Mean Glucose Values Research Articles

Self-monitoring of Blood Glucose can be Misleading Without Periodic Re-Calibration of Glucose Meters

Introduction / Background: Diabetes mellitus is highly prevalent in both developed and developing countries today affecting about 429 million adults globally and is expected to rise by 147% to 629 million in 2045. Effective management of diabetes mellitus requires the periodic measurement of fasting plasma glucose. Self-monitoring blood glucose has been used to achieve this for over three decades now. This study, therefore, assesses the performance of three blood glucose meters used by patients with diabetes in our environment. Materials and Methods: This study adopted a comparative analytical prospective design that involved three of the frequently used glucose meters in our environment namely RUBY®, ONCALL®, and FINETEST®. Glucose calibrators of increasing concentrations from 40 mg/dL to 200 mg/dL were prepared from a freshly constituted 1800 mg/dl stock solution of glucose. Sera obtained from five patients were assayed along with control sera using a routine laboratory method (glucose oxidase [GOX]) for standardization and the three glucose meters simultaneously and the results were compared for statistical differences on Microsoft Excel using means and standard deviation. P ≤ 0.05 was set as a level of significance. Results: The mean glucose values of calibrators (120 ± 63.3) were statistically significantly different from the mean glucose values of the RUBY (139.6 ± 80.9), (P = 0.0118) and the ONCALL (188.8 ± 82.1), (P ≤ 0.0001) glucose meters, respectively. The percentage increase in blood glucose estimation by the RUBY and ONCALL devices was 115.8% and 157.3% respectively. The FINETEST glucose meter overestimated glucose by 232.0% higher than the laboratory GOX method even though there was no statistical significance (P = 0.062) between the two means. The percentage imprecision for the different glucose meters was: RUBY 9.5%, FINETEST 14.8%, and ONCALL 18.2%. Conclusion: Quality control should be used routinely in the use of point of care testing glucose measurements and devices should be sent to the central laboratory periodically for recalibration to avoid mismanagement of diabetic patients on hypoglycaemic drugs.

Glucose 6 phosphate dehydrogenase deficiency: A single-center experience.

This study aims to evaluate the demographic information, clinical and laboratory findings of patients with glucose 6 phosphate dehydrogenase deficiency. We collected data by reviewing files and electronic records of 65 patients with glucose 6 phosphate dehydrogenase deficiency under the age of 18 years who were followed up in our clinic between 2007 and 2019. Demographic, clinical, and laboratory features, family history, complications of the disease, and history of splenectomy and cholecystectomy were evaluated. Mean, standard deviation, and median values were used when descriptive analyses were presented. The age of diagnosis ranged between 1-192 months and the median age of diagnosis was two months. Fifty-nine patients (90.7%) were boys and six (9.2%) were girls. The mean value of glucose 6 phosphate dehydrogenase enzyme on admission was 1,9±1,4 U/g of hemoglobin (Hb). Family history was pesent in 40% of patients in whom information was avaliable. The most common presentation was prolonged jaundice and the most common physical finding was jaundice. Splenomegaly was detected in none of the patients. Cholelithiasis was present in one of 21 patients who were evaluated with ultrasonography. None of the patients required splenectomy, cholecystectomy, and regular erythrocyte transfusion during follow-up. As G6PD variants with chronic hemolysis are not usually seen in Turkey, patients who required splenectomy, cholecystectomy, and regular erythrocyte transfusion were not detected. Although glucose 6 phosphate dehydrogenase deficiency is more common in males, it can also be seen in girls. In Turkey, glucose 6 phosphate dehydrogenase deficiency should be considered in patients presenting with prolonged jaundice.

The differences between insulin glargine U300 and insulin degludec U100 in impact on the glycaemic variability, arterial stiffness and the lipid profiles in insulin na\xefve patients suffering from type two diabetes mellitus \u2013 outcomes from cross\u2010over open-label randomized trial

