Normoglycemic Patients Research Articles

Importance of Blood Glucose Management Before 18F-FDG PET/CT in 322 Patients with Bacteremia of Unknown Origin.

We investigated the effects of blood glucose levels on the performance of 18F-FDG PET/CT for detecting an infection focus in patients with bacteremia. Methods: A total of 322 consecutive patients with bacteremia who underwent 18F-FDG PET/CT between 2010 and 2021 were included. Logistic regression analysis was performed to evaluate the association between finding a true-positive infection focus on 18F-FDG PET/CT and blood glucose level, type of diabetes, and use of hypoglycemic medication. C-reactive protein, leukocyte count, duration of antibiotic treatment, and type of isolated bacteria were considered as well. Results: Blood glucose level (odds ratio, 0.76 per unit increase; P = <0.001) was significantly and independently associated with 18F-FDG PET/CT outcome. In patients with a blood glucose level between 3.0 and 7.9 mmol/L (54-142 mg/dL), the true-positive detection rate of 18F-FDG PET/CT varied between 61% and 65%, whereas in patients with a blood glucose level between 8.0 and 10.9 mmol/L (144-196 mg/dL), the true-positive detection rate decreased to 30%-38%. In patients with a blood glucose level greater than 11.0 mmol/L (200 mg/dL), the true-positive detection rate was 17%. In addition to C-reactive protein (odds ratio, 1.004 per point increase; P = 0.009), no other variables were independently associated with 18F-FDG PET/CT outcome. Conclusion: In patients with moderate to severe hyperglycemia, 18F-FDG PET/CT was much less likely to identify the focus of infection than in normoglycemic patients. Although current guidelines recommend postponing 18F-FDG PET/CT only in cases of severe hyperglycemia with glucose levels greater than 11 mmol/L (200 mg/dL), a lower blood glucose threshold seems to be more appropriate in patients with bacteremia of unknown origin and other infectious diseases.

EVALUATION OF IMPACT OF HYPERGLYCEMIA AND HYPONATREMIA ON CLINICAL OUT-COME OF ACUTE STROKE

Hyponatremia and hyperglycemia are common metabolic disorders which could worsen the outcome after a cerebrovascular accident (stroke). This study aimed to evaluate the impact of hyponatremia and hyperglycemia on stroke and its clinical outcome, including morbidity and mortality. This prospective cohort study included 50 stroke patients admitted in tertiary care hospitals. Stroke severity, Glasgow coma scale (GCS), conscious level, gag reflex, clinical presentations, and outcomes were recorded. Following a stroke, patients were monitored for a period of six months, during which the patient's death was recorded on the event form. Linear logistic regression model was used to determine the stroke mortality. Hyponatremia and hyperglycaemia were associated with higher odds ratio of deaths, poor functional recovery, severe disability, low mean GCS score as compared to normonatremic and normoglycemic patients (odds ratio [OR] = 4.7; 95% CI= 0.929-43.782) and hyperglycaemia (OR= 2.74; 95% CI=0.577-13.03). Stroke patients admitted with hyperglycemia or hyponatremia were associated with greater morbidity and mortality and poor functional recovery.

The role of stress hyperglycemia and hyperlactatemia in non-diabetic patients with myocardial infarction treated with percutaneous coronary intervention.

Stress hyperglycemia and lactates have been used separately as markers of a severe clinical condition and poor outcomes in patients with myocardial infarction (MI). However, the interplay between glucose and lactate metabolism in patients with MI have not been sufficiently studied. The aim in the present study was to examine the relationship of glycemia on admission (AG) and lactate levels and their impact on the outcome in non-diabetic MI patients treated with percutaneous coronary intervention (PCI). A total of 405 consecutive, non-diabetic, MI patients were enrolled in this retrospective, observational, single-center study. Clinical characteristic including glucose and lactate levels on admission and at 30-day mortality were assessed. Patients with stress hyperglycemia (AG ≥ 7.8 mmol/L, n = 103) had higher GRACE score (median [interquartile range]: 143.4 (115.4-178.9) vs. 129.4 (105.7-154.5), p = 0.002) than normoglycemic patients (AG level < 7.8 mmol/L, n = 302). A positive correlation of AG with lactate level (R = 0.520, p < 0.001) was observed. The coexistence of both hyperglycemia and hyperlactatemia (lactate level ≥ 2.0 mmol/L) was associated with lower survival rate in the Kaplan-Meier estimates (p < 0.001). In multivariable analysis both hyperglycemia and hyperlactatemia were related to a higher risk of death at 30-day follow-up (hazard ratio [HR] 3.21, 95%, confidence interval [CI] 1.04-9.93; p = 0.043 and HR 7.08; 95% CI 1.44-34.93; p = 0.016, respectively) CONCLUSIONS: There is a relationship between hyperglycemia and hyperlactatemia in non-diabetic MI patients treated with PCI. The coexistence of both hyperglycemia and hyperlactatemia is associated with lower survival rate and are independent predictors of 30-day mortality in MI patients and these markers should be evaluated simultaneously.

