Poor Glucose Control Research Articles

Correlation of serum hyaluronic acid with diabetic indices in type 2 diabetes mellitus patients with diabetic nephropathy

Introduction: Hyaluronic Acid (HA) is produced by the endothelial smooth muscle cells and adventitial fibroblasts of the arterial wall. In conditions of hyperglycemia, there is an accumulation of HA in blood vessels and can contribute to the diabetic micro- and macrovascular complications. The current study aims to determine the association of serum Hyaluronic Acid levels in Type 2 diabetes mellitus with diabetic nephropathy and its correlation with diabetic indices and renal function test parameters. Materials and Methods: 60 male subjects,30 cases of Type 2 Diabetes Mellitus patients with diabetic nephropathy and 30 non-diabetic healthy subjects as controls. Fasting venous blood samples were collected from cases and controls and analyzed for serum HA by ELISA and HBA1C, FBS, PPBS, urea, and creatinine by Beckmann Coulter Au 480 automated analyser.24 hours urine was collected and analyzed for urinary microalbumin by an immunoturbidimetric method. Statistical analysis was done with SPSS package and p-value Results: Serum HA levels were significantly higher in diabetic patients with nephropathy (756 ng/ml) when compared to the normal control groups (255 ng/ml). Serum HA also showed a significant positive correlation with FBS, PPBS, HbA1C, urea, creatinine and urine microalbumin. Conclusion: Highly elevated serum Hyaluronic Acid levels and its positive correlation with diabetic indices and renal function test parameters in Type 2 Diabetes Mellitus patients with diabetic nephropathy suggests its association with poor blood glucose control and may possibly predict the development of diabetesrelated vascular complications in Type 2 diabetics without any complications. Keywords: Type 2 Diabetes Mellitus, Hyaluronic acid, Glycocalyx.

Hypercoagulable State and Glycemic Control in Diabetic Patients with Malignancy

BACKGROUND:Diabetes and malignancy are two chronic diseases that have a major impact on the healthy population in developing countries, both contribute to the increase of morbidity and mortality of the patients. Diabetes presented with hyperglycemia due to insufficiency or resistance of insulin has been associated with an increased risk of thrombosis. Malignancy or cancer is number two killer in the developing countries after infectious diseases, one of the most common cause of death in cancer despite the disease itself is thrombosis, which occurred frequently as cancer cause changes in tumor biology, abnormal vascularisation, endothelial dysfunction, activation of coagulation and inflammation. Poor glucose control reflects by HbA1C has a significant correlation with a hypercoagulable state.AIM:This study was to evaluate the relation between hypercoagulable state and glycemic control in diabetic patients with malignancy.METHODS:This is a case control study, eighty samples of diabetes (40 samples were diabetes with malignancy) were collected from private hospitals and clinics. HbA1c, blood glucose level and Ddimer were measured.RESULTS:The forty five percent of the blood glucose level of the samples was not well controlled. Sixty five percent of the samples in this group were norm weight, overweight 20% and obese 10%. The Ddimer levels were elevated in both groups and there was a significant correlation between HbA1C and Ddimer (p-0.046), blood glucose and age (p = 0.017).CONCLUSION:Chronic hyperglycemia will increase the risk of hypercoagulable state, that will also increase the morbidity and mortality rate in diabetes with malignancy patients.

A longitudinal study of the stress of poor glucose control and diabetes distress.

Poor glucose control can be viewed as a stressor, possibly promulgating diabetes distress. We examined the relationship between perceived blood glucose control and diabetes distress over time using a partially controlled cross-lagged path analysis model. After controlling for demographics, control at 6 months was directly related to change in distress at 12 months. Subsequently, distress at 12 months was directly related to change in control at 18 months. Both 6-month control and distress had significant indirect effects on 18-month control and distress. This demonstrates the nuanced bi-directional relationship between the stress of poor perceived control and diabetes distress.

The Intracellular Growth of M. tuberculosis Is More Associated with High Glucose Levels Than with Impaired Responses of Monocytes from T2D Patients.