Background and aimsDiabetes mellitus type two is one of the major cardiovascular risk factors. Treatment of diabetes can reduce this risk, but the treatment options differ a lot in their risk-reducing capabilities. We compared the impact of insulin degludec (IDeg-100) and insulin glargine U300 (IGlar-300) on cardiovascular risk parameters - glycaemic variability (GV), arterial stiffness and lipid parameters - in insulin naive patients with DMT2.MethodsTo 23 individuals who previously had uncontrolled DMT2 on two or more oral antidiabetic drugs, IGlar-300 and IDeg-100 were applied for 12 weeks and then switched in a cross over design manner. Prior and after of each insulin phase, we analysed biochemical parameters,7-point SMBG profile over three days and arterial stiffness which was assessed indirectly by measuring the augmentation index (AIx) on the principles of applanation tonometry.ResultsThere were no significant differences between IGlar-300 and IDeg-100 regarding reduction of mean glucose values and coefficient of variation (CV). Both insulins insignificantly reduced AIx for standardised pulse of 75 beats/min and without differences between them. IGlar-300 and IDeg-100 reduced triglycerides and increased HDL with no significant difference between the two insulins. IGlar-300 increased the total cholesterol level and IDeg-100 decreased total cholesterol, but without statistically significant difference. IGlar-300 increased LDL level by 0.508 mmol/L and IDeg-100 decreased LDL by 0.217 mmol/L, with statistically significant difference (p = 0.0215).ConclusionsThis study did not show significant difference between IGlar-300 and IDeg-100 regarding glycaemic parameters and augmentation index using the same dose of 0.2 IU/kg for both insulins, but it has revealed possible differences in impact on lipid profile.Trial RegistrationClinicaltrials.gov, NCT04692415. Retrospectively registered on December 31th 2020.

The Association between Hba1c- Derived Estimated Average Glucose (Eag) with Fasting Blood Sugar (FBS) and Post Prandial Blood Sugar (PPBS) in Patients with Type 2 Diabetes in A Cohort of Patients in a Tertiary Care Hospital in Sri Lanka

Introduction: Type 2 Diabetes mellitus (T2DM) is a chronic illness, caused due to resistance to insulin or poor production. FBS, PPBS and Glycated Haemoglobin (HbA1c) are the major tests that are used to monitor chronic glycemia worldwide. HbA1c level remains the gold standard test for assessment of glycemic control at follow up and it reflects the mean glucose values in the previous three - month period. HbA1c is expressed as a percentage, whereas the day-to-day monitoring and treatment of diabetes are based on blood glucose levels expressed as milligrams per deciliter (mg/dl) or millimoles per liter (mmol/L). Due to the difference in the denominators of FBS/PPBS with HbA1c, it causes confusion to the patients regards their glycaemic control. “Estimated average glucose” or eAG derived from HbA1c has been promoted by the American Diabetes Association (ADA). American Association of Clinical Chemists concludes that the correlation (r =0.92) is strong enough to justify reporting both HbA1c and eAG which indicate the 3- month control of the average sugar of the patient. This is easy for the patient as both FBS/PPBS and eAG are expressed with the same denominator for daily glucose checks and long-term control respectively, enhancing the glycaemic control.
 Objectives: To determine the statistical correlation between eAG derived from HBA1C using the Nathan’s regression equation with FBS and PPBS in patients with T2DM. To analyze the significance of eAG as opposed to HbA1C as a marker of long-term glycemic control in T2DM.
 Methodology: A retrospective analytical study done at the Department of Haematology of the Sri Jayewardenepura General Hospital, Sri Lanka. A simple random sampling technique was used, over a period of one year commencing June 2019 to June 2020, to obtain the laboratory records through laboratory information system of 201 adult patients both males and females who were diagnosed with T2DM. HbA1c, FBS, PPBS done on the same day were recorded. The eAG(mg/dl) was calculated using the Nathan’s regression equation (eAG = 28.7 x HbA1c – 46.7). Three groups were generated according to the patients’ levels of FBS and PPBS.
 Statistical Analysis: Data were double entered and analyzed using (SPSS) version 20. Descriptive statistical methods were used to calculate the median, mean standard deviation of age, HBA1c, FBS, and PPBS. Correlations between study variables were done with Pearson’s correlation method. The p value, lower than 0.05 was considered as statistically significant. Coefficient of determination (R Sq) was used to a statistical measure of how close the data are to the fitted regression line.
 Results: The total population of patients in both the FBS and PPBS groups showed a significant statistical correlation with eAG. The individual subgroups did not conform to this correlation. The results reveal no statistical correlation in both FBS and PPBS with eAG in patients with good glycaemic control. There was a significant statistical correlation in both FBS and PPBS with eAG in the groups of patients with moderately poor control. In those with markedly poor control the FBS did not show a statistical correlation with eAG, as opposed to the PPBS.
 Conclusion: The clinical importance of HbA1C/eAG in diagnosis and management of T2DM can be re-emphasized by this study. HbA1C along with eAG may be added as a test in the management of T2DM, for the better understanding and maintenance of good glycemic control. As eAG values, derived by the Nathan’s regression equation in our study scattered very close to the regression line, it provided a more complete and representative measure of average glucose in past 3 months. We conclude that HbA1c values were reliably translated into eAG measurements which would be easily understood by the patients being of the same denominator as the FBS/PPBS.

