Mean Blood Glucose Values Research Articles

Improvement of blood glucose control and reduction of hypoglycemia, body weight, and C-reactive protein in type 1 diabetic patients treated with intensive insulin therapy with insulin analogs

Background/Aim. Good metabolic control can delay the onset and progression of chronic complications of diabetes mellitus (DM). Intensified insulin therapy (IIT) is the cornerstone of good metabolic control in the treatment of type 1 DM (T1DM) while avoiding hypoglycemia and body weight (BW) gain in those patients. The aim of the study was to assess the effects of IIT with insulin analogs (aspart and glargine) in T1DM patients. Methods. This prospective clinical study included 49 patients with at least one year of T1DM duration, who were on IIT with human insulin at that moment. They commenced therapy with insulin aspart for three months, followed by insulin glargine for another three months. An analysis of blood glucose (BG) control (glycated hemoglobin ? HbA1c, mean BG, fasting BG, postprandial BG, and glycemic variability) and analysis of BW, hypoglycemia, and C-reactive protein (CRP) levels were performed. Results. The HbA1c level decreased slightly (non-significantly) after three months of insulin aspart therapy (from 9.28% to 8.83%) and decreased significantly after the aspart/glargine combination (to 8.08%; p < 0.001). After the first three months with aspart therapy, a significant reduction in postprandial BG was noted after all three main meals. The mean postprandial rise of BG was significantly reduced. The variability of daily BG was significantly reduced (standard deviation of BG fell from 2.28 mmol/L to 1.90 mmol/L; p < 0.05). The mean BG value in the profiles decreased (from 9.11 mmol/L to 8.31 mmol/L; p < 0.05). All BG values in the profiles after six months were statistically significantly lower compared to the initial values, as well as the mean BG (6.88 mmol/L; p < 0.001) and the variability of daily BG (1.49 mmol/L; p < 0.01). Our results showed a significant reduction in the number of hypoglycemias after three months, especially after the introduction of insulin glargine therapy (significant reduction in the number of symptomatic, asymptomatic, and nocturnal hypoglycemias). The results showed a discrete but significant reduction in BW and a significant reduction in CRP levels (from 3.43 mg/L to 2.25 mg/L; p < 0.001). Conclusion. Treatment of patients with T1DM with insulin analogs (insulin aspart and insulin glargine) in IIT leads to improved BG control with a reduction in the number of hypoglycemia, BW, and CRP levels.

A Machine Learning Web App to Predict Diabetic Blood Glucose Based on a Basic Noninvasive Health Checkup, Sociodemographic Characteristics, and Dietary Information: Case Study.

Over the past few decades, diabetes has become a serious public health concern worldwide, particularly in Bangladesh. The advancement of artificial intelligence can be reaped in the prediction of blood glucose levels for better health management. However, the practical validity of machine learning (ML) techniques for predicting health parameters using data from low- and middle-income countries, such as Bangladesh, is very low. Specifically, Bangladesh lacks research using ML techniques to predict blood glucose levels based on basic noninvasive clinical measurements and dietary and sociodemographic information. To formulate strategies for public health planning and the control of diabetes, this study aimed to develop a personalized ML model that predicts the blood glucose level of urban corporate workers in Bangladesh. Based on the basic noninvasive health checkup test results, dietary information, and sociodemographic characteristics of 271 employees of the Bangladeshi Grameen Bank complex, 5 well-known ML models, namely, linear regression, boosted decision tree regression, neural network, decision forest regression, and Bayesian linear regression, were used to predict blood glucose levels. Continuous blood glucose data were used in this study to train the model, which then used the trained data to predict new blood glucose values. Boosted decision tree regression demonstrated the greatest predictive performance of all evaluated models (root mean squared error=2.30). This means that, on average, our model's predicted blood glucose level deviated from the actual blood glucose level by around 2.30 mg/dL. The mean blood glucose value of the population studied was 128.02 mg/dL (SD 56.92), indicating a borderline result for the majority of the samples (normal value: 140 mg/dL). This suggests that the individuals should be monitoring their blood glucose levels regularly. This ML-enabled web application for blood glucose prediction helps individuals to self-monitor their health condition. The application was developed with communities in remote areas of low- and middle-income countries, such as Bangladesh, in mind. These areas typically lack health facilities and have an insufficient number of qualified doctors and nurses. The web-based application is a simple, practical, and effective solution that can be adopted by the community. Use of the web application can save money on medical expenses, time, and health management expenses. The created system also aids in achieving the Sustainable Development Goals, particularly in ensuring that everyone in the community enjoys good health and well-being and lowering total morbidity and mortality.