Diabetes mellitus, a metabolic disease characterized by hyperglycemia and poor glucose control, is a risk factor for Mycobacterium tuberculosis (M. tuberculosis) infection and the development of active tuberculosis. To evaluate whether M. tuberculosis infection susceptibility is associated with an intrinsic factor in monocytes from type 2 diabetes (T2D) patients or it is associated with hyperglycemia per se, we analyzed TLR-2 and TLR-4 expression by flow cytometry and the cytokines IL-1β, IL-6, IL-8, IL-10, and TNF-α by cytometric bead array assays, either stimulated with TLR-2 and TLR-4 ligands or infected with M. tuberculosis in the whole blood from T2D patients (n = 43) and healthy subjects (n = 26) or in CD14+ monocytes from healthy subjects cultured in high glucose (HG) (30 mM). The intracellular growth of M. tuberculosis was evaluated by CFU counts at 0, 1, and 3 days in both monocytes from T2D patients and monocytes from healthy subjects cultured in HG. We did not find significant differences in TLR expression, cytokine production, or growth of M. tuberculosis in monocytes from T2D patients compared with those in monocytes from healthy subjects. Despite these results, in vitro assays of monocytes cultured with 30 mM glucose led to significantly increased TLR-2 and TLR-4 basal expression compared to those of monocytes cultured with 11 mM glucose (P < 0.05). Conversely, the production of IL-6 by TLR-2 ligand stimulation, of IL-1β, IL-6, and IL-8 by TLR-4 ligand stimulation, and of IL-8 by M. tuberculosis infection significantly decreased in monocytes cultured in HG (P < 0.05). Additionally, the intracellular survival of M. tuberculosis increased in monocytes in HG after day 3 of culture (P < 0.05). In conclusion, HG decreased IL-8 production and the intracellular growth control of M. tuberculosis by monocytes, supporting the hypothesis that hyperglycemia plays an important role in the impaired immune responses to M. tuberculosis in patients with T2D.

Challenges And Factors Associated With Poor Glycemic Control Among Type 2 Diabetes Mellitus Patients At Nekemte Referral Hospital, Western Ethiopia.

BackgroundDiabetes is increasing at an alarming rate throughout the world, and ~80% of diabetics live in developing countries. Similar to the rest of sub-Saharan African countries, Ethiopia is experiencing a significant burden of diabetes, with increased prevalence, complications, and mortality, as well as life threatening disabilities. Reasons for poor glycemic control among type 2 diabetes patients are complex and multivariable. Hence, this study aimed to identify challenges and factors associated with poor glycemic control among type 2 diabetes patients.MethodA hospital-based cross-sectional study was conducted among type 2 diabetic patients attending the diabetic clinic of Nekemte Referral Hospital (NRH) from February 1 to April 30, 2018. Fasting blood glucose levels of the last three clinic visits were obtained and the mean fasting blood glucose measurement was used to determine the level of glycemic control. Analysis included both descriptive and inferential statistics with SPSS version 20.0. Predictor variable P<0.05 was considered statistically significant.ResultsOut of the total 228 included type 2 diabetes mellitus (DM) patients, 51.8% were males. The mean age of patients was 43±12.4 years and 154 (67.5%) were found to not be following their general dietary program correctly. Nearly one third, 73 (32%), of patients never attended diabetic education and 52 (22.8%) of the patients had greater than 10 years’ duration on treatment. The majority, 148 (64.9%), of patients had poor blood glucose control. Age 40–60 years (AOR=2.01, 95% CI=0.04–0.06, P=0.044), being illiterate (AOR=3.12, 95% CI=1.52–8.50, P=0.001), having informal education only (AOR=2.28, 95% CI=2.14–32.60, P=0.024), longer duration of diabetes treatment (>10 years) (AOR=3.94, 95% CI=1.51–27.83, P=0.012), inadequate physical exercise (AOR=3.19, 95% CI=1.05–19.84, P=0.019), and smoking (AOR=4.51, 95% CI=0.00–0.50, P=0.022) were independent predictors of poor glycemic control on multivariable logistic regression analysis.ConclusionNearly two-thirds of patients had poorly controlled diabetes. Age, exercise, level of education, duration of the treatment, and smoking were significantly associated with poor glycemic control. Health facilities should provide continuous education, and barriers of glycemic control should be explored with further research.

Fructose tolerance test in obese people with and without type 2 diabetes

Fructose is distinct among common sugars in its ability to raise serum uric acid, and some studies suggest fructose-induced uric acid production may have a role in the ability of this sugar to induce metabolic syndrome. A fructose tolerance test has been previously developed to evaluate the relative ability of fructose to raise uric acid in individuals. However, the effect of fructose to raise uric acid in people with diabetes has not been studied. People with type 2 diabetes (n = 143) and without diabetes controls (n = 132) with similar body mass index (BMI) underwent an oral fructose tolerance test. As a comparison, participants also had their uric acid levels measured after an oral glucose tolerance test on a different day. Serum uric acid was lower in people with type 2 diabetes compared to controls with a similar BMI, especially those with poor glucose control (glycosylated hemoglobin [HbA1c] ≥ 8%). Fructose administration raised serum uric acid in both groups, with a lower absolute rise in people with diabetes. People with diabetes with a blunted rise in serum uric acid had higher baseline serum uric acid concentrations and a higher BMI. People without diabetes with a higher BMI also showed a blunted serum uric acid response. Oral glucose administration lowered serum uric acid in both participants, with a greater fall in those with diabetes. Both the presence of diabetes and obesity blunt the serum uric acid response to fructose ingestion. These data demonstrate altered fructose-dependent urate metabolism in type 2 diabetes.