The prognostic role of hyperglycemia and glucose variability in covid-related acute respiratory distress Syndrome

AimsDue to heterogeneity on the prognostic role of glucose values and glucose variability in Novel Coronavirus (COVID) disease, we aimed at assessing the prognostic role for Intensive Care Unit (ICU) death of admission hyperglycaemia, peak glycemia and glucose variability in critically ill COVID patients: Methods83 patients consecutively admitted for COVID-related Acute Respiratory Distress Syndrome (ARDS) from from 1st March to 1st October 2020. ResultsNon survivors were older, with more comorbidities and a more severe disease. Corticosteroids were used in the majority of patients (54/83, 65%) with no difference between survivors and non survivors. Mean blood glucose values, (during the first 24 and 48 h, respectively), were comparable between the two subgroups, as well as SD 24 and CV 24. During the first 48 h, survivors showed significantly lower values of SD 48 (p < 0.001) and CV 48, respectively (p < 0.001) than non survivors. Conclusionsin consecutive COVID-related ARDS patients admitted to ICU hyperglycemia (>180 mg/dl) is more common in non survivors who also showed a significantly higher glucose variability in the first 48 h since ICU admission. Our findings point to the clinical significance of in-ICU glucose control in severe COVID patients.

Features of lipid, carbohydrate metabolism and renal function in patients with type 1 diabetes and different levels of albumin in the urine depending on the level of cystatin C

Annotation. The aim of the study was to examine the differences in lipid, carbohydrate metabolism and renal function in patients with type 1 diabetes (T1D) with different levels of albumin in the urine depending on the level of cystatin C. The sample was 78 men and 62 women aged 22-26 years, T1D patients. The control group consisted of 8 almost healthy men and 13 almost healthy women of the same age. The level of microalbuminuria and cystatin C was determined in all patients by enzyme-linked immunosorbent assay. Biochemical evaluation of fasting glucose, fasting blood glucose, glucose 2 h after exercise, mean value of glucose, glycated hemoglobin, total cholesterol, triglycerides, GFR according to Cockcroft-Gault, CKD EPI and GFR according to cystatin C. Statistical processing of the obtained results was performed in the license package “Statistica 5.5”, using non-parametric evaluation methods. In T1D patients compared to the control group found significantly higher values – fasting blood glucose, glucose 2 hours after exercise, the average value of glucose, glycated hemoglobin, total cholesterol and triglycerides, cystatin C and lower values – international normal ratio, GFR according to Cockcroft-Gault, GFR by CKD EPI and GFR by cystatin C. With increasing levels of albumin in urine in patients with cystatin C&lt;0.9, there were changes in the following indicators: higher values of total cholesterol in men with proteinuria compared to men with normo- and microalbumin ; and lower values – the international normal ratio in women with microalbuminuria, compared with women with normoalbuminuria; Cockcroft-Gault GFR in men with proteinuria and GFR by CKD EPI in men with proteinuria and microalbuminuria compared to men with normoalbuminuria. With increasing levels of albumin in the urine in patients with cystatin C&gt;0.9 there were changes in the level of the following indicators: higher values – fasting blood glucose and triglycerides in women with proteinuria compared with women with normoalbuminuria, and glycated hemoglobin and total cholesterol compared with and microalbuminuria; international normal ratio in men with microalbuminuria, compared with men with normoalbuminuria; and smaller values – GFR level by Cockcroft-Gault in men with microalbuminuria compared to men with normoalbuminuria; GCF levels by Cockcroft-Gault in women with proteinuria compared to women with microalbuminuria and GFR levels by CKD EPI in women with proteinuria compared to women with normoalbuminuria and microalbuminuria. With increasing levels of cystatin C, a decrease in glycated hemoglobin in men and women with microalbuminuria and triglycerides in women with microalbuminuria, as well as greater values of the international normal ratio in men with normoalbuminuria and GFR on cystatin C in men and women with normoalbuminuria and micro. Thus, the study obtained results that indicate the existence of differences in the studied indicators between healthy and sick subjects, between men and women and between groups of T1D patients’ men or women with different levels of albumin and cystatin C.

Evaluation of the Effect of Macronutrients Combination on Blood Sugar Levels in Healthy Individuals.

