Mean Blood Glucose Concentration Research Articles

Evaluation of a point‐of‐care blood glucose monitor in healthy goats

To assess agreement between a point-of-care glucometer (POCG) and a laboratory chemistry analyzer for blood glucose measurements in goats. Prospective study. University teaching hospital. Eighteen healthy adult goats. Whole blood samples were obtained via jugular venipuncture prior to premedication with xylazine and butorphanol (T0), following premedication (T20), and after 1 hour of inhalant anesthesia (T60). Each sample was tested with a POCG and a laboratory analyzer (HITA). Agreement was assessed using concordance correlation coefficients and calculation of bias and 95% limits of agreement. Mean blood glucose concentration at T0 was 3.9±0.6mmol/L (70±10mg/dL; POCG) and 2.9±0.4mmol/dL (53±8mg/dL; HITA). Glucose concentrations at T20 were 6.7±2.4mmol/L (121±43mg/dL) and 5.4±2.1mmol/L (97±37mg/dL) and at T60 were 5.7±1.7mmol/L (102±31mg/dL) and 4.7±1.3mmol/L (85±24mg/dL) when measured with the POCG and HITA, respectively. The POCG overestimated blood glucose compared to the HITA. The bias±SD was 1.08±0.53mmol/L (19.4±9.5mg/dL) (95% LOA 0.04 to 2.11mmol/L [0.7 to 38.0mg/dL]) and the concordance correlation coefficient was 0.82. After correcting the results of the POCG using a mixed-effects linear model, the bias was 0.0±0.38mmol/L (0.0±6.8mg/dL) (95% LOA ±0.74mmol/L [±13.4mg/dL]) and the concordance correlation coefficient was 0.98. The POCG overestimated blood glucose concentrations in goats, compared to the HITA, but when the POCG concentrations were corrected, the agreement was excellent.

The oral glucose test predicts laminitis risk in ponies fed a diet high in nonstructural carbohydrates

The aim of this study was to investigate the relationship between laminitis development in ponies and insulin/glucose concentrations in response to the oral glucose test (OGT) and a dietary challenge high in nonstructural carbohydrates (NSCs). After undergoing an OGT (1 g dextrose/kg BW in feed), 37 ponies with 2-h serum insulin concentrations ranging from 22 to 1,133 μIU/mL were subjected to a diet challenge period (DCP), consuming 12 g NSC/kg BW/d for up to 18 d. Insulin and glucose responses were measured on day 2 of the DCP. Clinical laminitis was diagnosed by blinded experts and confirmed radiographically. Basal ACTH levels and clinical signs were assessed to investigate concurrent putative pituitary pars intermedia dysfunction (PPID). The diet induced Obel grade 1 or 2 laminitis in 14 ponies (38%). The ponies that developed laminitis had higher maximum concentrations of blood glucose (P = 0.04) and serum insulin (P = 0.02) in response to the diet. The geometric mean (95% CI) blood glucose concentration for laminitis cases was 14.9 (12.9–17.2) mM, compared to 10.7 (9.2–12.5) mM for ponies who did not develop laminitis. Similarly, the geometric mean (95% CI) for serum insulin was 396 (301–520) μIU/mL for laminitis cases, compared to 216 (148–316) μIU/mL for ponies who did not develop laminitis. Laminitis incidence was likewise associated with insulin concentrations measured during the OGT. Laminitis occurred at frequencies of 0% (0/7) if postdextrose insulin (μIU/mL) was <50; 35% (8/23) if insulin was 50 to 195; and 86% (6/7) if insulin was >195 μIU/mL. Basal ACTH concentrations were above seasonally accepted reference ranges in 16/37 ponies, and 8 of these animals (50%) developed laminitis. This included all 5 ponies in the study that had clinical signs of PPID (100%). In contrast, hyperinsulinemia and laminitis occurred in only 3/11 ponies (27%) with elevated ACTH concentrations and no clinical signs of PPID (P = 0.009). Thus, laminitis occurrence was associated with higher glucose and insulin responses to both the OGT and challenge diet, and the frequency of laminitis can be predicted based on insulin and glucose hyperresponsiveness to these oral carbohydrate challenges.

