Mean Plasma Glucose Values Research Articles

Addition of essential oil from Lippia sidoides to the diet of tambaqui: An analysis of growth, metabolic and blood parameters, and intestinal enzymes

Plant essential oils can benefit fish growth and health when incorporated into fish diets. This study aimed to evaluate the effect of dietary supplementation of essential oil from Lippia sidoides (EOLS) on growth performance, hematological and biochemical variables, and digestive enzymes in tambaqui (Colossoma macropomum) juveniles. Five diets with different levels of EOLS—0.0 (control), 0.25, 0.50, 1.00, and 1.50 mL kg diet−1— were evaluated for 60 days. Carvacrol was the major chemical compound (44.50%) of EOLS. Supplementation of 0.50 mL EOLS kg diet−1 improved growth performance and increased hematocrit, hemoglobin rate, mean corpuscular hemoglobin concentration, plasma glucose, liver, and muscle glycogen values in juveniles. The tambaqui fed a diet supplemented with 1.00 or 1.50 mL EOLS kg−1 increased plasma triglycerides, albumin, lysozyme, and alanine aminotransferase levels, in addition to intestinal amylase and lipase activity. As the EOLS concentration in the diet increased, intestinal alkaline protease activity was reduced. In conclusion, the addition of 0.50 to 1.00 mL EOLS kg diet−1 is a promising alternative for tambaqui juveniles, as it has been shown to improve growth, metabolism, hematological parameters, and plasma lysozyme and intestinal amylase and lipase activity.

Glycemic Control and Variability of Diabetes Secondary to Total Pancreatectomy Assessed by Continuous Glucose Monitoring.

The extent of the glycemic variability in diabetes secondary to total pancreatectomy is not fully understood. To evaluate glycemic variability in totally pancreatectomized (PX) patients and compare it to glycemic variability in hemoglobin A1c (HbA1c)-matched patients with long-standing type 1 diabetes (T1D). A case-control study was performed. Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark. Ten PX patients (mean [SEM]: age 64.3 [9.8] years; body mass index (BMI) 34.4 [5.0] kg/m2; duration of diabetes 3 [2.8] years), 10 HbA1c-matched patients with T1D (63.9 [8.6] years; 24.6 [3.1] kg/m2; 22 [4] years), and 10 gender-, age-, and BMI-matched healthy controls. All patients were managed on multiple daily injections of insulin. Continuous glucose monitoring (CGM) (Medtronic MiniMed iPro 2) during 12 consecutive days. Glycemic variability. HbA1c levels were similar in the PX group and the T1D group. The PX group had greater continuous overall net glycemic action per 60 minutes (CONGA60 min) compared with the T1D group (mean [SEM]: 9.5 [0.3] vs 8.3 [0.2] mmol/L, P < 0.003) and mean plasma glucose values were higher in the PX group (10.6 [0.9] vs 9.0 [0.9] mmol/L, P < 0.001), whereas coefficient of variation for plasma glucose and standard deviation of mean plasma glucose, respectively, were similar in the 2 groups. Time spent below range was not different between the PX and the T1D group (2.3 [0.8] vs 4.5 [0.8]%, P = 0.065), whereas time spent above range was higher in the PX group (51.4 [3.3] vs 37.6 [1.9]%, P < 0.001). CGM-assessed glycemic variability showed higher CONGA60 min and time spent above range in our PX patients compared with HbA1c-matched T1D patients. This study is registered at www.ClinicalTrials.gov (NCT02944110).

Correlation between plasma glucose and hemoglobin A1c in HIV-infected individuals receiving zidovudine and non-zidovudine containing antiretroviral therapy regimens

