Normoglycemic Group Research Articles

Lycium Barbarum polysaccharides ameliorates hyperglycemia-exacerbated cerebral ischemia/reperfusion injury via protecting blood-brain barrier

BackgroundHyperglycemia exacerbates brain damage in cerebral ischemia/reperfusion injury. Previous study found that Lycium barbarum polysaccharides (LBP) has a neuroprotective effect on hyperglycemia-aggravated ischemic brain injury, which raising the possibility for treatment of neurodegenerative diseases. However, the underlying mechanism of LBP-induced protection by ameliorating hyperglycemia-aggravated ischemia/reperfusion injury needs to be tested. This study aimed to investigate the effects of LBP on blood–brain barrier (BBB) integrity with a hyperglycemia-aggravated cerebral ischemia/reperfusion injury model. MethodsSprague-Dawley male rats were randomly divided into three groups: normoglycemic (NG), hyperglycemic (HG), and LBP-pretreated hyperglycemic (HG + LBP). Animals underwent middle cerebral artery occlusion (MCAO) for 30 min, followed by 1-, 3-, and 7-day of reperfusion. ResultsOur results showed that the neurological deficit, infarct volume, cell apoptosis, and IgG leakage in the HG group significantly increased separately, compared with that of the NG group, (p < 0.05). Pre-treatment with LBP reversed these injury indicators (p < 0.05). And much more severe degree of swelling endothelium, swollen astrocyte, and decreased tight junctions in the micro-vessel were detected in the HG group comparing to that of the NG group. In addition, increased degree of basement membrane degradation, dissociation between the astrocyte endfeet and basement membrane, and tight junction's protein degradation was found in the HG group compared with the NG group (p < 0.05). However, when exposure to LBP therapy could reverse the above alterations (p < 0.05). ConclusionsThese results demonstrated that LBP could ameliorate hyperglycemia-exacerbated cerebral ischemia/reperfusion injury via protecting the blood-brain barrier.

Monocyte-Lymphocyte Ratio and Dysglycemia: A Retrospective, Cross-Sectional Study of the Saudi Population.

Abnormalities in fasting blood glucose (FBG) resulting in hypoglycemia (OG), impaired fasting glycemia (IFG), or hyperglycemia (HG) arise from disordered metabolic regulation caused in part by inflammation. To date, there is a dearth of evidence regarding the clinical utility of the monocyte-lymphocyte ratio (MLR), an emerging inflammatory index, in the management of dysglycemia. This retrospective, cross-sectional study explored MLR fluctuations as a function of glycemic control in 14,173 Saudi subjects. Data collected from 11 August 2014 to 18 July 2020 were retrieved from Al-Borg Medical Laboratories. Medians were compared by Mann-Whitney U or Kruskal-Wallis tests and the prevalence, relative risk (RR), and odds ratio (OR) were calculated. MLR was significantly elevated in IFG (p &lt; 0.0001) and HG (p &lt; 0.05) groups compared to the normoglycemia (NG) group, and individuals with elevated MLR (&gt;0.191) had significantly increased FBG (p &lt; 0.001). The risk of IFG (RR = 1.12, 95% CI: 1.06-1.19, p &lt; 0.0002) and HG (RR = 1.10, 95% CI: 1.01-1.20, p &lt; 0.0216) was significantly increased if MLR was elevated, and individuals with elevated MLR were 1.17 times more likely to have IFG (OR = 1.17, 95% CI: 1.08-1.26, p &lt; 0.0002) and 1.13 times more likely to have HG (OR = 1.13, 95% CI: 1.02-1.24, p &lt; 0.0216). Elevated MLR is correlated with and carries a greater risk for IFG and HG. However, large prospective cohort studies are needed to establish the temporal relationship between MLR and FBG and to examine the prognostic value of this novel marker.

Neurocognitive Outcomes at Age 2 Years After Neonatal Hypoglycemia in a Cohort of Participants From the hPOD Randomized Trial