Investigation of The Effect of Combined Exercises on Glycemic Control in Individuals with Type 1 Diabetes

The aim of the present study was to investigate the effect of the combined physical exercise protocols on the blood glucose (BG) of children with T1D. The study was conducted over four weeks using self-controlled clinical trials. The first two weeks were control period and the last two weeks were the experimental period. A total of 6 exercise sessions were performed 3 days a week during the experimental period. The exercise program consisted of aerobic, stretching, and resistance exercises. Each exercise session was performed for 40 minutes. A total of 15 children with T1D, whose mean age was 13.3±SD, were included in the study. The blood glucose and insulin dose data of the participants were recorded in both periods through the continuous glucose measurement system and the registry. It was determined that aerobic exercises provided a significant decrease in blood glucose (p < .05). There was no statistically significant difference between the mean BG values in the control (211.7±37.3) and experimental (208.7±40.4) periods (p >0.05). On the other hand, a statistically significant decrease was found in the total daily insulin doses used by participants during the experimental (31.6±20.8 Unit) period (p < 0.001). Physical exercises had an acute positive effect on blood glucose in children with T1D. However, the effect of exercise alone is not sufficient for chronic glycemic control in T1D. For chronic glycemic control, first of all, the injected insulin doses should be carefully regulated according to carbohydrates and exercise.

Systematic Literature Review and Indirect Treatment Comparison of Three Ready-to-Use Glucagon Treatments for Severe Hypoglycemia.

Ready-to-use glucagon represents a significant advancement in the management of severe hypoglycemia for people with diabetes and their caregivers. This indirect treatment comparison (ITC) evaluated the efficacy and safety differences among the three ready-to-use glucagon treatments, Baqsimi® (nasal glucagon), Gvoke® (glucagon injection) and Zegalogue® (dasiglucagon injection), in adults and children with type 1 diabetes (T1D) or type 2 diabetes (T2D). A systematic literature review was conducted to identify randomized clinical trials assessing the efficacy and safety of Baqsimi, Gvoke or Zegalogue versus reconstituted, injectable glucagon (IG) in reversing insulin-induced hypoglycemia. Bayesian fixed-effect network meta-analysis was used to perform the ITC. Study endpoints included proportion of participants achieving treatment success, maximum blood glucose achieved, time to achieve treatment success and maximum blood glucose and treatment-emergent adverse events (TEAE). Ten clinical trials were included in the ITC (four for Baqsimi, three for Gvoke, and three for Zegalogue). All three treatments achieved high proportions of treatment success (> 98%). In adults, the efficacy results from combined T1D and T2D analysis were consistent with the T1D analysis, except statistically significantly faster in achieving treatment success for Baqsimi vs Gvoke in the combined analysis (13.96 vs 14.66min). The mean maximum blood glucose values were also statistically significantly lower for Baqsimi (168mg/dl) vs Gvoke (220mg/dl) and Zegalogue (190mg/dl). There was a trend towards a lower number of adults experiencing ≥ 1 TEAE with Baqsimi compared to Gvoke or Zegalogue, but no statistical significance was reached. Baqsimi, Gvoke and Zegalogue had comparable high proportions of treatment success in reversing insulin-induced hypoglycemia. Baqsimi achieved a lower mean maximum blood glucose value, which may have implications for the re-establishment of euglycemia. These findings may help support patients, caregivers and health care providers in their decision-making process when discussing various ready-to-use glucagon treatment options.

