Mean Plasma Glucose Levels Research Articles

6905 The Necessity For New Criteria To Evaluate Overbasalization In East Asian Patients With Type 2 Diabetes Using Basal Insulin

Abstract Disclosure: H. Jang: None. Background: Overbasalization, which refers to adjusting the dose of basal insulin beyond an appropriate dose, should be avoided when using basal insulin in patients with type 2 diabetes. It is recommended to evaluate overbasalization when the basal insulin dose exceeds 0.5 units/kg/day or when post-meal glucose levels are > 180 mg/dL. However, this is an expert opinion, and specific criteria for East Asians have not been presented. Methods: Patients with type 2 diabetes using basal insulin (insulin glargine U-100, insulin glargine U-300, insulin degludec, NPH) at Seoul National University Bundang hospital from December 2020 to November 2023, with fasting plasma glucose (FPG) levels between 80 mg/dL and 130 mg/dL, were retrospectively analyzed. Patients with CKD ≤ grade 3b (estimated glomerular filtration rate < 45 mL/min/1.73m2), those taking medications such as steroids that may affect blood glucose levels, and patients undergoing cancer treatment were excluded. Results: A total of 548 patients were analyzed. The mean age of the subjects was 64.7 ± 12.4 years, with 299 (54.6%) being male, and the mean body mass index was 25.1 ± 6.6 kg/m2. The mean duration of diabetes was 18.1 ± 9.6 years. The mean HbA1c level was 7.7 ± 1.1%, while the mean fasting plasma glucose and median fasting C-peptide levels were 105.4 ± 13.9 mg/dL and 1.4 [0.8, 2.1] ng/mL, respectively. Insulin degludec being the most commonly administered (279 [50.9%]). The mean 2-hr postprandial glucose was 206.3 ± 64.8 mg/dL, with 350 (63.9%) having 2-hr postprandial glucose > 180 mg/dL. The administered insulin dose was 0.35 ± 0.17 units/kg/day, and 101 (18.4%) had an insulin dose > 0.5 units/kg/day. Conclusion: In East Asian patients with type 2 diabetes receiving basal insulin, although high 2-hr postprandial glucose levels suggest the possibility of overbasalization, the administered dosage of basal insulin was relatively low. Considering the lower insulin secretion capacity in East Asians, it is thought that new, specific criteria for overbasalization in East Asians are necessary. Presentation: 6/3/2024

Evaluation of stress in farmed Atlantic salmon (Salmo salar) using different biological matrices

Atlantic salmon were subjected to an acute crowding scenario, and their subsequent stress responses were observed under three distinct swimming speed/water flow (WF) conditions: 0.5, 1, and 1.5 body lengths per second (BL/s). Feces, dermal mucus, and plasma were collected for analysis at 1, 6, and 24 h (h) post-stress. Additionally, the head kidney and two regions of the brain (pituitary and POA) were collected for transcript expression analysis. Fish swimming at 0.5 BL/s exhibited higher pre-stress (baseline) cortisol levels. Across all groups and matrices, the highest cortisol/cortisol metabolites (CM) levels were observed at the 1 h post-stress sampling point. At 6 h (second sampling time point), a clear decline toward baseline levels were observe in all groups. Significant increases in mean plasma glucose levels were observed at 1 h post-stress for all groups. The mean plasma lactate levels varied based on WF treatments, with a significant increase observed at 1 h only for the 1.5 BL/s group. Additionally, significant decreases in mean plasma lactate were noted at 6 and 24 h post-stress for some groups. The mRNA abundances of the tested genes (star, cyp17a1, hsd11β2, srd5a1) increased following the stress events. These changes were not uniform across all groups and were tissue dependent. In summary, the results indicate that mucus and feces can be used as potentially less invasive matrices than blood for evaluating stress and, consequently, the welfare of Atlantic salmon in captivity.

Initiation or switch to insulin degludec/insulin aspart in adults with type 2 diabetes in India: Results from a prospective, non-interventional, real-world study.