Relationship between Measures of Neonatal Glycemia, Neonatal Illness, and 2-Year Outcomes in Very Preterm Infants

To investigate relationships between early neonatal glycemia, neonatal characteristics, neonatal illness, and developmental outcomes in very preterm infants. A retrospective, observational cohort study of 443 infants born weighing <1500 g or <30 weeks of gestation, and admitted within 24 hours to National Women's Hospital, Auckland, New Zealand. Glucose variability was defined as the standard deviation around the mean after log transformation of all blood glucose concentrations. Absolute glycemic excursions in the first week were used to divide the infants into 4 groups: normoglycemic; hypoglycemic; hyperglycemic, and unstable. Compared with normoglycemic infants, hypoglycemic and unstable infants had lower birth weight z-scores, and hyperglycemic and unstable infants were of lower birth weight. Hypoglycemic infants had similar outcomes to normoglycemic infants. Hyperglycemic and unstable infants were less likely to survive without neonatal morbidity and less likely to survive without neurodevelopmental impairment at 2 years of age. Higher mean blood glucose concentration was seen in the hyperglycemic and unstable groups, and was associated with worse neonatal and 2-year outcomes. Greater glucose variability was seen in the hypoglycemic and unstable groups, and was associated with worse neonatal illness but not outcome at 2 years. No associations between measures of neonatal glycemia and neonatal or 2-year outcomes remained after correction for gestation, birth weight z-score, and socioeconomic status. In very preterm infants, measures of neonatal glycemia are markers of gestational age and intrauterine growth, and are not independent predictors of neonatal illness or outcomes at 2 years of age.

Treatment with long-acting lanreotide autogel in early infancy in patients with severe neonatal hyperinsulinism

BackgroundTreatment of severe diffuse congenital hyperinsulinism (CHI) without sufficient response to diazoxide is complicated by the lack of approved drugs. Therefore, patients are often hospitalized long-term or have to undergo pancreatic surgery if episodes of severe hypoglycaemia cannot be prevented. A long-acting somatostatin analogue, octreotide, has been reported to be an effective treatment option that prevents severe hypoglycaemia in children with CHI, and its off-label use is common in CHI. However, octreotide requires continuous i.v. or s.c. infusion or multiple daily injections. Here, we report our experiences with the use of a monthly application of a long-acting somatostatin analogue, lanreotide autogel® (LAN-ATG), in early infancy.ResultsThe mean blood glucose concentration within 7 days before the first LAN-ATG administration were compared to 7 days after the first LAN-ATG administration and increased by 0.75 mmol/L (range 0.39–1.19 mmol/L). In the following weeks intravenous glucose infusions, octreotide, and glucagon treatment could be successfully stopped in all patients 3–20 days after the first LAN-ATG injection without substantial worsening of the hypoglycaemia rate. Increased carbohydrate requirements could be normalized with an average reduction in the carbohydrate-intake of 7 g/kg body weight/d (range 1.75–12.8 g/kg body weight/d). Over a total of 52 treatment months, no serious adverse effects occurred.ConclusionLong-term LAN-ATG treatment improved blood glucose concentrations, lowered the frequency of hypoglycaemia or allowed for normalization of oral carbohydrate intake in infants with CHI younger than 6 months of age. No severe side effects were observed. LAN-ATG might be an alternative treatment option in infants with severe CHI who lack risk factors for necrotizing enterocolitis and are not responding to current treatment regimens as an alternative to surgery after careful individual evaluation.

Implementing a pharmacist consultation model for multimodal insulin therapy.

The implementation of pharmacist-managed insulin dosing for selected hospitalized patients under a multimodal insulin protocol (MMIP) is described. Hyperglycemia has been linked to increased thrombosis, decreased wound healing, and decreased immune response. Current recommendations support the use of multimodal (basal-bolus) insulin therapy in noncritically ill inpatients. As part of a systemwide quality-improvement initiative to improve glycemic management, the pharmacy department of a community hospital initiated a service to provide protocol-directed insulin dosing for selected patients under a pharmacist consultation model. An MMIP targeting patients with 2 blood glucose (BG) readings of >180 mg/dL within a 12-hour period was developed and approved. Pharmacist consultations, including patient assessment, entry of initial insulin orders, and ongoing insulin dosage adjustments, are performed pursuant to electronic notifications and computerized prescriber order entry. Noncritically ill patients who meet the criteria for protocol-guided insulin dosing are managed according to an approved weight-based MMIP for calculating and adjusting nutritional and basal insulin doses. Prior to the initiation of MMIP-guided insulin dosing, pharmacists were trained on the use of the protocol and passed a competency assessment. In the 90-day period after protocol implementation, 158 hyperglycemic patients received pharmacist-managed insulin dosing. The goal of achieving a mean BG concentration of ≤180 mg/dL by day 3 of hyperglycemia management under a pharmacist-managed MMIP was attained in the second and third months after protocol implementation.