Neonatal hypoglycemia is common, but its association with later neurodevelopment is uncertain. To examine associations between neonatal hypoglycemia and neurocognitive outcomes at corrected age 2 years. Exploratory cohort analysis of the Hypoglycaemia Prevention With Oral Dextrose (hPOD) randomized clinical trial was conducted. The trial recruited participants from January 9, 2015, to May 5, 2019, with follow-up between January 26, 2017, and July 31, 2021. Infants were recruited from 9 maternity hospitals in New Zealand and assessed at home or in a research clinic. Children born late preterm and at term at risk of neonatal hypoglycemia but without evidence of acute or imminent illness in the first hour after birth were screened and treated to maintain blood glucose concentrations greater than or equal to 47 mg/dL. Hypoglycemia was defined as any blood glucose concentration less than 47 mg/dL, recurrent as 3 or more episodes, and severe as less than 36 mg/dL. Neurologic examination and tests of development (Bayley III) and executive function. The primary outcome was neurosensory impairment (any of the following: blindness, deafness, cerebral palsy, developmental delay, or executive function total score worse than 1.5 SD below the mean). A total of 1197 of 1321 (91%) eligible children were assessed at a mean of corrected age 24 months; 616 (52%) were male. Compared with the normoglycemia group, children who experienced hypoglycemia were more likely to have neurosensory impairment (111 [23%] vs 125 [18%]; adjusted risk ratio [aRR], 1.28; 95% CI, 1.01-1.60), particularly if they experienced severe episodes (30 [28%] vs 125 [18%]; aRR, 1.68; 95% CI, 1.20-2.36), but not recurrent episodes (12 [19%] vs 125 [18%]; aRR, 1.06; 95% CI, 0.63-1.80). The risk of cognitive, language, or motor delay was similar between groups, but children who experienced hypoglycemia had lower Bayley-III composite cognitive (adjusted mean difference [aMD], -1.48; 95% CI, -2.79 to -0.18) and motor scores (aMD, -2.05; 95% CI, -3.30 to -0.79). In children born at risk of hypoglycemia but otherwise well, those who experienced neonatal hypoglycemia were more likely to have neurosensory impairment at corrected age 2 years, with higher risks after severe episodes. Further research is required to determine causality.

Cesarean delivery rates and indications in pregnancies complicated by diabetes

Objective Rates of pregestational (PGDM) and gestational diabetes (GDM), and their associated pregnancy complications, are rising. Pregnancies complicated by diabetes have increased cesarean delivery (CD) rates; however, there are limited data regarding the current rates of, and contributing factors to, these deliveries. The Robson Ten Group Classification System (TGCS) is a clinically relevant, standardized framework that can be used to evaluate and analyze cesarean rates. The objective of this study was to evaluate rates of, and indications for, intrapartum, unplanned CD among pregnancies complicated by diabetes, compared to normoglycemic (NG) pregnancies, in a large United States birth cohort. Methods This retrospective cohort study used chart-abstracted data on births between 24 and 42 weeks’ gestation at 17 hospitals that contributed to the Obstetrical Care Outcome Assessment Program database between 01/2016 and 03/2019. The CD rate for NG pregnancies, and pregnancies complicated by gestational and PGDM was calculated and compared using the Robson TGCS. The indications for intrapartum CD in patients with term, singleton, vertex gestations without a prior cesarean were then analyzed. Univariate and multivariate logistic regression models were used to compare the cesarean rate and indications for CD, between the diabetic groups and the NG group. Results were adjusted for maternal age, BMI, neonatal birth weight, and insurance status, as well as clustering by hospital. Results A total of 86,381 pregnant people were included in the study cohort. Of these 76,272 (88.3%) were NG, 8591 (9.9%) had GDM, and 1518 (1.8%) had PGDM. Compared to NG patients, overall cesarean rates were higher in patients with GDM (40.3% vs. 29.7%; aOR 1.25, 95%CI 1.18–1.31) and PGDM (60.0% vs. 29.7%; aOR 2.53, 95%CI 2.04–3.13). This finding remained true when the cohort was restricted to term, singleton, vertex laboring patients without a prior cesarean; compared to NG patients, the cesarean rate was higher in patients with GDM (17.4% vs. 12.2%, aOR 1.37, 95%CI 1.29–1.45) and PGDM (26.0% vs. 12.2%, aOR 2.55, 95%CI 2.00–3.25). The cesarean rate for fetal indications was similar in the GDM (5.7%) and NG (4.4%) groups, while those patients with PGDM had a significantly higher rate (10.4%; aOR 2.01, 95%CI 1.43–2.83). Similarly, the rate of cesarean for labor dystocia in patients with PGDM was significantly higher than in NG patients (16.9% vs. 7.0%, and aOR 2.28, 95%CI 1.66–3.13) while patients with GDM had an intermediate rate (10.6% vs. 7.0%, aOR 1.49, 95%CI 1.40–1.57). Conclusions The CD rate is significantly higher in pregnancies complicated by diabetes, particularly pregestational, compared to NG pregnancies. Despite controlling for maternal factors and birth weight, pregnancies complicated by diabetes are more likely to undergo an unplanned intrapartum cesarean secondary to labor dystocia than their NG counterparts, but only pregnancies complicated by PGDM have an increased risk of cesarean for fetal indications. More research is needed to understand whether this higher cesarean rate is due to factors intrinsic to diabetes in laboring patients or is due to a difference in the way clinicians manage diabetics in labor.

