Mean Glycemic Values Research Articles

Diabetes-associated factors in hospitalized COVID-19 patients with concomitant type 2 diabetes mellitus: focus on mean in-hospital glycemic values

Aim of the study: to evaluate the significance of mean glycemic values during hospitalization as a potentially important diabetes-associated risk factor of unfavorable outcomes in inpatients with COVID-19 and type 2 diabetes mellitus (T2DM).Materials and methods. 139 patients with COVID-19 were observed in the hospital, 42 of them had concomitant type 2 diabetes mellitus (DM2). In patients with COVID-19 and type 2 diabetes, the relationship between mean glycemic values during hospitalization and adverse outcomes (death and/or transfer of the patient to the intensive care unit (ICU)) was assessed. The average number of tests to assess glycemia in the hospital was 38.4 ± 15.68 per patient.Results and discussion. According to correlation analysis data, an increase in mean in-hospital glycemia correlated with the severity of lung damage by computed tomography (R = 0.54, p = 0.002), the need for respiratory support by SMRT-CO score (R = 0.29, p = 0.070) and hypercoagulation by the international normalized ratio (R= –0.42, p=0.008). According to regression analysis, predictors of unfavorable outcomes included mean in-hospital glycemia (OR 1.4 [0.93; 2.12], p=0.073) and the percentage of tests with hypoglycemia in the hospital (OR 2.09 [0.89; 5 .40], p=0.016) as well as a history of diabetes (OR 5.5 [0.95, 31.60], p=0.029).Conclusion. Impaired glycemic control during the whole hospitalization period negatively affects disease severity and the risk of adverse outcomes in patients with COVID-19 and type 2 diabetes.

Impact of Lifestyle Modification: An Intervention on Newly Diagnosed Diabetics of the Urban Slum of Meerut.

Introduction Diabetes is a long-term condition that necessitates ongoing medical attention and self-care to prevent immediate complications and minimize the likelihood of long-term issues. Early diagnosis is one of the most important steps for people living with diabetes to take. Public awareness regarding the importance of lifestyle modification in managing type 2 diabetes mellitus is a crucial preventive measure. Despite continuous efforts to raise public awareness, the prevalence of type 2 diabetes continues to increase, with most people overlooking the importance of a healthy lifestyle. Our goal was to assess the impact of lifestyle modification on glycemic control in newly diagnosed diabetic patients. Materials and methods A total of 503 adults aged 30 years and above who were nondiabetic or were unaware of their diabetic status were assessed for their fasting blood glucose levels. Individuals identified as diabetic based on their fasting blood glucose levels were subjected to lifestyle modification for a period of three months. Glycemic levels were measured at the beginning and the end of the study period for comparison. Results Of the study participants, 7.6% were undiagnosed diabetics with increased blood sugar levels who were unaware of their diabetic status. Mean anthropometric measurements from pre- to postintervention values improved overall.Overall reduction was observed in weight (66.21±12.97 to 63.18±11.48), waist circumference (96.21±13.01 to 91.77±11.82), hip circumference (105.16±11.91 to 103.58±10.88), waist-hip ratio (0.91±0.09 to 0.88±0.08) and body mass index (27.48±6.04 to 26.18±5.30). Significant reductions were observed in the mean glycemic values, including fasting blood sugar (180.19±55.81 to 152.56±45.74)and glycosylated hemoglobin levels (8.61±1.97 to 6.68±1.67). Conclusion Lifestyle modification plays a crucial role in managing diabetes, both in preventing its onset and controlling its progression. The present study highlights the importance of early diagnosis and lifestyle interventions in the management of diabetes, thereby stressing the necessity of comprehensive strategies to combat this situation.

Glucagon kinetics assessed by mathematical modelling during oral glucose administration in people spanning from normal glucose tolerance to type 2 diabetes.

