Random Glucose Levels Research Articles

Screening blood donors for diabetes: analysis of use, accuracy, and cost

The objective was to determine if a free, voluntary diabetes screening program as a part of the blood donation process might be cost-effective. During the first 6 months of the program, 26,415 donors were screened using a single random plasma glucose (RPG) level. All donors were asked to eat before donation. Low-, moderate-, and high-risk groups were formed based on RPG levels (<140, 140-200, and >200 mg/dL). Contact with a telephone questionnaire was made with 139 of 178 (78%) of the persons in the high-risk group with 33 new cases of diabetes diagnosed by the donor's physician and 26 donors indicating that they were not diagnosed with diabetes. Sex- and age-matched donors in the low- and moderate-risk groups were contacted and administered the same questionnaire. The three risk groups were similar, except for body mass index (28.1 ± 5.4 kg/m2 vs. 29.9 ± 5.5 kg/m2 vs. 32.7 ± 5.6 kg/m2 , p < 0.001). The discriminative effectiveness of screening was evaluated by the area under the receiver operating characteristics (AROC) curve. The AROC curve was 0.950 (95% confidence interval, 0.920-0.979) for the identification of diabetes. Using a RPG cutoff of 200 mg/dL, sensitivity was 100%, specificity was 82%, and positive predictive value was 56%. Cost analyses showed that the mean cost to screen, per donor, was less than $1. Cost per case identified was estimated to be less than $500 for a RPG cutoff of 200 mg/dL. Screening during the blood donation process appears to be accurate, convenient, and inexpensive.

Relationship between random blood glucose levels and body mass index among rural adults in north central Nigeria

BackgroundObesity, usually assessed using Body Mass Index (BMI), has been identified as one of the risk factors for type 2 Diabetes mellitus. However, there are mixed reports on the relationship between blood glucose levels and BMI .ObjectiveThe objective of this study was to determine the relationship between Random blood glucose levels and Body Mass Index among rural adults in North Central Nigeria.&#x0D; MethodsWe carried out a cross-sectional descriptive study between February and May 2005. Seven hundred and fifty subjects who were ≥15years were sampled using systematic sampling technique. Data were collected with a structured questionnaire. Subjects were measured for height (m) and weight (kg); the Body Mass Index (BMI) was calculated. Blood samples of subjects were used for the estimation of blood glucose concentration using the glucose oxidase method of Trinder.&#x0D; ResultsThe study population consisted of 385(51.3%) males and 365(48.7%) females (male: female= 1.05:1). The mean age of the study population was 39.42±16.17years while the mean ages of the males and female were 35.23±14.09years and 43.83±17.04years respectively (t=7.55, p&lt;0.001). The mean Random Plasma glucose level (RPGL) in the study subjects was 5.68(±2.16)mmol/L [males 5.69(±2.42)mmol/L and females 5.67(±1.86)mmol/L, t=0.11, P=0.91]. The mean BMI of the subjects was 23.86(±4.01)kg/m2 [males 23.19(±3.23)kg/m2 and females 24.56(±4.56)kg/m2, t=4.75, P&lt;0.001].There was no relationship between random blood glucose levels and BMI of study subjects(r=0.00, P=0.30).&#x0D; ConclusionWe found no relationship between the levels of random blood glucose and Body Mass Index among the rural adult in the north central Nigeria. It seems BMI would not be a good predictor of Diabetes Mellitus among rural adults.

Possible Cefcapene Pivoxil- or Clarithromycin-Induced Severe Hyperglycemia in a Patient With Type 2 Diabetes: A Case Report

There are various reasons for the deterioration of glycemic control observed in patients with diabetes, one of which is drug-induced hyperglycemia. Antibiotics, especially the fluoroquinolones, have been reported to be associated with glucose disturbances. However, induction of hyperglycemia by cephem or macrolide antibiotics has rarely, if ever, been reported. Here, we report the case of possible antibiotics-induced severe hyperglycemia in a patient with type 2 diabetes. A 67-year-old Japanese diabetic man, who was not using oral hypoglycemic agents or insulin but whose condition was controlled with diet and exercise, presented at an otolaryngology clinic with nasal discharge and rhinorrhea. His glycosylated hemoglobin (HbA1c) level had been stable at 6.6-7.2% for several years. He was diagnosed with acute sinusitis and given an oral cephem antibiotic, cefcapene pivoxil, for 1 week. His otolaryngeal symptoms were slight and disappeared soon. Thereafter, therapy was switched to a macrolide antibiotic, clarithromycin, for 3 weeks. Twenty-five days after the initiation of antibiotic therapy, severe hyperglycemia was pointed out; his random serum glucose and HbA1c levels were 29.4 mmol/L and 10.6%, respectively. The patient required insulin and oral hypoglycemic agent therapy. The Naranjo probability scale suggests that the relationship between the administration of cefcapene pivoxil or clarithromycin and the patient’s severe hyperglycemia might be possible. To the best of our knowledge, there has been no previous report of a deterioration in glycemic control in a patient with diabetes administered a cephem (cefcapene pivoxil) or macrolide (clarithromycin) antibiotic. Considering the global prescription of cephem and macrolide antibiotics, awareness of the fact that some patients are at high risk for impaired glucose tolerance is important when prescribing antibiotics. Further studies are warranted to determine the incidence rate of hyperglycemia among patients with diabetes who are administered cephem and macrolide antibiotics. J Med Cases. 2013;4(6):416-419 doi: https://doi.org/10.4021/jmc1274w