Efficacy and safety of closed-loop control system for type one diabetes in adolescents a meta analysis

This meta-analysis compares the efficacy and safety of Closed-Loop Control (CLC) to Sensor-Augmented Insulin Pump (SAP) for adolescent patients with Type 1 Diabetes Mellitus (T1DM). Eleven randomized-controlled trials were included with a total of 570 patients, from a total of 869 articles found adhering to PRISMA guidelines. The efficacy of the therapies were evaluated from the day, night and during physical activities monitoring of the of the mean blood glucose (BG), Time In Range (TIR), and Standard Deviation (SD) of the glucose variability. The safety measure of the therapies, was assessed from the day and night recording of the hypoglycemic and hyperglycemic events occurred. Pooled results of comparison of mean BG values for day, night and physical activities, − 4.33 [− 6.70, − 1.96] (P = 0.0003), − 16.61 [− 31.68, − 1.54] (P = 0.03) and − 8.27 [− 19.52, 2.99] (P = 0.15). The monitoring for day, night and physical activities for TIR − 13.18 [− 19.18, − 7.17] (P < 0.0001), − 15.36 [− 26.81, − 3.92] (P = 0.009) and − 7.39 [− 17.65, 2.87] (P = 0.16). The day and night results of SD of glucose variability was − 0.40 [− 0.79, − 0.00] (P = 0.05) and − 0.86 [− 2.67, 0.95] (P = 0.35). These values shows the superiority of CLC system in terms of efficacy. The safety evaluation, of the day, night and physical activities observations of average blood glucose goal hypoglycemic events − 0.54 [− 1.86, 0.79] (P = 0.43), 0.04 [− 0.20, 0.27] (P = 0.77) and 0.00 [− 0.25, 0.25] (P = 1.00) and hyperglycemic events − 0.04 [− 0.20, 0.27] (P = 0.77), − 7.11 [− 12.77, − 1.45] (P = 0.01) and − 0.00 [− 0.10, 0.10] (P = 0.97), highlights the commendable safety factor of CLC. The CLC systems can be considered as an ideal preference in the management of adolescents with type 1 diabetes to be used during a 24 h basis.

Correlation of 25-Hydroxycholecalciferol and Glycaemic Status in Recent Onset Type 2 Diabetes Mellitus

Introduction: Type 2 Diabetes Mellitus (T2DM) is a non communicable disease caused by increased insulin resistance and beta cells dysfunction. Recently vitamin D has sparked wide spread interest in pathogenesis of diabetes by playing a role in insulin resistance. As a major regulator of homeostasis of calcium, vitamin D directly and/or indirectly improves insulin exocytosis and glucose tolerance. Aim: To estimate the serum 25 hydroxy cholecalciferol level and also to correlate with fasting, two hour postprandial blood glucose and Glycated Haemoglobin (HbA1c) values in recent onset T2DM patients. Materials and Methods: This cross-sectional study was conducted at Government Kilpauk Medical College, Tamil Nadu, India from November 2017-April 2018. One hundred and thirty nine recently diagnosed T2DM patients aged between 30-60 years of both sex, who were on oral hypoglycemic drugs for less than three months duration were included in the study. The patients were grouped into three groups according to their vitamin D levels, Group 1 Vitamin D deficient- 52 patients (≤20 ng/mL), Group 2- Insufficient Vitamin D -33 patients (&gt;20-30 ng/mL), Group 3- Vitamin D sufficient-54 patients (&gt;30 ng/mL). Fasting and 2 hour postprandial glucose, 25 hydroxy cholecalciferol and HbA1c were estimated. Statistical analysis was performed using analysis of variance (ANOVA) and Pearson’s correlation. Results: Out of 139 participants, 64 were males and 75 were females. The mean age of the study population was 50.64±5.343 years. The mean fasting blood glucose values among the three groups were 168.13, 129.61, and 125.33 mg/dL respectively. The mean two hour postprandial blood glucose values among the three groups were 269.44, 212.45, and 194.11 mg/dL respectively. The mean HbA1c among the three groups were 7.481±1.16, 6.027±0.31, and 5.86±0.19, respectively. Decreased 25 hydroxy cholecalciferol level in patients of T2DM showed a statistically significant inverse correlation with fasting and two hour postprandial blood glucose and HbA1c with p-value &lt;0.001. Conclusion: The study suggested that hypovitaminosis D was prevalent in T2DM. The study showed that decreased vitamin D level in T2DM patients was associated with increased fasting, postprandial blood sugar, and HbA1c. So, vitamin D screening in diabetics and supplementation can improve the glycemic status.