Background:The positive effects of blood glucose levels should be demonstrated in healthy or type 2 diabetic individuals who can be recommended to consume macronutrients (protein + fat) with carbohydrates. Therefore, at the end of the research planned with the amount of carbohydrates and fats that can be consumed in a meal, we aimed to recommend the consumption of food with high protein content egg together with the carbohydrate source.Methods:The study was carried out from Nov 2017 to Apr 2018 by looking at fasting blood glucose levels using feeding 2 different test foods on a minimum of 8 h of fasting in the Haliç University Sutluce Campus, Istanbul, Turkey. Before and after the carbohydrate and carbohydrate + protein source, blood glucose was measured from the fingertip for 3 days in 30 min, 60 min and 120 min periods. The average of 3 days was used in the analysis.Results:Blood glucose values were compared after individuals were given carbohydrate and carbohydrate + protein source. The mean blood glucose value 60 min after the carbohydrate administration was significantly higher than the average blood glucose value 60 min after the carbohydrate + protein administration (P= 0.006).Conclusion:A protein-containing diet positively affects the glycemia response and can recommend it. In individuals with diabetes, they should focus on the effects of proteins to achieve glycemia control.

Critical illness myopathy precedes hyperglycaemia and high glucose variability

Critical Illness Myopathy (CIM) is a serious ICU complication, and dysglycaemia is widely regarded as a risk factor. Although glucose variability (GV) has been independently linked to ICU mortality, an association with CIM has not been investigated. This study examines the relationship between CIM and GV. Retrospective investigation including ICU patients with SOFA ≥8, mechanical ventilation, and CIM diagnostics. Glucose readings were collected every 6h throughout the first week of treatment, when CIM is thought to develop. GV was measured using standard deviation (SD), coefficient of variability (CV), mean absolute glucose (MAG), mean amplitude of glycaemic excursions (MAGE), and mean of daily difference (MODD). 74 patients were included, and 50 (67.6%) developed CIM. Time on glycaemic target (70-179mg/dL), caloric and insulin intakes, mean, maximum and minimum blood glucose values were similar for all patients until the 5th day, after which CIM patients exhibited higher mean and maximum glucose levels. Significantly higher GV in CIM patients were observed on day 5 (SD, CV, MAG, MAGE), day 6 (MODD), and day 7 (SD, CV, MAG). CIM patients developed transient increases in GV and hyperglycaemia only late in the first week, suggesting that myopathy precedes dysglycaemia.

EVALUATION OF THE EFFECT OF TASTE GOOD BISCUITS ON BLOOD GLUCOSE LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

BACKGROUND: Momordica charantia is widely used in the traditional medicine to manage patients with type 2 Diabetes Mellitus(DM). OBJECTIVE: To evaluate the effect of Taste Good biscuits (TGB) on blood glucose levels in patients with type 2 DM using CGMS. MATERIALS AND METHODS: This was an open label, controlled, non-randomized, prospective study. Total duration of study was for 14 days, 1-7 days of control period without TGB and 8-14 days of active period with TGB. During the control period regular antidiabetic treatment was continued, however during the active period, two TGB were consumed at 11am and at 4pm along with their regular anti diabetic treatment. Continuous glucose monitoring system (CGMS) was used to detect the fluctuations in the blood glucose levels during the entire study period. RESULTS: 62 type 2 DM patients participated in the study, 3 were lost to follow up. 39 were males and 20 females. There was statistically significant reduction in the mean glucose values during the active period with TGB as compared to the control period without TGB (p&lt; 0.001). The glucose variability between the minimum and maximum glucose during the control period was statistically significantly more as compared to active period ( p &lt;0.01). The glucose levels were in the target range of (80-140mg/dl) during the active period as compared to the control period (p&lt; 0.001). However, the glucose levels were above the target range during the control period as compared to the active period (p &lt; 0.001). CONCLUSION: TGB reduced the glucose variability in patients with type 2DM, hence TGB can be used as an adjuvant with regular antidiabetic medications.

Efficacy of telemedicine for persons with type 1 diabetes during Covid19 lockdown

BackgroundStarting March 2020 the Italian Government imposed a lockdown to limit the spread of SARS-CoV-2. During lockdown outpatient visits were limited and telemedicine (TM) was encouraged.MethodsWe retrospectively analyzed data from continuous or flash glucose monitoring systems shared through different cloud systems during the lockdown by subjects with type 1 diabetes and compared data obtained 4 weeks before and 4 weeks after structured telephonic visit. Variables considered were mean glucose, time spent in target (70–180 mg/dl), hypoglycemia (<70 mg/dl) and hyperglycemia (>180 mg/dl), coefficient of variation, and length of sensor use.ResultsDuring the 4 weeks following the telephonic visit there was an improvement of glycemic control, with a significant reduction of mean glucose values (161.1 before vs 156.3 mg/dl after, p = 0.001), an increase of the time spent in target (63.6 vs 66.3, p = 0.0009) and a reduction of time spent in hyperglycemia (33.4 vs 30.5, p = 0.002). No changes were observed regarding glucose variability, time spent in hypoglycemia, and length of sensor use. Similar results were observed in subjects treated with multiple daily injections or continuous subcutaneous insulin infusion.ConclusionsA structured telephonic visit appears to be an effective way to replace or integrate routine visits in particular conditions.