STATUS OF HbA1c;

Background: Glycated hemoglobin [HbA1c] is a marker to identify the average plasma glucose level over past threemonths but it is also influenced by the iron deficiency status of an individual. Objective: Research is designed to assess the relationshipbetween HbA1c concentration and iron status among diabetic and non diabetic subjects. Design: Cross sectional comparative study.Setting: Tertiary Care Unit of Karachi, Pakistan. Period: Dec 2010 till June 2011. Material and methods: A total of 75 subjects of bothsexes were taken and divided into three groups. Fasting and random glucose levels, serum iron and TIBC were performed by enzymaticmethod while HbA1c was estimated by fast iron resin separation method and Complete blood count (CBC ) was done by Coulter.Statistical analysis: The data feeding and analysis was on computer package SPSS (Statistical Packages of Social Sciences) version16.0. the results were given in the mean and Standard Deviation (SD) and correlation ( r ) for quantitative data i.e. age, FBS, RBS, HbA1c,Serum Iron , Hb HCT, and TIBC. Using Analysis of Variance (ANOVA) with tukey test for comparison (Controls, Iron deficiency anemia withand without diabetes mellitus). In all statistical analysis only p &lt; 0.01 will be considered significant. Results: HbA1c is a non-specificmarker of Diabetes mellitus in iron deficieny anemia patients. Thus it is reccomended that iron status of diabetic patients must beconsidered while interpreting results. This study showed significantly raised levels of Fasting blood glucose (FBS), random blood glucose(RBS) and HbA1c in diabetic anemic patients when compared to control and nondiabetic anemic subjects (p &lt; 0.01) while total ironbinding capacity (TIBC) and HbA1c in nondiabetic anemic subjects were also significantly raised when compared to control (p &lt; 0.01).Hemoglobin (Hb) , Hematocrit (HCT) and Serum Iron levels were significantly decreased in diabetic and nondiabetic anemic subjectswhen compared to control (p &lt; 0.01). Conclusions: Our study depicted that while diagnosing Diabetes mellitus in iron deficient patientsone should be carefull as HbA1c is not a very reliable parameter to assess glycemic control in iron deficiency anemia patients.

Glucagon receptor is required for long-term survival: A natural history study of the Mahvash disease in a murine model

Background and aimWe have described a novel Mahvash disease of hyperglucagonemia and pancreatic neuroendocrine tumors (PNETs) associated with an inactivating glucagon receptor mutation, and identified the glucagon receptor-deficient (Gcgr−/−) mice as its murine model. We aim to elucidate the natural history of the rare Mahvash disease by long-term observation of the Gcgr−/− mice. Materials and methodWild type (WT) (n=52), heterozygous (n=127), and Gcgr−/− (n=56) mice living under standard vivarium conditions were observed without specific treatments over 22months. Autopsy was performed on dead animals. ResultsThe WT and heterozygous mice did not exhibit any measurable differences. The Gcgr−/− mice became progressively lethargic and cachexic after 12months. Random glucose levels were stable in WT and heterozygous mice but decreased with age in the Gcgr−/− mice. At the end of observation, 28/56 Gcgr−/−, 7/52 WT, and 24/127 heterozygous mice died. The survival curve of Gcgr−/− mice began to separate from those of WT and heterozygous mice at 12months and the survival difference widened with age. At 18months, survival probability was 17% for Gcgr−/− mice but 77% for WT and 81% for heterozygous mice. Autopsy revealed numerous PNETs up to 15mm in diameter in most well-preserved Gcgr−/− pancreata (17/20) but none in WT or heterozygous ones. Four Gcgr−/− mice developed liver or subcutaneous metastasis. ConclusionThe untreated Mahvash disease may cause cachexia, severe hypoglycemia, and early death. Patients with Mahvash disease need to undergo life-long surveillance for PNETs. Functional glucagon receptor is thus required for long-term survival.