The Effect of Diabetes and Hyperglycemia on Horizontal Guided Bone Regeneration: A Clinical Prospective Analysis.

Guided bone regeneration (GBR) is a reconstructive procedure for treating atrophic alveolar ridges. This study aims to assess the correlation between different glycemic control levels and clinical findings in patients undergoing horizontal GBR before implant placement. The study population consisted of all patients requiring horizontal GBR. Patients were divided into three groups based on HbA1c levels: non-diabetic normoglycemic patients (HbA1c < 5.7%), non-diabetic hyperglycaemic patients (HbA1c < 6.5%), and patients with controlled diabetes (HbA1c < 7%). The primary outcomes were the horizontal (mm) and vertical (mm) dimensional changes of the alveolar ridge 6 months after the procedure. The study sample consisted of 54 patients. Sixty-eight implants (95.8%) were classified as "successful," meaning the possibility of inserting a standard-sized implant following the GBR (diameter ≥ 4 mm). There was a statistically significant difference between the three groups in terms of horizontal gain at 6 months: in particular, there was a statistically significant difference between group 1 and group 2 (p = 0.026) and between group 1 and group 3 (p = 0.030). The present investigation showed that patients with HbA1c levels below 7% could undergo GBR and obtain a statistically significant horizontal bone gain.

Patients with type 2 diabetes and severe periodontitis harbor a less pathogenic subgingival biofilm than normoglycemic individuals with severe periodontitis.

Whether, and to what extent, diabetes mellitus (DM) can affect the subgingival biofilm composition remains controversial. Thus, the aim of this study was to compare the composition of the subgingival microbiota of non-diabetic and type 2 diabetic patients with periodontitis using 40 "biomarker bacterial species." Biofilm samples of shallow (probing depth [PD] and clinical attachment level [CAL] ≤3mm without bleeding) and deep sites (PD and CAL ≥5mm with bleeding) of patients with or without type 2 DM were evaluated for levels/proportions of 40 bacterial species by checkerboard DNA-DNA hybridization. A total of 828 subgingival biofilm samples from 207 patients with periodontitis (118 normoglycemic and 89 with type 2 DM) were analyzed. The levels of most of the bacterial species evaluated were reduced in the diabetic compared with the normoglycemic group, both in shallow and in deep sites. The shallow and deep sites of patients with type 2 DM presented higher proportions of Actinomyces species, purple and green complexes, and lower proportions of red complex pathogens than those of normoglycemic patients (P<0.05). Patients with type 2 DM have a less dysbiotic subgingival microbial profile than normoglycemic patients, including lower levels/proportions of pathogens and higher levels/proportions of host-compatible species. Thus, type 2 diabetic patients seem to require less remarkable changes in biofilm composition than non-diabetic patients to develop the same pattern of periodontitis.

Could METS-VF provide a clue as to the formation of kidney stones?

The lifetime occurrence rate of kidney stones is 14%, making it one of the most prevalent urological conditions. Other contributing elements, such as obesity, diabetes, diet, and heredity, are also taken into account. Our research sought to explore the potential link between high visceral fat scores (METS-VF) and the occurrence of kidney stones, as a means of understanding how to prevent them. This research utilized data from the National Health and Nutrition Examination Survey (NHANES), mirroring the demographics of the United States. We carried out an in-depth analysis of the connection between METS-VF and kidney stones, based on data from 29,246 participants in the National Health and Nutrition Examination Survey spanning 2007 to 2018, involving logistic regression, segmentation, and dose-response curve analysis. Our study of 29,246 potential participants found that METS-VF was positively associated with the prevalence and progression of kidney stones. After subgroup analysis by gender, race, blood pressure, and blood glucose, our results showed that the ORs for METS-VF and kidney stones were (1.49, 1.44) in males and females, respectively; while in Mexicans, whites, blacks, and In other populations, the OR values were (1.33, 1.43, 1.54, 1.86); in hypertensive and normal populations, the OR values were (1.23, 1.48); in diabetic patients and normoglycemic patients were (1.36,1.43). This proves that it works for all groups of people. Our studies demonstrate a strong connection between METS-FV and the emergence of kidney stones. It would be beneficial to investigate METS-VF as a marker for kidney stone development and progression in light of these findings.