Background Hemoglobin A1c (HbA1c) has been used for the diagnosis of diabetes and glycemic monitoring. However, using HbA1c for glycemia estimation has some fallacies in anemic persons. Zidovudine (AZT) treatment is associated with anemia and/or increased mean corpuscular volume (MCV). Objective This study aimed to compare the correlation between HbA1c and plasma glucose in HIV-infected individuals who were receiving AZT and non-AZT containing regimens. Methods A cross-sectional study was conducted in 150 HIV-infected individuals. We evaluated the correlation of paired fasting plasma glucose (FPG), random plasma glucose (RPG), mean plasma glucose (MPG) and HbA1c values by using Pearson correlation. Multivariate linear regression was used to determine the associated factors of HbA1c. Results The mean age was 49.0 ± 10.5 years, and 60.0% were male. Thirteen patients (8.7%) had diabetes and 14 patients (9.3%) had anemia. There were significant correlations between HbA1c and plasma glucose (FPG, RPG, and MPG; p < 0.05, all). The correlation between HbA1c and MPG in patients receiving AZT [HbA1c = 3.18 + 0.02MPG; R2=0.44] and not receiving AZT [HbA1c = 3.76 + 0.02MPG; R2=0.43] indicated that HbA1c in patients receiving AZT was 0.58% underestimated. Multivariate linear regression analysis showed that hematocrit [β 0.192; 95% confidence interval (CI) 0.003, 0.690; p = 0.032] and MCV [β −0.195; 95% CI -0.326, −0.002; p = 0.047] were associated with HbA1c levels. Conclusions HbA1c underestimates glycemia in HIV-infected individuals receiving AZT containing regimens. Factors associated with decreased HbA1c levels in HIV-infected individuals included decreased hematocrit and increased MCV. In HIV-infected individuals receiving AZT, using HbA1c for diabetes diagnosis or glycemia monitoring should be cautiously interpreted.

Effect of pre-anesthetic fasting on gastric emptying and plasma glucose in healthy dogs of different age groups

ABSTRACT: Gastric emptying and plasma glucose were evaluated in young and adult dogs, fed with dry and wet food, submitted to different periods of pre-anesthetic fasting (6, 8, and 12 hours). Forty healthy dogs were selected, which were segmented into four groups according to the age group and type of diet. It was evaluated the gastric emptying by ultrasound and serum glycemia. Only 17.5% presented complete gastric emptying, and no significant differences were found between the 6 and 8-hour fasting evaluations, or between the age groups and the diets, considering significance level p&lt;0.05. Mean plasma glucose values from the groups indicated normal glycemia at all times of evaluation. A significant difference was found between the means of glycemia in young and adult dogs, with the 8-hour fasting with wet diet (p=0.03) and with 12 hours with dry diet (p=0.04). Healthy young and adult dogs, in physiological equilibrium, maintain average values of plasma glucose despite prolonged periods of pre-anesthetic fasting, which may be necessary, since 8-hour fasting for solid food is not enough to provide complete gastric emptying.

A Three-Way Accuracy Comparison of the Dexcom G5, Abbott Freestyle Libre Pro, and Senseonics Eversense CGM Devices in an Outpatient Study of Subjects with Type 1 Diabetes

There are no published studies directly comparing the accuracy of continuous glucose monitoring (CGM) devices in the outpatient setting. We tested the performance of the Dexcom G5, Abbot Freestyle Libre Pro, and Senseonics Eversense (an implantable CGM approved in Europe) during a 6-week, free-living, outpatient bionic pancreas study involving 23 subjects with type 1 diabetes who wore all 3 devices concomitantly. The primary outcome was the mean absolute relative difference (MARD) vs. plasma glucose (PG) values measured with the Nova Biomedical StatStrip Xpress meter that was also used for calibrations according to the manufacturer's instruction (except for Libre Pro that is not calibrated). We compared PG values with CGM readings when they were available from all 3 CGMS in the 5 minutes preceding the PG values (n=829 sets). Since the Libre Pro records readings every 15 minutes, we also did a two-way comparison between the G5 and the Eversense that allowed a higher number of comparisons (n=2277 sets). Statistical significance was determined using a repeated measurements model fitted with the generalized estimating equation method. All 3 CGM systems produced higher average MARDs than during in-clinic studies. However, since all three CGM systems were worn by the same individuals and used the same meter for calibration and as comparator, we were able to directly compare their performance under real-world conditions. In the 3-way comparison Eversense achieved the lowest nominal MARD (14.8%) followed by Dexcom G5 (16.3%) and Libre Pro (18.0%) (Eversense vs. Libre Pro p=0.004, other comparisons p=NS). In the 2-way comparison the MARD difference between Eversense (15.1%) and G5 (16.9%) was statistically significant (p=0.008). We found that the point accuracy of the Eversense was significantly better than two other CGM systems. The Eversense CGM system may be useful to provide glucose values to artificial pancreas devices. Disclosure R.Z. Jafri: None. C.A. Balliro: None. F. El-Khatib: Stock/Shareholder; Self; Beta Bionics. Employee; Self; Beta Bionics. M. Maheno: None. M.A. Hillard: None. A.J. O'Donovan: None. R. Selagamsetty: None. H. Zheng: None. E. Damiano: Other Relationship; Self; Beta Bionics. S.J. Russell: Other Relationship; Self; Beta Bionics, Novo Nordisk Inc.. Advisory Panel; Self; Companion Medical, Tandem Diabetes Care, Inc., Unomedical a/s. Research Support; Self; Beta Bionics, Zealand Pharma A/S, MITRE Corporation.