Blood Glucose Levels and Characteristics of Hypoglycemia in Low Birth Weight Neonates

Introduction: Low birth weight (LBW) neonates comprising of preterm and small for gestational age (SGA) are at risk of hypoglycemia. Hypoglycemia as such in LBW neonates is not well characterized. We aimed to study the blood glucose levels of these neonates and characterise the hypoglycemia. Methods: Blood glucose levels in singleton neonates with birth weight between 1500 gm and 2499 gm were studied prospectively. Glucose levels were assessed at six hour intervals in the first 48 hours of life and extended if indicated. Glucose level ≤ 45 mg/dL in the first 24 hours and &lt; 50 mg/dL thereafter was considered hypoglycaemia. Results: A total of 320 among 3822 neonates satisfied inclusion criteria; 104 had at least one low glucose reading with an incidence of hypoglycaemia of 32.5%. Preterm neonates constituted 158 (49.4%) and SGA 76 (23.8%). Mean blood glucose values were lowest in the first hour of life (60.1 ± 17.2 mg/dL). Incidence of hypoglycemia was highest within one hour of life followed by day two of life (16.3% and 11.6% respectively). About 86 (82.6%) neonates were asymptomatic. Overall, 75% of neonates had a single episode of hypoglycemia and 25% had a recurrence. Hypoglycaemia was noted in 31.8% of neonates born to diabetic mothers, mostly in the first hour (57.1%). Other risk factors for hypoglycemia included intrapartum fluids, birth weight &lt; 2000 g and polycythemia. Conclusions: About a third of LBW neonates had hypoglycemia; mostly on the first hour and day one of life. Asymptomatic nature of hypoglycaemia in the large majority and recurrent hypoglycemia in 25% cases warrants glucose monitoring in this subgroup.

ADIPOCYTE FATTY ACID BINDING PROTEIN (A-FABP) AS A NOVEL BIOCHEMICAL MARKER OF DIABETIC RETINOPATHY

Introduction: Diabetes mellitus is acomplex metabolic disorder associated with increased risk of microvascular and macrovascular disease characterized by chronic hyperglycaemia resulting from defect in insulin secretion, insulin action, or both. Diabetic retinopathy (DR) causes visual impairment as a result of long term accumulated damaged to the small blood vessels in the retina.Adipocyte fatty acid binding protein(AFABP), been suggested as a third adipokine, in addition to leptin and adiponectin. AFABP might have a role in the proliferation of endothelial cells, as well as in angiogenesis. A-FABP levels were determined in subjects witout diabetes mellitus, with type 2 diabetes mellitus without DR and with DR at admission in order to investigate a possible association of A-FABP to the increased risk of incidence of DR. Material and methods: This study was done on non-diabetic (n=25) and Type 2 diabetes subjectswith(n=25) and without retinopathy (n=25) who visited HAHC hospital. Blood glucose (fasting and post prandial), glycated hemoglobin(HbA1c), urea, creatinine, uric acid, total protein, serum albumin,serum electrolytes (sodium, potassiumand chloride), totalcholesterol,triglyceride, high density lipoprotein(HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL) and and AFABP were measured . Result: The mean values of blood glucose (fasting and post prandial),HbA1C,urea, creatinine , TG, LDL VLDL and AFABP were higher in diabetic subjectswith diabetic retinopathy in comparison to diabetic subjects without retinopathy and subjects without diabetes mellitus and were highly significant statistically.(p&lt;0.01). The mean value of HDL was lower in diabetic subjects with diabetic retinopathy in comparison to diabetic subjects without retinopathy and subjects without diabetes mellitus and was highly significant statistically. Conclusion:The study helps in associating AFABP as an early biochemical marker for identifying onset of diabetic retinopathy in subjects with diabetes mellitus at an early stage.