Effects of Hemodialysis and Peritoneal Dialysis on Glycometabolism in Patients with End-Stage Diabetic Nephropathy

Objective: The objective is to study the fluctuation pattern of blood glucose spectrum in patients with end-stage diabetic nephropathy (ESDN) receiving hemodialysis (HD) and peritoneal dialysis (PD), respectively, and to compare the influences of these 2 dialysis methods on glycometabolism. Methods: Sixty-four dialysis patients with ESDN were recruited, including 35 HD patients and 29 PD patients. The 24-h blood glucose on dialysis days of the 2 groups was monitored by the continuous glucose monitoring system, and the relevant glycometabolism indexes were recorded and compared. Results: The control of blood glucose in both groups was not satisfactory. At the same blood glucose level, the dosage of exogenous insulin needed by patients in the PD group was larger than that in the HD group (p < 0.05). However, the fluctuation of blood glucose and consequently the incidence of hyperglycemia and hypoglycemia in HD group were greater than that in PD group (p < 0.05). The patients’ blood glucose levels decreased progressively during the course of HD. The mean blood glucose (MBG) values estimated by glycosylated hemoglobin (HbA1c) in both groups were lower than the actual measured blood glucose values (p < 0.05). Preliminary correlation analysis showed that the deviation of the MBG values estimated by HbA1c was positively correlated with the degree of anemia. Conclusion: HD patients have larger glycemic variability as compared with PD patients, while PD patients have overall increased blood glucose levels. Hypoglycemic programs should be made according to the corresponding changes in blood glucose. The HbA1c value of dialysis patients has a large deviation, so it is necessary to explore its influencing factors and develop more accurate blood glucose assessment indicators.

Treatment Effects of Short-Term Continuous Positive Airway Pressure on Blood Glucose Control in Type 2 Diabetic Patients with Obstructive Sleep Apnea Syndrome.

PurposeThe study aimed at assessing glucose control measured with a continuous glucose monitoring system (CGMS) before and after short-term continuous positive airway pressure (CPAP).Materials and MethodsTwenty-four type 2 diabetic patients (T2DM) with Obstructive sleep apnea syndrome (OSAS) (mean age 55.0 ± 9.0 years; BMI 29.5 ± 5.2 kg/m2) were admitted and kept under diet control for 2 days, then underwent 2 overnight polysomnographies: a diagnostic study and one with CPAP titration. Then they were treated by CPAP during sleep for the following three nights. Participants were divided into subgroup D (only diet control) and subgroup M (with DM medication). CGMS was utilized over the last five days. Glucose control was also assessed with plasma insulin and a clinical measure of insulin resistance (HOMA-IR) index.ResultsThe mean (±SD) apnea-hypopnea index (AHI) at diagnostic polysomnography was 51.2 ± 22.4 (range 10–88) events/h. CPAP treatment in the subjects with OSAS resulted in the index of oxygenation desaturations being reduced from 33.3 ± 20.1 to 1.1 ± 1.6 (P =0.00). CGMS showed mean 24-hours glucose values significantly lower after CPAP treatment than at baseline in both subgroups (7.97±1.31 vs 7.52±0.94, P=0.033 in subgroup D; and 7.72±1.51 vs 7.17±1.21, P=0.05 in subgroup M), as the fasting plasma insulin levels and HOMA-IR were also decreased significantly after CPAP treatment (13.0 ± 7.5μU/mL vs 10.8 ± 5.4μU/mL, P=0.044; and 4.2 ± 2.2 vs 3.1±1.7, P=0.003, respectively). Standard deviation (SD) and mean amplitude of glucose excursions (MAGE) were also decreased in the subgroup D (1.91 ± 1.10 vs 1.61 ± 1.20, P=0.014; 1.26 ± 1.13 vs 1.01 ± 0.98, P=0.008, respectively) only.ConclusionShort-term CPAP treatment in OSAS with type 2 diabetic patients is accompanied by a decrease in blood glucose level and improved insulin sensitivity. Glucose variability was reduced but only in the patients with diet control.

Glycaemic profiles of diverse patients with type 2 diabetes using basal insulin: MOBILE study baseline data.