Efficacy and safety of switching to insulin glulisine from other rapid-acting insulin analogs in children with type 1 diabetes.

We investigated the efficacy and safety of switching to insulin glulisine (GLU) from other rapid-acting insulin analogs (Ra) in children with type 1 diabetes treated with multiple daily injections of insulin or continuous subcutaneous insulin infusion. A total of 26 children with type 1 diabetes were included. Ra in all of these patients was changed to GLU, and they were observed for a 6-month period after having previously finished treatment with other Ra. The mean glycated hemoglobin value decreased from 7.6 ± 1.0 to 7.4 ± 0.9% (P = 0.0034), and mean plasma glucose values after breakfast and supper also improved from 183 ± 50 to 153 ± 32 mg/dL (P = 0.0035), and from 203 ± 29 to 164 ± 23 mg/dL (P < 0.0001), respectively. Furthermore, the mean frequency of hypoglycemia was reduced from 7 ± 6 to 4 ± 4/month (P = 0.0004), while insulin doses and obesity degree were stable with statistically non-significant differences. In conclusion, switching to GLU might be a good treatment option for improving glycemic control in children with type 1 diabetes.

The Acute Effects of Interval- Vs Continuous-Walking Exercise on Glycemic Control in Subjects With Type 2 Diabetes: A Crossover, Controlled Study

Glycemic control improves with physical activity, but the optimal exercise mode is unknown. The objective of the study was to determine whether interval-based exercise improves postprandial glucose tolerance and free-living glycemia more than oxygen consumption- and time duration-matched continuous exercise. This was a crossover, controlled study with trials performed in randomized order. The study was conducted in hospitalized and ambulatory care. PATIENTS diagnosed with type 2 diabetes mellitus (n=10, no withdrawals) participated in the study. Subjects performed three 1-hour interventions: 1) interval walking (IW; repeated cycles of 3 min of slow and fast walking); 2) continuous walking (CW); and 3) control (CON). Oxygen consumption (VO2) was measured continuously to match mean VO2 between exercise sessions (∼75% VO2peak). A mixed-meal tolerance test (MMTT; 450 kcal, 55% carbohydrate) with stable glucose isotopic tracers was provided after each intervention, and glucose kinetics were measured during the following 4 hours. Free-living glycemic control was assessed for approximately 32 hours after the MMTT using continuous glucose monitoring. VO2 was well matched between the exercise interventions. IW decreased the mean and maximal incremental plasma glucose during the MMTT when compared with the CON (mean 1.2 ± 0.4 vs 2.0 ± 0.5 mmol/L, P < .001; maximal 3.7 ± 0.6 vs 4.6 ± 0.7 mmol/L, P = .005) and mean when compared with CW (1.7 ± 0.4 mmol/L, P = .02). No differences in the mean or maximal incremental plasma glucose values were seen between the CW and CON. The metabolic clearance rate of glucose during the MMTT was increased in the IW compared with CW (P = .049) and CON (P < .001). Continuous glucose monitoring mean glucose was reduced in IW compared with CW for the rest of the intervention day (8.2 ± 0.4 vs 9.3 ± 0.7 mmol/L, P = .03), whereas no differences were found between IW and CW the following day. One interval-based exercise session improves glycemic control in type 2 diabetes mellitus subjects when compared with an oxygen consumption- and time duration-matched continuous exercise session.