DISTRIBUTION OF KCNJ11 RS5219 POLYMORPHISM IN VIETNAMESE POPULATION AND ITS ASSOCIATION WITH HYPERGLYCEMIA

Aims: KCNJ11 gene, encoding ATP-sensitive channel subunits, involves in insulin secretion. The study aimed at investigating the distribution of the KCNJ11 E23K (rs5219) polymorphism and its association with prediabetes and type 2 diabetes (T2D) in Vietnamese population. Methods: A cross-sectional study randomly recruited 2.676 participants aged 40-64 years from a general population in Ha Nam province, Vietnam. Glycemic status of the subjects was classified based on fasting plasma glucose and oral glucose tolerance test. PCR-restriction fragment length polymorphism method was applied to detect the KCNJ11-rs5219 polymorphism. Genotype frequencies were compared to find the distribution difference among normoglycemic, prediabetes, and T2D groups. Generalized linear models and multinomial logistic regression analysis were used to determine the associations of the KCNJ11-rs5219 polymorphism with prediabetes and T2D. Results: The frequencies of minor K allele in normoglycemic, prediabetes and T2D groups were 33.2, 32.6 and 35.4%, respectively. Genotype distribution of the E23K polymorphism was in Hardy-Weinberg equilibrium and not significantly different among the three glucose groups (p &gt; 0.05). Fasting plasma glucose and 2-h glucose levels were not significantly different among three genotypes EE, EK, and KK (p &gt; 0.05). After adjusted for social-economic status, lifestyle and clinical patterns, no significant association was found between the KCNJ11-rs5219 polymorphism and hyperglycemia with ORs from 0.80 to 1.29. Conclusions: The minor K allele was predominant and genotype frequency in the population was remained constant among generations. The study suggests no significant association between the KCNJ11-rs5219 polymorphism and hyperglycemia in the Vietnamese population.

Difference on Glucose Profile From Continuous Glucose Monitoring in People With Prediabetes vs. Normoglycemic Individuals: A Matched-Pair Analysis.

Comprehensive characteristics of the glycemic profile for prediabetes derived by continuous glucose monitoring (CGM) are unknown. We evaluate the difference of CGM profiles between individuals with prediabetes and normoglycemic individuals, including the response to oral glucose tolerance test (OGTT). Individuals with prediabetes matched for age, sex, and BMI with normoglycemic individuals were instructed to use professional CGM for 1 week. OGTT was performed on the second day. The primary outcomes were percentages of glucose readings time below range (TBR): <54 or <70 mg/dL, time in range (TIR): 70 to 180 mg/dL, and time above range (TAR): >180 or >250 mg/dL. Area under the curve (AUC) was calculated following the OGTT. Glucose variability was depicted by coefficient of variation (CV), SD, and mean amplitude of glucose excursion (MAGE). Wilcoxon sign-ranked test, McNemar mid P-test and linear regression models were employed. In all, 36 participants (median age 51 years; median body mass index [BMI] = 26.4 kg/m2) formed 18 matched pairs. Statistically significant differences were observed for 24-hour time in range (TIR; median 98.5% vs. 99.9%, P = .013), time above range (TAR) >180 mg/dl (0.4% vs. 0%, P = .0062), and 24-hour mean interstitial glucose (113.8 vs. 108.8 mg/dL, P = .0038) between people with prediabetes compared to normoglycemic participants. Statistically significant differences favoring the normoglycemic group were found for glycemic variability indexes (median CV 15.2% vs. 11.9%, P = .0156; median MAGE 44.3 vs. 33.3 mg/dL, P = 0.0043). Following OGTT, the AUC was significantly lower in normoglycemic compared to the prediabetes group (median 18615.3 vs. 16370.0, P = .0347 for total and 4666.5 vs. 2792.7, P = .0429 for incremental 2-hour post OGTT). Individuals with prediabetes have different glucose profiles compared to normoglycemic individuals. CGM might be helpful in individuals with borderline glucose values for a more accurate reclassification.

Neutrophil to high-density lipoprotein cholesterol ratio predicts adverse cardiovascular outcomes in subjects with pre-diabetes: a large cohort study from China

BackgroundThis study aimed to examine whether the neutrophil to high-density lipoprotein cholesterol ratio (NHR) can predict cardiovascular outcomes in normoglycemic individuals with elevated fasting glucose levels.MethodsA total of 130,801 participants with normal blood glucose levels were enrolled in the Kailuan study. Participants were categorized according to NHR quartiles and further divided into normal glucose regulation (NGR) and pre-diabetes (pre-DM) subgroups. The follow-up endpoint was major adverse cardiovascular events (CVE), including stroke and myocardial infarction.ResultsOver a median of 12.53 (8.95–13.08) years of follow-up, subjects with NHR levels in the highest quartile experienced more CVE than those with NHR levels in the lowest quartile. Multivariate Cox analyses showed that continuous changes in NHR (hazard ratio, 1.21; 95% confidence interval [CI], 1.15–1.28) and the highest quartile of NHR (hazard ratio, 1.30; 95% CI, 1.21–1.39) were independent predictors of CVE (all P < 0.001). Furthermore, when participants were categorized by both NHR quartile and glucose metabolism status, the NHR level in the highest quartile plus pre-DM group was associated with a 1.60-fold (95% CI, 1.38–1.86; P < 0.001] higher risk of CVE than that in the lowest quartile plus normoglycemic group. Significantly, the addition of NHR only, presence of pre-DM only, or combination of NHR and pre-DM to the prediction algorithm, including traditional risk factors, improved the C-statistic by 0.19, 0.05, and 0.23 (all P < 0.001).ConclusionsElevated NHR or fasting blood glucose level were independently associated with a higher risk of CVE among normoglycemic individuals. Moreover, pre-DM participants with high NHR levels tended to have worse prognosis, suggesting that NHR could provide greater risk stratification value than traditional risk factors for subjects with pre-DM.