Assessment of Serum Electrolytes and Glycated Hemoglobin Level in Non-diabetic Iron-Deficient Anaemic Patients.

The WHO has recognised iron deficiency anaemia (IDA) as the most common nutritional deficiency in the world, with 30% of the population being affected by this condition. The patient's glycemic status during the past three months is shown by the glycated haemoglobin A1C (HbA1c) test. According to several studies, iron deficiency can increase HbA1C levels without affecting blood sugar levels. HbA1C levels of≥6.5% have been approved by the American Diabetes Association (ADA) as a diagnostic indicator for diabetes mellitus (DM). An imbalance in serum electrolyte levels and anaemia havebeenlinked by several studies. Aim: To analyze the effect of iron deficiency anaemia on HbA1c levels and serum electrolytes in an adult non-diabetic population. This was a descriptive cross-sectional studyconducted in Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India from January 2021 to June 2022. A total of 65 moderate to severe normoglycemic iron deficiency anemia patients between 18 to 75 years were enrolled in the studyafter fulfilling inclusion and exclusion criteria. A detailed history, clinical and biochemical examination was performed including HbA1c levels. The results were pooled and statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY, USA). We found elevated HbA1c levels (5.67±1.1%) in non-diabetic iron-deficient anaemia individuals, and elevation was more in women of reproductive age group (30.8%). There was a statistically significant Spearman negative correlation between hemoglobin and HbA1C levels. Also, 16 patients had hyponatremia with a mean haemoglobin (Hb) of 4.8 g/dL and one patient had hyperkalemia with a mean Hb of 3.2 g/dL which was statistically non-significant. In this study haemoglobin and HbA1c had a statistically significant positive correlation with serum sodium and a negative correlation with serum potassium in moderate to severely iron-deficient anaemic patients, especially females of the reproductive age group.

Serum Alpha-Hydroxybutyrate Predicts Elevated 1-Hour Glucose Levels in Normoglycemic Patients

Serum Alpha-Hydroxybutyrate Predicts Elevated 1-Hour Glucose Levels in Normoglycemic Patients

Finger-Stick Artifactual Hypoglycemia in the Emergency Department: A Case Report

BackgroundArtifactual hypoglycemia is a low glucose measurement in a normoglycemic patient. Patients in a shock state or with extremity hypoperfusion can metabolize a higher proportion of the glucose in the poorly perfused tissue, and blood obtained from those tissues may have far lower glucose concentration than the blood in the central circulation. Case ReportWe present the case of a 70-year-old woman with systemic sclerosis, progressive functional decline, and cool digital extremities. The initial point-of-care testing (POCT) for glucose was 55 mg/dL from her index finger, with subsequent repeated low POCT glucose reading, despite glycemic repletion and contradictory euglycemic serologic readings from her peripheral i.v. sites. Two separate POCTs were then obtained from her finger and her antecubital fossa, which had vastly different glucose readings; the latter was in congruence with her i.v. draws. The patient was diagnosed with artifactual hypoglycemia. Alternative sources of blood to avoid artifactual hypoglycemia on POCT samples are discussed. Why Should an Emergency Physician Be Aware of This?Artifactual hypoglycemia is a rare but commonly misdiagnosed phenomenon that can occur in emergency department patients when peripheral perfusion is limited. We encourage physicians to confirm peripheral capillary results with a venous POCT or explore alternative sources of blood to avoid artificial hypoglycemia. Small absolute errors can matter when the erroneous result is hypoglycemia.