Evaluation of a computer-based intervention to enhance metabolic monitoring in psychiatry inpatients treated with second-generation antipsychotics

Second-generation antipsychotics (SGAs) play an important role in the pharmacologic management of various psychiatric conditions. Use of these medications has been associated with metabolic complications. Adherence to guideline-recommended monitoring is suboptimal. We evaluated the effect of a computerized physician order entry (CPOE) pop-up alert designed to improve rates of laboratory metabolic monitoring of patients treated with SGAs on a University Hospital inpatient psychiatry unit. A single-centre, retrospective chart review was performed in which patient demographics and SGA drug and laboratory data were extracted from the CPOE database. We assessed the number of orders for appropriate metabolic monitoring data for patients admitted within a 6-month period before or after the alert implementation. Pre-alert (n = 171) and post-alert (n = 157) groups were similar with respect to age, length of stay, sex, race and comorbidities. Following alert implementation, significant increases in monitoring both random (92.4% vs. 100%) and fasting (46.8% vs. 70%) glucose levels as well as random (28.7% vs. 74.5%) and fasting (18.7% vs. 59.9%) lipid panels (all P ≤ 0.001) were observed. The number of patients with both a fasting glucose level and fasting lipid panel available for monitoring increased from 12.9% to 47.8% (P < 0.0001). Significantly more post-alert laboratory orders were submitted at the same time as the SGA drug order (P < 0.0001), suggesting that the alert itself had a direct influence on the ordering of metabolic monitoring labs. Implementation and use of an electronic pop-up alert in an inpatient psychiatric unit significantly improved rates of ordering fasting blood glucose and lipid levels for inpatients treated with SGAs. Overall rates remain suboptimal, suggesting a need for additional strategies to further improve metabolic monitoring.

Participation in blood glucose test, knowledge and prevalence of hyperglycemia among traders at New Market, Enugu.

Background: Diabetes mellitus causes great health complications which include cardiovascular diseases and nerve damage.Aim: To ascertain the participation in blood glucose test, knowledge of diabetes mellitus (DM) and prevalence of hyperglycemia among traders at New market, Enugu State.Methods: The study is a cross-sectional survey involving measurement of random plasma glucose level of the participants using Accu-check glucometer, and collection of data on the knowledge and participation of subjects in blood glucose test using structured questionnaire. The informed consent of the participants was duly obtained after detailed explanation of the objectives and procedures of the study. All the participants had a minimum of senior secondary school education. They were 130 (50 males and 80 females) from the age of 40 years and above. The data collected include participation in blood glucose test, knowledge of diabetes and prevalence of hyperglycemia. The data was analyzed descriptively.Results: The results showed that 53.08% was aware of DM while, 46.92% was unaware; 11.54% of the people have checked their plasma blood glucose level within four years while 88.46% had not; 91.53% had normal plasma blood sugar level while, 8.46% had hyperglycemia; 36.36% of participants with hyperglycemia was aware of their diabetes status while, 63.64% was unaware.Conclusion: There is high percentage of participants who were aware of diabetes mellitus; high percentage of those who have not checked their plasma glucose level within 4 years, low prevalence of hyperglycemia and high percentage of those who were not aware of their diabetes status.Key words: Diabetes mellitus, hyperglycemia, awareness, prevalence.

Effect of maternal high-fat diet on pancreatic beta cells of the offspring

Whereas ample evidence suggests that maternal malnutrition reduces pancreatic beta-cell function, only a few studies have investigated the effect of high-fat diet during gestation and lactation on beta-cell function. Here we elucidate the effect of maternal high-fat diet on beta-cells in a mouse model. Pregnant C57BL/6J mice received 60 % high-fat diet for the duration of both gestation and lactation (HFGL), gestation only, or lactation only. Beta-cell function of the male offspring of each group at 6 weeks of age was compared with those under standard diet. Although body weight, insulin sensitivity judged by insulin tolerance test, and random glucose level were comparable among the groups, only offspring of the HFGL group showed glucose intolerance with impaired insulin secretion during intraperitoneal glucose tolerance test. A compensatory increase in pancreatic beta-cell mass was observed in the offspring of the HFGL group, and decreased glucose-stimulated insulin secretion from isolated islets was confirmed by batch-incubation and perifusion experiments. Our results demonstrated that high-fat diet consumed during gestation and lactation elicits beta-cell dysfunction in the offspring of C57BL/6J mice.