Glucose Variability Measures as Predictors of Oral Feeding Intolerance in Acute Pancreatitis: A Prospective Pilot Study.

Oral feeding intolerance (OFI) is a common complication in patients with acute pancreatitis (AP). Variations in blood glucose are associated with impaired gastrointestinal function but, to date, measures of glucose variability have not been investigated to predict OFI in patients with AP. To investigate the usefulness of several glucose variability measures in predicting the occurrence of OFI early in the course of AP. In this prospective cohort study, six measures of glucose variability were calculated prior to the occurrence of OFI. Multivariate binary logistic regression analyses were conducted, and the diagnostic performance and accuracy of glucose variability measures were assessed. Of the 95 prospectively enrolled patients, 21 (22%) developed OFI. After adjusting for confounders, admission blood glucose concentration and mean blood glucose concentration were significantly associated with OFI [odds ratio 1.49 (95% confidence interval 1.01-2.20) and odds ratio 1.67 (95% confidence interval 1.07-2.61), respectively]. Both admission blood glucose and mean blood glucose had an area under the curve of 0.83 and positive likelihood ratios of 6.45 and 10.19, respectively. Blood glucose concentration before refeeding, standard deviation of blood glucose concentration, coefficient of variation, and mean amplitude of glycemic excursions were not significantly associated with OFI. In-hospital blood glucose concentrations are associated with subsequent development of OFI in patients with AP. In particular, admission blood glucose and mean blood glucose could be useful predictors of OFI in this setting.

Immediate effect of bitter gourd, ash gourd, Knol-khol juices on blood sugar levels of patients with type 2 diabetes mellitus: A pilot study

AimThe aim of this study was to investigate the immediate effect of bitter gourd, Knol-khol, and ash gourd juices on blood glucose level among Type II diabetes mellitus patients. MethodsIn 2015, pilot study was conducted randomly enrolling 30 patients with type 2 diabetes mellitus into three groups in SRK college, India. The first group received bitter gourd juice at FBS range between 120 to 300 mg per dl. The second, third group received Knol-khol, ash gourd juice respectively in the same range of fasting blood sugar level. Blood sugar level was evaluated ½ hour interval till 2 h after received respective juices. Data were collected for statistical analysis. ResultsThe mean blood glucose concentration in bitter gourd group was not statistically significant between time points, (P = .176). However, 90 min after the intake of bitter gourd juice shows statistical significant reduction of blood glucose level when compare with fasting level, (p = .049). After Knol khol juice the mean blood glucose level differed statistically significant between time points, shown in (p = .029). But no statistical changes seen in ash gourd group. As a result bitter gourd juice is immediately reducing the blood glucose level, while Knol khol juice reduces the blood sugar level gradually for longer period of 120 min. ConclusionThis study shows the significance of hypoglycemic effects of bitter gourd and Knol khol juices among the type 2 Diabetic patients. Hence Bitter gourd juice, Knol khol juices may be beneficial in Diabetes patients to reduce the blood glucose level.

Refractive Index Tomograms and Dynamic Membrane Fluctuations of Red Blood Cells from Patients with Diabetes Mellitus