Metabolic control, healthcare satisfaction and costs 1 month after diagnosis of type 1 diabetes: a randomised controlled trial of hospital-based care vs. hospital-based home care

Procedures for the initial management of children newly diagnosed with diabetes vary greatly worldwide and the evidence available is insufficient for conclusively determining the best process regarding hospital-based or home-based care. The aim of the study was to compare two different regimens for children with newly diagnosed type 1 diabetes; hospital-based care and hospital-based home care (HBHC), defined as specialist care in a home-based setting. A randomised controlled trial, including 60 children, took place at a university hospital in Sweden during the period of March 2008 to September 2011. After 2-3 d with hospital-based care, children from 3 to 15 yr of age were randomised to either continued hospital-based care for a total of 1-2 wk or to HBHC. This article presents results 1 month after diagnosis. No differences were shown in the daily mean glucose level or in its variability when the children received care but, after discharge, children who received HBHC showed lower mean plasma glucose values and lower variability compared to children who received hospital-based care. Children in HBHC had fewer episodes of hypoglycaemia during the first month after diagnosis. Inthe HBHC group, parents were more satisfied with the healthcare received and healthcare costs for the first month were 30% lower as compared to hospital-based care. The results 1 month after diagnosis support the HBHC programme as being a safe and cost-effective way of providing care. A follow-up will continue for 2 yr to evaluate which process was best for the majority of families over time.

Initial Trophic vs Full Enteral Feeding in Patients With Acute Lung Injury: The EDEN Randomized Trial

The amount of enteral nutrition patients with acute lung injury need is unknown. To determine if initial lower-volume trophic enteral feeding would increase ventilator-free days and decrease gastrointestinal intolerances compared with initial full enteral feeding. The EDEN study, a randomized, open-label, multicenter trial conducted from January 2, 2008, through April 12, 2011. Participants were 1000 adults within 48 hours of developing acute lung injury requiring mechanical ventilation whose physicians intended to start enteral nutrition at 44 hospitals in the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Participants were randomized to receive either trophic or full enteral feeding for the first 6 days. After day 6, the care of all patients who were still receiving mechanical ventilation was managed according to the full feeding protocol. Ventilator-free days to study day 28. Baseline characteristics were similar between the trophic-feeding (n = 508) and full-feeding (n = 492) groups. The full-feeding group received more enteral calories for the first 6 days, about 1300 kcal/d compared with 400 kcal/d (P < .001). Initial trophic feeding did not increase the number of ventilator-free days (14.9 [95% CI, 13.9 to 15.8] vs 15.0 [95% CI, 14.1 to 15.9]; difference, -0.1 [95% CI, -1.4 to 1.2]; P = .89) or reduce 60-day mortality (23.2% [95% CI, 19.6% to 26.9%] vs 22.2% [95% CI, 18.5% to 25.8%]; difference, 1.0% [95% CI, -4.1% to 6.3%]; P = .77) compared with full feeding. There were no differences in infectious complications between the groups. Despite receiving more prokinetic agents, the full-feeding group experienced more vomiting (2.2% vs 1.7% of patient feeding days; P = .05), elevated gastric residual volumes (4.9% vs 2.2% of feeding days; P < .001), and constipation (3.1% vs 2.1% of feeding days; P = .003). Mean plasma glucose values and average hourly insulin administration were both higher in the full-feeding group over the first 6 days. In patients with acute lung injury, compared with full enteral feeding, a strategy of initial trophic enteral feeding for up to 6 days did not improve ventilator-free days, 60-day mortality, or infectious complications but was associated with less gastrointestinal intolerance. clinicaltrials.gov Identifiers: NCT00609180 and NCT00883948.

Validation of a glucose meter at an intensive care unit

IntroductionHyperglycemic patients admitted to intensive care units (ICUs) have higher morbidity and mortality than normoglycemic patients. Blood glucose levels of ICU patients are usually measured with a glucose meter. The aim of this study was to evaluate a glucose meter (StatStrip, Nova Biomedical) to assess its agreement with the standard laboratory method for testing glucose. Material and methodsEighty-nine different samples were collected from patients (76.4% men and 23.6% women) admitted to an ICU from September to December 2010. Each blood sample was collected into two tubes, a lithium heparin tube and an EDTA tube. The total blood aliquot was used to measure glycemia using the glucose meter. The lithium heparin tube was processed at the same time for measuring plasma glucose (Cobas 6000 Analyzer, Roche Diagnostics, SA). Agreement between the two methods was assessed according to the EP-9-A2 Clinical Laboratory Standards Institute guideline. ResultsMean whole blood glucose level measured by the glucose meter was 126.53+49.28mg/dL (range, 33.5–431mg/dL), while mean plasma glucose value measured by the laboratory reference method was 138.13+78.6mg/dL (range, 43–451mg/dL). Correlation coefficient was 0.99, with a 95% confidence interval of 0.98–0.99. Coefficient of determination (R2) was 0.97, and intraclass correlation coefficient was 0.99 with a 95% CI of 0.98–0.99. ConclusionsThe tested glucose meter (StatStrip) shows a good linear association, precision, and accuracy when compared to the laboratory reference method. This device is adequate for glucose monitoring.