To investigate clinical outcomes in adults with type 2 diabetes (T2D) after insulin degludec/insulin aspart (IDegAsp) treatment in a real-world setting. The 26 weeks study involved 1102 adults with T2D who were either initiated with or switched to IDegAsp according to local practice in six countries. It was an open-label, non-interventional study. The primary endpoint was the change in glycosylated haemoglobin (HbA1c) levels from baseline to the end of study (EOS). From India, 185 adults participated in this study with mean age of 58.1 (10.3) years and 14.4 (8.1) years of mean duration of T2D. Mean HbA1c decreased from 9.8% (1.8) at baseline to 8.2% (0.1) at the EOS; change in HbA1c from baseline [95% CI]: -1.6% (0.1) [-1.8; -1.4], P < 0.0001. There was a significant reduction in mean fasting plasma glucose (FPG) level from 190.0 (65.8) mg/dl at baseline to 141.9 (4.3) mg/dl at EOS; change in FPG from baseline [95% CI]: -52.2 (4.3) mg/dl [-60.7; -43.7], P < 0.0001. There was a numerical reduction in resource utilization related to diabetes and its complications and hypoglycaemic episodes. From baseline to EOS, the participants with outpatient visits (72 to 32) and workdays missed (2 to 0) decreased. Additionally, the number of patient-reported non-severe hypoglycaemic (47 to 8) and severe hypoglycaemic (4 to 1) episodes decreased as well. Initiation or switching to IDegAsp led to improvement in glycaemic control in real-world population of Indian adults with T2D. This was accompanied by a numerical reduction in resource utilization and patient-reported hypoglycaemia. Clinical trial registration: NCT04042441.

The Effect of Maternal Blood Glucose on Umbilical Cord Blood Fibrinogen in Women With Gestational Diabetes.

Gestational diabetes mellitus (GDM) is delineated by the presence of glucose intolerance at any level that manifests or is initially identified during pregnancy. Factor I fibrinogen is among the most essential blood coagulation proteins. The concentration of fibrinogen influences platelet aggregation and blood viscosity. This study aimed to determine the correlation between fetal cord blood fibrinogen and plasma fibrinogen in pregnant women with GDM and between fetal cord blood fibrinogen and maternal blood sugar. A cross-sectional study was executed at Al-Elwiya Maternity Teaching Hospital in the obstetrics and gynecology department. The sample included 90 term pregnant women: 45 were confirmed to have GDM, and 45 healthy pregnant women served as control. Estimation of prelabor maternal fasting and random plasma glucose and plasma fibrinogen was performed. During delivery, blood was drawn from the umbilical cord to estimate neonatal plasma glucose and fibrinogen levels. The mean maternal plasma fibrinogen level exhibited a notable increase in women with GDM compared to the control (330.11 ± 56.92 mg/dl versus 254.89 ± 41.01 mg/dl). The infants of diabetic mothers had significantly lower mean cord plasma glucose levels (65.71 ± 14.63 mg/dl versus 77.80 ± 7.81 mg/dl) and higher mean cord plasma fibrinogen levels (269.42 ± 25.91 mg/dl versus 229.69 ± 21.29 mg/dl). Umbilical cord plasma fibrinogen was correlated positively with maternal plasma sugar and fibrinogen. A positive correlation between maternal and fetal cord fibrinogen levels was determined in women with GDM. Monitoring plasma fibrinogen levels in neonates of mothers with GDM could be facilitated by longitudinal, large-scale validation studies enabled by artificial intelligence as a new, evolving technique that contributes to more valuable outcomes. This would shed additional light on the course and function of plasma fibrinogen for a more comprehensive analysis of the fetal clotting system.

Prevalence of Non-diabetic Hyperglycemia in Young Adults and Its Impact on Periodontal Health.

Background Non-diabetic hyperglycemia is a transitional phase of hyperglycemia that poses a hidden risk for the development of diabetes mellitus and related complications, including periodontal destruction. The current study sought to determine the prevalence of non-diabetic hyperglycemia in young adults and any possible links to periodontal health. Methods A total of 400 participants in this cross-sectional study were evaluated for non-diabetic hyperglycemia between the ages of 18 and 35 years. Group I consisted of non-diabetic hyperglycemic participants. Group II comprised an equal number of matched, healthy subjects. The groups' hyperglycemic and clinical periodontal characteristics were contrasted. Using a one-sample t-test and logistic regression analysis, the acquired data were subjected to statistical analysis. Results The prevalence of non-diabetic hyperglycemia was 19%, with men (13%) having a higher prevalence than women (6%). The mean fasting plasma glucose and hemoglobin A1c (HbA1c) levels were 114.47 ± 6.40 mg/dL and 6.10 ± 0.21%, respectively, for group I, and 85.72 ± 7.24 mg/dL and 4.38 ± 0.70% for group II. When compared to healthy controls, all periodontal parameters, including plaque index, gingival index, bleeding on probing, probing depth, and clinical attachment loss, were significantly higher in group I non-diabetic hyperglycemic patients. The regression analysis revealed statistically significant links between hyperglycemic and periodontal parameters. Conclusion The prevalence of non-diabetic hyperglycemia among young adults is a serious concern similar to that of older adults with the risk for periodontal diseases. Non-diabetic hyperglycemic considerations in young adults should be emphasized in dental and medical clinics to reduce the risk of developing diabetes mellitus and to avoid irreversible periodontal tissue damage.