Disse index and free fatty acids as markers of insulin resistance and their association with hospital outcomes of coronary bypass surgery in patients with different glycemic status

AIM: to analyze various indices of insulin resistance and plasma free fatty acid (FFA) levels, and their association with the preoperative status and in-hospital complications after coronary artery bypass grafting (CABG) in normoglycemic patients and patients with carbohydrate metabolism disorders (CMD).MATERIALS AND METHODS: The study included 708 patients who underwent CABG. The glycemic status, preoperative parameters, the specifics of surgical intervention, in-hospital complications were analyzed. The patients were divided into 2 groups: Group 1 (n=266) — patients with CMD (type 2 diabetes mellitus (T2DM) and prediabetes); Group 2 (n=442) — patients without CMD. Plasma FFA and fasting plasma insulin levels were determined, the Disse index, the quantitative insulin sensitivity check index (QUICKI), revised QUICKI were estimated in 383 patients.RESULTS: Screening prior to CABG increased the number of patients with T2DM from 15.2% to 24.1%, prediabetes – from 3.0% to 13.4%, with any CMD – from 18.2% to 37.5%.Patients with CMD showed a higher percentage of significant hospital complications (25.2% vs 17.0%, p=0.007), progression of renal failure (6.3% vs 2.9%, p=0.021), multiple organ failure (4.5% vs 1.7%, p=0.039), sternal wound complications (6.3% vs 2.9%, p=0.018), renal replacement therapy (3.7% vs 1.1%, p=0.020), surgery on peripheral arteries (1.5% vs 0%, p=0.039).According to the results of multivariate analysis, the Disse index turned out to be a significant predictor of the end point (hospital stay &gt;10 days or any significant complication CABG) in several regression models (OR 1.060 in one of the models; 95% CI 1.016–1.105; p=0.006). Independent predictors of the end point were: female gender, age, body mass index, cardiopulmonary bypass duration, left atrium size, left ventricular end diastolic dimension, T2DM, FFA levels (OR 3.335; 95% CI 1.076–10.327; p=0.036), average postoperative glycemia on the 1st day after CABG, failure to achieve the target range of perioperative glycemia.CONCLUSION: Screening for CMD prior to CABG can significantly increase the number of patients with diagnosed CMD. Significant in-hospital complications after CABG tend to be more prevalent in patients with CMD compared with normoglycemic patients. Insulin resistance index Disse, FFA, postoperative glycemia are independent predictors of prolonged hospital stay or postoperative complications of CABG.

Prevalence of Gestational Diabetes and Pregnancy Outcome of antenatal patients in Ilorin.

Gestational Diabetes mellitus (GDM) is fast becoming an important cause of maternal and perinatal morbidity and mortality. The objective of this study is to assess the prevalence and the perinatal outcome of gestational diabetes in an antenatal population. This was a cross-sectional study. The patients were pregnant women between 24-28 weeks of gestation without a prior diagnosis of diabetes mellitus. The consenting women were evaluated using fasting plasma glucose and oral glucose tolerance testing using 75 grams of glucose in 300ml of water orally. Two hundred and fifteen women participated in the study and the prevalence of GDM was 9%. The mean fasting plasma glucose was 4.04mmol/l at the time of the Oral glucose tolerance test (OGTT) and 5.78mmol/l after the oral glucose load. When compared with pregnant normoglycaemic patients, GDM patients had significantly fewer vaginal deliveries (p=0.05), higher birth weight (3.71kg), and more neonatal admissions (50%). Gestational diabetes mellitus is an important disease entity, and it is a cause of maternal and perinatal morbidities.

Outcomes of Prediabetes Compared with Normoglycaemia and Diabetes Mellitus in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis.

Background: Patients with prediabetes are at increased risk of coronary artery disease (CAD). However, the association between prediabetes and adverse clinical outcomes following percutaneous coronary intervention (PCI) is inconsistent, in contrast to outcomes in patients with diabetes mellitus (DM). Thus, this meta-analysis evaluated the impact of dysglycaemia on PCI outcomes. Methods: The PubMed, Embase, Cochrane, and ClinicalTrials.gov databases were systematically reviewed from inception of databases until June 2022. In 17 studies, outcomes of PCI in patients with prediabetes were compared with patients who were normoglycaemic, and patients with DM. The primary outcome was all-cause mortality at the longest follow-up. Results: Included were 12 prospective and five retrospective studies, with 11,868, 14,894 and 13,536 patients undergoing PCI in the prediabetes, normoglycaemic and DM groups, respectively. Normoglycaemic patients had a statistically lower risk of all-cause mortality, (risk ratio [RR] 0.66, 95% confidence interval [CI] 0.52-0.84), myocardial infarction (MI; RR 0.76, 95% CI 0.61-0.95) and cardiac mortality (RR 0.58, 95% CI 0.39-0.87) compared with prediabetic patients undergoing PCI at the longest follow-up. Patients with prediabetes had a lower risk of all-cause mortality (RR=0.72 [95% CI 0.53-0.97]) and cardiac mortality (RR =0.47 [95% CI 0.23-0.93]) compared with patients with DM who underwent PCI. Conclusion: Among patients who underwent PCI for CAD, the risk of all-cause and cardiac mortality, major adverse cardiovascular events and MI in prediabetic patients was higher compared with normoglycaemic patients but lower compared with patients with DM.