A Randomized Controlled Trial of an Intensive Insulin Regimen in Patients With Hyperglycemic Acute Lymphoblastic Leukemia

Hyperglycemia during hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and high-dose cytarabine, with methylprednisolone premedication) chemotherapy is associated with poor outcomes of acute lymphoblastic leukemia (ALL). To examine whether intensive insulin therapy could improve outcomes, a randomized trial was conducted that compared glargine plus aspart vs. conventional therapy. Intensive insulin did not improve ALL clinical outcomes despite improved glycemic control. Secondary analysis suggests that the choice of antidiabetic pharmacotherapy may influence ALL outcomes. Hyperglycemia during hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and high-dose cytarabine, with methylprednisolone premedication) chemotherapy is associated with poor outcomes of acute lymphoblastic leukemia (ALL). To examine whether an intensive insulin regimen could improve outcomes compared with conventional antidiabetic pharmacotherapy, a randomized trial was conducted that compared glargine plus aspart vs. conventional therapy (control). Between April 2004 and July 2008, 52 patients newly diagnosed with ALL, Burkitt lymphoma, or lymphoblastic lymphoma who were on hyper-CVAD in the inpatient setting and had a random serum glucose level >180 mg/dL on ≥2 occasions during chemotherapy were enrolled. The trial was terminated early due to futility regarding ALL clinical outcomes despite improved glycemic control. Secondary analysis revealed that molar insulin-to-C-peptide ratio (I/C) > 0.175 (a surrogate measure of exogenous insulin usage) was associated with decreased overall survival, complete remission duration and progression-free survival (PFS), whereas metformin and/or thiazolidinedione usage were associated with increased PFS. In multivariate analyses, factors that significantly predicted short overall survival included age ≥ 60 years (P = .0002), I/C ≥ 0.175 (P = .0016), and average glucose level ≥ 180 mg/dL (P = .0236). Factors that significantly predicted short PFS included age ≥ 60 years (P = .0008), I/C ≥ 0.175 (P = .0002), high systemic risk (P = .0173) and average glucose level ≥ 180 mg/dL (P = .0249). I/C ≥ 0.175 was the only significant (P = .0042) factor that predicted short complete remission duration. A glargine-plus-aspart intensive insulin regimen did not improve ALL outcomes in patients with hyperglycemia. Exogenous insulin may be associated with poor outcomes, whereas metformin and thiazolidinediones may be associated with improved outcomes. Analysis of these results suggests that the choice of antidiabetic pharmacotherapy may influence ALL outcomes.

DEVELOPING A NEW HEMOGLOBIN A1C BASED EQUATION TO ESTIMATE -BLOOD GLUCOSE IN MAINTENANCE HEMODIALYSIS PATIENTS.

HbA1c has been widely used as a clinically important assessment tool for outcome analyses related to glycemic control. However, there is no HbA1c-blood glucose equation formula specific for hemodialysis (HD) patients. In this study, we sought to develop HbA1c-blool glucose equation models for dialysis patients. We examined associations between HbA1c levels and random serum glucose levels over time in a contemporary cohort of 18,361 diabetic maintenance HD patients treated in DaVita dialysis clinics from July 2001 through June 2006 with 276,277 paired measurements of HbA1c and glucose. Time-averaged HbA1c values and blood glucose (BG) values were compared using regression models with and without adjustment for hemoglobin, albumin, patients' age, gender, and/or race/ethnicity to determine a new equation model. The new models were compared to the previously reported equations (DCCT and ADAG). modal formula adjust R 2 Our modal BG=53.7+28.8 * HbA1c-18.2 * Alb 0.3243 DCCT BG=35.6 * HbA1c-77.3 0.3141 ADAG BG=28.7 * HbA1c-46.7 0.3141 In conclusion, the association between HbA1c and BG in HD patients is different from non-HD patient. Our proposed model results in better estimated BG level in HD patients compared to previously reported models.