Analysis of Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Case-Control Study

The incidence of DM (Diabetes mellitus) is rising all over the world. Inadequate glycemic control in patients having type 2 DM presents a higher risk of developing associated complications. This study was conducted to analyse the information on the management of diabetes in standard clinical practice. The study provides description of clinical profile of subjects with DM2 (Type 2 diabetes mellitus) under treatment with insulin and oral hypoglycemic drugs. A total of 500 patients diagnosed with DM2, and equal number of age and gender matched controls participated in the study. Clinical data including previous medical history of diabetes, medication taken for treatment, comorbidities, pre-prandial and post-prandial plasma glucose, and glycosylated haemoglobin (HbA1c) levels were collected. It was observed that among all participants 59.4% were obese and 30.6% were overweight. It was also found that 57.4% patients were suffering from hypertension while 56% were suffering from hyperlipidemia. Patient’s data about family history revealed that 62.2% patients had both or either of the two parents suffering from diabetes. The mean fasting and random plasma glucose levels were found to be 178.6mg/dL and 245.4mg/dL respectively. Moreover, only 8% patients achieved glycemic goals and had HbA1c levels under normal limits. The study reveals that lack of awareness and poor self-care can increase the risk of comorbidities associated with type 2 DM. This study provides a basis for further investigations on quality of life of diabetic patients in various regions of Pakistan.

Analysis of Glycemic Control in Patients with Type 2 Diabetes Mellitus: A Case-Control Study

The incidence of DM (Diabetes mellitus) is rising all over the world. Inadequate glycemic control in patients having type 2 DM presents a higher risk of developing associated complications. This study was conducted to analyse the information on the management of diabetes in standard clinical practice. The study provides description of clinical profile of subjects with DM2 (Type 2 diabetes mellitus) under treatment with insulin and oral hypoglycemic drugs. A total of 500 patients diagnosed with DM2, and equal number of age and gender matched controls participated in the study. Clinical data including previous medical history of diabetes, medication taken for treatment, comorbidities, pre-prandial and post-prandial plasma glucose, and glycosylated haemoglobin (HbA1c) levels were collected. It was observed that among all participants 59.4% were obese and 30.6% were overweight. It was also found that 57.4% patients were suffering from hypertension while 56% were suffering from hyperlipidemia. Patient’s data about family history revealed that 62.2% patients had both or either of the two parents suffering from diabetes. The mean fasting and random plasma glucose levels were found to be 178.6mg/dL and 245.4mg/dL respectively. Moreover, only 8% patients achieved glycemic goals and had HbA1c levels under normal limits. The study reveals that lack of awareness and poor self-care can increase the risk of comorbidities associated with type 2 DM. This study provides a basis for further investigations on quality of life of diabetic patients in various regions of Pakistan.

Association of metabolic syndrome and insulin resistance in papulosquamous diseases

Background: Metabolic syndrome (MetS), insulin resistance (IR) and papulosquamous diseases with shared pathophysiology leads to conglomeration of risk factors of non-communicable diseases like cardiovascular disease (CVD) and type 2 diabetes (T2D) causing high mortality worldwide. The objective is to study the association of MetS and IR in papulosquamous diseases. Methods: It is a hospital-based case-control study conducted on 200 age-sex matched cases and controls with consent. Subjects were administered a pre-validated questionnaire, diagnosis of papulosquamous diseases was based on clinical examination and skin biopsy. MetS was diagnosed based on national cholesterol education program's- adult treatment plan iii with Asian modification for abdominal circumference criteria. Fasting serum insulin levels (FI) was used as a surrogate marker of IR. Results: Mean serum HDL- C level was low and statistically significant (p=0.017). Mean fasting plasma glucose level was significantly higher in patients (p=0.008). Mean FI level was significant between cases and controls (p=0.013). IR was found in 76% of cases which was significantly higher than in controls (p&lt;0.05). IR was highest in psoriasis 29% followed by LP 22%, PRP 19%, and LS 6% which was statistically significant (p&lt;0.05). MetS was mostly found in psoriasis (17%), LP (9%) and least in PRP, LS. Conclusions: This study intends clinicians to do periodic MetS and IR evaluation in papulosquamous diseases. Thus, subclinical cases of non-communicable diseases can be detected and potential co-morbidities can be prevented.