Impact of elevated glycosylated hemoglobin (HbA1c) on the outcome following coronary artery bypass graft surgery

Objective Glycosylated hemoglobin (HbA1c) is the commonly measured variable to predict or study the outcome following cardiac surgery in diabetic patients. It is a reliable measure of long term glucose control (2 to 3 months). HbA1c level >7% indicates poor blood glucose control. Our objective was to evaluate the association between the elevated HbA1c and adverse outcome after coronary artery bypass surgery both in diabetic as well as in non-diabetic patients. Methods 1080 patients were included in the prospective observational study. All patients underwent elective coronary artery bypass grafting surgery (CABG) using cardiopulmonary bypass. 581 patients were diabetic and 499 patients were non-diabetic. They were further divided into two groups based on HbA1c > 7% and Results The mean age of patients was in group of patients having HbA1c more than 7% was 58.3±9.6 and in patients with less than 7% was 56±11.6. There was no difference in Ejection fraction between patients having HbA1c more than 7% when compared with patients having less than 7% (46.5±11.3 Vs 47.6±11.2, p 0.11). 71.4% (415/581) of patients with DM were having HbA1c >7%.The overall in-hospital mortality was 6.3% (68/1080). Out of 68 patients died, 46 patients were in diabetic group. 32 patients (70%) who died in diabetic group were having HbA1c levels >7%. The length of stay (LOS) in ICU was significantly higher in patients with HbA1c >7% (5.44 ± 4.13 Vs 3.19 ± 2.63, p 7% were having longer ICU stay (4.19±2.91 Vs 1.25±3.37, p Conclusion Increased HbA1c was associated with increased morbidity and mortality in patients undergoing cardiac surgery using cardiopulmonary bypass. HbA1c may predict the adverse outcomes after cardiac surgery. Optimal preoperative HbA1c may improve the outcome following cardiac surgery.

Adhesion to the Mediterranean diet in diabetic patients with poor control

ObjectiveTo analyse the relationship between the level of adherence to the Mediterranean diet and the control of cardiovascular risk factors. MethodA descriptive, observational study was conducted on patients diagnosed with Diabetes Mellitus type 2, with poor blood glucose control and a Body Mass Index greater than 25kg/m2. The relationship between the adherence to the Mediterranean diet and cardiovascular risk factors was evaluated before and after education about the Mediterranean diet. The patients were given a questionnaire on the level of adherence to the Mediterranean diet (the Mediterranean diet score), at the beginning of the study and at 6 month after having education about the Mediterranean diet in the Primary Care medical and nursing clinics. An analysis was carried out on the variables including, gender, age, weight, height, and Body Mass Index, as well as the analytical parameters of blood glucose, glycosylated haemoglobin, total, HDL, LDL cholesterol, and triglycerides. The relationship between the primary variable, ‘adherence to the Mediterranean diet’, and the rest of the variables was calculated before and after the educational intervention. ResultsThe initial ‘adherence to the Mediterranean diet score’ in the questionnaire was relatively low (6.22). Excess weight, as well as to have an elevated Body Mass Index are associated with a lower adherence to the Mediterranean diet, as well as low adherence to treatment (p<.00 and p<.02, respectively). The values of HDL cholesterol values increased with greater adherence (p<.04). Elevated LDL and total cholesterol are associated with a lower adherence to the Mediterranean diet (p<.01 and p<.05, respectively), similar to that of elevated triglycerides (p<.00). Elevated baseline blood glucose levels are also associated with low adherence to the Mediterranean diet (p<.04), as well as the increase in glycosylated haemoglobin (p<.06).Thus the cardiovascular risk increases with low adherence (p<.08).After the educational intervention, a moderate increase was observed in the adherence to the Mediterranean diet (a score of 6.84) as well as a notable improvement in the control of the cardiovascular risk factors. ConclusionsAdherence to the Mediterranean diet is associated with improved control of cardiovascular risk factors.

Cardiac Function in Infants Born to Mothers With Gestational Diabetes - Estimation of Early Diastolic Intraventricular Pressure Differences.