Glucagon is important in the maintenance of glucose homeostasis, with also effects on lipids. In this study, we aimed to apply a recently developed model of glucagon kinetics to determine the sensitivity of glucagon variations (especially, glucagon inhibition) to insulin levels ("alpha-cell insulin sensitivity"), during oral glucose administration. We studied 50 participants (spanning from normal glucose tolerance to type 2 diabetes) undergoing frequently sampled 5-hr oral glucose tolerance test (OGTT). The alpha-cell insulin sensitivity and the glucagon kinetics were assessed by a mathematical model that we developed previously. The alpha-cell insulin sensitivity parameter (named SGLUCA; "GLUCA": "glucagon") was remarkably variable among participants (CV=221%). SGLUCA was found inversely correlated with the mean glycemic values, as well as with 2-hr glycemia of the OGTT. When stratifying participants into two groups (normal glucose tolerance, NGT, N=28, and impaired glucose regulation/type 2 diabetes, IGR_T2D, N=22), we found that SGLUCA was lower in the latter (1.50 ± 0.50·10-2 vs. 0.26 ± 0.14·10-2 ng·L-1 GLUCA/pmol·L-1 INS, in NGT and IGR_T2D, respectively, p=0.009; "INS": "insulin"). The alpha-cell insulin sensitivity is highly variable among subjects, and it is different in groups at different glucose tolerance. This may be relevant for defining personalized treatment schemes, in terms of dietary prescriptions but also for treatments with glucagon-related agents.

Diet Oriented Safety of Pakistani Biryani with reference to Glycemic Response in Healthy Human Subjects

Introduction: Traditional Pakistani Biryani is popular food particularly among Asian population. The objective of this study was to evaluate glycemic response of compound test food in conjunction with Food Oriented Diet Safety in healthy human subjects. Material and methods: This Quasi-Interventional Study was conducted in research unit of Baqai medical university. This study was conducted in period of two days and twenty healthy volunteers were enrolled. On day 1; fasting blood sugars were checked. Subsequently on day 2 participants were instructed to report with 12 hr. fasting, Later Compound test food was offered according to Health Body Mass Index (BMI) and Calories Calculator. Sequential plasma glycemic response was recorded on 0, 30, 60, 90 and 120 minutes. Results: Day 1, Glycemic response of study subjects showed mean glycemic value of 104 mg/dl. Day 2, glycemic response of 0, 30, 60, 90 and 120 minutes showed of 118,130, 121,109, 106 mg/dl respectively. This study highlights desirable incremental and decremented glycemic response after 30 & 120 mins respectively. Conclusion: This study concludes; that consumption of tested compound food according to BMI expected to have physiological mean peak glycemic response. Therefore this study identifies that consumption of beef biryani is safe; as study population never showed abnormal mean glycemic peak.

Comparative Analysis between Portable Glucometer and Enzyme Method for Measurement of Blood Glucose Levels in Cattle

Background: Changes in glycemic levels can negatively affect the body. Several techniques for the measurement of blood glucose have been described, but the enzymatic method is considered standard and more accurate in both humans and animals. The College of American Pathologists recommends the use of portable glucometers (PGs), which are routinely used in human medicine because this is an easy, relatively inexpensive method that delivers results quickly. The aim of this study was to compare the results of the measurement of blood glucose in cattle obtained using portable Accu-Check® glucometer with the enzymatic method (EM), which is still considered standard.Materials, Methods & Results: Thirty crossbred cattle (Bos taurus), male and female, of different ages were evaluated. Through a puncture of the jugular vein, 10 mL of blood was collected, and one drop was immediately used in an Accu-Chek® PG; the remaining blood was stored in tubes containing sodium fluoride and tubes containing EDTA. The samples were packaged and sent to the laboratory for processing. Blood glucose was measured in the sodium fluoride samples using the enzymatic-colorimetric method (EM) employing Labtest® glucose kits with automatic ELISA spectrophotometer readings. The glycemic values obtained in this study with PG and EM ranged from 62 to 163.3 mg/dL. Mean glucose concentrations for the PG and EM methods were 93.53 mg/dL and 94.84 mg/dL, respectively, with no statistical difference (P > 0.05). The glycemia measurement results generated by both tests were normally distributed by the Shapiro–Wilk test (P > 0.05) and equal variances by the Levene test (P > 0.05). Discussion: The glycemic values obtained in this study meant that most of the mean glycemic values evaluated were >45 to 75 mg/dL, considered a reference for the species. This may have occurred due to the stress of handling during sample collection. Some authors compared the GP and EM methods and reported that the mean glucose concentrations obtained using PGs were significantly lower than those using the EM in both cattle and sheep and suggested using a correction factor for PGs. The error rates between PG and EM in our study ranged from 1.7 to 7.8%, much lower than the limits set by the Food and Drug Administration, which stipulates that PG cannot have error rates greater than 20% for blood glucose concentration. Comparison of PG and EM efficacy has been reported for dogs, cats, and horses, and significant differences were observed in the statistical analysis. In studies from other authors concluded that PG provides significantly different results from EM in the measurement of bovine and sheep blood glucose, but the final values can be corrected in order to obtain reliable results to be used in clinical practice. Hematocrit below 30% leads to erroneously high results, whereas hematocrit greater than 55% may give erroneously low results. However, failures are mainly caused by the user, such as improper application of the sample, excessive time to perform the exam, lack of equipment maintenance, and improper storage of test strips. PGs are becoming a very useful tool in the clinical practice with small animals, as studies have shown its reliability in relation to the EM, which is considered the gold standard. This practice may also be extended to cattle due to the reliability of PGs, as indicated in this study.