Basal insulin is often prescribed to patients with suboptimally controlled type 2 diabetes (T2D); however, its therapeutic efficacy is inadequate in many. During the MOBILE study's baseline phase, we evaluated 173 participants' continuous glucose monitoring (CGM) data (mean ± SD age 57 ± 9 years; 50% female; HbA1c 9.1% [range 7.1%‐11.6%]; 40% using sulphonylureas; 19% using NPH; reported self‐monitored blood glucose [SMBG] frequency median 1.0 checks/day) who were using basal, but not prandial insulin. Blinded CGM data were recorded for 10 days prior to randomization. The mean glucose value was 208 ± 47 mg/dL and it was lowest in the early morning. Mean time in the 70‐180 mg/dL range was 9.6 ± 6.1 hours/day (40% ± 25%). Hyperglycaemia was extensive with medians of 14.7 (61%) and 5.0 (20.9%) hours/day with glucose greater than 180 and 250 mg/dL, respectively. Hypoglycaemia was infrequent (median [IQR] 0 [0, 4.3] minutes/day [0.0% {0.0%, 0.3%}] with glucose less than 70 mg/dL). Blinded CGM highlights the limitations of infrequent SMBG in basal insulin users with T2D and allows characterization of hyperglycaemia and hypoglycaemia in basal insulin users with suboptimal control. The MOBILE study randomized phase will define the benefits of using real‐time CGM compared with SMBG in this population.

Assessment of Hemato-biochemical, mineral and oxidative changes in postpartum anoestrous (true anoestrus) Murrah Buffaloes

The present study was aimed to assess the hemato-biochemical, mineral and oxidative changes in postpartum anoestrous Murrah buffaloes. A total of 30 multiparous buffaloes of almost same age and body weight were used for the experiment. The experimental group I (GI) consisted of 15 postpartum anoestrous buffaloes (PPA) and control group II (GII) consisted of 15 normal cyclic buffaloes. Blood samples were collected by jugular vein puncture and analyzed for hematological parameters. Further, the serum was separated from another aliquot of blood sample and utilized for biochemical, mineral, MDA and SOD activity. The mean Hb, PCV, glucose, cholesterol and phosphorous values were significantly (p 0.05) difference was observed in total protein and calcium concentration between groups. From the present study, it was concluded that postpartum anoestrous can be attributed to oxidative stress, which induces significant changes in hemato-biochemical and mineral profile.

Inadequacy of Vitamin D Nutritional Status in Individuals with Metabolically Unhealthy Obesity Phenotype: The Relevance of Insulin Resistance.

PurposeThe aim was to evaluate 25(OH)D serum concentrations in metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO) and its relation with biochemical and clinical parameters in both groups according to homeostatic model assessment-insulin resistance (HOMA-IR) definition of the obesity phenotypes.Patients and MethodsDescriptive cross-sectional study was conducted with individuals of both genders. Anthropometric data [waist circumference, body mass index (BMI)] and metabolic parameters: blood glucose, glycated hemoglobin, insulin, lipid profile, calcium, phosphorus, parathyroid hormone (PTH) and high-sensitivity c-reactive protein (hs-CRP) and (25(OH)D) were obtained. The cutoff points for vitamin D deficiency and insufficiency were ≤20 and 21–29 ng/mL, respectively. Individuals were classified as MUHO according to HOMA-IR≥2.5.ResultsThis study comprised 232 individuals with obesity (BMI≥35 kg/m2; 42.6±4.7 kg/m2). The MUHO phenotype was observed in 76.7% of the population. The mean values of glucose (P<0.001), insulin (P<0.001), HOMA-IR (P<0.001), and triglycerides (P=0.049) were significantly higher in the MUHO than in the MHO phenotype group. The mean value of 25(OH)D showed a significant difference between the MHO and MUHO phenotype groups (P=0.011). Additionally, and in line, lower mean 25(OH)D values were found in the MUHO vs the MHO phenotype group in the deficiency (14.5±3.6 ng/mL/17.1±2.7 ng/mL, P=0.004) and insufficiency (24.5±2.9 ng/mL/25.7±2.6 ng/mL, P=0.077) 25(OH)D groups. An increase of 1 ng/mL of vitamin D increased in 1.051 (95% CI= 1.011–1.093, P=0.012) the odds of the healthy phenotype.ConclusionThe highest prevalence of inadequacy of serum concentrations of 25(OH)D and greater severity of this deficiency in individuals with MUHO phenotype were observed. Low serum concentrations of this vitamin were associated, mainly, with insulin resistance. Monitoring the nutritional status of vitamin D in individuals with obesity that present with MUHO phenotype may contribute to minimize the occurrence and aggravation of diseases associated with obesity.