Background: This study compared the myocardial performance of infants born to mothers with gestational diabetes mellitus (IGDM) and without GDM (controls) under the new GDM definitions.Methods and Results: The subjects consisted of 36 IGDM and 39 control infants. GDM diagnosis was based on oral glucose tolerance test during pregnancy or the presence of diabetes prior to the current pregnancy. Between-group infant cardiac function was determined and compared using 2-D speckle tracking analysis, intraventricular pressure difference (IVPD) and IVP gradient (IVPG), using color M-mode Doppler imaging. IVPD and IVPG were higher in IGDM than in the controls, particularly the mid–apical IVPG. The global circumferential strain (GCS) and endocardial GCS were higher in IGDM than in controls. Increased maternal glycated hemoglobin was correlated with reduced transmural and epicardial GCS in the IGDM. Maternal maximum fasting blood sugar had a mild, positive correlation with IVPD and IVPG.Conclusions: Ventricular sucking force, measured as the IVPD, IVPG, and endocardial GCS, were higher in IGDM than in the controls. A hyperglycemic environment during pregnancy leads to impaired cardiac performance in IGDM, compared with control infants. IGDM might have favorable systolic and diastolic cardiac performance due to cardiac metabolic adaptations occurring before poor glucose control causes impaired cardiac performance.

Psychometric assessment and application of the Chinese version of the Compliance with Annual Diabetic Eye Exams Survey in people with diabetic retinopathy.

To translate the Compliance with Annual Diabetic Eye Exams Survey (CADEES) into Chinese, allowing assessment of its reliability and validity, and to identify variables that predict attendance at annual eye examinations. People with vision-threatening diabetic retinopathy were recruited from the Shanghai Diabetic Eye Study. The study involved three phases: (1) translation and cross-cultural adaptation, (2) a pilot study (n=496) to evaluate the psychometric properties of the Chinese-CADEES, and (3) a primary cross-sectional survey (n=3818) to assess self-reported attendance at annual eye examinations. Factors related to non-attendance were identified using univariate analysis, and then a multiple logistic regression model. Finally, a component model and individual item models were built to predict attendance. The Chinese-CADEES had satisfactory reliability and validity. The issue of low attendance at annual eye examinations was serious. In addition to 13 health belief items, living in semi-urban suburban areas, shorter duration of diabetes, poor glucose control, lower education level, better presenting visual acuity and milder diabetic retinopathy diagnosis were significantly related to non-attendance. The multivariate predictive model was able to predict, with 64.7% accuracy, whether or not participants were going to attend annual eye examinations and explained ~11.3% of the variance in attendance. The Chinese-CADEES showed good reliability and validity for predicting attendance at annual eye examinations in people with diabetic retinopathy. Clinicians and researchers can improve attendance by addressing modifiable characteristics and increasing education on diabetic retinopathy and the importance of eye health in people with diabetes.

Current nursing status of diabetes mellitus with alzheimer’s disease

The occurrence of alzheimer's disease is closely related to diabetes.When diabetic patients suffer from long-term poor blood glucose control, repeated hypoglycemia and other problems, central nervous system and cerebrovascular diseases will occur, accelerating the occurrence of alzheimer's disease.In this paper, the current and effective nursing interventions for diabetes mellitus with alzheimer's disease were summarized to reduce the incidence of complications and improve the quality of life of patients. Key words: Diabetic mellitus; Alzheimer's disease; Current nursing status

Evaluation of lipoprotein-associated phospholipase A2 as a marker for renal microvasculopathy in adolescents with Type 1 diabetes.

To assess the relevance of lipoprotein-associated phospholipase A2activity as a diagnostic andprognostic marker for renalmicrovascular diseases. We analysed lipoprotein-associated phospholipase A2 activity and lysophosphatidylcholine levels (as a surrogate marker of oxidative stress) in 165 adolescents (aged 17.0 ± 2.3 years) with a history of Type 1 diabetes greater than 10 years. Clinical data were obtained from the German/Austrian nationwide Diabetes-Patients Follow-up(DPV) registry at blood collection and on average 2.4 ± 1.3 years later at follow-up. Relationships between lipoprotein-associated phospholipase A2 activity and clinical, demographic and laboratory variables, lysophosphatidylcholine levels and presence of albuminuria were evaluated by multivariable linear and logistic regression. Lipoprotein-associated phospholipase A2 activity was higher in male than female adolescents (P = 0.002). Albuminuria was present in 14% (22/158) of participants at baseline, and 5% (4/86) of participants without albuminuria at baseline developed albuminuria until follow-up. Lipoprotein-associated phospholipase A2 activity was associated neither with present nor with incident albuminuria. Lysophosphatidylcholine did not correlate with lipoprotein-associated phospholipase A2 activity. Cross-sectional bivariate correlation as well as multivariable linear regression analysis revealed a negative correlation of lipoprotein-associated phospholipase A2 activity with HbA1c and HDL-cholesterol. Lipoprotein-associated phospholipase activity was not associated with surrogate markers for oxidative stress and early diabetic nephropathy. The association of decreased lipoprotein-associated phospholipase A2 activity with poor glucose control might limit its function as a predictor of micro- and macrovascular diseases in Type 1 diabetes.