Continuous subcutaneous insulin infusion in preschool children: butt or tummy, which is the best infusion set site?

Choosing the right infusion set site can be an important factor in obtaining good glycemic control, especially in very young children. In an attempt to identify the best infusion site, we performed a crossover study in six preschool children with type 1 diabetes using insulin pump therapy. We enrolled six patients 5.2±0.7 years old (range, 4-6 years), with type 1 diabetes for more than 1.5 years, using insulin pump therapy for at least 6 months. For each patient, body mass index, glycated hemoglobin, and all data downloaded from the system were evaluated on two occasions: the first with the infusion set placed on the buttock and the second on the abdomen, each for 3 days. The order of infusion set placement was randomized. Mean capillary blood glucose, mean continuous glycemia, mean area under the curve (AUC) using the trapezoidal rule for both >140 mg/dL and <70 mg/dL, insulin daily dose, carbohydrate/insulin ratio, total basal insulin, total bolus insulin, and mean amplitude of glucose excursions (MAGE) were evaluated. Mean glycemic values, mean AUC >140 mg/dL, and MAGE were significantly lower when the infusion set was placed on the buttock versus the abdomen (144.6±31.9 mg/dL vs. 166.0±34.8 mg/dL [P=0.000], 28.4±18.3% vs. 48.8±28.2% [P=0.000], and 32±10 vs. 60±15 mg/dL [P<0.001], respectively), whereas mean AUC <70 mg/dL was higher (1.47±2.77% vs. 0.87±1.03% [P<0.001]). The present findings suggest that preschool children with type 1 diabetes using insulin pump therapy could benefit from inserting the infusion set in the buttock instead of the abdomen.

Use of neutral protamine lispro insulin (NPL) in patients with hyperglycemia receiving parenteral nutrition.

Nutritional support with parenteral nutrition (PN), a key component in the care of critically ill patients, usually requires insulin therapy in patients with diabetes or may require insulin treatment in patients not known to be diabetic. We wanted verify whether it is possible to use neutral protamine lispro (NPL) in double administration monotherapy in patients receiving artificial nutrition (AN) and if the same NPL is capable of obtaining and maintaining acceptable glycemic control without inducing hypoglycemia. We studied 18 consecutive patients, who were not taking insulin, they needed to start artificial nutrition, and presenting at least two consecutive blood glucose > 120 mg/dL. Each patient was given at least 1 U of insulin for every 10 grams of glucose infused. Eighteen consecutive patients, not stratified in any way, were judged eligible in the last 24 months, with a mean age of 71 years (range 54-85 yrs). All patients were evaluated after 2, 3 and 5 days of treatment; only 1 patient has not been evaluated to 5 days. Mean glycemic values on days 2, 3, 5 were in range between 145 and 180 mg/dL. Any adjustments in NPL dose were carried out by the team of nutrition and there was no hypoglycemia that required medical intervention in emergency. Our impression is that also lispro protamine insulin (NPL) in double subcutaneous administration may contribute to improving the glycemic values in patients receiving parenteral nutrition with hyperglycemia.

Gestational diabetes and pregnancy outcome – do we have right diagnostic criteria?