Validación de un glucómetro en una unidad de cuidados intensivos

Introduction Hyperglycemic patients admitted to Intensive care units (ICUs) have higher morbidity and mortality than normoglycemic patients. Blood glucose levels of ICU patients are usually measured with a glucose meter. The aim of this study was to evaluate a glucose meter (StatStrip, Nova Biomedical) to assess its agreement with the standard laboratory method for testing glucose. Material and methods Eighty-nine different samples were collected from patients (76.4% men and 23.6% women) admitted to an ICU from September to December 2010. Each blood sample was collected into two tubes, a lithium heparin tube and an EDTA tube. The total blood aliquot was used to measure glycemia using the glucose meter. The lithium heparin tube was processed at the same time for measuring plasma glucose (Cobas 6000 Analyzer, Roche Diagnostics, SA). Agreement between the two methods was assessed according to the EP-9-A2 Clinical Laboratory Standards Institute guideline. Results Mean whole blood glucose level measured by the glucose meter was 126.53 + 49.28 mg/dL (range, 33.5-431 mg/dL), while mean plasma glucose value measured by the laboratory reference method was 138.13 + 78.6 mg/dL (range, 43-451 mg/dL). Correlation coefficient was 0.99, with a 95% confidence interval of 0.98 to 0.99. Coefficient of determination (R2) was 0.97, and intraclass correlation coefficient was 0.99 with a 95% CI of 0.98 to 0.99. Conclusions The tested glucose meter (StatStrip) shows a good linear association, precision, and accuracy when compared to the laboratory reference method. This device is adequate for glucose monitoring.

English

&nbsp; The extract of&nbsp;Jatropha gossypifolia&nbsp;leaf was obtained by crushing the leaf in a mortal and the fluid expressed out. The suitability of the leaf extract as an anticoagulant for biochemical and haematological analyses was determined. The anticoagulant effect of the extract was found to be highest at a concentration of 0.1 ml per ml of blood. Blood tubes with dried leaf extract at the stated concentration were used for obtaining plasma. Mean plasma glucose values obtained from fluoride oxalate plasma were compared with values obtained from dried leaf extract plasma. The values obtained for biochemical parameters with the exception of bicarbonate from the leaf extract plasma samples were significantly higher (P&lt;0.05) than values obtained from conventional anticoagulants. The leaf extract was later found to contain each of these parameters in high concentrations. The results of heamatological parameters obtained from the leaf extract and those of the dipotassium ethylenediamine tetraacetic acid were comparable. The leaf extract is suitable as an anticoagulant for heamatological analysis but must be purified to remove interfering substances for it to be suitable for biochemical analysis. &nbsp; Key words:&nbsp;Jatropha gossypifolia, anticoagulants, analysis.

Effect of long term feeding of ammoniated wheat straw treated with or without HCl on blood biochemical parameters in growing male buffalo (Bubalus bubalis) calves