Dietary Inflammation Index and Its Association with Long-Term All-Cause and Cardiovascular Mortality in the General US Population by Baseline Glycemic Status.

Dietary inflammatory potential has been proven to be correlated with the incidence of diabetes and cardiovascular diseases. However, the evidence regarding the impact of dietary inflammatory patterns on long-term mortality is scarce. This cohort study aims to investigate the dietary inflammatory pattern of the general US individuals by baseline glycemic status and to estimate its association with long-term mortality. A total of 20,762 general American adults with different glycemic statuses from the National Health and Nutrition Examination Survey were included. We extracted 24-h dietary information, and the dietary inflammatory index (DII) was calculated. The outcomes were defined as 5-year all-cause and cardiovascular mortality. Compared with the normoglycemia group, individuals with prediabetes and type 2 diabetes had higher DII scores (overall weighted p < 0.001). Compared with low DII scores, participants with high DII scores were at a higher risk of long-term all-cause mortality (HR: 1.597, 95% CI: 1.370, 1.861; p < 0.001) and cardiovascular mortality (HR: 2.036, 95% CI: 1.458, 2.844; p < 0.001). The results were stable after adjusting for potential confounders. Moreover, the prognostic value of DII for long-term all-cause mortality existed only in diabetic individuals but not in the normoglycemia or prediabetes group (p for interaction = 0.006). In conclusion, compared to the normoglycemia or prediabetes groups, participants with diabetes had a higher DII score, which indicates a greater pro-inflammatory potential. Diabetic individuals with higher DII scores were at a higher risk of long-term all-cause and cardiovascular mortality.

Big Endothelin-1 and long-term all-cause death in patients with coronary artery disease and prediabetes or diabetes after percutaneous coronary intervention

Background and aimsThe present study aimed to examine the association between big endothelin-1 (big ET-1) and long-term all-cause death in patients with coronary artery disease (CAD) and different glucose metabolism status. Methods and resultsWe consecutively enrolled 8550 patients from January 2013 to December 2013. Patients were categorized according to both status of glucose metabolism status [Diabetes Mellitus (DM), Pre-Diabetes (Pre-DM), Normoglycemia (NG)] and big ET-1 levels. Primary endpoint was all-cause death.During a median of 5.1-year follow-up periods, 301 all-cause deaths occurred. Elevated big ET-1 was significantly associated with long-term all-cause death (adjusted HR: 2.230, 95%CI 1.629–3.051; p < 0.001). Similarly, patients with DM, but not Pre-DM, had increased risk of all-cause death compared with NG group (p < 0.05). When patients were categorized by both status of glucose metabolism and big ET-1 levels, high big ET-1 were associated with significantly higher risk of all-cause death in Pre-DM (adjusted HR: 2.442, 95% CI 1.039–5.740; p = 0.041) and DM (adjusted HR: 3.162, 95% CI 1.376–7.269; p = 0.007). The Kaplan–Meier curve indicated that DM patients with the highest big ET-1 levels were associated with the greatest risk of all-cause death (p < 0.05). ConclusionsThe present data indicate that baseline big ET-1 levels were independently associated with the long-term all-cause death in DM and Pre-DM patients with CAD undergoing PCI, suggesting that big ET-1 may be a valuable marker in patients with impaired glucose metabolism.

The reduced serum concentrations of β-arrestin-1 and β-arrestin-2 in pregnancies complicated with gestational diabetes mellitus