Is it time to abandon glucose control in critically ill adult patients?

To summarize the advances in literature that support the best current practices regarding glucose control in the critically ill. There are differences between patients with and without diabetes regarding the relationship of glucose metrics during acute illness to mortality. Among patients with diabetes, an assessment of preadmission glycemia, using measurement of Hemoglobin A1c (HgbA1c) informs the choice of glucose targets. For patients without diabetes and for patients with low HgbA1c levels, increasing mean glycemia during critical illness is independently associated with increasing risk of mortality. For patients with poor preadmission glucose control the appropriate blood glucose target has not yet been established. New metrics, including stress hyperglycemia ratio and glycemic gap, have been developed to describe the relationship between acute and chronic glycemia. A 'personalized' approach to glycemic control in the critically ill, with recognition of preadmission glycemia, is supported by an emerging literature and is suitable for testing in future interventional trials.

Adherencia a la dieta mediterránea en pacientes diabéticos con mal control

ObjectiveTo analyse the relationship between the level of adherence to the Mediterranean diet and the control of cardiovascular risk factors. MethodA descriptive, observational study was conducted on patients diagnosed with Diabetes Mellitus type 2, with poor blood glucose control and a Body Mass Index greater than 25kg/m2. The relationship between the adherence to the Mediterranean diet and cardiovascular risk factors was evaluated before and after education about the Mediterranean diet. The patients were given a questionnaire on the level of adherence to the Mediterranean diet (the Mediterranean diet score), at the beginning of the study and at 6 month after having education about the Mediterranean diet in the Primary Care medical and nursing clinics. An analysis was carried out on the variables including, gender, age, weight, height, and Body Mass Index, as well as the analytical parameters of blood glucose, glycosylated haemoglobin, total, HDL, LDL cholesterol, and triglycerides. The relationship between the primary variable, ‘adherence to the Mediterranean diet’, and the rest of the variables was calculated before and after the educational intervention. ResultsThe initial ‘adherence to the Mediterranean diet score’ in the questionnaire was relatively low (6.22). Excess weight, as well as to have an elevated Body Mass Index are associated with a lower adherence to the Mediterranean diet, as well as low adherence to treatment (P<.00 and P<.02, respectively). The values of HDL cholesterol values increased with greater adherence (P<.04). Elevated LDL and total cholesterol are associated with a lower adherence to the Mediterranean diet (P<.01 and P<.05, respectively), similar to that of elevated triglycerides (P<.00). Elevated baseline blood glucose levels are also associated with low adherence to the Mediterranean diet (P<.04), as well as the increase in glycosylated haemoglobin (P<.06).Thus the cardiovascular risk increases with low adherence (P<.08).After the educational intervention, a moderate increase was observed in the adherence to the Mediterranean diet (a score of 6.84) as well as a notable improvement in the control of the cardiovascular risk factors. ConclusionsAdherence to the Mediterranean diet is associated with improved control of cardiovascular risk factors.

MON-287 CORRELATION OF HBA1c AND URINE ALBUMIN CREATININE RATIO (UACR) WITH RENAL AND CARDIOVASCULAR HEALTH RISK FACTORS IN PATIENTS WITH DIABETES MELLITUS