Más allá de la hiperglucemia: la variabilidad glucémica como factor pronóstico en el infarto cerebral agudo

IntroductionGlycaemic variability (GV) refers to variations in blood glucose levels, and may affect stroke outcomes. This study aims to assess the effect of GV on acute ischaemic stroke progression. MethodsWe performed an exploratory analysis of the multicentre, prospective, observational GLIAS-II study. Capillary glucose levels were measured every 4 hours during the first 48 hours after stroke, and GV was defined as the standard deviation of the mean glucose values. The primary outcomes were mortality and death or dependency at 3 months. Secondary outcomes were in-hospital complications, stroke recurrence, and the impact of the route of insulin administration on GV. ResultsA total of 213 patients were included. Higher GV values were observed in patients who died (n = 16; 7.8%; 30.9 mg/dL vs 23.3 mg/dL; p = 0.05). In a logistic regression analysis adjusted for age and comorbidity, both GV (OR = 1.03; 95% CI, 1.003-1.06; p = 0.03) and stroke severity (OR = 1.12; 95% CI, 1.04-1.2; p = 0.004) were independently associated with mortality at 3 months. No association was found between GV and the other outcomes. Patients receiving subcutaneous insulin showed higher GV than those treated with intravenous insulin (38.95 mg/dL vs 21.34 mg/dL; p < 0.001). ConclusionsHigh GV values during the first 48 hours after ischaemic stroke were independently associated with mortality. Subcutaneous insulin may be associated with higher VG levels than intravenous administration.

Breastfeeding and Postpartum Glucose Regulation Among Women With Prior Gestational Diabetes: A Systematic Review.

Gestational diabetes mellitus is associated with adverse maternal and fetal outcomes and increases subsequent risk of Type 2 diabetes. Researchers have shown that breastfeeding may reduce diabetes risk in women with recent gestational diabetes. To assess association between infant feeding and postpartum glucose tolerance in mothers with recent gestational diabetes within 1 year postpartum. A literature search was performed up to December 31, 2019, retrieving articles related to infant feeding, gestational diabetes, and postpartum glucose regulation in four major databases (PubMed, Cochrane, CINAHL, and Embase). Methodological quality was assessed using tools from the United States National Institutes of Health and the National Heart, Lung, and Blood Institute. The search yielded 15 cohort studies meeting the selection criteria. Of the 15 studies, 13 (86.7%) examined the influence of breastfeeding on postpartum glycemic status, and eight (53.4%) compared the mean blood glucose values between breastfeeding and non-breastfeeding participants. Of the 13 studies that compared postpartum glycemic status, nine (60%) of the research teams found that breastfeeding lowered rates of impaired glucose tolerance, and four (26.7%) showed no significant change. In eight of the studies reporting mean blood glucose values, six (75%) reported significantly lower fasting plasma glucose in breastfeeding participants, with reductions ranging from 3.7 to 7.4 mg/dL (0.2-0.4 mmol/L). Breastfeeding has been associated with improved postpartum glucose regulation in mothers with gestational diabetes. In pregnant women with gestational diabetes, breastfeeding may reduce the risk of Type 2 diabetes, and women with gestational diabetes should be strongly encouraged and supported to breastfeed.

Exercise Snacking And Detraining Effects On Postprandial Glucose Responses - A Randomized Crossover Trial In Trained Older Adults

PURPOSE: Experimental data suggest that frequent interruptions in sedentary behavior (SB) promote improvements in postprandial glucose (PPG) responses. However, little is known about the impact of these interruptions before and after a detraining period in active older adults. The main purpose of this investigation was to examine the acute effects of interrupting prolonged SB in a sample of trained older adults, before and after 2-weeks of detraining, on PPG. METHODS: Older active adults performing structured exercise at least 2/week for the past 6 months (n=14; aged between 65 and 90 years-old), were enrolled in a randomized crossover trial. Participants performed two conditions before and after 2-weeks of detraining (i.e. refrain from structured exercise): 1) uninterrupted sitting, where participants remained seated throughout 7 hours (SIT); 2) Sitting + moderate intensity breaks (INT), where participants were instructed to sit for 7 hours, while interrupting this behavior with 2 minutes of moderate-intensity physical activity (PA) every 30 minutes. The primary outcome was changes in PPG, while body composition and cardiorespiratory fitness (CRF) were considered secondary outcomes. Generalized estimating equations (GEE) were used. SUMMARY OF RESULTS: Both at baseline and after detraining, no differences were observed for 7-h total area under the curve (7h-AUC) for glucose (baseline: ∆ -3.1%, p = 0.542; post-detraining: ∆ -8.8%, p = 0.182) and mean glucose (MG) values (baseline: ∆ -3.3%, p = 0.541; post-detraining: ∆ -9.0%, p = 0.188) between INT and SIT experimental conditions. An unfavorable effect was observed for the SIT condition from baseline to after the detraining period, with higher values for 7h-AUC (∆ 10.6%, p = 0.014) and MG (∆ 11.7%, p = 0.015). No changes were observed in the response to INT condition between baseline and after detraining in PPG values (7h-AUC: ∆ 4.4%, p = 0.535; MG: ∆ 5.2%, p = 0.523). CONCLUSION: Frequent interruptions in SB had no effect on PPG, prior to or after a 2-week detraining period, when compared to prolonged SB in active older adults. On the contrary, older adults experiencing a short-term detraining period can use strategies, such as breaking up SB, in order to potentially improve glycemic control during these intermissions.