Objective This study aimed to analyze maternal serum β-arrestin-1 and β-arrestin-2 concentrations in pregnant women complicated with gestational diabetes mellitus (GDM) and compare them with the normoglycemic uncomplicated healthy control group. Methods A prospective case-control study was conducted, including pregnant women complicated with GDM between 15 February 2021, and 31 July 2021. We recorded serum β-arrestin-1 and β-arrestin-2 concentrations of the participants. Receiver operating characteristic (ROC) curves were used to describe and compare the performance of diagnostics value of variables β-arrestin-1, and β-arrestin-2. Results The mean β-arrestin-1 and β-arrestin-2 levels were found to be significantly lower in the GDM group (41.0 ± 62.8 ng/mL, and 6.3 ± 9.9 ng/mL) than in the control group (93.1 ± 155.4 ng/mL, and 12.4 ± 17.7, respectively, p < .001). When we analyze the area under the ROC curve (AUC), maternal serum β-arrestin-1 and β-arrestin-2 levels can be considered a statistically significant parameter for diagnosing GDM. β-arrestin-1 had a significant negative correlation with fasting glucose (r = −0.551, p < .001), plasma insulin levels (r = −0.522, p < .001), HOMA-IR (r = −0.566, p < .001), and HbA1C (r = −0.465, p < .001). β-arrestin-2 was significantly negatively correlated with fasting glucose (r = −0.537, p < .001), plasma insulin levels (r = −0.515, p < .001), HOMA-IR (r = −0.550, p < .001), and HbA1C (r = −0.479, p < .001). Conclusion β-arrestin 1 and β-arrestin 2 could be utilized as biomarkers in the diagnosis of GDM. The novel therapeutic strategies targeting these β-arrestins may be designed for the GDM treatment.

The Kynurenine Pathway in Obese Middle-Aged Women with Normoglycemia and Type 2 Diabetes.

We examined the relationships of tryptophan (Trp) and the metabolites of the kynurenine pathway (KP) to the occurrence of type 2 diabetes (T2D) and metabolic risk factors in obese middle-aged women. The study included 128 obese women divided into two subgroups: a normoglycemic group (NG, n = 65) and a T2D group (n = 63). The concentrations of serum tryptophan (Trp), kynurenine (Kyn), 3-hydroxykynurenine (3HKyn), quinolinic acid (QA), and kynurenic acid (Kyna) were analyzed using ultra-high-performance liquid chromatography coupled with electrospray ionization/triple quadrupole mass spectrometry. Blood biochemical parameters and anthropometric parameters were measured. The women with T2D had significantly higher Trp, Kyna, Kyna/QA ratio, and Kyna/3HKyn ratio values than the NG women. Logistic regression analysis showed that the concentrations of Trp and Kyna and the values of the Kyna/3HKyn ratio were most strongly associated with T2D occurrence, even after controlling for confounding factors. The model with Trp level and Kyna/3HKyn ratio accounted for 20% of the variation in the presence of T2D. We also showed a different pattern of correlations between kynurenines and metabolic factors in the NG and T2D women, which was mostly reflected in the stronger relationship between BMI and KP metabolites in the NG obese women. An increase in Trp and Kyna levels with an accompanying increase in Kyna/3HKyn ratio value is associated with the occurrence of T2D in obese middle-aged women.

Oxidative Status and Thiol/Disulfide Homeostasis Are Changed During 75 g Oral Glucose Tolerance Test over a Five-Hour Period

Background Oral glucose loading may affect oxidative status during oral glucose tolerance test (OGTT). We aimed to investigate how oxidant and antioxidant markers and thiol/disulfide parameters change during OGTT. Methods OGTT was performed to 42 volunteers who were considered risk of type 2 diabetes and were divided into three groups (normoglycemic, prediabetes, diabetes) according glucose levels during OGTT. Glucose, insulin, c-peptide, total antioxidant status (TAS), total oxidant status (TOS), total thiol and native thiol were investigated with auto-anaylzer for five-hours period. Results Decrease of TAS and increase of TOS levels began with the increase in glucose and insulin levels. The increase of TAS started at third hour and reached the highest levels at fifth hour. OSI levels were higher at fourth hour than fasting and first hours in normoglycemic and diabetes groups. In the prediabetic group, TAS were higher than the other groups, TOS peak was at the second hour (p < 0.05). Native thiol and total thiol levels showed variable course during OGTT, both parameters increased at the end of the process (p < 0.05). Disulfide levels showed an increase trend but it was not statistically different in normoglycemic and diabetes groups. In prediabetes group, second hour disulfide level was lower than fasting state and disulfide was significantly increased at third, fourth and fifth hours and fifth hour disulfide level was also higher than fasting. Conclusion Oxidative stress parameters and thiol/disulfide balance were found to deteriorate within five-hours after glucose loading in all groups. These results indicates that oxidative stress occurs during OGTT.

Effects of Hypertension on Two-Year Outcomes According to Glycemic Status in Patients With Acute Myocardial Infarction Receiving Newer-Generation Drug-Eluting Stents.