Age differences in the risk of diabetes incidence according to body mass index level in Japanese women: BMI and diabetes in women

To investigate the age differences in the risk of diabetes incidence according to body mass index (BMI). For an average of 10.3 years, this study prospectively followed a cohort of 4725 women aged 30-69 years without diabetes at a baseline health check-up conducted between April 1990 and March 1992. Diabetes onset was identified by fasting and random plasma glucose level, HbA1c or the medical treatment for diabetes by questionnaire. We stratified the subjects according to age (30-39, 40-49, 50-59 and 60-69 years), and calculated the risk of diabetes incidence according to BMI categories (<18.5, 18.5-22.9, 23.0-24.9 and ≥25.0 kg/m(2)) using the Cox proportional hazards model. During 48,866 person-years of follow-up, 392 subjects developed diabetes. Using the normal group as the reference, the HR (95% CI) for diabetes incidence was elevated in obese women of all ages, ranging from a high of 4.72 (1.79-12.40) for women who were 30-39 years of age, to a low of 1.54 (1.02-2.33) for those who were 50-59 years of age. The risk of diabetes incidence according to BMI is different among different age groups of Japanese women. Obese is a strong risk factor for diabetes incidence among women of all ages, and especially among young adults.

Prevalence of Unrecognized Diabetes Mellitus in Patients Admitted With Acute Coronary Syndrome

We assessed the prevalence of unrecognized diabetes mellitus (DM) in patients with acute coronary syndrome (ACS) as determined by elevated glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and random plasma glucose (RPG) levels. This prospective study recruited 583 patients admitted with ACS without previous diagnosis of DM during 1-year period. Glycosylated hemoglobin was checked for most patients especially those with high values of FPG and or RPG. Patients were classified according to their glycemic state into 123 (21.1%) with DM, 82 (14.1%) with prediabetes, and 57(9.8%) with stress hyperglycemia, while 321 (55%) were classified as nondiabetics. Glycosylated hemoglobin estimation in the setting of ACS was helpful in the diagnosis of DM to eliminate the effect of stress-induced hyperglycemia that might accompany this condition.

Impact of smoking cessation on incidence of diabetes mellitus among overweight or normal-weight Japanese men

AimsTo assess the impact of smoking cessation on incidence of diabetes among overweight or normal-weight Japanese men. MethodsThis 9.2-year cohort study included 2070 men aged 40–69 years without diabetes. We classified them according to smoking status as non-smokers, past smokers (>9, 6–9, 3–5 and <3 years) and current smokers. Participants were followed up until diabetes developed or the end of 2006. The incidence of diabetes was determined from fasting and random plasma glucose levels, HbA1c levels or being under medical treatment for diabetes. ResultsDuring 18,963 person-years of follow-up, 246 of the participants developed diabetes. The risk for diabetes peaked within 3 years of quitting (HR: 2.98, 95% CI: 1.38–6.27) and persisted at 5 years after quitting smoking (HR, 2.49; 95% CI, 1.18–5.26) among overweight individuals. Moreover, this study identified a high risk for diabetes among past smokers who had quit >9 years in both normal weight and overweight. ConclusionsCigarette smoking predicts incidence of diabetes, but smoking cessation leads to higher short-term risk in overweight and long-term risk in both. Preventing smoking is superior to smoking cessation, and is very important for avoiding diabetes.

Oral Ingestion of Aloe vera Phytosterols Alters Hepatic Gene Expression Profiles and Ameliorates Obesity-Associated Metabolic Disorders in Zucker Diabetic Fatty Rats

We investigated the effects of the oral administration of lophenol (Lo) and cycloartanol (Cy), two kinds of antidiabetic phytosterol isolated from Aloe vera , on glucose and lipid metabolism in Zucker diabetic fatty (ZDF) rats. We demonstrated that the administrations of Lo and Cy suppressed random and fasting glucose levels and reduced visceral fat weights significantly. It was also observed that treatments with Lo and Cy decreased serum and hepatic lipid concentrations (triglyceride, nonesterified fatty acid, and total cholesterol). Additionally, Lo and Cy treatments resulted in a tendency for reduction in serum monocyte chemotactic protein-1 (MCP-1) level and an elevation in serum adiponectin level. Furthermore, the expression levels of hepatic genes encoding gluconeogenic enzymes (G6 Pase, PEPCK), lipogenic enzymes (ACC, FAS), and SREBP-1 were decreased significantly by the administrations of aloe sterols. In contrast, Lo and Cy administration increased mRNA levels of glycolysis enzyme (GK) in the liver. It was also observed that the hepatic β-oxidation enzymes (ACO, CPT1) and PPARα expressions tended to increase in the livers of the Lo- and Cy-treated rats compared with those in ZDF-control rats. We therefore conclude that orally ingested aloe sterols altered the expressions of genes related to glucose and lipid metabolism, and ameliorated obesity-associated metabolic disorders in ZDF rats. These findings suggest that aloe sterols could be beneficial in preventing and improving metabolic disorders with obesity and diabetes in rats.