Background: Diabetic effects on blood rheology are important topics and have been extensively investigated. In particular, it has been known that diabetic RBCs exhibit significantly deteriorated deformability compared to healthy RBCs. Despite the importance of previously measured mechanical properties of diabetic RBCs, several problems remain to be elucidated. First, conventional techniques have difficulties in measuring intrinsic properties of individual cells. Detailed quantification of diabetic alteration in RBCs at the individual cell level is also hard to achieve. Accordingly, previous approaches do not allow the systematical correlative analyses to be performed on simultaneously measured various cell parameters. As a consequence, there are still no general agreements on the integrated effects of diabetic complications or hyperglycemia on individual human RBCs.Methods: To effectively settle the arisen problems, we quantitatively and non-invasively measured the individual RBCs from diabetic and healthy blood donors to figure out the characteristics of diabetic RBCs by employing the quantitative phase imaging (QPI) technique. From the reconstructed three-dimensional (3-D) refractive index (RI) tomogram and the time-series of 2-D phase map of individual RBCs, the morphological (volume, surface area, and sphericity), biochemical (Hb concentration and Hb content), and mechanical (membrane fluctuation) parameters were retrieved. Systematic correlative analyses among measured six RBC parameters and independently determined HbA1c level, defined as the ratio of HbA1c to total Hb, were also performed. In measuring red cells, only gently sedimented RBCs of discocytes were selected. After excluding erroneously measured RBCs, 40, 40, 40, 38, 39, 40 control RBCs of six healthy donors and 40, 40, 40, 40, 40, 40 diabetic RBCs of six diabetic patients were finally analyzed respectively for the study of diabetic effects on characteristics of individual human RBCs.Results: HbA1c level is defined as a percentage of HbA1c, the majority of glycated Hbs in RBC, to total Hb contents in blood. Because HbA1c is formed through 120-days long, non-enzymatic glycation process of Hb, HbA1c level has been perceived as an effective mean to estimate mean glucose concentration of individuals for the last three months. In other words, HbA1c reflects the degree of hyperglycemia. The most noticeable alterations in diabetic RBCs can be found when mean RBC membrane fluctuations of individuals are rearranged in the increasing order of the measured HbA1c levels. The mean values of membrane fluctuations for RBCs are 59.7 ¡¾ 6.2, 58.3 ¡¾ 4.9, 55.0 ¡¾ 5.4, 57.1 ¡¾ 7.4, 51.0 ¡¾ 6.8, and 49.6 ¡¾ 4.6 nm for healthy volunteers, and 45.1 ¡¾ 4.0, 46.9 ¡¾ 3.4, 48.8 ¡¾ 4.0, 47.6 ¡¾ 4.2, 43.0 ¡¾ 4.1, and 48.0 ¡¾ 5.0 nm for diabetic patients, in order of increasing HbA1c. As shown in Fig. 4, mean membrane fluctuation of non-diabetic RBCs tends to decrease as the HbA1c level increases (Pearson correlation coefficient of -0.87 with a p-value of 0.02). Beyond this level of HbA1c, RBCs from diabetic patients exhibit significantly decreased and settled membrane fluctuation. This observed negative correlation between RBC membrane fluctuation and HbA1 is also conceptually in accordance with the report of the previous study.Conclusions: We quantitatively and non-invasively characterize the morphological, biochemical, and mechanical alterations of individual RBCs by diabetes mellitus. HbA1c levels of subjects, which reflect one's mean blood glucose concentration of last three months, were also determined using hematology analyzers. Accordingly, correlative analyses among the retrieved individual RBC parameters and HbA1c level were performed to search unique features which cannot be addressed by conventional techniques with incapability of simultaneous measurement of those parameters. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Assessing the Link Between Colonoscopy Preparation Quality and Diabetes Mellitus

Introduction: Factors such as advanced age, male gender, and comorbidities, such as diabetes mellitus, are independent risk factors for poor bowel preparation. Studies have shown that diabetic patients have a significantly poorer response to 6 Liters Golytely preparation compared to non-diabetic patients, unfortunately correlation between varying levels of HbA1c with a much larger sample size has not been investigated. Our aim in this retrospective study was to find a correlation between poor bowel preparation and the following factors: Hba1c levels, age, gender, body mass index (BMI), and mean blood glucose concentration (MBGC). The goal of this study was to recognize and bridge this gap, in order to assist gastroenterologists with tailoring more effective bowel preparation regimens. Methods: Retrospective chart review from 2011 to 2015 was obtained for 380 consecutive patients who had HbA1c measured within 3 months of having a colonoscopy. Aronchick scores of 1 and 2 were defined as good preparations and scores of 3-5 were categorized as poor preparations. Predictors included HbA1c, age, gender, BMI, and mean blood glucose concentration. Results: The sample size was equally distributed between those with good and poor quality colonoscopy preparations (53.4% vs 46.6% respectively). HbA1c levels did not statistically differ between the preparation groups. Only sex was statistically significant in difference between the groups where males had a greater percentage of poor quality preparation than females (61.6% vs. 38.4%). In addition, patients who had colonoscopies as outpatients were more likely to have poor preparations than those who were inpatient at the time of the procedure (55% vs. 40%). Age, BMI, and MBGC did not show any statistical significance. Conclusion: Similar to prior studies, this study showed with statistical significance that male gender was associated with poor colonoscopy preparation (Figure 1). Good bowel preparation was seen more often among our inpatient population compared to outpatients included in our study. However, contrary to previously reported data, our study shows no statistical significance between HbA1c and preparation quality. As inpatients tend to have a stricter glycemic control during the days prior to the procedure, a correlation between blood glucose levels during the days leading to the procedure and preparation quality may be beneficial to explore.Figure 1Figure 2

Effects of saxagliptin add-on therapy to insulin on blood glycemic fluctuations in patients with type 2 diabetes: A randomized, control, open-labeled trial.