Objective: To determine thresholds of maternal glycemia at which specific adverse pregnancy outcomes occur in high-risk population.Methods: A total of 1002 pregnant women with risk factors for gestational diabetes mellitus (GDM) underwent an originally modified glucose tolerance test (OGTT) with 75 g of glucose. Information on OGTT results and pregnancy outcomes were collected from database and medical records.Results: Large for gestational age (LGA) newborn, infant’s stay in the neonatal intensive care unit (NICU) >24 h, neonatal hyperbilirubinemia and cesarean section due to cephalopelvic disproportion were identified as specific GDM adverse outcomes. In the study group of participants with one or more specific GDM adverse outcomes, mean glycemic values during the modified OGTT (4.2 ± 1.0 mmol/L at 0 min, 6.8 ± 1.7 mmol/L at 30 min, 7.9 ± 2.1 mmol/L at 60 min, 7.7 ± 2.3 mmol/L at 90 min and 7.5 ± 2.3 mmol/L at 120 min) according to Student’s t-test for independent samples were significantly higher than mean glycemic values in the control group of participants without specific adverse outcomes (p < 0.001, p = 0.02, p < 0.001, p < 0.001, p < 0.001).Conclusion: This study provides additional data that support the acceptance of the newly recommended outcome-based GDM diagnostic criteria.

Glucagon-like peptide-1 secretion in women with gestational diabetes mellitus during and after pregnancy.

Gestational diabetes mellitus (GDM) predisposes women to future development of Type 2 diabetes mellitus (DM2) and the two conditions share similar metabolic alterations. Recent observations suggest that a defective glucose stimulated insulin secretion by glucagon-like peptide-1 (GLP- 1) plays a role in the pathogenesis of DM2. Whether such a defect is impaired in GDM remains to be ascertained. We have determined GLP-1 secretion in response to oral glucose tolerance test (OGTT) in GDM and normal glucose tolerance (NGT) during and after pregnancy. 100-g-3h OGTT was performed in 12 GDM and 16 NGT women at 27.3 ± 4.1 weeks of gestation, for determination of plasma GLP-1, glucose, insulin, and C-peptide. Insulin sensitivity (ISI) and insulin secretion (first and second phase); as well as ISI-secretion index (ISSI) were also derived. NGT and GDM women were comparable for age pre-pregnancy body mass index (BMI) and weight gain. GDM had higher glucose area under the curve (AUC): 27,575.5 ± 3448 vs 20,685.88 ± 2715 mg/dl min (p<0.01), but lower first-phase insulin secretion (993.12±367 vs 1376.61 ± 423, p<0.05) and ISSI compared to controls (3873.23 ± 1185 vs 6232.13 ± 1734, p<0.001). When we examined GLP-1 mean levels in relation to mean glycemic values, GLP-1 secretion was inappropriately low with respect to mean glycemic values in GDM compared to NGT. At follow-up, AUCGLP-1 was significantly lower in post-partum GDM compared to post-partum NGT women (2542 ± 273 vs 10,092 ± 7367 pmol·l-1·min-1, p<0.05, respectively). Our study suggests that GLP-1 secretion in GDM women is inadequate for the prevailing glycemic levels both in pregnancy and post partum. Moreover, we cannot exclude that other important aspects of the incretin effect may be involved in GDM development.

Study of new capacities in the evaluation of glycemic control in patients with type 2 diabetes

The purpose of the study was to comprehensively analyze glycemic control in type 2 diabetes (T2D) patients who were first given glucose-reducing therapy. Glidiab MB and Diabeton MB caused a comparable reduction in glycemic control parameters: the level of HbA1c, fasting glycemia, and mean glycemic levels as shown by the results of its continuous glucose monitoring system (CGMS) study. The lower glycemic level was not accompanied by weight gain and it improved lipid spectrum parameters. The readings of monthly self-control of glycemia were transformed to its deviation from the goal range (ADRR) that and the hyper- and hypoglycemia indices calculated from the continuous glycemic control were used to evaluate glycemic lability not reflected by HbA1c. In this connection ADRR may be used to evaluate the efficiency of sugar-reducing therapy and in the examined groups it proved to be low, which generally reflects the stable course of the disease in new cases of T2D. The mean glycemic value calculated from CGMS data virtually coincides with the mean glycemia estimated from glycemic self-control readings both on the day of continuous glucose monitoring and in the month to come before and after CGMS study. In this connection the latter is justified only when the continuous glycemic curve undergoes a complex analysis. The complex analysis of the continuous glycemic curve includes symmetrization of the continuous glycemia scale; calculation of hyper- and hypoglycemic indices, hourly diurnal hyperglycemic index and hourly glycemic variations (Poincare method). The use of this procedure could compare the glucose-reducing effect of the two drugs within the framework of a short-term study.