Renal and cardiovascular comorbidity are important risk factor for overall mortality in both Type 1 and 2 diabetes mellitus (DM) patients. Poor blood glucose control has an unfavourable impact on complications. It is also believed that development of kidney disease in these patients worsens cardiovascular risk. To better ameliorate these major vascular complications we have tried to study the correlation of HbA1c and UACR (two easily measured biomarkers) with modifiable clinical and biochemical parameters in DM patients. Both these biomarkers have the potential to facilitate prevention and management of several specific aspects of diabetes mellitus patients. A prospective observational cohort study was conducted between July 2015 and June 2018 in our clinic. All type 1 and 2 diabetes mellitus patients who consented to be part of this investigative trial were included. The presence of hypertension on clinical evaluation was noted. Conventional diabetes biomarkers (hemoglobin, HbA1c, serum creatinine / eGFR; serum lipid profile, serum albumin, urine albumin creatinine ratio.) were tested in the cohort.Correlation between HbA1c and UACR with clinical and laboratory biomarkers were studied. A total of 1077 patients were evaluated. There were 61% males. Of these 260 were of type 1 diabetes mellitus and 817 were type 2 DM patients .Hypertension (a major cardiovascular and renal risk factor) was significantly associated not only with high HbA1c and high UACR but also with renal functions (creatinine, eGFR) and poor glucose control in this cohort. Table 1. The biomarker HbA1c was significantly correlated positively with urine albumin creatinine ratio (nephropathy), serum total cholesterol (poor glycemic control).It was negatively correlated with serum albumin (nephropathy – albuminuria) and serum creatinine (preexisting impaired renal function, tight glycemic control and hypoglycemia).A high UACR was significantly (a) positively correlated with HbA1c (poor glycemic control), and (b) negatively correlated with hemoglobin (anemia of CKD). Table 2. Table 1Correlation of hypertension with biochemical factorsHypertensionHemoglobin (g/dl)HbA1c %Albumin g/dlUACR mcg/mgCreatinine mg/dleGFR ml/minHTN -12.99.73.8410.6121HTN+12.28.53.72671.555p value0.070.040.250.00000.00000.0000 Open table in a new tab Table 2Correlation between HbA1c and UACR with other biochemical parametersBiochemical ParameterHbA1c (%) R2 P valueUACR (mcg/mg) R2 P valueUACR mcg/mgR2 =+ 0.16P value= 0.0001-----------HbA1c (%)---------------R2=0.16P value =0.0001Hemoglobin (g/dl)R2= 0.07 P value =0.07R2= - 0.16P value 0.0001Serum Albumin (g/dl)R2= -0.13 P value =0.002R2= -0.26P value 2.2Creatinine (mg/dl)R2= -0.14 P value =0.001R2=0.23P value=4.2eGFR ml/min/1.73m2R2=0.26 P value = 9.6R2= -0.19P value =4.4Cholesterol (mg/dl)R2=0.13 P value = 0.004R2=0.03P value=0.48Triglycerides (mg/dl)R2=0.18 P value =2.9R2=0.04P value =0.26 Open table in a new tab Utilising easily available biomarkers(HbA1c and UACR) for risk prediction of cardiovascular and renal complications in DM patients may be a feasible approach in resource limited setting.

SUN-140 EFFECTS OF PARATHYROID HORMONE ON GLUCOSE METABOLISM IN RENAL PROXIMAL TUBULES

Gluconeogenesis in renal proximal tubules (PTs) is markedly enhanced in prolonged fasting and even in diabetic patients, which is comparable to the liver. However, its pathophysiological significance and hormonal regulation are not well known. We have recently found that cAMP increases mRNA expression levels of gluconeogenic enzyme, and insulin suppresses PT gluconeogenesis via insulin receptor substrate (IRS)1/Akt2 pathway (ASN Kidney Week 2017). On the other hand, parathyroid hormone (PTH) has also been reported to enhance PT gluconeogenesis along with the fact that the high level of PTH is associated with abnormal glucose metabolism. Therefore, in this study we investigated the details of PTH-enhanced gluconeogenesis in PTs. PTs were freshly isolated from rat kidneys or human kidneys, which were surgically obtained from consented patients of kidney cancer. To analyze the direct effect and mechanism of PTH on PT gluconeogenesis, PTs treated with 10 µM PKA (protein kinase A) inhibitor H89 or 100 nM PKC (protein kinase C) inhibitor Gö6983 were incubated with 1 nM PTH in DMEM overnight. To examine the relationship to insulin signaling, PTs were stimulated by 10 nM insulin for 4-hr after overnight incubation with PTH or 0.2 mM cAMP. We also performed siRNA against FoxO1 (forkhead box protein O1). During the whole process, PT gluconeogenesis was evaluated by measuring the mRNA expression levels of gluconeogenic enzyme phosphoenolpyruvate carboxykinase (PEPCK), glucose-6-phosphatase (G6P) by quantitative PCR. The mRNA expression levels of FoxO1 were also measured by quantitative PCR. Further, we performed western blotting in both of rat and human kidney cortex to analyze Akt phosphorylation in insulin signaling pathway. In PTs, PTH significantly increased the mRNA expression levels of PEPCK and G6P by 6 and 4 times, respectively. Not PKA inhibitor but PKC inhibitor completely abolished this PTH effect, which was consistent with PKC-mediated PTH signaling pathway. Interestingly, insulin failed to inhibit this PTH-enhanced PT gluconeogenesis, while insulin completely inhibited cAMP-enhanced PT gluconeogenesis. Moreover, siRNA against FoxO1 completely dissipated the PTH effect. In the kidney cortex, insulin induced Akt phosphorylation, which was preserved after incubation with PTH. Our results, for the first time to our knowledge, revealed that PTH increases mRNA expression levels of gluconeogenic enzymes in PTs via PKC pathway, and induces insulin resistance in PTs. Considering these results, the high level PTH may cause poor glucose control in these states through the direct enhancement of PT gluconeogenesis or exacerbating insulin resistance.