Sex-dependent effects of Canagliflozin on kidney protection in mice with combined hypertension-type 1 diabetes.

Canagliflozin (CANA) is a sodium-glucose cotransporter 2 (SGLT2) inhibitor with blood glucose lowering effects. CANA also promotes kidney protection in patients with cardiovascular diseases and type 2 diabetes (T2D), as well as in normoglycemic patients with hypertension or heart failure. Clinical studies, although conduct in both sexes, do not report sex-dependent differences in T2DM treated with CANA. However, the impact of CANA in type 1 diabetes, as well in sex-dependent outcomes in such cohort needs further understanding. To analyze the effects of CANA in mice with combined hypertension and type 1 diabetes, diabetes was induced by STZ injection (5 days, 50mg/kg/day) in both male and female 8 weeks old genetic hypertensive mice (Lin), whereas the control (Lin) received 0.1M sodium citrate injections. 8 weeks after STZ. Mice were fed either regular or CANA-infused diet for 4 weeks. 8 weeks after STZ, hyperglycemia was present in both male and female mice. CANA reversed BG increase mice fed regular diet. Male LinSTZ mice had elevated water intake, urine output, urinary albumin to creatinine ratio (ACR), kidney lesion score, and creatinine clearance compared to the Lin control group. Kidney injury was improved in male LinSTZ + CANA group in male mice. Water intake and urine output were not statistically significantly different in female LinSTZ compared to female LinSTZ+ CANA. Moreover, CANA did not improve kidney injury in female mice, showing no effect in creatinine clearance, lesion score and fibrosis when compared to LinSTZ fed regular diet. Here we show that Canagliflozin might exert different kidney protection effects in male compared to female mice with hypertension and type 1 diabetes. Sex-dimorphisms were previously found in the pathophysiology of diabetes induced by STZ. Therefore, we highlight the importance of in-depth investigation on sex-dependent effects of CANA, taking in consideration the unique characteristics of disease progression for each sex.

Presence of Subclinical Polyneuropathy in Patients with Elevation of Hba1c.

It is aimed to investigate the relationship between the asymptomatic individiuals with elevated HbA1c and occurrence of polyneuropathy by way of comparison to normoglycemic condition. The study includes 30 female patients diagnosed with subclinical elevation of HbA1c and 30 normoglycemic healthy female patients who applied to our hospital polyclinics with symptoms other than neuropathy between January-March 2017. Nerve conduction examination is done in these patients, parameters of both groups are compared. In regard to amplitude distribution; when compared to control group, tibial motor and ulnar sensory nerve amplitude is lower than the control group (p<0.05). In peroneal, median and ulnar motor nerves, distal latency values are extended compared to control group (p<0.05). Sural, median and ulnar sensory nerve latency is extended compared to control group. In terms of transmission rate distribution; in sural, median and ulnar sensory nerve, transmission speed is lower compared to the control group (p<0.05). In asymptomatic cases with subclinical elevation of HbA1c, peripheral nervous system involvement is monitored, and early glycemic control should be provided in order to prevent development of neuropathy in patients.

Discriminative value of pulse wave velocity for arterial stiffness and cardiac injury in prediabetic patients.

Prediabetes (PD) is defined as impaired fasting glucose and/or impaired glucose tolerance (IGT) and may be associated with high risk of cardiovascular injury. It is recommended that PD patients be screened for signs of arterial stiffness and cardiovascular injury to reinforce therapeutic strategies. To identify pulse wave velocity values discriminative for arterial stiffness and cardiovascular injury in PD patients. A cross-sectional study was conducted with PD (N=43) and normoglycemic (N=37) patients who underwent clinical evaluation, arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor, laboratory blood analysis, investigation of morphological and functional cardiac variables by transthoracic echocardiogram, and assessment of carotid intima-media-thickness (CIMT) by carotid ultrasonography. A statistical analysis was performed using SPSS software and values of p<0.05 were considered significant. A cfPWV cut-off value of 6.9 m/s was identified for IGT (Sensitivity [SE]: 74% and Specificity [SP]: 51%). Comparison of general data and risk factors between subsets with values above and below this cutoff value revealed higher rates of fasting glucose (p=0.02), obesity (p=0.03), dyslipidemia (p=0.004), early signs of left ventricle (p=0.017) and right ventricle (p=0.03) impaired diastolic function, and elevated CIMT in subjects with cfPWV ≥ 6.9m/s (p=0.04). In PD patients, a cfPWV cutoff of 6.9 m/s was considered a discriminative value for arterial stiffness. These findings highlight the value of early investigation of cardiovascular injury and aggressive therapy strategies with good control of risk factors in PD.