The effects of hypertension on long-term outcomes according to glycemic status in patients with acute myocardial infarction (AMI) after successful implantation of newer-generation drug-eluting stents (DES) have not been fully investigated. In this retrospective cohort study, a total of 11,911 patients were classified into 6 groups according to their glycemic status and presence or absence of hypertension. The major outcome was major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (Re-MI), or any revascularization. In patients without hypertension, the major outcomes were similar between the normoglycemia and prediabetes groups. However, MACE, all-cause death, cardiac death (CD), Re-MI rates were higher in patients with type 2 diabetes mellitus (T2DM) than in normoglycemic patients. Additionally, Re-MI was higher in patients with T2DM than in prediabetic patients. In patients with hypertension, although the major outcomes were similar between the prediabetes and T2DM groups, in both the prediabetes and T2DM groups, MACE, all-cause death, and CD rates were higher than those in the normoglycemia group. During a 2-year follow-up, the comparable harmful effects of hypertension in patients with AMI and prediabetes or T2DM were observed. Effective blood pressure and glucose control should be strengthened to reduce mortality in these patients.

Prevalence of carbohydrate metabolism disorders and association with cardiovascular diseases in a large Siberian region

Aim. To study the prevalence of carbohydrate metabolism disorders in a repre - sentative sample of the working-age population of the Krasnoyarsk Krai aged 25-64 years and to identify the association of these disorders with cardiovascular pathology.Material and methods. A random representative sample within the all-Russian epidemiological study ESSE-RF included 1603 residents of the Krasnoyarsk Krai aged 25 to 64 years. The gradation of carbohydrate metabolism disorders was carried out on the basis of fasting plasma glucose level in accordance with the criteria of the American Diabetes Association (ADA). Hypertension (HTN) was defined as office BP ≥140/90 mm Hg or an indication of previous use of antihypertensive drugs. The presence of myocardial infarction (MI), stroke, coronary artery disease (CAD) was detected by anamnesis collection. Statistical processing was carried out using IBM SPSS v 22 and Microsoft Excel 2021 programs. When comparing differences by sex, age, level of education, and type of residence, differences was assessed by chi-squared test and considered significant at p≤0,05.Results. In total representative sample of Krasnoyarsk Krai population, 3,6% of participants indicated prior diabetes, while its prevalence naturally increased with age. The detection rate of fasting glucose of 5,6-6,9 mmol/l among individuals without prior diabetes (impaired fasting glycemia (IFG), as one of the criteria for prediabetes, according to ADA guidelines) was 22,5% of the general population. Fasting hyperglycemia (HG) ≥7,0 mmol/l without prior diabetes was registered in 3,8%. This figure can be roughly considered as the proportion of people with newly diagnosed diabetes. IFG and HG were significantly more common among men, as well as among those with primary and secondary education compared with higher education. In rural residents, all types of carbohydrate metabolism disorders were more common than in urban ones. Compared with the normoglycemic group, the presence of prior diabetes, IFG and GH was associated with a significantly higher prevalence of hypertension, CAD and stroke.Conclusion. The prevalence of IFG, fasting HG ≥7,0 mmol/l and diagnosed diabetes in a representative sample of the Krasnoyarsk Krai aged 25-64 years exceeds the national average, although it is consistent with the data of a number of other Siberian regions. The prevalence of both carbohydrate metabolism disorders in general and the percentage of possible undiagnosed diabetes increases with age. At the same time, there are more such individuals among those with primary and secondary education, as well as among rural residents. The approximate proportion of undiagnosed diabetes in the study population reaches 50%. Timely detection of carbohydrate metabolism disorders can contribute to the earlier implementation of active preventive measures and reduce the risk of cardiovascular events.

Hyperglycemia and Physical Impairment in Frail Hypertensive Older Adults.

BackgroundFrailty is a multidimensional condition typical of elders. Frail older adults have a high risk of functional decline, hospitalization, and mortality. Hypertension is one of the most common comorbidities in elders. Hyperglycemia (HG) is frequently observed in frail older adults, and represents an independent predictor of worst outcomes, with or without diabetes mellitus (DM). We aimed at investigating the impact of HG on physical impairment in frailty.MethodsWe studied consecutive older adults with frailty and hypertension at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, from March 2021 to September 2021. Exclusion criteria were: age <65 years, no frailty, no hypertension, left ventricular ejection fraction <25%, previous myocardial infarction, previous primary percutaneous coronary intervention and/or coronary artery bypass grafting. Blood glucose, Hb1Ac, and creatinine were measured in all patients. Physical frailty was assessed applying the Fried Criteria; we performed a 5-meter gait speed (5mGS) test in all patients.Results149 frail hypertensive older adults were enrolled in the study, of which 82 had normoglycemia (NG), and 67 had HG. We observed a significantly slower 5mGS in the HG group compared to the NG group (0.52 ± 0.1 vs. 0.69 ± 0.06; p<0.001). Moreover, we found a strong and significant correlation between 5mGS and glycemia (r: 0.833; p<0.001). A multivariable linear regression analysis using 5mGS as a dependent variable revealed a significant independent association with glycemia (p<0.001) after adjusting for likely confounders.ConclusionsHG drives physical impairment in frail hypertensive older adults independently of DM.

Association between Stress Hyperglycemia and Adverse Outcomes in Children Visiting the Pediatric Emergency Department.