Background:To investigate whether saxagliptin add-on therapy to continuous subcutaneous insulin infusion (CSII) further improve blood glycemic control than CSII therapy in patients with newly diagnosed type 2 diabetes (T2D).Methods:This was a single-center, randomized, control, open-labeled trial. Newly diagnosed T2D patients were recruited between February 2014 and December 2015. Subjects were divided into saxagliptin add-on therapy to CSII group (n = 31) and CSII therapy group (n = 38). The treatment was maintained for 4 weeks. Oral glucose tolerance test was performed at baseline. Serum samples were obtained before and 30 and 120 minutes after oral administration for glucose, insulin, and C-peptide determination. Continuous glucose monitoring (CGM) was performed before and endpoint.Results:A total of 69 subjects were admitted. After 4-week therapy, CGM data showed that patients with saxagliptin add-on therapy exhibited further improvement of mean amplitude glycemic excursion (MAGE), the incremental area under curve of plasma glucose >7.8 and 10 mmol/L compared with that of control group. In addition, the hourly mean blood glucose concentrations, especially between 0000 and 0600 in patient with saxagliptin add-on therapy, were significantly lower compared with that of the control patients. Furthermore, patients in saxagliptin add-on group needed lower insulin dose to maintain euglycemic control. In addition, severe hypoglycemic episode was not observed from any group.Conclusion:Saxagliptin add-on therapy to insulin had the ability of further improve blood glycemic controlling, with lower insulin dose required by patients with T2D to maintain euglycemic controlling.

Hemoglobin A1c and Race: Should Therapeutic Targets and Diagnostic Cutoffs Differ among Racial Groups?

Type 2 diabetes mellitus results from a combination of insulin resistance and inadequate insulin secretion, which together lead to impaired glucose homeostasis, culminating in hyperglycemia. Nonenzymatic attachment of glucose to a protein is termed glycation. The glucose concentration in blood modulates the extent of glycation of proteins in the circulation; higher glucose increases glycation. Hemoglobin A1c (Hb A1c)2 forms when glucose attaches to the N-terminal valine of the β chain of Hb A. Erythrocyte lifespan is approximately 120 days, and Hb A1c thus reflects the mean blood glucose concentration over the preceding 8–12 weeks. As a marker of chronic glycemia, Hb A1c is used extensively in individuals with diabetes to predict complications and monitor therapy, with target values established for optimal treatment (1). More recently, the use of Hb A1c was advocated for screening and diagnosis of diabetes (1). Several different methods, including immunoassay, HPLC, affinity chromatography, capillary electrophoresis, and enzymatic assay, are used to measure Hb A1c. Importantly, assay standardization has resulted in equivalent values among methods (2). Like other analytes, Hb A1c is not perfect. The main limitation is that the Hb A1c concentration may be altered by factors other than glycemia (3). In particular, any condition that changes erythrocyte lifespan will change Hb A1c. Examples include severe thalassemia, hereditary spherocytosis, splenomegaly, autoimmune hemolytic anemia, and some hemoglobin variants. Conceptually, this problem could be eliminated if one could apply a factor to correct for erythrocyte age. However, it is extremely difficult to measure erythrocyte lifespan, thus precluding the use of this strategy. Chronic renal failure is a common complication of diabetes. Patients with chronic renal failure have lower Hb A1c due to shortened erythrocyte survival. In many of these patients, erythropoietin is used …

Use of video-based education and tele-health home monitoring after liver transplantation: Results of a novel pilot study