Associação entre perfil glicêmico materno e o índice de líquido amniótico em gestações complicadas pelo Diabetes mellituspré-gestacional

to study the relation between amniotic fluid volume and glycemic control in pregnancies complicated by diabetes mellitus type 1 and 2, followed in a specialized multidisciplinary prenatal care service. This descriptive study was performed between January 2001 and December 2004. Inclusion criteria were: simple pregnancy, diagnosis of pregestational diabetes, beginning of prenatal care before the 26th week and absence of fetal anomaly. Cases with newborns small for gestational age were excluded. The amniotic fluid index (AFI) was measured weekly, beginning at the 27th week of gestation and continued until delivery and the maternal glycemic profile was obtained a week before ultrasound assessment. This profile consisted of the glycemic level averages and percentages of the abnormal high values. Correlation between the glycemic profile and the AFI was shown by the Spearman correlation test. Sixty pregnant women were assessed and 659 correlations between the AFI and glycemic profile were obtained. No correlation was observed in any of the gestational weeks studied. The mean glycemic value was 103.69 mg/dl (SD=13.69) in the group with AFI pound18 cm, and the 103.67 mg/dl (SD=11.46) in the group with AFI < 18 cm and no significant difference was detected. This study showed no correlation between AFI and maternal glycemic profile during the third trimester in type 1 and 2 diabetic pregnant women, undergoing standardized treatment and rigorous metabolic control.

Use of glargine in pregnant women with Type 1 diabetes mellitus: A case-control study

Background: Insulin glargine is a once-daily basal insulin analog with prolonged duration of action and absence of an evident peak. Glargine is associated with reduced frequency of hypoglycemic episodes (mostly nocturnal) as well as effective glycemic control. Maintenance of good metabolic control before conception and throughout pregnancy is essential to lower the risk of fetal malformations. Glargine might be a valuable alternative in the management of pregnancies complicated by diabetes mellitus. However, because its clinical utility has not been established, the use of glargine is not currently recommended during pregnancy. Objective: The aim of this study was to retrospectively evaluate (years 2004–2007) the effectiveness and safety of insulin glargine compared with neutral protamine Hagedorn (NPH) in women affected by type 1 diabetes mellitus (T1DM) during pregnancy. Methods: The study comprised pregnant women affected by T1DM who were followed up in the Diabetes and Pregnancy Outpatient Clinic at the University of Palermo, Palermo, Italy, within 8 ± 3.4 weeks subsequent to a positive pregnancy test. All patients with T1DM were treated with conventional basal-bolus insulin therapy (aspart or lispro analogs at the 3 main meals plus glargine or NPH at bedtime). Healthy pregnant women were used as controls for fetal and neonatal parameters. Patients were consecutively enrolled. In all women, metabolic status was determined daily by mean glycemic values (2-hour postprandial blood glucose) and glycosylated hemoglobin (HbA1c) values (at 3-month intervals). Fetal measurements (<50th and >90th centiles of the head circumference, abdomen circumference, and femoral length) were evaluated by ultrasound at second and third trimesters. Weight and femoral length were assessed at birth, and neonates were classified according to the fetal growth curve for the Italian population (<10th centile = small for gestational age; and >90th centile = large for gestational age (LGA). Results: A total of 73 pregnant women (30 with T1DM and 43 healthy [control]) were included in the study. Of the 30 diabetic pregnant women included in the study, 15 (mean [SD] age, 27.4 [5.2] years; mean pregravidic weight, 59.7 [11.7] kg) maintained their preconception therapy with glargine, and 15 (mean age, 30.1 [2.4] years; mean pregravidic weight, 60.7 [8.7] kg) with NPH. No significant difference was observed between the glargine-treated group and the NPH-treated group with regard to pregravidic hypertension, third-trimester preeclampsia, maternal complications and/or their progression during pregnancy (diabetic retinopathy, micro- or macroalbuminuria) and episodes of mild hypoglycemia, severe hypoglycemia, and ketosis. There were no significant betweengroup differences in insulin requirements (IU/kg of body weight) and glycemic profile, with the exception of better fasting and 2 hours after breakfast glycemic values in the glargine group during the first ( P = 0.008 and P < 0.001, respectively) and the second ( P = 0.015 and P = 0.016) trimesters, confirmed by the lower HbA1c levels in the first trimester ( P = 0.037). The frequency of femoral length <50th centile at both second and third trimesters was 4/15 (26.7%) in the glargine-treated group ( P = 0.033 and P = 0.013, respectively, vs control), 3/15 (20.0%) and 1/15 (6.7%), respectively, in the NPH-treated group (both, P = NS vs control), and 2/43 (4.7%) and 1/43 (2.3%), respectively, in the control group. The prevalence of LGA was 7/15 (46.7%) in the glargine group ( P < 0.001 vs control), 4/15 (27.6%) in the NPH group ( P = 0.033 vs control), and 2/43 (4.7%) in the control group. Conclusions: Although our retrospective study involved only a small number of participants, no significant difference was found in glycemic control between glargine and NPH treatments. Use of glargine was associated with a significantly higher frequency of femoral length <50th centile. Further larger prospective studies are necessary to assess the safety profile of glargine in T1DM during pregnancy.