Stress hyperglycemia (SH) is often identified in patients visiting the pediatric emergency department (PED), and SH in adults has been associated with adverse outcomes, including mortality. In this retrospective study, we determined the adverse outcomes according to blood glucose (BG) levels of children visiting the PED of tertiary hospitals. Data were collected from the electronic medical records of children aged <18 years between 1 January 2011 and 31 December 2020. A total of 44,905 visits were included in the analysis. SH was identified in 1506 patients, with an incidence rate of 3.4%. Compared to those without SH, patients with SH had significantly higher ward admission rates (52.6% vs. 35.9%, p < 0.001), intensive care unit admission rates (2.6% vs. 0.7%, p < 0.001), and mortality rates (2.7% vs. 0.3%, p < 0.001). Compared to the normoglycemic group of 45 ≤ BG < 150 mg/dL, the odds ratios (95% CI) for mortality were 5.61 (3.35–9.37), 27.96 (14.95–52.26), 44.22 (17.03–114.82), and 39.94 (16.31–97.81) for levels 150 ≤ BG < 200, 200 ≤ BG < 250, 250 ≤ BG < 300 and ≥300 mg/dL, respectively. This suggests that SH is common in children visiting the PED and is associated with higher adverse outcomes. Thus, there is a need to quickly identify its cause and take prompt intervention to resolve it.

Evidence From a Systematic Review and Meta-Analysis: Classical Impaired Glucose Tolerance Should Be Divided Into Subgroups of Isolated Impaired Glucose Tolerance and Impaired Glucose Tolerance Combined With Impaired Fasting Glucose, According to the Risk of Progression to Diabetes.

BackgroundThe American Diabetes Association (ADA) 2003 diagnostic criteria divide impaired glucose tolerance (IGT) into isolated impaired glucose tolerance with normal fasting glucose (I-IGT, IGT+NFG) and impaired glucose tolerance combined with impaired fasting glucose (IGT+IFG), while the World Health Organization (WHO) 1999 criteria do not. The aim of this meta-analysis was to evaluate whether IGT should be divided into I-IGT (IGT+NFG) or IGT+IFG according to their risk of progression to type 2 diabetes.MethodsThe MEDLINE and EMBASE were searched to identify prospective cohort studies published in English prior to April 18, 2020. Review Manager 5.3 was used to calculate the pooled risk ratios (RRs) and 95% confidence intervals (CIs) as summary statistics for each included study.ResultsSixteen eligible studies (n = 147,006) were included in the analysis. The subsequent incidence of type 2 diabetes was lower in the I-IGT (IGT+NFG) group than in the IGT+IFG group (0.45 [95% CI 0.37, 0.55] according to WHO 1999 criteria and 0.59 [95% CI 0.54, 0.66] according to ADA 2003 criteria). It was higher in the I-IFG, I-IGT (IGT+NFG), and IGT+IFG groups than in the normoglycemic group (95% CI of 5.53 [3.78, 8.08], 5.21 [3.70, 7.34], and 11.87 [7.33, 19.20] according to the WHO 1999 criteria and 95% CI of 2.66 [2.00, 3.54], 3.34 [2.81, 3.97], and 6.10 [4.72, 7.88] according to the ADA 2003 criteria). In general, the incidence of diabetes in the IGT+IFG group was the highest in the prediabetic population.ConclusionsThe present meta-analysis suggested that the established WHO diagnostic criteria for IGT should be revised to separately identify individuals with IGT+NFG or IGT+IFG.

Abstract WP249: Effect Of Acute Hyperglycemia On Stroke Outcome And Immune Response

Background: Acute hyperglycemia occurs in over 40% of ischemic stroke patients, increases hemorrhagic transformation (HT) and worsens stroke outcome. Previous rodent studies reported deleterious effects of hyperglycemia on stroke outcome during acute stroke (within hours to days), however, its impact during subacute stroke period (days to weeks) remains unclear. Moreover, the mechanisms underlying hyperglycemia’s worsening of stroke outcomes remains elusive. In this study, we investigated the effect of acute hyperglycemia on immune responses and stroke outcome in acute and subacute phases. Method: Male C57/BL6 mice were subjected to middle cerebral artery occlusion (MCAO) for 30 min, followed by reperfusion to mimic ischemic stroke. Acute hyperglycemia was induced by glucose injection 10 min before MCAO. For the acute phase study, mice were sacrificed at 4.5 hrs to assess blood-brain barrier leakage (Evans blue) and brain immune cell populations (flow cytometry), and at 24 hrs to evaluate brain infarct, swelling and HT. In the sub-acute phase, mice were allowed to survive 14 days after stroke to evaluate mortality rate, neurological deficit, and motor-sensory dysfunction using a rotating beam test. Result: In the acute phase, hyperglycemia rapidly increased BBB leakage by 4.5 hrs after stroke, when compared to the normoglycemia group (p&lt;0.0001). At this early timepoint, hyperglycemic mice brains showed more Ly6C hi microglia and infiltrating myeloid cells, including neutrophils and Ly6C hi monocytes, than normoglycemic mice. By 24 hrs after stroke, hyperglycemic mice showed increased HT and larger brain edema; brain infarct volume however, was not affected. In the subacute-phase, hyperglycemic mice exhibited a higher mortality rate than normoglycemic mice (100% VS 25%, p=0.0008), with greater body weight loss, and worsened neurological deficit and rotating beam performance. Conclusion: Acute hyperglycemia adversely impacts stroke outcomes in acute and subacute phases, with HT and brain edema as the key pathological events associated with higher mortality, as well as more severe neurological and motor-sensory deficits. Rapid modulation of immune responses may play an important role in mediating the detrimental effect of hyperglycemia.