In this observational study, we analyzed the feasibility and early results of a perioperative, video-based educational program and tele-health home monitoring model on postoperative care management and readmissions for patients undergoing liver transplantation. Twenty consecutive liver transplantation recipients were provided with tele-health home monitoring and an educational video program during the perioperative period. Vital statistics were tracked and monitored daily with emphasis placed on readings outside of the normal range (threshold violations). Additionally, responses to effectiveness questionnaires were collected retrospectively for analysis. In the study, 19 of the 20 patients responded to the effectiveness questionnaire, with 95% reporting having watched all 10 videos, 68% watching some more than once, and 100% finding them effective in improving their preparedness for understanding their postoperative care. Among these 20 patients, there was an observed 19% threshold violation rate for systolic blood pressure, 6% threshold violation rate for mean blood glucose concentrations, and 8% threshold violation rate for mean weights. This subset of patients had a 90-day readmission rate of 30%. This observational study demonstrates that tele-health home monitoring and video-based educational programs are feasible in liver transplantation recipients and seem to be effective in enhancing the monitoring of vital statistics postoperatively. These data suggest that smart technology is effective in creating a greater awareness and understanding of how to manage postoperative care after liver transplantation.

Effects of in-yolk-sac administration of carvacrol on cholesterol resorption from yolk residuals and physiological adaptive indicators in broiler chicks exposed to neonatal fasting

Abstract. Three hundred and twenty Ross 308 male broiler chicks were used to examine effects of in-yolk-sac (IYS) administration of carvacrol on cholesterol resorption from yolk and physiological adaptive responses of broiler chicks subjected to post-hatch fasting periods of up to 72 h. Effects of the four experimental treatments, namely non-handled control (NHCON), sham injection control (SICON), polysorbate-80 injection (POLS), and carvacrol injection (CARV), were examined in 5 replicates of 10 birds each. Liver proportional weight was greater in carvacrol-injected chicks compared with other birds 24 h post-hatch (P &lt; 0.05). The mean blood glucose concentration was 199.0 mg dL−1 when chicks were removed from the hatcher baskets, and decreased in all birds after being subjected to a 72 h post-hatch fasting. However, the slope of decrease in serum concentration of glucose was slower in carvacrol-injected birds than in the other birds, and they had a greater plasma glucose level compared with NHCON and SICON birds after 72 h post-hatch fasting. Lower plasma cholesterol levels were observed in carvacrol-treated chicks compared with those subjected to the other treatments at 72 h post-hatch (P &lt; 0.05). Blood concentration of calcium (Ca) was greater in carvacrol-injected birds at 24 h post-hatch than in NHCON and SICON birds (P &lt; 0.05), but at 72 h it significantly increased in all birds, with the exception of carvacrol-treated chicks, which had significantly lower blood Ca concentration (11.17 mg dL−1) compared with other birds (P &lt; 0.05). Blood potassium concentration increased in polysorbate-80 and carvacrol-injected chicks 24 h post-hatch compared with the NHCON and SICON birds (P &lt; 0.05). In conclusion, the results of the current study revealed that there was no direct interaction between cholesterol and carvacrol leading to reduced cholesterol absorption from yolk sac in newly hatched broiler chicks.

Metformin in severe exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial

BackgroundSevere exacerbations of COPD are commonly associated with hyperglycaemia, which predicts adverse outcomes. Metformin is a well-established anti-hyperglycaemic agent in diabetes mellitus, possibly augmented with anti-inflammatory effects, but its effects...

Glycemic index values of monofloral Turkish honeys and the effect oftheir consumption on glucose metabolism*

Clinical trials have shown that low glycemic index (GI) nutrition reduces mean blood glucose concentrations and insulin secretions. The aim of the present study was to determine the GI values of various monofloral (citrus, milk-vetch, chestnut, thyme, lime, pine) honeys of Turkey, and the effect of their consumption on glucose metabolism. Processing data from 20 healthy volunteers, GI values were determined from the glycemia values by using the incremental area method. Serum insulin and C-peptide levels were also measured before and 120 min after the test. The GI values of citrus, thyme, lime, chestnut, pine, and milk-vetch honeys were found to be 44.9, 52.6, 55.3, 55.5, 58.8, and 69, respectively. Serum insulin and C-peptide values after honey consumption were relatively lower than those after reference food (glucose) consumption. By the end of the 120 min, serum insulin levels were significantly higher, while a significant decrease was observed after the consumption of chestnut honey (P < 0.05). Citrus and thyme honeys were determined to have low GI, while serum insulin levels were significantly lower after the consumption of chestnut honey. Long-term research is needed to compare the effects of honey consumption on healthy and diabetic individuals.

Sex differences in plasma clozapine and norclozapine concentrations in clinical practice and in relation to body mass index and plasma glucose concentrations: a retrospective survey.