Prevalenceof gestational diabetes and pregnancy outcome in Pakistan

Prevalence of gestational diabetes mellitus and the pregnancy outcome of women registered at the Aga Khan Maternity Home, Karachi was studied. Initial screening was by a glucose challenge test with 50 g glucose. If the 1-hour blood glucose level exceeded 130 mg%, then a 3-hour oral glucose tolerance test with 100 g glucose was performed. Diagnosis was based on O’Sullivan’s criteria. Insulin was prescribed if the fasting blood glucose was more than 95 mg%, and the 2-hour post-prandial over 125 mg%, after a week of diet therapy. The prevalence of gestational diabetes was 3.45% with an aggregate birth weight of 3.24 kg, and perinatal loss of 2.08%. The mean blood glucose values were 93.46 mg% fasting and 117.03 mg%, 2 hours post-prandial

700-P: Glucotab-Based Basal-Bolus Insulin Therapy for Inpatient Glycemic Control Using Insulin Degludec

Guidelines recommend insulin therapy and the use of clinical decision support systems to manage hyperglycemia and diabetes mellitus in hospitalized patients. The aim of the study was to evaluate glycemic control using insulin degludec in an algorithm driven electronic decision support system in hospitalized patients with type 2 diabetes (T2D). The electronic decision support system GlucoTab® was applied for diabetes management in 30 hospitalized patients with T2D (18 women, age 74.1±10.9 years, HbA1c 71±23mmol/mol, BMI 28.6±5.6kg/m2, diabetes duration 14.9±15.1 years, creatinine 1.5±1.2mg/dl, length of hospital stay 9.1±4.0 days). Insulins degludec and aspart were used for basal-bolus insulin therapy. Blood glucose was tested four times daily using a point-of-care device integrated into the hospital information system. The overall mean blood glucose (BG) value was 144±53 mg/dl (mean pre-enrolment BG 211±84mg/dl). BG measurements were in 74.9% in the range of 70-&amp;lt;180 mg/dl. BG measurements in the ranges &amp;lt;40mg/dl, &amp;lt;70mg/dl, 180-&amp;lt;300 and ≥300mg/dl were observed in 0.0%, 1.5%, 22.9% and 0.7% of all measurements, respectively. Total daily insulin dose was 34.0±19.9 U (bolus insulin dose 18.7±13.1 U, basal insulin dose 16.0±7.9 U). Adherence to the algorithm-calculated total daily insulin dose was 93.2%; adherence to inject the algorithm-calculated basal and bolus insulin doses was high (99.0% and 85.3%). Basal-bolus therapy using GlucoTab® covered 80.8±19.9% of the patients’ total hospital stay. Glycemic control using insulin degludec in an algorithm driven electronic decision support system could safely be established in the hospital setting with high adherence to algorithm advice. Disclosure J. K. Mader: Advisory Panel; Self; Becton, Dickinson and Company, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Roche Diabetes Care, Speaker’s Bureau; Self; Abbott Diabetes, Novo Nordisk A/S, Roche Diabetes Care, Sanofi, Stock/Shareholder; Self; decide Clinical Software GmbH. T. Pieber: Advisory Panel; Self; ADOCIA, Arecor, AstraZeneca, Eli Lilly and Company, Novo Nordisk A/S, Sanofi, Research Support; Self; AstraZeneca, Novo Nordisk A/S. P. Beck: Employee; Self; decide Clinical Software GmbH, Stock/Shareholder; Self; decide Clinical Software GmbH. P. M. Baumann: None. F. Aberer: None. D. A. Hochfellner: None. A. Simic: None. L. Bytyqi: None. T. Poettler: None. B. Hoell: Employee; Self; decide Clinical Software GmbH. A. Fahrleitner-pammer: None. Funding Novo Nordisk

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

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

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

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

Critical illness myopathy precedes hyperglycaemia and high glucose variability

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

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

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

Pengaruh Progressif Muscle Relaxation (PMR) Terhadap Perubahan Kadar Glukosa Darah Pada Pasien Diabetes Melitus