Abstract 2683: Biomarkers of glucose homeostasis and inflammation and risk of prostate cancer: A case-cohort study

Abstract Background: Type 2 diabetes (T2DM) is associated with a lower risk of prostate cancer especially low-grade and localized prostate cancer. The association with aggressive prostate cancer is inconclusive. Few studies have directly examined the associations of diabetes biomarkers with prostate cancer risk. Methods: Among a cohort of 13,994 men who were on average 70.2 years (SD=5.5) and cancer free at blood draw between 1998 and 2001, 1,206 developed non-aggressive prostate cancer and 313 developed aggressive prostate cancer (AJCC stage 3-4 or Gleason score 8-10) during follow-up through June 2013. We conducted a case-cohort study including a random sub-cohort of 1,303 men, 391 non-aggressive cases and 313 aggressive cases to examine circulating hemoglobin A1c (HbA1c), c-peptide, and C-reactive protein (CRP) in relation to prostate cancer risk. Results: HbA1c, a biomarker of hyperglycemia, was inversely associated with non-aggressive prostate cancer after adjusting for age, race, family history of prostate cancer, prostate-specific antigen screening, smoking, alcohol intake, physical activity, and total energy intake (relative risk (RR) per unit increase: 0.89, 95% confidence interval (CI): 0.79-1.00, P=0.04). Further adjustment for body mass index (BMI) attenuated the association. In contrast, HbA1c was associated with a higher risk of aggressive prostate cancer after adjusting for the covariates including BMI (RR per unit increase: 1.11, 95% CI: 0.98-1.25, P=0.11). In an analysis combining self-reported T2DM and HbA1c, men with T2DM and poor blood glucose control (HbA1c ≥6.5%) had a lower risk of developing non-aggressive prostate cancer (RR: 0.53, 95% CI: 0.30-0.95) than men without T2DM and good blood glucose control (HbA1c &amp;lt;6.5%). After excluding men with self-reported T2DM, HbA1c was statistically significantly positively associated with risk of aggressive prostate cancer (RR per unit increase: 1.25, 95% CI: 1.04-1.51, P=0.02) but was not associated with non-aggressive prostate cancer. C-peptide and CRP were not associated with risk of either aggressive or non-aggressive prostate cancer.Conclusions: The present study suggests that men with hyperglycemia may have a lower risk of developing non-aggressive but a higher risk of developing aggressive prostate cancer. Further studies are needed to examine the role of hyperglycemia in the etiology of aggressive prostate cancer and in prostate cancer progression. Citation Format: Ying Wang, Peter T. Campbell, Victoria L. Stevens, Christina C. Newton, Eric J. Jacobs, Michael Pollak, Susan M. Gapstur. Biomarkers of glucose homeostasis and inflammation and risk of prostate cancer: A case-cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2683.

Methicillin-resistant Staphylococcus aureus pneumonia in diabetics: a single-center, retrospective analysis.

Background:Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an important issue with significant morbidity and mortality in clinical practice, especially in diabetes mellitus (DM). Studies focusing on S. aureus pneumonia in DM is limited, we sought to make a relatively comprehensive exploration of clinical characteristics, antimicrobial resistance, and risk factors for mortality of S. aureus pneumonia in DM and non-diabetics mellitus (non-DM).Methods:A retrospective study was conducted in Ruijin Hospital from 2014 to 2017. The characteristics of DM and non-DM patients were assessed, including demographics, comorbidities, using of invasive mechanical ventilation, Hemoglobin A1c (HbA1C), confusion, urea, respiratory rate, blood pressure, age ≥65 years (CURB-65) score, length of hospital stay, clinical outcomes, antimicrobial susceptibility. Independent risk factors for mortality were identified by univariate and multivariate logistic regression analysis.Results:A total of 365 patients with S. aureus pneumonia were included in our study, including 144 with DM and 221 non-DM. DM patients were more susceptible to MRSA infection (65.3% vs. 56.1%, P > 0.05), suffered from much severer pneumonia with a higher CURB-65 score, invasive mechanical ventilation rate (46.5% vs. 28.1%, P < 0.01) and mortality rates (30.6% vs. 23.1%, P > 0.05); almost all DM patients had higher antimicrobial resistance than non-DM patients, the DM group had a higher co-infection rate (47.2% vs. 45.7%, P > 0.05), and Acinetobacter baumannii was the most common bacterium in DM, while Klebsiella pneumoniae ranked first in patients with non-DM. Independent risk factors for pneumonia-related mortality were MRSA and CURB-65. Higher HbA1c levels were linked to a higher MRSA infection and co-infection rate and more severe pneumonia, leading to an increase in mortality.Conclusions:DM patients with poor glucose control are more susceptible to MRSA infection. They suffer from higher antimicrobial resistance, a higher co-infection rate, and much severer pneumonia than non-DM. MRSA itself is an independent risk factor for mortality in all patients.