BackgroundClozapine is widely prescribed and, although effective, can cause weight gain and dysglycemia. The dysmetabolic effects of clozapine are thought to be more prevalent in women with this gender on average attaining 17 % higher plasma clozapine concentrations than men.MethodsWe investigated the relationship between dose, body mass index (BMI), plasma glucose concentration, and plasma clozapine and N-desmethylclozapine (norclozapine) concentrations in 100 individuals with a severe enduring mental illness.ResultsMean (10th/90th percentile) plasma clozapine concentrations were higher for women [0.49 (0.27–0.79) mg/L] compared with men [0.44 (0.26–0.70) mg/L] (F = 2.2; p = 0.035). There was no significant gender difference in the prescribed clozapine dose. BMI was significantly higher in women [mean (95 % CI) = 34.5 (26.0–45.3)] for females compared with 32.5 (25.2–41.0) for males. Overall, BMI increased by 0.7 kg/m2 over a mean follow-up period of 210 days. A lower proportion, 41 % of women had a fasting blood glucose ≤6.0 mmol/L (<6.0 mmol/L is defined by the International Diabetes Federation as normal glucose handling), compared with 88 % of men (χ2 = 18.6, p < 0.0001).ConclusionsWe have shown that mean BMI and blood glucose concentrations are higher in women prescribed clozapine than in men. Women also tended to attain higher plasma clozapine concentrations than men. The higher BMI and blood glucose in women may relate to higher tissue exposure to clozapine, as a consequence of sex differences in drug metabolism.

English

Diabetes mellitus (DM), mycobacterium tuberculosis (TB) and human immunodeficiency virus (HIV) are important health issues. A bi-directional association between them has been demonstrated by many researchers. The link of DM and TB/HIV is more prominent in developing countries where TB and HIV are endemic and the burden of diabetes mellitus is increasing. A total of 845 subjects were recruited for this study. Fasting blood sugar was determined by the glucose oxidase method while HIV serology was performed using the National Algorithm. The method adopted for mycobacterium tuberculosis identification was the geneXpart as described by Tenover. The prevalence of DM in HIV seropositive subject co-infected with mycobacterium tuberculosis was 107 (12.6%). Out of the 350 patient that tested positive for HIV, 38 (4.5%) had DM, 11 (1.3%) were of Type-1 origin while 27 (3.2%) were of Type-2 origin. On the other hand, 450 patients were TB positive, 45 (5.3%) had DM, 9 (1.0%) were of Type-1 origin while 36 (4.3%) were of Type-2 origin while that of HIV seropositive subjects co-infected with TB: 24 (2.8%) had DM, 5 (0.5%) were Type-1 origin while 19 (2.2%) were of Type-2 origin. There are highly more female 57 (6.7%) with DM than male 50 (5.9%). Our finding has shown no significant increase in the mean blood glucose concentration of HIV seropositive subjects compared with individuals infected with TB (P 0.05). The same pattern was observed in HIV seropositive subjects co-infected with TB compared with individual infected with HIV (P > 0.05). It is recommended that all patients with HIV and mycobacterium tuberculosis infections should be screened for diabetes mellitus as this would help in effective management of the disease conditions. Keywords: Diabetics mellitus, TB, HIV, mycobacterium tuberculosis, seropositive.

Use of intravenous insulin aspart for treatment of naturally occurring diabetic ketoacidosis in dogs.

To characterize the utility and safety of IV insulin aspart in the treatment of diabetes ketoacidosis (DKA) in dogs and to determine the times to resolution of hyperglycemia, ketonemia, and acidemia in dogs treated with IV insulin aspart. Prospective noncontrolled single arm study of dogs with DKA between February 2010 and March 2011. University teaching hospital. Six dogs with spontaneous DKA and blood glucose (BG) concentration >13.8 mmol/L (250 mg/dL), pH between 7.0 and 7.35, and blood beta-hydroxybutyrate >2.0 mmol/L were treated with an IV continuous rate infusion (CRI) of aspart insulin. The time to biochemical resolution of DKA was defined as the time interval from when the IV CRI of aspart insulin began until marked hyperglycemia (BG concentration >13.8 mmol/L [250 mg/dL]), acidemia (venous pH <7.35), and ketonemia (beta-hydroxybutyrate concentration >2.0 mmol/L) resolved. Aspart insulin was administered as an IV CRI at an initial dose of 0.09 U/kg/h. The dose was adjusted according to a previously published protocol. The median time to biochemical resolution of DKA in dogs treated with insulin aspart was 28 hours (range, 20-116 h). Mean BG concentration decreased significantly from the time IV fluid resuscitation began (32.0 mmol/L [576 mg/dL]; range, 14.9-38.9 mmol/L [268-700 mg/dL]) until 6 hours later when IV aspart insulin CRI began (20.1 mmol/L [363 mg/dL]; range, 9.4-26.1 mmol/L [169-470 mg/dL], P = 0.03). No adverse effects were observed in association with IV insulin aspart administration. Median cost of hospitalization was US$3,477 (range, US$1,483-10,469). Median total units per kilogram of administered IV insulin aspart was 2.97 U/kg (range, 2.04-10.52 U/kg). Intravenous CRI of insulin aspart is a safe and effective treatment for DKA in dogs. IV fluid resuscitation is recommended prior to insulin administration.