The problem in this study is that there are still many changes in blood glucose levels in diabetes mellitus patients at the Lais Care Health Center. The aim of the study was to determine the effect of progressive muscle relaxation (PMR) on changes in blood glucose levels in diabetes mellitus patients at the Lais Care Health Center. The design of this study used a quasi-experimental design using a pre and post test design. The sample in this study amounted to 10 people. The data used are primary data and secondary data. The analysis used was univariate analysis and bivariate analysis, the statistical test used was the T test. The mean values of blood glucose before and after Progressive Muscle Relaxation (PMR) in Diabetes Mellitus patients were 211.00 mg / dl and 196.30 mg / dl. It was concluded that there was an effect of progressive muscle relaxation (PMR) on changes in blood glucose levels in Diabetes Mellitus patients (p = 0.000).

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

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

2250-PUB: Lower Blood Glucose Values Lead to Higher Sleep Efficiency in Adolescents with Type 1 Diabetes

Objective: Sleep disturbances occur frequently in youth with type 1 diabetes (T1D) with only 20% of adolescents meeting recommendations for sleep duration during the week. Few studies have directly evaluated the relationship between objectively measured sleep behaviors and mean blood glucose (BG) as measured by continuous glucose monitors (CGM). Methods: Twenty adolescents with T1D (Age: M= 14.69, SD= 1.58, Sex= 50% female; Race= 80% Caucasian) participated. Youth’s average HbA1c was 9.0% (SD= 1.70), and all participants used an insulin pump. Youth wore an accelerometer on their non-dominant wrist and a CGM for seven consecutive days. We estimated multilevel models using SAS PROC MIXED and reverse-lagged nighttime sleep variables to specifically examined the impact of BG values on each sleep variable the following night. We examined total sleep time (TST), sleep efficiency (i.e., percentage of time spent asleep while in bed), and onset latency (i.e., minutes between going to bed and falling asleep) independently, as proxies for sleep behavior. We entered a dichotomous weekday/weekend variable in the model as a level 2 moderator. Results: Participants averaged 9.1 hours (SD= 84.9 minutes, range= 2.82-11.15 hours) of TST. Sleep variables did not differ on weekdays versus weekends. Our multilevel models did not reveal a significant association between sleep variables predicting mean BG. We did observe an association between within-person mean BG values significantly predicting sleep efficiency (β= -0.06802). This suggests an adolescent’s sleep efficiency may increase when their BG is lower than typical for themselves. Conclusions: The results of the study add support to previous laboratory studies that indicate lower BG levels associate with better sleep efficiency in youth with T1D. Clinicians may consider assessing sleep patterns in youth with T1D as an additional treatment target for optimal T1D self-management. Disclosure A. Monzon: None. R. McDonough: None. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc. S.R. Patton: None.

Hematological and Biochemical Profile of Patients Infected with Schistosoma mansoni in Comparison with Apparently Healthy Individuals at Sanja Town, Northwest Ethiopia: A Cross-Sectional Study.