Twenty-four growing male buffalo calves (one year of age; 88.54 +/- 3.81 kg average body weight) were divided into three comparable groups (I, II and III) on the basis of their body weight (BW) in a completely randomised design to study the effect of long term feeding of ammoniated wheat straw (AWS) and hydrochloric acid treated ammoniated wheat straw (HCl-AWS) on blood biochemical changes. The animals were offered a concentrate mixture (CM) along with wheat straw (WS), ammoniated wheat straw (AWS) (4% urea at a 50% moisture level) and hydrochloric acid treated ammoniated wheat straw (HCI-AWS) (4% urea at a 50% moisture level and HCI added to trap 30% of NH3 evolved) in groups I, II and III, respectively for an average daily gain (ADG) of 500 g. All the diets were made iso-nitrogenous by preparing three types of concentrate mixtures of different CP levels. The blood was collected from the jugular vein randomly from three animals of each group initially after 8 months post feeding and subsequently after two months interval up to 14 months of experimental feeding. Due to urea ammoniation, the CP content of WS increased from 3.66 to 8.51 and was further increased to 11.35 due to the addition of HCl during urea-ammoniation of wheat straw. The cumulative period mean plasma glucose values (mg %), in group II (53.13) were significantly (P < 0.001) higher than those in groups I (48.44) and III (50.60). The cumulative period mean values of serum albumin and globulin (g %) were not significantly different and were comparable among the groups I (3.33 and 3.06), II (3.53 and 2.97) and III (3.49 and 2.94). The cumulative period mean values of serum albumin: globulin ratio and total protein values were not significantly different among the different groups. Serum urea and creatinine values were significantly (P < 0.001) higher in group III (58.66 and 2.24) as compared to groups I and II. The cumulative period mean values of serum alkaline phosphatase (ALP) (KA units) did not differ significantly, but serum glutamate pyruvate transaminase (SGPT) and glutamate oxaloacetate transaminase (SGOT) values (units x mL(-1) were significantly (P < 0.001) higher in groups II and III than in group I. The cumulative period mean values of T3 (ng x mL(-1)) did not differ significantly among the groups, but T4 values were significantly (P < 0.001) higher in group III (22.74) than in groups 1 (21.41) and II (20.89), respectively. Since the mean values of all the blood parameters were within the normal range, it may be concluded that feeding of ammoniated wheat straw treated with and without HCl to growing male buffalo calves for fourteen months has no adverse effect on the blood biochemical parameters.

Postprandial versus preprandial dosing of biphasic insulin aspart in elderly type 2 diabetes patients

Preprandial dosing (within 5 min before meal) and postprandial dosing (15–20 min after meal onset) of NovoLog Mix 70/30 (BIAsp 30, a biphasic formulation of insulin aspart, 30% soluble and 70% protamine-crystallized) were compared in elderly (≥65 years) type 2 diabetes patients in this open-label, 12-week, crossover study. Ninety-three patients were treated with b.i.d. preprandial injections of BIAsp 30 during a 2-week run-in period and subsequently randomized to a 4-week treatment with either pre- or postprandial b.i.d. BIAsp 30, followed by crossover to the other regimen for 4 weeks. Mean plasma glucose values during a 4-h mealtest at the end of each treatment were similar for pre- and postprandial BIAsp 30 (153±58 mg/dl and 161±59 mg/dl, respectively, difference not significant). However, the mean blood glucose increment from self-measured blood glucose values was slightly but significantly greater after postprandial injection than after preprandial injection (treatment difference: 16.3 mg/dl; 95% CI: [0.5, 29.3]). Fifty-six percent of patients reported a hypoglycemic episode; postprandial injection did not increase the incidence of hypoglycemia as compared to preprandial injection (113 episodes versus 125 episodes, respectively). For some elderly type 2 diabetes patients, postprandial injection of BIAsp 30 may be an acceptable alternative to standard preprandial injection.

Diabetes attenuates the hemodynamic stabilizing effects of oral clonidine during off-pump coronary artery bypass surgery

Study objective To investigate the influence of diabetes mellitus on the hemodynamic-stabilizing effect of clonidine during off-pump coronary artery bypass (OPCAB) surgery. Design Prospective study. Setting Public, university-affiliated hospital. Patients 40 patients (32 male, 8 female) scheduled for OPCAB surgery. Interventions and measurements Patients were divided into equal groups of diabetic and nondiabetic patients. All patients were given 150 μg oral clonidine 1 hour before induction. Anesthesia was induced and maintained with fentanyl, propofol, and sevoflurane. Propranolol was administered intermittently to maintain an adequate heart rate (HR; 50 to 70 bpm). Preoperative demographic data (fasting blood glucose concentration and hemoglobin A1c), dose of intraoperative drugs (propofol and propranolol), and outcome data (duration of intubation and duration of hospital stay after surgery) were analyzed. Main results In the diabetic and nondiabetic groups, the mean (±SD) plasma glucose values were 7.8 ± 2.3 mmoL · L −1 and 5.4 ± 0.7 mmoL · L −1 , respectively (p < 0.05), and the mean (±SD) HbA1c values were 7.1 ± 1.3% and 5.2 ± 0.4%, respectively (p < 0.05). The mean propofol infusion rate was 2.8 ± 0.9 mg · kg −1 · h −1 in diabetic patients and 3.1 ± 1.0 mg · kg −1 · h −1 in nondiabetics (NS, p > 0.05). The total requirement for propranolol was 5.1 ± 2.4 mg in diabetic patients and 1.6 ± 1.1 mg in nondiabetics (p < 0.05). Conclusions Diabetes attenuates the hemodynamic stabilizing effects of preanesthetic oral clonidine in the clinical setting.