COMPARISM OF ANTICOAGULATED TUBES CONTAINING FLUORIDE OXALATE AND FLUORIDE OXALATE WITH EDTA-ANY DIFFERENCE IN GLUCOSE VALUES?

Glucose values are essential and common investigations in clinical practice. The choice of anticoagulated tubes for sample collection affects the final glucose results obtained. This study aims to compare if there is any statistical difference between two anticoagulated tubes-fluoride oxalate and fluoride oxalate with EDTA used for glucose collection. A total of 64 adults participants (made up of 40 females, and 24males) were involved in the study with an average of 30.4±4.5years. After an initial overnight fast venous blood was collected and put into fluoride oxalate((group 1) and fluoride oxide + EDTA ( group 2) anticoagulated bottles. The group with fluoride oxalate alone had 64 samples and was labeled group 1,while the group 2 also had 64 samples(consisting of fluoride oxide + EDTA). Results of glucose samples in both groups were obtained and analyzed.. The mean glucose values in group 1 was 4.55±1.37mmol/L, while it was 4.61±1.44mmol/L in group 2. Correlation studies done for the two groups showed a strong correlation between them(r=0.892,p˂0.001).The p value of the two groups comparism was not statistically significant(p=0.458).Hence, there was really no statically difference in the samples fixed in fluoride oxalate alone or those in fluoride oxalate +EDTA. Our conclusions are that, samples in both groups1 and 2 gave similar results. and this does not affect the results of glyacted hemoglobin. This offers a good advantage in diabetic patients investigated for both glycated hemoglobin (HbA1C) and glucose as the fluoride oxalate with EDTA tube can suffice for both tests thus enhancing laboratory economy.

869-P: Using CGM as Feedback Tool in Diabetes Mellitus Patients Management: A Retrospective Real-World Evidence Study Conducted in India

Introduction: Since many new diabetic medications are costly and often have side effects, quick feedback would allow for timely decisions. The current study present the role of CGM in titrate medication to achieve glycemic target of diabetes mellitus patients using 14 days CGM report (AGP). Methodology: Retrospective AGP of 214 patients was collected from 2017 to 2019. Target glucose range was considered as 70-180 mg/dL, hypoglycemia was categorized as low (54-69 mg/dL) and very low (&amp;lt;54 mg/dL) and hyperglycemia as high (180-250 mg/dL) and very high (&amp;gt;250 mg/dL). The % of time a patient spent in above ranges was illustrated as time in target range (TIR), time below range (TBR), and time above range (TAR), respectively. The glycemic variability (GV) parameters included standard deviation (SD) and coefficient of variation (CV). Changes in diabetic medications were done, if required, after first week of CGM. Variation in TIR, TAR, TBR and CV were analyzed before (first week) and after medication (last week). Results: Improvement was observed in mean glucose values and SD from 152.1 to 135.5 and 41.0 to 35.1 mg/dL, respectively, % of time in TIR from 57.9 to 64.5% and TAR from 25.9 to 16.9% (high: 16.9 to 12.6% and very high: 9.0 to 4.3%) from first to last week. However, % of time in hypoglycemia (TBR) was increased from 7.9 to 11.2% (low: 6.6 to 8.8% and very low: 1.3 to 2.4%). The patients count with high glycemic variability (CV &amp;gt;36) was reduced from 27 to 21. The average eA1C was improved by 0.6 units (6.9 to 6.3). Conclusion: The patients who were hyperglycemic were well controlled with medication, albeit with episodes of hypoglycemia during night-time. The treating clinicians can focus on these soft spots after first week instead of waiting long to intervene if they use CGM to titrate the medication. Thus, CGM can be instrumental in giving quick feedback in maintaining desired glycemic targets. Disclosure M. Sabharwal: None. S. Palukuri: None. S. Deka: None. G. Chanana: None. R. Kumar: None.