Magnesium and Melatonin Co-Administration Attenuates Blood Glucose Levels in Streptozotocin-Induced Diabetic Rats

Diabetes mellitus (DM) is a serious metabolic disorder characterized by elevated blood glucose. The raised blood glucose level if not properly managed can results in damage and failure of several vital organs such as the eyes, kidneys, nerves, heart, and blood vessels. The aim of this study was to evaluate the effects of co-administration of melatonin and magnesium on blood glucose level of streptozotocin-induced Type 1 diabetic Wistar rats. To achieve this aim sixty-four Wistar rats were used in the study. Streptozotocin (STZ) was used to induce chemical type 1 diabetes mellitus (T1DM) after two weeks acclimatization period in fifty-eight Wistar rats. Fifty-three rats were diabetic and fourty-eight diabetic rats were randomly distributed in eight groups and six normal normoglycaemic rats were used as control. The animals were assigned into nine groups as follows, Normal control group (NC), Diabetic control (DC) group, Melatonin Low dose group of 10 mg/kgb (MLD), magnesium low dose group of 240 mg/kgbw (MgLD), melatonin and magnesium combined low dose group of 10mg/kgbw+240mg/kgbw (MMgLD), melatonin high dose group of 20mg/kgbw (MHD), magnesium high dose group of 480mg/kgbw (MgHD), melatonin and magnesium high dose combined group of 20mg/kgbw+480mg/kgbw (MMgHD) and insulin at 500mg/kgbw group (IN). Melatonin and insulin were administered through intraperitoneal injections (IP) while magnesium was by oral administration. The control groups were given placebo and all group treatment was for twenty-one days. Blood glucose was measured weekly in all groups by day 8, day 15 and day 22. At the end of the evaluation Day 22, the blood glucose levels showed a highly significant decrease (p˂0.05) in melatonin treatment group at low dose (MLD), melatonin and magnesium combined group at low doses (MMgLD), melatonin treatment group at high doses (MHD) and insulin treated group (IN) when compared with normoglycaemic group (NC) while groups treated with Magnesium at low doses (MgLD), magnesium treated group at high doses and melatonin and magnesium treatment group at high doses (MMgHD) showed no significant decrease (p˂0.05) in blood glucose levels as compared with diabetic control (DC). Melatonin and magnesium co-administration has hypoglycaemic effects on blood glucose levels in STZ-induced type 1 diabetic Wistar rats.

Predictive Value of Glycemia and Free Fatty Acid Levels upon Admission of Children with Scorpionism in Egypt.

Scorpion envenomation is a life-threatening emergency and causes serious health problems in tropical and subtropical regions. The aim of this study was to correlate the serum levels of biochemical parameters at admission in children with scorpion envenomation with subsequent morbidity and mortality. It was a prospective, observational, and descriptive study conducted for scorpion-envenomed children who presented to emergency and intensive care units between April 2019 and September 2019. Demographic, clinical, and laboratory findings of patients were recorded and tabulated. Routine investigations were done for all patients in addition to blood levels of lactate, free fatty acids (FFA), and insulin. All patients were compared according to outcome as survivors and nonsurvivors and according to glucose level as normoglycemic and hyperglycemic groups. There were 62 scorpion sting cases; their mean age was 8.6 ± 3.2 years. Patients aged more than 6 years (74.2%), and males (66.1%) were more affected than others. As regards severity, 25.8% were suffering organ dysfunction, 40.3% suffered systemic manifestations without organ dysfunction, and (33.9%) with only local manifestations. Serum glucose and FFA were significantly higher in nonsurvivors compared with survivors. Shock, convulsion, coma, heart failure, and pulmonary edema were significantly more common in hyperglycemic than normoglycemic group. Hyperglycemia, and raised FFA were associated with severe scorpion envenomation. Raised FFA was well correlated with presence of heart failure, leucocytosis, and hyperglycemia. Adding serum glucose and FFA to monitoring parameters of scorpionism severity can help the prediction of high-risk patients.