP block group, although this figure was significantly higher in the TAP block group 24 hours after surgery. A significant decrease in the mean blood sugar, serum cortisol, CRP, and WBC in both groups at 6 and 24 hours after the surgery was noted. The pain score decreased 24 hours after surgery in the epidural anesthesia group and increased in the TAP block group.

A prospective cohort study on glucose variability and clinical outcomes in comatose children due to acute central nervous system infections admitted in the pediatric intensive care unit

Background: Pediatric acute central nervous system (CNS) infections are associated with severe neuromorbidity. This study aimed to study the effect of glucose variability on clinical outcomes in comatose children due to acute CNS infections admitted in pediatric intensive care unit (PICU). Subjects and Methods: A prospective cohort study enrolled comatose children aged 1 month to 12 years due to acute CNS infection. Within 6 h, continuous glucose monitoring was started (Freestyle Libre Pro, Abbott). The unit practice was targeting blood glucose (BG, mg/dL) of &lt;140–145. The hyperglycemic index was calculated to estimate the relative time spent above BG of &gt;126, &gt;140, &gt;180, &gt;200, and &lt;60. Glucose variability was defined as BG fluctuation, with both hypoglycemia (&lt;60) and hyperglycemia (&gt;126). The primary outcome was new-onset organ dysfunction. The secondary outcomes were organ support, length of mechanical ventilation, hospital (including PICU) stay, and 90-day composite poor outcome (mortality or severe neurodisability). Results: Total BG values measured were 27,792 from 66 patients (mean [standard deviation (SD)] 421.1 [212.6] values per patient). The mean (SD) BG was 103.2 (37.7) (minimum: 42.1; maximum: 228.8). The new-onset organ dysfunction has occurred in 83.3% (n = 55/66), and no difference was noted among normoglycemic and abnormal glycemic groups (84.4% vs. 80.9%; relative risk = 1.09, 95% confidence interval: 0.67–1.76). The median (interquartile range) PICU stay (days) was higher in the normoglycemic group (7, 5–14 vs. 4, 3.5–8.5; P = 0.014). No difference was noted in other outcomes. Conclusions: Glucose variability was not significantly associated with new-onset organ dysfunction and poor outcome in comatose children due to acute CNS infections.

Impact of Age on HbA1c Level of Diabetic Patients Attending Ahmadu Bello University Teaching Hospital Zaria, Nigeria

The present study looked into the possibility of impact of age on HbA1c level of diabetic patients attending Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Nigeria, as there have been reports of correlation between age and HbA1c in some other parts of the world. Three hundred and fifty (350) diabetic patients were initially recruited over a period of 10 months, from March 2018 to December 2018. Subjects consisted of 200 female and 150 male diabetic patients. After 10-12 hours fast, 5mL of blood was drawn from volunteer patients. About 3mL was centrifuged in order to separate the serum after which the serum was then analysed for glucose. Two hundred and fifteen (215) subjects, comprising of 110 female and 105 male diabetic patients, with ages between 46 years and 84 years (mean age = 65±19 years) and mean blood glucose of 200±20 mg/dL were then selected for the study. The remaining 2mL whole blood was analysed immediately for HbA1c. Information about patient’s age was obtained via a well-designed questionnaire and matched with hospital record. There was no significant difference in the mean HbA1c levels of male and female participants. For the given blood glucose range, the HbA1c level increased by 0.2%, proportionally, with every decade (10 years) increase in age. It was concluded that HbA1c increases consistently – independent of blood glucose and gender – with increase in age of diabetic patients.

Evaluation of Blood Sugar, Blood Pressure and Foot Health in Individuals Not Diagnosed with Diabetes, Hypertension

Objective: Diabetes Mellitus constitutes a significant health concern given its incidence and associated complications. Furthermore, obesity, being a chronic disease, represents a risk factor for hypertension, cardiovascular diseases, and diabetes. In light of these considerations, our study aims to perform a public screening for conditions that are closely related, including hypertension, obesity, diabetes, and foot health. Methods: The study was conducted over a three-day period from September 12 to September 15, 2017, between the hours of 09:00-17:00. The sample comprised of volunteers who passed by the established stands and were not diagnosed with diabetes or hypertension. Blood glucose levels (BG) were measured using a glucometer, while weight and height were measured using a scale. Waist circumference was measured using a tape measure, and foot examinations were conducted using a podoscope. In addition, a questionnaire was administered to gather sociodemographic information and health-related data from participants. Measurements were taken of random capillary BG, blood pressure (BP), height, weight, and waist circumference. A general foot examination was performed, and any pressing foot issues were evaluated with a podoscope. Results: In our study, the mean BG level of 428 participants was 126 g/dl, with 7% of them recording BG levels above 200 g/dl. During foot examinations, 29% of participants reported experiencing pain, while 26% had issues with false nail clipping. Pes planus was detected in 14% of individuals during podoscopic examination, and it was observed that those who used sports shoes and those who had previous foot examinations had fewer foot health problems. Additionally, individuals with high BMI values exhibited a higher prevalence of claudication findings, ingrown nails, and dryness and cracks in the skin. Participants with higher systolic BP were found to have more instances of ingrown nails and other nail problems, including interdigital maceration. Conclusion: The selection of appropriate footwear and regular foot examinations are crucial in the prevention of foot health problems. Our study found a significant association between foot health problems and high BMI and systolic blood pressure levels.

Mindfulness eating based on spiritual interventions on diet compliance and blood sugar levels in type 2 DM patients

Introduction: Diet is one component of diabetes mellitus (DM) self-management for controlling blood sugar levels. Several obstacles in the implementation of the diet program have the potential for non-compliance, so that blood sugar levels tend to increase. Mindfulness eating based on spiritual intervention is one of the interventions that is expected to form adaptive eating behavior control to achieve dietary compliance and controlled blood sugar levels. The purpose of this study was to analyze the effect of mindfulness eating based on spiritual intervention on dietary compliance and blood sugar levels in patients with type 2 diabetes. Methods: The study's quasi-experimental, untreated control group design included dependent pre- and post-test samples. The population used was all patients with type 2 diabetes. The sample was taken using a simple random sampling technique with determination according to inclusion and exclusion criteria. The independent variables in this study were mindfulness eating based on spiritual intervention, while the dependent variables were dietary compliance and blood sugar levels. A glucometer and the Personal Diabetes Questionnaire (PDQ) were the tools employed in this investigation. The t-test was used as the statistical test. Results: There were a total of 50 samples that were divided between the control group and the intervention group. The results of the statistical test showed that mindfulness eating based on spiritual intervention had a statistically significant effect on dietary compliance (p &lt; 0.001) and blood glucose levels (p &lt; 0.001) compared to the control group. Conclusion: The value of diet adherence is greatly increased by mindfulness eating practices based on spiritual intervention, and mean blood glucose levels are significantly reduced at the conclusion of the study. Exercises in mindfulness eating that are based on spiritual intervention can be popularized as a way to deal with dietary issues and blood sugar regulation.