Simple skinfold-thickness measurements complement conventional anthropometric assessments in predicting glucose tolerance

Skinfold-thickness measurements are considered to have limited clinical utility. To assess whether skinfold-thickness measurements may be a useful adjunct to conventional anthropometric assessments in predicting glucose and insulin regulation, we studied responses to replicate 75-g oral-glucose-tolerance tests (OGTTs) and performed simple anthropometry in a cross section of subjects. Thirty-five subjects completed the study: 11 lean [mean (+/-SEM) age: 33 +/- 3.2 y; body mass index (BMI; in kg/m(2)): 24.1 +/- 0.8; and percentage body fat (%BF): 11.5 +/- 1.5%], 12 normal-weight (age: 33 +/- 2.9 y; BMI: 23.9 +/- 0.7; and %BF: 24.3.5 +/- 1.3%), and 12 obese (age: 41 +/- 4.5 y; BMI: 34.5 +/- 1.7; and %BF: 34.2 +/- 1.5%) individuals. The lean and normal-weight groups were selected to have similar BMIs but different %BFs. We measured the participants' heights, weights, %BFs, waist circumferences, hip circumferences, and truncal and peripheral skinfold thicknesses. Subjects received nine 75-g OGTTs and blood samples were collected at 0, 15, 30, 45, 60, 90, and 120 min. Mean plasma glucose and insulin values were used to calculate the insulin sensitivity index. The obese group had higher plasma glucose concentrations and areas under the curve (AUCs) than did the normal-weight or lean group and higher plasma insulin concentrations and AUCs than did the lean group (P < 0.05). Stepwise multiple regression, with adjustment for demographic and anthropometric measurements, identified the following predictors: waist circumference, peripheral skinfold thickness, and BMI for fasting plasma glucose (partial R(2) = 0.20, 0.13, and 0.13, P < 0.05); waist circumference and truncal skinfold thickness for plasma glucose AUC (partial R(2) = 0.20 and 0.13, P < 0.05); age, waist-to-hip ratio, and peripheral skinfold thickness for fasting plasma insulin (partial R(2) = 0.26, 0.22, and 0.15, P < 0.05); truncal skinfold thickness for plasma insulin AUC (partial R(2) = 0.41, P < 0.001); and peripheral skinfold thickness for both 2-h plasma glucose (partial R(2) = 0.59, P < 0.001) and the insulin sensitivity index (partial R(2) = 0.49, P < 0.001). Skinfold-thickness measurements may complement other established measurements for predicting abnormal glucose and insulin regulation.

Increased urinary endothelin-1 excretion in newly diagnosed type 2 diabetic patients.

To investigate whether urinary and plasma endothelin (ET)-1 concentrations are responsive to the alteration of intravascular blood volume in uncontrolled diabetic patients, we determined urinary ET-1 excretion and plasma ET-1 concentration in 42 newly diagnosed type 2 diabetic patients and 38 normal subjects. Mean fasting plasma glucose value (12.8 +/- 0.72 mmol l-1) and plasma renin activity (PRA, 2.80 +/- 0.44 ng ml-1 hr-1) in diabetic patients were significantly higher as compared to normal controls (mean plasma glucose value: 5.2 +/- 0.83 mmol l-1; mean PRA value: 1.34 +/- 0.17 ng ml-1 hr-1), whereas plasma ET-1 value (1.33 +/- 0.07 pmol l-1) was not significantly different from that (1.29 +/- 0.06 pmol l-1) of normal controls. Mean urinary ET-1 excretion level (7.53 +/- 0.74 nmol mol-1 creatinine) was significantly higher than that (5.36 +/- 0.37 nmol mol-1 creatinine) of normal controls. Urinary ET-1 excretion was correlated with plasma glucose value (r = 0.360, p < 0.05) and PRA value (r = 0.381, p < 0.05). Urinary ET-1 excretion rate (5.17 +/- 0.37 nmol mol-1 creatinine) and PRA value (1.42 +/- 0.18 ng ml-1 hr-1) declined to normal levels when mean plasma glucose value decreased to the level of 7.1 +/- 0.39 mmol l-1 in diabetic patients after 4 months of glycemic control. Our results indicated that renal-derived ET-1 was responsive to the alteration of intravascular blood volume in untreated newly diagnosed type 2 diabetic patients.