A study on incidence of stress hyperglycemia in acute ischemic stroke in non-diabetic patients and its prognostic significance

Background: Hyperglycemia detected during acute illness-like ischemic stroke is associated with adverse outcomes more than in normoglycemic patients. However,very limited data regarding stress hyperglycemia and its prognostic value are available for our Indian population. Aims and Objectives: This study was aimed at comparing the stress hyperglycemic and normoglycemic patients in terms of mortality and functional recovery during 28 days follow-up assessed by the Barthel index for Activities of Daily Living. Materials and Methods: Adult non-diabetic patients with ischemic stroke were assessed for random venous blood glucose and HbA1c levels and divided into two groups: Patients with hyperglycemia and normoglycemia. The Barthel Index for Activities of Daily Living was used to compare mortality and functional recovery on the day of admission, day 3, and day 28 after stroke. Results: Mortality over the 28 days follow-up was significantly higher in hyperglycemic patients (45% vs. 20%,P=0.02). The Barthel Index score on admission (day 0) was 8.75±7.41 among stress hyperglycemic patient whereas it was13.54±11.12 among normoglycemic patient, which was significantly different (P=0.028). Similarly, day 3 (18.89±6.08 vs. 23.26±13.05, P&lt;0.05) and day 28 scores (83.24±7.49 vs. 84.55±12.84, P=0.039) were significantly better in normoglycemic patients. Conclusion: The mortality rate was much higher and functional recovery was much poorer in stress hyperglycemic patients. Further studies should be directed toward determining complications in long-term follow-up related to stress hyperglycemia and the effects of management on patient outcome.

STRESS HYPERGLYCEMIAAS PREDICTOR FOR SHORT TERM OUTCOME IN ACUTE ISCHEMIC STROKE

Stroke is one among the leading causes of long term morbidity and the second leading cause of mortality worldwide. Diabetes mellitus is a well know risk factor for stroke, increasing the risk of mortality and morbidity with stroke compared to non diabetic patients. Acute stroke can cause stress hyperglycemia which may have an impact on the outcome. Thus, hyperglycemia foretells increased mortality and morbidity among the other variables that affect the outcome of a stroke, such as the subtype and severity of the stroke. This study was done to assess the presence of stress hyperglycemia and its effects on acute ischemic stroke. Materials and methods:Aprospective and comparative study was conducted at Narayana Medical College and Hospital, Nellore, on 110 acute ischemic stroke patients. National institute of health stroke scale (NIHSS) and Capillary blood glucose (CBG) were noted from all the study participants, at admission and at follow up period of 3 months. Patients were categorised into normoglycemic, stress hyperglycemia and diabetes mellitus groups based on FBS, PPBS, HbA1C values. Short term functional recovery among the 3 groups were assessed.Results: Stress hyperglycemia was observed in 26.37% of the study patients. Relatively less functional recovery at the end of 3 months was observed in stress hyperglycaemic patients compared to normoglycemic stroke patients. Stress hyperglycemia can be considered as a signicant prognostic marker of short term outcome in ischemic stroke. Conclusion: Stress hypeglycemia has poor short term outcome on morbidity with ischemic stroke. Hence, adequate management of glycemic levels at presentation can have a better short term outcomes of ischemic stroke.

The prevalence of hyperglycemia and its impact on mortality among people living with HIV in Georgia.