Gliclazide treatment of streptozotocin diabetic rats restores GLUT4 protein content and basal glucose uptake in skeletal muscle

This study examined whether the treatment of streptozotocin (STZ)-diabetic rats with gliclazide (5 mg/kg body weight twice daily orally) increases muscle glucose uptake. Rats were treated (group G, n = 10) or untreated (group D, n = 11) for 12 days. Normal rats served as controls (group C, n = 11). At the end of the treatment, both basal and insulin-stimulated glucose uptake by the perfused hindquarters were measured. In gastrocnemious muscles, the protein content of GLUT4 and the insulin binding and tyrosine kinase activity of partially purified solubilized insulin receptors were measured. Group G had a lower mean glycemic value during the treatment period than group D (mean ± SEM, 17 ± 0.6 v 19.7 ± 0.5 mmol/L, P < .05), without differences in serum insulin levels. Basal glucose uptake by the hindquarters was significantly higher in group G versus group D (2.8 ± 0.3 v 1.3 ± 0.2 μmol/g/h, P < .05), and was not different versus group C (3.6 ± 0.2 μmol/g/h). Insulin-stimulated glucose uptake was higher ( P < .05) in group C compared with the two groups of diabetic rats. Glucose uptake at 10 −7 mol/L insulin was higher in group G than in group D (9.2 ± 0.6 v 7.0 ± 0.6 μmol/g/h, P < .05). Both insulin binding and tyrosine kinase activity were similar in muscle insulin receptors from both groups of diabetic rats. The GLUT4 protein content was higher in group G than in group D (95 ± 10 v 57 ± 7 arbitrary units [AU]/μg protein, P < .05) and similar to that of group C (113 ± 13 AU/μg protein). In conclusion, gliclazide has a glucose-lowering effect in STZ-diabetic rats that could be attributed to an increase in muscle glucose clearance by a post-insulin receptor mechanism, probably related to a normalization of GLUT4 content.

Lack of effect of intravenous hypertonic glucose on the intensity of alcohol intoxication induced experimentally and observed in patients of an emergency room.

In the present paper, two experiments are performed to test the efficacy of the intravenous administration of hypertonic glucose (25 or 50%) in alcoholic intoxication. In a first experiment, 10 healthy, nonstarved volunteers, received 15 min after the ingestion of 1.0 g/kg alcohol, 40 ml of 25% glucose i.v., the same volume of 0.9% NaCl or no injection. According to evaluations performed at several time intervals up to 2 h after alcohol ingestion, no difference among the 3 conditions was observed either in the intensity of alcohol intoxication or on blood alcohol levels. In a second experiment, blood glucose and alcohol levels were evaluated in 80 alcoholized patients in an emergency room. The mean glycemic value was 94 mg/100 ml. No difference was found by comparing this value with that presented by nonalcoholized patients. The 80 patients were distributed in two groups of 40 each: one of them was intravenously administered 40 ml of glucose 50% while the other was injected with saline. About 20-30 min later the patients of both groups were clinically evaluated by the physician on duty, being considered equally improved regardless of the injection. The self-evaluation by the patients provided similar results.