Background Schistosomiasis is a parasitic disease that resides in the vascular system of vertebrates, causing a chronic, debilitating disease that affects more than 200 million people and 800,000 deaths per year in over 70 countries. This parasite causes liver dysfunction and disorders normal hematological and biochemical profiles in addition to portal vein hypertension syndrome, ascites, and liver fibrosis. The general objective of the current study is to assess hematological and biochemical profiles of patients infected with Schistosoma mansoni in comparison with apparently healthy individuals (control group) in Sanja town, northwest Ethiopia. Method A comparative cross-sectional study was conducted from February to April 2019 among microscopically confirmed S. mansoni-infected patients attending Sanja hospital and apparently healthy (control group) from Sanja town community. A total of 220 participants, 110 from the S. mansoni-infected and 110 from the control group, were enrolled using convenient sampling technique. Three grams of stool and six milliliters of blood samples were collected from each study participant. Stool samples were processed using the Kato–Katz technique to determine infection and count parasite density. The blood sample was processed for the analysis of hematological and biochemical profiles using Cell Dyn 1800 (Abbot Hematology, IL, USA) and iChem535 chemistry analyzer, respectively. All data were analyzed using SPSS version 20, and P value less than 0.05 was taken as statistically significant. Results This study showed that the mean values of serum alanine aminotransferase, aspartate aminotransferase, total protein, total cholesterol, hemoglobin, mean corpuscular hemoglobin concentration, and total white blood cell count were different in the Schistosoma mansoni-positive group as compared with the control group with statistically significant value (P ≤ 0.05). However, the mean values of blood glucose, red blood cell, packed cell volume, and granulocyte count difference were not statistically significant (P ≥ 0.05). The mean value of hemoglobin, red blood cells, blood glucose, mean corpuscular hemoglobin concentration, total protein, total cholesterol, and total white blood cell was significantly dropped in the moderate and heavy S. mansoni parasitic load patients as compared with the control group and light S. mansoni parasite density patients. However, the mean of AST and ALT progressively elevated as the burden of S. mansoni increased. Conclusion. Most hematological and biochemical profiles were significantly lower in the Schistosoma mansoni-positive group as compared with the control group. Most hematological and biochemical profiles decline significantly as the parasite density increased. Hence, with Schistosoma treatment, supportive treatment against hematological and biochemical disorders is recommended.

Risks of Maternal Obesity in Pregnancy: A Case-control Study in a Portuguese Obstetrical Population.

The present study aims to understand to what extent obesity is related to adverse maternal, obstetrical, and neonatal outcomes in a Portuguese obstetrical population. A retrospective case-control study was conducted at the Department of Obstetrics of a differentiated perinatal care facility. The study compared 1,183 obese pregnant women with 5,399 normal or underweight pregnant women for the occurrence of gestational diabetes, hypertensive pregnancy disorders, and preterm birth. Mode of delivery, birthweight, and neonatal intensive care unit (ICU) admissions were also evaluated. Mean blood glucose values were evaluated and compared between groups, in the first and second trimesters of pregnancy. Only singleton pregnancies were considered. The prevalence of obesity was 13.6%. Obese pregnant women were significantly more likely to have cesarean sections (adjusted odds ratio [aOR] 2.0, p < 0.001), gestational diabetes (aOR 2.14, p < 0.001), hypertensive pregnancy disorders (aOR 3.43, p < 0.001), and large-for-gestational age or macrosomic infants (aOR 2.13, p < 0.001), and less likely to have small-for-gestational age newborns (aOR 0.51, p < 0.009). No significant differences were found in terms of preterm births, fetal/neonatal deaths, low birthweight newborns, and neonatal ICU admissions among cases and controls. Maternal obesity was significantly associated with higher mean blood glucose levels, in the first and second trimesters of pregnancy. Obesity is associated with increased risks of adverse pregnancy and neonatal outcomes. These risks seem to increase progressively with increasing body mass index (BMI) class. Female obesity should be considered a major public health issue and has consequences on maternal-fetal health.

Use of a real-time, algorithm-driven, publicly displayed, automated signal to improve insulin prescribing practices

AimThe clinical andon board (CAB) is a novel electronic surveillance and communication system, which alerts providers to and prompts treatment of dysglycemia. This investigation was designed to determine the CAB’s effectiveness in supporting adherence to standardized evidence-based protocols, as well as improving glycemic control. MethodsThis study was a retrospective pre/post analysis of insulin orders and blood glucose values. We used a Student’s t-test for continuous variables and Chi2 for all other variables. This study included patients 18 years or older admitted to the hospital medical service as an inpatient with a length of stay greater than 24 h and less than 90 days. We used Pearson’s correlation coefficient to evaluate the relationship between CAB and blood glucose. ResultsThe rate of compliance in prescribing basal insulin for patient with diabetes increased from 56% to 77% (p < 0.001). Similarly, compliance rates for prescribing correctional insulin in patients without diabetes increased from 15% to 37% (p < 0.001). Performance on the CAB was linearly related to blood glucose (p = 0.004), and there was a small statistically (not clinically) significant improvement in mean blood glucose values. ConclusionThis approach is effective in alerting and engaging providers to prescribe insulin in a standardized manner with potential to improve glycemic control.