Global burden and drivers of hyperglycemia: Estimates and predictions from 1990 to 2050

Hyperglycemia is a key risk factor for death and disability worldwide. To better inform prevention strategies, we aimed to delineate and predict the temporal, spatial, and demographic patterns in mean fasting plasma glucose (FPG) levels and their related disease burden globally. Based on the Global Burden of Disease Study 2019, we estimated the distributions of mean FPGlevels and high FPG-related disease burden by age, sex, year, socioeconomic status (SES), and geographical region from 1990 to 2050. We also investigated the possible associations of demographic, behavioral, dietary, metabolic, and environmental factors with FPG levels and high FPG-related disease burden. In 2019, the global mean FPG level was 5.40mmol/L (95% uncertainty interval [UI]: 4.86-6.00), and high FPG contributed to 83.0 deaths (95% UI, 64.5-107.1) and 2,104.3 DALYs (95% UI: 1,740.7-2,520.7) per 100,000 people. For both historical (1990-2019) and future (2020-2050) periods, the mean FPG levels and the high FPG-related disease burden increased globally, with greater increases among the middle-aged and elderly, and people in low-to-middle SES countries, relative to their counterparts. Aging, unhealthy lifestyles, elevated body mass index, and lower air temperatures were potential risk factors for high FPG levels and the high FPG-related disease burden. This study demonstrates that high FPG continues to contribute to the global disease burden and is expected to do so for at least the next 30 years. Older people and those living in low-to-middle SES countries should receive more attention in glycemic management health interventions. In addition, effective interventions that target identified risk factors should be adopted to handle the increasingly large disease burden of high FPG.

Determinant of the Frequency of Short-Term Undesirable Events in Diabetes Discharged from the Emergency Department

Correction of hyperglycemia in these patients with nonemergency hyperglycemia is controversial. This study aims to reveal the effect of plasma glucose level and other factors (diabetes type, insulin dependence, age, and gender) on the frequency of revisits to the emergency department (ED) and hospitalization of diabetic patients discharged from the ED. Diabetic patients over the age of 18 who applied to the emergency department were included in the prospective, cross-sectional study. All data of patients who applied to the ED were recorded by the physician providing the patient’s care. There was no statistically significant difference in mean plasma glucose levels of patients who had revisits to the ED and were hospitalized (7–30 days, \(p>0.05\)). In hyperglycemic (\(n\): 104) and normoglycemic (\(n\): 125) DM patients, no significant difference was found in terms of frequency of revisit to the ED and hospitalization (respectively, revisit and hospitalization within 7 and 30 days/\(p=0.738\), 0.805, 0.130, and 0.697). When we evaluated the outcomes of revisit to the ED and hospitalization, it was found that the frequency of revisits within 7 and 30 days and hospitalization within 7 days increased significantly in IDDM patients (Table 3). Other factors such as gender, age, admission glucose level, and diabetes type were not found to be effective. In nonemergency hyperglycemic patients admitted to the emergency department, blood plasma glucose levels are not determinative in ED revisits and hospitalizations. However, the management and follow-up of IDDM patients should be done more carefully.

Direct comparison two fixed-ratio combination glucagon-like peptide receptor agonist and basal insulin on glycemic and non glycemic parameters in type 2 diabetes