Manifold implications of forgotten hyperglycemia in clinical opiate dependence

Both chronic opiate dependence and diabetes are widespread public health problems. The historically causal relationship between opiate pharmacology and hyperglycemia would appear to have fallen from curent medical knowledge. The aims of this study were to assess the severity of hyperglycemia in our opiate substance use disorder (SUD) patient population and review its pathophysiological basis. A review was undertaken of our clinical pathology database, comparing SUD patients and general medical controls (NSUD). A total of 1,602 SUD patients were compared with 2,858 NSUD patients 15–50 years of age. Mean ages were 31.29 ± 7.40 and 31.55 ± 9.17 years, respectively (P = 0.42) and were 68.60 and 52.76% male (P < 0.0001). The glycosylated hemoglobin (HbA1c) level in diabetics was 8.14 ± 2.76 and 6.29 ± 1.88 (P = 0.0032). In a nested case-control subset, random glucose, HbA1c, and fructosamine levels were all significantly elevated (P < 0.05). Adjusted for age, the HbA1c level was elevated among the SUD group (P < 0.0001) the age at addiction interaction was also significant (P < 0.0001). Serum glucose, HbA1c, fructosamine, and microalbumin levels were shown to be biomarkers of age. At multiple regression analysis, interactions between age, addictive status, glycemia, and the inflammatory markers, ethrocyte sedimentation rate and C-reactive protein, were significant (P < 0.05). At age 50, diabetic SUD patients had a HbA1c of 8.31%, which was equivalent to that of NSUD patients at age 140.54 years, a 181.07% elevation. These results confirm that hyperglycemia is higher in both an absolute and an age-dependent sense among diabetic SUD patients. These results are consistent with an acceleration of age-related and degenerative pathologies in many tissues and therefore carry far-reaching implications for the safety of indefinite opiate maintenance.

Diabetes mellitus in centenarians.

To describe the prevalence of diabetes mellitus (DM) in centenarians. Cross-sectional, population-based. Forty-four counties in northern Georgia. Two hundred forty-four centenarians (aged 98-108, 15.8% male, 20.5% African American, 38.0% community dwelling) from the Georgia Centenarian Study (2001-2009). Nonfasting blood samples assessed glycosylated hemoglobin (HbA(1c)) and relevant clinical parameters. Demographic, diagnosis, and DM complication covariates were assessed. 12.5% of centenarians were known to have DM. DM was more prevalent in African Americans (27.7%) than whites (8.6%, P < .001). There were no differences between men (16.7%) and women (11.7%, P = .41) or between centenarians living in the community (10.2%) and in facilities (13.9%, P = .54). DM was more prevalent in overweight and obese (23.1%) than nonoverweight (7.1%, P = .002) centenarians. Anemia (78.6% vs 48.3%, P = .004) and hypertension (79.3% vs 58.6%, P = .04) were more prevalent in centenarians with DM than in those without, and centenarians with DM took more nonhypoglycemic medications (8.6 vs 7.0, P = .02). No centenarians with HbA(1c) of less than 6.5% had random serum glucose levels greater than 200 mg/dL. DM was not associated with 12-month all-cause mortality, visual impairment, amputations, cardiovascular disease, or neuropathy. Thirty-seven percent of centenarians reported onset before age 80 (survivors), 47% between age 80 and 97 (delayers), and 15% aged 98 and older (escapers). Diabetes mellitus is a risk factor for cardiovascular disease and mortality but is seen in persons who live into very old age. Aside from higher rates of anemia and use of more medications, few clinical correlates of DM were observed in centenarians.

Risk factors for hepatocellular carcinoma in patients with chronic liver disease: a case–control study

The majority of data on risk factors (RFs) for hepatocellular carcinoma (HCC) comes from studies involving populations without underlying liver disease. It is important to evaluate RFs for HCC in patients with chronic liver disease since HCC rarely occurs in those without underlying liver disease. We conducted a hospital-based case-control study of 259 incident HCC cases and 781 controls by convenience sampling between 02/2001 and 12/2009 from the liver clinic at Stanford University Medical Center. The study population was 41% White, 14% Hispanic, 3% African American, 40% Asian American, and 2% other race/ethnicity. RFs were examined through medical records and an in-person questionnaire. Alcohol and tobacco use was calculated by cumulative grams of alcohol or cumulative pack(s) of cigarette consumed over one's lifetime. Diabetes mellitus (DM) was defined by random glucose level of ≥200mg/dL. RFs were evaluated using multivariate logistic regression. Independent predictors of HCC risk, after mutual adjustment and additional control for alcohol use, etiology of liver diseases, and DM, included age >40 (OR=8.5 [2.6-28.3]), male gender (OR=3.5 [2.2-5.8]), presence of cirrhosis (OR=2.8 [1.6-4.9]), Asian ethnicity (OR=2.8 [1.8-4.6]), AFP>50 (OR=4.2 [2.6-6.8]), and cumulative lifetime tobacco use of >11,000 packs (OR=1.7 [1.0-2.9]). Heavy prolonged cigarette smoking, but not alcohol use, was a significant independent predictor for HCC in patients with underlying liver disease. Besides older age, male gender, presence of cirrhosis, and elevated AFP, Asian ethnicity and heavy cumulative tobacco use are strong independent predictors of HCC.