Cellular-Enabled Glucometers and Maternal Glucose Control: A Quality Improvement Initiative.

Management of diabetes in pregnancy is burdensome due to self-glucose monitoring, recording, and reporting demands. Cellular-enabled glucometers provide real-time transmission of glucose values independent of internet access and cell phone data plans. We describe a quality improvement (QI) intervention that introduced cellular-enabled glucometers for use during pregnancies complicated by diabetes. Our aim was to improve maternal glucose control in a cohort of insulin-requiring pregnant women enrolled in a telemedicine diabetes program. During initial establishment of a QI program, women were offered cellular-enabled glucometers but could elect to keep their standard meter. The primary outcome evaluated was glycosylated hemoglobin A1c (HbA1c) at delivery. Baseline characteristics including initial HbA1c were similar between women using a standard glucometer (n = 45) and those using a cellular-enabled glucometer (n = 72). Women who used a cellular-enabled glucometer had a lower HbA1c at delivery compared to those using a standard glucometer (5.8% vs 6.3%, P = .03). This improvement was particularly notable for women with poor glucose control (defined as HbA1c >6.5%) at initial obstetric visit. Women with poor glucose control who used a cellular-enabled glucose monitor had significantly lower HbA1c at delivery (6.0% vs 6.8%, P = .03) and greater change from initial visit compared to those using a standard glucometer (-2.6% vs -1.4%, P = .02). No statistically significant differences were detected in tracked neonatal outcomes. For pregnancies complicated by insulin-requiring diabetes, use of cellular-enabled glucometers as part of a perinatal diabetes program improves glucose control at delivery with timely transmission of accurate values throughout gestation.

1642-P: Glucose Control among Diabetes Cases Selected from a Representative National Survey in Brazil

Background: A target of an HbA1c &amp;lt;7% is frequently the cornerstone of clinical guidelines for the care of diabetes globally. Yet, nationally representative NHANES surveys indicate that only 50 to 60% of those with diabetes meet this target. Our aim was to evaluate glucose control when assessed by HbA1c in a national sample of Brazilian adults with diabetes. Methods: A sub-sample of adults (18 years or older) of the representative Brazilian National Health Survey (2014-2015) was randomly selected for the collection of biological samples. Of these, 8952 (52%) individuals provided samples, and 8541 (50%) have HbA1c results. HbA1c was measured at a NDPG-certified central laboratory. Diabetes was defined by self-report of a physician diagnosis. Given the complex sampling used to select participants and the response rate obtained, we used the rake method of post-stratification survey weights, calculated according to sex, age, and education, to estimate national rates. Results: Among the 8541 adults, 573 (5.87%; 95% CI: 5.41%-6.33%) reported having received a previous diagnosis of diabetes outside of pregnancy. Of these, only 55.2% (51.1%-59.4%) had HbA1c less than 7%, and 69.5% (65.7%-73.4%) less than the more flexible HbA1c target of 8%. On the other hand, 19.8% (16.5%-23.1%) had HbA1c ≥9.0%, indicating very poor glucose control. Though small sample size limited statistical testing, we found no differences across socio-demographic characteristics except for educational achievement, those of lesser education more frequently presenting worse glucose control (p=0.004). Conclusion: Our results, showing a glucose control similar to that observed in representative U.S. surveys, highlight the large fraction of cases with very poor control. New strategies are needed to improve glucose control in the entire population of persons living with diabetes. Disclosure R.C.P. dos Reis: None. B.B. Duncan: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company. M.I. Schmidt: Research Support; Self; Eli Lilly and Company. Research Support; Spouse/Partner; Eli Lilly and Company.