BackgroundTwo types of fixed-ratio combinations of basal insulin and a glucagon-like peptide-1 receptor agonist (GLP-1RA) have been approved for use in type 2 diabetes. One is insulin degludec/liraglutide (iDergLira), and the other is insulin glargine/lixisenatide (iGlarLixi). Direct comparisons between these two combination is not available.MethodsThe retrospective study included 186 patients with type 2 diabetes mellitus (DM) with inadequate glycemic control on metformin and basal insulin (degludec, glargine 100, glargine 300) who were switched to fixed-ratio combination GLP-1 RA and basal insulin. Patients were divided into two groups based on the basal insulin before study: group I (n = 86) treated with degludec were switched to iDegLira and patients group II (n = 99), treated with glargine were switched to iGlarLixi. The aim of this study was to directly compare the effects between two fixed – ratio combination on glycemic parameters and non glycemic parameters. Follow up was 6 months.ResultsMean HbA1c decreased similarly (− 1.2% vs.-1.1%). Higher percentage patients in iDegLira group had reached the HbA1c < 7% after 6 months (22% vs. 18.2%, p < 0.05). The mean change in fasting plasma glucose (FPG) was comparable for the two groups, while mean decrease postprandial plasma glucose (PPG) level were lower in iGlarLixi group (2 vs 1.8 mmol/l, p > 0.05). Change in body weight was significant in iDegLira group (1.8 kg vs. 0.7 kg, p < 0.001). At the end of the study patients showed decrease in total cholesterol (TC) and low-density lipoprotein (LDL) for 0.2 mmol/L in iDegLira, 0.1 mmol/l in iGlarLixi, triglycerides decreased 0.3 mmol/l in both groups, high-density lipoprotein(HDL) increased 0.1 mm/l in iGlarLixi.ConclusionOur results showed that more patients with iDegLira had HbA1c less than 7% and these combination had better effect on weight loss. There was no difference observed in FPG and PPG, lipid profile and rate of hypoglycemia.

Assessment of Plasma Glucose and Lipid Profile Dysregulation among Patients on Antipsychotics in Sokoto

Background: Antipsychotic drugs used in the treatment of psychotic disorders have been implicated in negative effects on the blood glucose and lipid profile levels of patients. Methods: We studied the anthropometric parameters and then the plasma glucose and lipid profile levels of one hundred and seventy-two (172) patients between the ages of 18 and 45 years; who are on various oral antipsychotics. Also, forty (40) treatment-naïve psychiatric patients and forty (40) healthy controls were included in the study. The results were analysed using standard methods. Results: The mean plasma glucose level was significantly higher (p&lt;0.05) in psychiatric patients on oral antipsychotic drugs compared to controls. The mean plasma glucose level of treatment-naïve psychiatric patients was also significantly higher (p&lt;0.05) compared to that of healthy controls. Furthermore, there was a significant increase in plasma glucose levels of patients on second-generation antipsychotic drugs compared to those on first-generation antipsychotic drugs. The lipid profile of patients on antipsychotic drugs showed a similar trend. There were significant increases in the plasma levels of Total Cholesterol (TC), Low-Density Lipoprotein (LDL), Triglycerides (TG) and a significant decrease in the plasma level of High-Density. However, the plasma TG levels were significantly higher in the typical antipsychotic drugs group. Lipoprotein (HDL) levels of individuals that were on antipsychotics were significantly decreased when compared to healthy controls Conclusion: The lipid profile and plasma glucose concentration were altered by oral antipsychotic drugs in Sokoto, Nigeria. Therefore, it may be clinically expedient to vigorously assess the plasma glucose and lipid profile levels of all patients that are on oral antipsychotic drugs and interventions planned as appropriate. Keywords: Antipsychotic drugs, lipid profile, glucose, Cholesterol, Lipoprotein

Evaluation of Insulinoma Cases Presented with Hyperinsulinemic Hypoglycemia: A single-centre Experience

Introduction&#x0D; Insulinomas constituting the most common cause of endogenous hyperinsulinism-related hypoglycemia are neuroendocrine tumors originating from pancreatic beta cells. They are generally benign and solitary lesions. Although most cases are sporadic, multiple endocrine neoplasia (MEN) 1-related patients are also present. &#x0D; Material and Method&#x0D; Thirteen patients followed up in Bursa Uludağ University Medical Faculty Endocrinology and Metabolic diseases clinic between the years 2012 and 2021 were retrospectively evaluated. Demographical, clinical, biochemical, radiological and histopathological data of the patients were assessed. &#x0D; Results&#x0D; Eight of the patients were females, and five were males with an average age of 43±14.9 years. Ten of the patients had sporadic, and three had MEN1 syndrome-related insulinoma. During the prolonged fasting test, the patients had a mean lowest plasma glucose level of 36.4 ± 6.2 mg/dl with a simultaneous mean insulin level of 11.3 (4.4 - 214.1) mIU/L and c-peptide level of 2.8 (0.46-12.8) mcg/L. In preoperative localization studies, a lesion was detected in 11 out of 13 (84.6%) patients with upper abdominal computed tomography (CT) and 6 out of 10 patients (60%) with magnetic resonance imaging (MRI). Six patients had grade 1, and 7 patients had grade 2 neuroendocrine tumor. The whole group's mean lesion diameter was 15 (11-48) mm. The mean patient follow-up duration was 30.5 ± 23 months. Hypoglycemia recurred in none of the patients in the postoperative period, and only two patients (15.4%) developed postoperative diabetes mellitus (DM). &#x0D; Conclusion&#x0D; Preoperative localization rates in insulinomas increased due to non-invasive imaging methods and technological developments in recent years. This will probably cause earlier diagnosis and treatment, and pancreas preserving surgery option will be more available in most insulinoma cases.