Life expectancy and quality of life of people living with HIV have been dramatically improved after introducing antiretroviral therapy, and the prevalence of non-communicable diseases has increased. Several studies have found that hyperglycemia with or without type 2 diabetes was associated with poor outcomes in people living with HIV. The study's objective was to determine the prevalence of hyperglycemia and assess its impact on mortality. A retrospective cohort study was conducted among people living with HIV diagnosed in 2012-2018 and followed through 2020 at the Infectious Diseases, AIDS and Clinical Immunology Research Center in Tbilisi, Georgia. Primary outcomes of interest included the prevalence of hyperglycemia and mortality. Causes of death were classified according to the Coding of Death in HIV (CoDe) protocol. Our study included 2914 people living with HIV. Two hundred and forty-two (8.3%) patients had hyperglycemia, with an increasing prevalence by age. Three hundred one (9.7%) participants died over the median 3.71 (IQR: 2.14-5.37) years of follow-up. Among these, 139 (46.2%) were due to AIDS- related causes, 123 (40.9%)-were due to non-AIDS causes, and in 39 (12.9%) cases, the cause of death could not be determined. Overall, the cohort contributed to 11,148 person-years of follow-up (PYFU), translating into a mortality rate of 2.70 deaths per 100 PYFU. The mortality rate was significantly higher among individuals with hyperglycemia-11.17 deaths per 100 PYFU vs 2.07 deaths per 100 PYFU among normoglycemic patients(p<0.0001). Hyperglycemia was associated with increased odds of mortality. Screening and management of hyperglycemia should be integrated into routine HIV clinical services as part of a comprehensive care package.

Microcirculation and neutrophil-related cytokine concentrations are not altered around narrow diameter implants in T2DM patients during wound healing

ObjectivesThe aim of this study was to assess the microcirculation and the expression patterns of wound-healing-related cytokines around narrow-diameter implants in type 2 diabetes mellitus (T2DM) and normo-glycemic patients.Materials and methodsA total of 31 patients, 16 of which diagnosed with T2DM (HbA1c > 6.5) and 15 normo-glycemic patients, received narrow diameter implants in the posterior mandible or maxilla. During the 3-month healing period, soft-tissue perfusion was monitored via laser Doppler flowmetry. Peri-implant fluid (PICF) was harvested and analyzed for concentrations of interleukin-1ß (IL-1ß), interleukin-23 (IL-23), interleukin-17 (IL-17), and granulocyte colony-stimulating factor (G-CSF) by a multiplex, bead-based immunoassay.ResultsMicrocirculatory perfusion patterns during wound healing exhibited no significant differences throughout the observation period. IL-1ß concentrations were expectedly elevated during the early phases of wound healing. At the first visit after surgery, IL-23 concentrations were significantly higher in implants of diabetic patients. This difference was diminished over the course of the observation period. For the other tested analytes, no differences were observable between both groups.ConclusionWound healing after implant surgery was similar in T2DM and healthy patients. Hydrophilic-surface titanium-zirconium implants with reduced diameter may be considered for implant therapy of diabetes mellitus type II patients.Registration numberNCT04630691 (clinicaltrials.gov).

The Emerging Role of Metformin in the Prevention and Treatment of Colorectal Cancer: A Game Changer for the Management of Colorectal Cancer.

Metformin is an old, inexpensive, and relatively safe anti-diabetic medication that can decrease the risk of several types of cancer in patients with diabetes. Recent meta-analyses have revealed that metformin markedly decreased the incidence of colorectal adenoma, advanced adenoma, and colorectal cancer (CRC) among patients with diabetes. Potential mechanisms by which metformin may decrease colorectal cancer risk include its effects on ameliorating intestinal inflammation and dysbiosis, suppressing major proliferative pathways, preventing DNA replication, accelerating tumor cells apoptosis, inhibiting intra-tumor angiogenesis and epithelial-mesenchymal transition (EMT), increasing tumor-infiltrating lymphocytes and CD68+ tumor-associated macrophages, and enhancing T cells cytotoxic activity. It is well-known that metformin can improve overall survival and CRC-specific survival among patients with diabetes and CRC. Interestingly, metformin decreases the incidence of colonic adenoma in patients with acromegaly and reduces the incidence of inflammatory bowel disease (IBD) among patients with diabetes, which can indirectly lower the risk of CRC. Results of phase II clinical trials have revealed that metformin can enhance the anti-cancer effects of chemotherapeutic agents, such as 5-Fluorouracil (5-FU) and irinotecan on refractory CRC. Furthermore, metformin decreases the risk of new polyps and adenomas in patients without diabetes. Regarding the results of previous preclinical and clinical studies, it is rational to assess the effect of metformin in normoglycemic patients with CRC and expand its clinical application for treating CRC or preventing it in a high-risk population.