Association of diabetes mellitus with arsenic trioxide (ATO) evaluated in the treatment of acute promyelocytic leukemia (APL).

e19724 Background: ATO has been administered for leukemia since 1878. It was approved for use in refractory and relapsed APL in 2000 and shown to have survival benefit as initial consolidation therapy by C9710 in 2010. Studies suggest an association of long term exposure to low doses of environmental inorganic arsenic with the development of type 2 diabetes mellitus (DM II). This study seeks to evaluate whether ATO at doses used to treat patients with APL is associated with an increase in DM II. Methods: A retrospective chart review of 35 patients with newly diagnosed APL treated with ATO at one university teaching hospital was conducted. For each patient, demographics, lab data, and treatment course were reviewed. 11 patients were excluded. Of the remaining 24 patients, glucose levels from lab panels were evaluated. Elevated serum glucose was defined as a random glucose level of >120 mg/dl. Results: Within one year following ATO, 54.2% of patients receiving arsenic were noted to have elevated serum glucose levels on more than one occasion. There was an average increase in serum glucose of 42.4% from baseline. 76.9% of patients with elevated glucose levels were seen in the first three months following arsenic. Conclusions: The results suggest that ATO at levels used to treat APL may increase glucose levels and subsequent risk for DM II. This calls for a reexamination of the glycemic status of surviving leukemic patients who previously received ATO. Additionally, steps should be taken to monitor glycemic control in APL patients whose treatment regimens include ATO. Patient demographics. Age 50yo ± 10.76 (range 22-77) Sex 16F, 8M Comorbidities Colon ca (1), breast ca (1), thyroid ca (1), prostate ca (1), crohn's disease (1), AIDS (1), CKD (1), seizure disorder (1), HTN (6), dyslipidemia (4), psoriasis (1), gout (1), hypothyroidism (2), GERD (3), depression (1), anemia (1), bipolar disorder (1), TB (1) Treatment follow-up 1 mo ± 1.05 (range - 48 to 57) No. of patients with glucose >120 mg/dL post-arsenic 13/24 Total ATO received 0.15 mg/kg/d IV for 5 days per week for 5 weeks (1-3 cycles) Exclusion 11 patients (4 from prior hx of diabetes, 5 from expiration within four weeks of dx, 2 from insufficient follow-up)

Detecting undiagnosed diabetes using glycated haemoglobin: an automated screening test in hospitalised patients

To assess the utility of glycated haemoglobin (HbA(1c)) level as an automated screening test for undiagnosed diabetes among hospitalised patients and to estimate the prevalence of undiagnosed diabetes among hospitalised patients. A 3-month prospective study of all adult patients admitted to a tertiary hospital. An HbA(1c) test was automatically undertaken on admission for all patients with a random plasma glucose (RPG) level ≥ 5.5 mmol/L. Demographic, admission and biochemical data were obtained from hospital databases. A subset of patients was recruited for an oral glucose tolerance test (OGTT) after discharge. Prevalence of undiagnosed diabetes (defined as HbA(1c) ≥ 6.5% in accordance with International Expert Committee and American Diabetes Association recommendations) and utility of automated HbA(1c) testing. The prevalence of undiagnosed diabetes was 11% (95% CI, 9.8%-12.4%) (262/2360) during the study period. A further 312 patients with known diabetes were admitted. The prevalence of undiagnosed diabetes was highest in the 65-74-years age group. The HbA(1c) test cost was $152 per new diagnosis of diabetes. Conservatively assuming an annual incidence of undiagnosed diabetes of 0.8%, the ongoing cost of testing hospitalised patients would be $2100 per new diagnosis of diabetes. RPG testing was not sensitive or specific in diagnosing diabetes. Patients were poorly compliant with the post-discharge OGTT (27% completion rate). HbA(1c) is a simple, inexpensive screening test that can be automated using existing clinical blood samples. Hospital screening for diabetes needs to be coupled with resources for management in the community.