Effect of Physical Exercise and Genetic Background on Glucose Homeostasis and Liver/Muscle Proteomes in Mice.

We compared the parameters related to glucose homeostasis, and liver and muscle proteomes in fluorosis-susceptible (A/J; S) and fluorosis-resistant (129P3/J; R) mice in response to fluoride (F) exposure and exercise. Ninety male mice (45 R-mice and 45 S-mice) were randomized into three groups: (SI; RI) No-F, No-Exercise, (SII; RII) 50 ppm F, No-Exercise, (SIII; RIII) 50 ppm F, Exercise. Overall, mean F concentrations in the plasma and femur were significantly higher in R-mice compared with S-mice. In R-mice, exercise resulted in an increase in F accumulation in the femur. In S-mice, the mean plasma glucose level was significantly higher in Group II compared with Groups I and III. There was an increase in liver proteins involved in energy flux and antioxidant enzymes in non-exercise groups (I, II) of S-mice in comparison with the corresponding groups of R-mice. The results also showed a decrease in muscle protein expression in Group I S-mice compared with their R-mice counterparts. In conclusion, the findings suggest an increased state of oxidative stress in fluorosis-susceptible mice that might be exacerbated by the treatment with F. In addition, fluorosis-susceptible mice have plasma glucose levels higher than fluorosis-resistant mice on exposure to F, and this is not affected by exercise.

Comparative efficiency and safety of insulin degludec/aspart with insulin glargine in type 2 diabetes: a meta-analysis of randomized controlled trials.

Recent studies have found compared with insulin glargine (IGlar), insulin degludec/aspart (IDeg/Asp) may provide adequate glycemic control and prevent hypoglycemia events in type 2 diabetes mellitus (T2DM). Consequently, we performed a meta-analysis to appraise and compare the efficiency and safety of IDeg/Asp and IGlar in the treatment of T2DM. We sought the databases including PubMed, Embase, Scopus, Cochrane library to confirm related articles which inspected the effect of IDeg/Asp versus IGlar for the treatment of T2DM until May 2021. Finally, six randomized controlled trials (RCTs) of 1,346 patients were included. The results showed that IDeg/Asp significantly decreased the mean hemoglobin A1c (HbA1c) level but was prone to serious adverse events, and IGlar increased the nocturnal confirmed hypoglycemia events. Besides, there were no significant changes in other indicators, including mean fasting plasma glucose (FPG) level, nine-point self-measured plasma glucose (SMPG) level, and adverse events. What's more, we found that there was no significant difference in the occurrence of hypoglycemia overall, but our subgroup analysis of confirmed hypoglycemia revealed the population in this subgroup (duration of diabetes ≤11 years) might has its particularity effecting the hypoglycemia outcome. Concerning efficiency, IDeg/Asp may have advantages in controlling the mean HbA1c level. Regarding safety, IGlar might increase the risk of nocturnal confirmed hypoglycemia. Further evidence is needed to compare better the efficiency and safety of IDeg/Asp versus IGlar therapy.