Assessment of Blood Glucose Regulation and Safety of Resistant Starch Formula-Based Diet in Healthy Normal and Subjects With Type 2 Diabetes.

To evaluate the effects of the new resistant starch (RS) formula, PPB-R-203, on glucose homeostasis in healthy subjects and subjects with type 2 diabetes.A cohort consisting of 40 healthy participants received test and control diets and was checked for up to 3 hours post-meal. A randomized, 2-regimen, cross-over, comparative study was conducted in 44 subjects with type 2 diabetes and glycemic control was assessed with a continuous glucose monitoring system.In healthy participants, serum glucose values and incremental areas under the glucose curves (AUC) were significantly lower in the PPB-R-203 than the control group (P < 0.05). In patients with type 2 diabetes, mean blood glucose concentrations for subjects on the control regimen were higher than those for subjects on the PPB-R-203-based regimen (7.9 ± 1.7, 95% confidence interval [CI] 7.4-8.4 vs 7.4 ± 1.6, 95% CI 6.9-7.9 mmol/L, respectively; P = 0.023). AUCs for total blood glucose and hyperglycemia (glucose >10 mmol/L) were also reduced for subjects on the PPB-R-203-based regimen as compared with those on control regimen (total blood glucose: 16.2 ± 4.0, 95% CI 14.9-17.4 vs 18.7 ± 4.0, 95% CI 17.6-20.1, P < 0.001; hyperglycemia: 4.9 ± 5.7, 95% CI 3.1-6.6 vs 6.3 ± 6.4, 95% CI 4.3-8.3 mmol/L × day, P = 0.021). However, AUC measurements for hypoglycemia (glucose <3.9 mmol/l) were not statistically significant.A PPB-R-203-based diet reduced postprandial hyperglycemia in patients with type 2 diabetes without increasing the risk of hypoglycemia or glucose excursion.

Routine use of continuous glucose monitoring in 10 501 people with diabetes mellitus.

AimsTo analyse blood glucose control according to continuous glucose monitoring use in data from the CareLink™ database, and to identify factors associated with continuation of sensor use during sensor‐augmented pump therapy.MethodsThe analysis used data from 10 501 people with Type 1 and 2 diabetes mellitus, of whom 7916 (61.7%) had used glucose sensors for ≥ 15 days during any 6‐month period over a 2‐year observation period. Data were analysed according to the extent of sensor use ( < 25%, 25–49%, 50–74% and ≥ 75% of the time). Time to discontinuation of sensor use was also analysed in new users of glucose sensors.ResultsCompared with patients in the lowest sensor usage group and non‐users, the highest glucose sensor usage group had significantly (P < 0.0001) lower mean blood glucose and blood glucose sd, were more likely to achieve a mean blood glucose concentration < 8.6 mmol/l, (odds ratio 1.5, 95% CI 1.3–1.7; P < 0.0001), and had 50% fewer hypoglycaemic (blood glucose concentration < 2.8 mmol/l) episodes. Among new users, sensor use during the first month of therapy was an important predictor of subsequent discontinuation. Lack of full reimbursement was also significantly associated with early discontinuation, whereas measures of glycaemic control were predictive of discontinuation during long‐term treatment.ConclusionsThe use of continuous glucose monitoring was significantly associated with reductions in hypoglycaemia and improved metabolic control during insulin pump therapy. Sensor use during the first month was strongly associated with long‐term adherence; patient education and training may be helpful in achieving this.