Hyperglycemia associated with olanzapine treatment

Sir, Olanzapine is an atypical antipsychotic that has been widely used because of its better clinical efficacy, superior activity against negative symptoms, lesser extra-pyramidal symptoms, and better tolerability profile compared to typical antipsychotics. Recently, a flurry of reports have stated that olanzapine is associated with high blood sugar levels in new onset or pre-existing diabetes mellitus and ketoacidosis,[1–4] which may be reversible after discontinuation of olanzapine. The exact cause of glucose dysregulation by olanzapine is not clear. It has been hypothesized that 5-HT1 antagonism may decrease the responsiveness of the pancreatic beta cells, thus reducing the secretion of insulin and causing hyperglycemia.[5] In vivo studies suggest that olanzapine impairs glycogen synthesis via inhibition of the classical insulin signaling cascade and this inhibitory effect may lead to the induction of insulin resistance in olanzapine-treated patients. Koller and Doraiswamy[6] reported 188 new-onset diabetes out of 237 cases, which had no previous history of diabetes mellitus. Olanzapine can cause fatal outcome like diabetic ketoacidosis that may lead to death. Same authors reported 23 deaths among 289 cases of hyperglycemia. Similarly, Spivak et al[7] reported a case where patient had higher blood sugar level but after discontinuation of olanzapine it became normal. Bechara and Goldman-Levine[8] and Ober et al[9] reported similar cases where treatment with olanzapine had worsened the clinical condition in patients with a history of diabetes mellitus. We report four cases of hyperglycemia in schizophrenic patients after starting olanzepine and sugar values returned to normal after changing the medication. A 54-year-old male with no past or family history of diabetes mellitus developed hyperglycemia 10 days after starting treatment with olanzapine with a random blood glucose level 275 mg/dl, fasting 118 mg/dl, and postprandial 207 mg/dl. Same day olanzapine was discontinued and trifluperazine was introduced. Fifteen weeks later blood sugar level came down to 95 mg/dl (fasting) and 129 mg/dl (postprandial) and remained well controlled throughout the entire period of follow-up of one year. Another patient a 33-year-old male with no past but family history of diabetes mellitus in father, developed hyperglycemia 40 days after starting olanzapine (random glucose level 266 mg/dl, fasting 195 mg/dl and postprandial 295 mg/dl). Same day, olanzapine was stopped and aripirazole was started. Six months later patient's blood glucose levels were 85 mg/dl (fasting) and 127 mg/dl (postprandial) and remained normal thereafter. Third case was a 48-year-old male with no past or family history of diabetes mellitus. Two weeks after starting olanzapine blood glucose levels shooted up to 230 mg/dl (random), 120 mg/dl (fasting), and 195 mg/dl (postprandial). Olanzapine was changed to pimozide and one year later patient's blood sugar levels came down to 74 mg/dl (fasting) and 96 mg/dl (postprandial). Fourth one was a 37-year-old male with positive family history of diabetes mellitus in father who developed hyperglycemia 11 days after starting olanzapine with blood sugar 240 mg/dl (random), 118 mg/dl (fasting), and 193 mg/dl (postprandial). Olanzepine was changed to quetiapine and two months later blood sugar level came down to 100 mg/dl (fasting) and 162 mg/dl (postprandial). Possibility of other risk factors for diabetes like positive family history, obesity, etc needs to be considered before starting olanzapine. Regular monitoring of body weight and blood sugar are important in olanzapine treatment especially those having risk factors for diabetes. In this case, series for two cases, there was no past or family history of diabetes mellitus indicating that these were new-onset of diabetes mellitus. But the limitation of a case series is that we do not have base line blood sugar value before starting of olanzapine. However, in all these cases blood sugar value became normal after stopping the offending agent and changing over to other antipsychotics with lesser propensity to develop hyperglycemia. This clearly shows a link between hyperglycemia and olanzapine. Since olanzapine is becoming more and more popular as a first line agent in the treatment of psychosis as well as in mood disorders, proper guidelines have to be established for monitoring blood glucose levels and determination of risk factors for diabetes mellitus. Hence, it is very important for clinicians that all patients started on olanzapine require regular monitoring of their blood sugar levels. Clinicians should take at most precaution in pre-existing diabetic patients before starting olanzapine. If olanzapine is suspected to being a causal factor for hyperglycemia, we can reduce that risk by withdrawal of olanzapine or switching over to some other medicines without worsening the psychiatric condition of patient. India being a diabetes rich country; the author strongly suggests at least a baseline survey should be undertaken on the prevalence of diabetes in Indian population among patients exposed to olanzapine.