Hemoglobin A1c and Fructosamine Evaluated in Patients with Type 2 Diabetes Receiving Peritoneal Dialysis Using Long-Term Continuous Glucose Monitoring

Introduction: Shortened erythrocyte life span and erythropoietin-stimulating agents may affect hemoglobin A_1c (HbA_1c) levels in patients receiving peritoneal dialysis (PD). We compared HbA_1c with interstitial glucose measured by continuous glucose monitoring (CGM) in patients with type 2 diabetes receiving PD. Methods: Fourteen days of CGM (Ipro2, Medtronic) were performed in 23 patients with type 2 diabetes receiving PD and in 23 controls with type 2 diabetes and an estimated glomerular filtration rate over 60 mL/min/1.73 m². Patients were matched on gender and age (±5 years). HbA_1c (mmol/mol), its derived estimate of mean plasma glucose (eMPG_A1c) (mmol/L), and fructosamine (µmol/L) were measured at the end of the CGM period and compared with the mean sensor glucose (mmol/L) from CGM. Results: In the PD group, mean sensor glucose was 0.98 (95% con­fidence interval (CI): 0.43–1.54) mmol/L higher than the eMPG_A1c compared with the control group (p = 0.002) where glucose levels were nearly identical (−0.05 (95% CI: −0.35–0.25) mmol/L). A significant association was found between fructosamine and mean sensor glucose using linear regression with no difference between slopes (p = 0.89) or y-intercepts (p = 0.28). Discussion/Conclusion: HbA_1c underestimates mean plasma glucose levels in patients with type 2 diabetes receiving PD. However, the clinical significance of this finding is undetermined. Fructosamine seems to more accurately reflect glycemic status. CGM or fructosamine could complement HbA_1c to increase the accuracy of glycemic monitoring in the PD population.

Clinical efficacy of capsules containing standardized extract of Bauhinia forficata Link (pata-de-vaca) as adjuvant treatment in type 2 diabetes patients: A randomized, double blind clinical trial

Ethnopharmacological relevanceBauhinia forficata Link, is a Brazilian native plant and popularly known as pata-de-vaca (“paw-of-cow”). The tea prepared with their leaves has been extensively used in the Brazilian traditional practices for the diabetes treatment. The aim of the present study was to investigate the effect of capsules containing granules of a standardized extract of B. forficata leaves as adjuvant treatment on the glycemic control of patients with type-2 diabetes melitus. Materials and methodsA double-blind, randomized clinical trial using capsules containing granules prepared by wet granulation of a standardized extract from B. forficata leaves as adjuvant treatment, was conducted. 92 patients aged 18–75 years from an outpatient clinic with type-2 diabetes were randomly assigned by a simple randomization scheme, in a 1:1 ratio to receive capsules of B. forficata or placebo for four months. The capsules used contain 300 mg of standardized extract from B. forficata leaves, yielding 2% of total flavonoid content per capsule. Primary outcome was glycated hemoglobin levels and fasting plasma glucose at 4 months. Possible harms were also determined. ResultsThe findings showed that at 4 months, the mean fasting plasma glucose levels and glycated hemoglobin were both significantly lower in the B. forficata group than in the placebo group. ConclusionThe present study suggests that the adjunctive use of capsules containing standardized extract of B. forficata can add to regular oral anti-diabetics in the metabolic and inflammatory control of type-2 diabetes patients.

The effect of laparoscopic sleeve gastrectomy on type 2 diabetes remission outcomes in patients with body mass index between 25 kg/m 2 and 32.5 kg/m 2

BackgroundThe effect of laparoscopic sleeve gastrectomy (LSG) in the treatment of type 2 diabetes (T2D) patients with body mass index (BMI is calculated by dividing weight in kilograms by height in meters squared) higher than 25 kg/m2 but lower than 32.5 kg/m2, especially in East Asian population characterized by abdominal obesity, are still unclear. This study aims to explore the effect of LSG in T2D patients with BMI higher than 25 kg/m2 but lower than 32.5 kg/m2. MethodsA total of 49 T2D patients with BMI(25–32.5 kg/m2) treated successfully with LSG were included in our study. The effect of LSG on T2D remission outcomes at 12 and 24 months after operation was analyzed. ResultsAll patients were treated successfully with LSG without conversion. The mean preoperative body weight,BMI, fasting plasma glucose, glycosylated hemoglobin (A1c) and fasting C-peptide were 81.7 ± 10.0 kg, 29.1 ± 2.4 kg/m2, 10.4 ± 3.9 mmol/L,8.2 ± 1.5%, and 2.3 ± 1.1 nmol/L,respectively.The age, duration of diabetes and ABCD score were 48.6 ± 9.6 years,6.6 ± 5.1 years, and 2.9 ± 1.5. The mean fasting plasma glucose,A1c, and C-peptide levels were significantly decreased at 12 and 24 months after operation. At postoperative 24 months, 18 out of 49 patients (36.7%) reached diabetes complete remission (A1c levels≤6.0%).14 out of 49 patients (28.6%) reached partial remission (6.0% < A1c levels<6.5%). 8 out of 49 patients (16.3%) reached notable improvement (6.5% < A1c levels<7%). At 24 months after LSG, the complete remission rate of T2D patients with a BMI of 25–27.5 kg/m2 was 35.3%, the complete remission rate of patients with a BMI of 27.5–30 kg/m2 was 11.1%, and the complete remission rate of patients with a BMI of 30–32.5 kg/m2 was 47.8%.At postoperative 24 months, the complete remission rate of T2D patients with ABCD score≤2 was 5.0%, the complete remission rate of patients with ABCD score 3 to 4 was 52.4%, and the complete remission rate of patients with ABCD score≥5 was 75.0%. ConclusionOur study demonstrates that LSG could result in a significant effect on T2D in patients with BMI 30–32.5 kg/m2. In addition, our study indicates that higher ABCD score can predict a better diabetes remission outcome in diabetes patients with BMI ≤32.5 kg/m2.