Sulfonylureas and daily blood glucose profiles in elderly diabetics

The aim of this study is to clarify the relationship between the efficacy of sulfonylureas and duration of diabetes in elderly diabetics. Daily blood glucose profiles were measured in 87 Type 2 elderly diabetic patients on sulfonylureas (tolbutamide, gliclazide or glibenclamide). Plasma glucose concentrations were determined at 08.00 (before breakfast), 10.00, 12.00 (before lunch), 14.00, 18.00 (before dinner), 20.00, 24.00, 03.00, 06.00, 08.00 hours. The subjects were divided into 4 sub-groups, according to their duration of the diabetes (< 10, 10-14, 15-19, 20 or more years). Mean plasma glucose values at 08.00, 10.00, 20.00, 03.00 and 06.00 hours were not significantly different among the four groups. However, mean plasma glucose values at 12.00, 14.00, 18.00, 00.00 hours and mean total blood glucose area under the daily profile (total BG) were significantly different among the four groups and the values in patients with a history of diabetes of 15 years or more increased. Duration of diabetes positively correlated with blood glucose values at 12.00, 14.00, 18.00, 00.00, 03.00 hours and total BG, and the dose of sulfonylureas positively correlated with blood glucose values at 12.00, 14.00, 18.00, 00.00 hours and total BG in multiple regression analysis. These results suggest that duration of diabetes and dose of sulfonylureas are important determinants of blood glucose control with sulfonylureas in elderly diabetic patients.

Genetic variation of some physiological traits of clonal ayu ( Plecoglossus altivelis) under stressed and non-stressed conditions

Clonal and normal diploid ayu fish were used to determine the degree of genetic variation in some haematological characteristics prior to and after the application of standardized stressful conditions, using the Genetic Variation Index (GVI) as an indicator of heritability. Shallow water and high and low temperature shocks were applied as stressors and quantified the haematocrit, red blood cells, haemoglobin, mean corpuscular volume and plasma glucose values as indicators of the stress response of the fish. The GVI values for the shallow water Stressor experiments showed were relatively high for haematocrit (0.407), red blood cells (0.608) and haemoglobin (0.561). For the temperature stressors, generally lower GVI values for haematocrit (0.215 in average) were recorded, although the haemoglobin and glucose values from the low temperature experiment were 0.499 and 0.427, respectively. These rather high GVI results may imply that the portion of the genetic variance in the physiological traits under study, may well be large enough as to be affected by the overall reduction assumed for the clonal fish. The usefulness of these isogenic organisms for identifying heritable traits, became evidenced as well.

Toward universal criteria for gestational diabetes: The 75-gram glucose tolerance test in pregnancy

OBJECTIVES: The purpose of this study was to determine the distribution of values for the 75 gm glucose tolerance test in pregnancy and to define glucose intolerance by the relationship between maternal glucose values and neonatal macrosomia. STUDY DESIGN: A total 3505 unselected pregnant women were given a 75 gm, 2-hour glucose tolerance test. Diet or insulin therapy was offered only to patients with a fasting plasma glucose level ≥ 105 mg/dl or a 2-hour post-glucose-load value ≥ 200 mg/dl. Birth weights of live-born singletons delivered from 36 to 42 weeks whose mothers had a fasting plasma glucose level < 105 mg/dl and 2-hour post-glucose-load value < 200 mg/dl were used to calculate relationships between glucose levels and birth weights. RESULTS: At 24 to 28 weeks' gestation the mean and SD plasma glucose values were fasting 83.6 (8.9) mg/dl, 1 hour 128.4 (32.9) mg/dl, and 2 hour 108.4 (24.8) mg/dl. In a multiple logistic regression model the factors found to be statistically significantly associated with macrosomia were maternal race, parity, prepregnancy body mass index, weight gain, gestational age at testing, fasting plasma glucose level, and 2-hour post-glucose-load value. A positive association was found between maternal glucose values and birth weight percentiles. No clinically meaningful glucose threshold values relative to birth weight or macrosomia were found. CONCLUSION: In the absence of a meaningful threshold relationship between glucose tolerance test values and clinical outcome, criteria defining gestational diabetes will probably be established by consensus.