Glucometers for Patients with Type 2 Diabetes Mellitus: Are they helpful?

Background: The effectiveness of self-monitoring of blood glucose (SMBG) in type 2 diabetes mellitus (T2DM) patients is debated in the literature. We aimed at elucidating the association and patterns of complications between SMBG use and plasma glucose values.&#x0D; Methods: This cross-sectional study comprised 303 participants from outpatient departments with T2DM for over 12 months. We analyzed sociodemographic and clinical variables including: anthropometry, SMBG use, disease duration, treatment modality, complications, plasma glucose level, and glycated hemoglobin level (%).&#x0D; Results: The mean duration of T2DM was 93±76 months. Participants were grouped into SMBG users (n=115, 38%) and non-SMBG users (n=188, 62%). The mean fasting plasma glucose levels of SMBG and non-SMBG users were 140.7±42.7 (95% Confidence Interval [95%CI]: 132.72;148.67) mg/dl and 145.4±50 (95%CI: 138.12;152.67) mg/dl (p=0.03), respectively. The mean post-prandial plasma glucose levels of the SMBG and non-SMBG groups were 202±63.42 (95%CI: 190.23;213.76) mg/dl and 209±84.54 (95%CI: 196.56;221.43) mg/dl (p=0.002), respectively. The mean difference in HbA1c among the groups were 8.14±1.69% (95%CI: 7.59;8.68) and 8.15±1.98% (95%CI: 7.27;9.02) (p=0.4), respectively. Hypoglycemia (n=50, 43.5%) was the most common complication. The prevalence of neuropathy (n=5, 4.3%, p=0.036) and cardiovascular disease (n=21, 18.3%, p=0.042) were significantly higher in the SMBG group.&#x0D; Conclusion: Although plasma glucose values were significantly lower in the SMBG group, its clinical significance remains questionable. Furthermore, many participants in both the groups had shortfalls in awareness, monitoring, and glycemic control. SMBG use needs to be evaluated in a cohort of patients with T2DM with adequate health awareness.

Effect of Aqueous Leaf Extract of Dissotis Roundifolia on Plasma Glucose and Creatinine Concentration in Normal Albino Rats

Dissotis rotundifolia?is a broad spectrum medicinal plant that has received worldwide recognition. This study was designed to investigate the effect of aqueous leaf extract of Dissotis rotundifolia on plasma glucose and creatinine level in normal albino rats. A total of 6 albino wistar rats each weighing 150g were assembled and randomly divided into 2 groups (control and tests) consisting of 3 rats each. The control group received pelleted growers mash and distilled water all through the period of experiment while the test group received 2ml/kg body weight of extract twice daily. Blood samples was collected into lithium heparin bottle for creatinine and sodium oxalate tube for glucose determination. The data obtained were subjected to statistical analysis using SPSS version 20. Results showed a significant increase in the mean plasma glucose and creatinine levels in rats treated with Dissotis rotundifolia compared with normal control group. This suggests a deleterious effect of Dissostis rotundifolia at the investigated dosage and thus, may not be safe for oral consumption. Hence, there is need for further studies in this regard in order to ascertain the safety of Dissostis rotundifolia.