Serum Fructosamine Concentrations Research Articles

Use of Glargine and Lente Insulins in Cats with Diabetes Mellitus

The goals of this study were to compare the efficacy of once-daily administered Glargine insulin to twice-daily administered Lente insulin in cats with diabetes mellitus and to describe the use of a high-protein, low-carbohydrate diet designed for the management of diabetes mellitus in cats. All cats with naturally occurring diabetes mellitus were eligible for inclusion. Baseline testing included a physical examination, serum biochemistry, urinalysis and urine culture, serum thyroxine concentration, and serum fructosamine concentration. All cats were fed the high-protein, low-carbohydrate diet exclusively. Cats were randomized to receive either 0.5 U/kg Lente insulin q12h or 0.5 U/kg Glargine insulin q24h. Re-evaluations were performed on all cats at weeks 1, 2, 4, 8, and 12, and included an assessment of clinical signs, physical examination, 16-hour blood glucose curve, and serum fructosamine concentrations. Thirteen cats completed the study (Lente, n = 7, Glargine, n = 6). There was significant improvement in serum fructosamine and glucose concentrations in all cats but there was no significant difference between the 2 insulin groups. Four of the 13 cats were in complete remission by the end of the study period (Lente, n = 3; Glargine, n = 1). The results of the study support the use of once-daily insulin Glargine or twice-daily Lente insulin in combination with a high-protein, low-carbohydrate diet for treatment of feline diabetes mellitus.

Comparison of a low carbohydrate–low fiber diet and a moderate carbohydrate–high fiber diet in the management of feline diabetes mellitus

This study compared the effects of a moderate carbohydrate-high fiber (MC-HF) food and a low carbohydrate-low fiber (LC-LF) food on glycemic control in cats with diabetes mellitus. Sixty-three diabetic cats (48 male castrated, 15 female spayed) were randomly assigned to be fed either a canned MC-HF (n = 32) food or a canned LC-LF (n = 31) food for 16 weeks. Owners were blinded to the type of diet fed. CBC, urinalysis, serum chemistry panel, fructosamine concentration and thyroxine concentration were determined on initial examination, and a complete blood count, serum chemistry panel, urinalysis and serum fructosamine concentration were repeated every 4 weeks for 16 weeks. Insulin doses were adjusted as needed to resolve clinical signs and lower serum fructosamine concentrations. Serum glucose (P = 0.0001) and fructosamine (P = 0.0001) concentrations significantly decreased from week 0 to week 16 in both dietary groups. By week 16, significantly more of the cats fed the LC-LF food (68%, 22/31), compared to the cats fed the MC-HF food (41%, 13/32), had reverted to a non-insulin-dependent state (P = 0.03). Cats in both groups were successfully taken off of insulin regardless of age, sex, type of insulin administered or duration of clinical disease before entering the study. There was no significant difference in the initial or final mean body weights or in the mean change in body weight from week 0 to week 16 between dietary groups. Diabetic cats in this study were significantly more likely to revert to a non-insulin-dependent state when fed the canned LC-LF food versus the MC-HF food.

Effect of supplemental l-arginine on the function of T lymphocytes and the formation of advanced glycosylated end products in rats with streptozotocin-induced diabetes

Objective We investigated the effect of supplemental l-arginine on lymphocyte function in diabetes and its association with suppressed formation of advanced glycosylated end products (AGEs). Methods For the in vivo study, rats with streptozotocin-induced (65 mg/kg of body weight, intravenously) diabetes were treated with or without 2% l-arginine or glycine (as a positive control) in drinking water for 8 wk. We then measured serum fructosamine concentrations and concanavalin A-induced proliferative ability of lymphocytes from these animals. For the in vitro study, AGEs derived from albumin were prepared by incubating d-glucose (200 mmol/L) and bovine serum albumin (100 mg/mL) at 37°C for 2 wk in the presence or absence of l-arginine (0.1–10 mmol/L). These preparations were quantified for their bovine serum albumin--derived AGE content, and their effect on concanavalin A-induced proliferative activity of T lymphocyte from normal rats was measured. Results Serum fructosamine concentrations were significantly higher in the diabetic rats than in the control rats ( P < 0.05) but were significantly lowered with l-arginine supplementation ( P < 0.05). The lower lymphocyte proliferation rate found in the diabetic rats was reversed by supplemental l-arginine ( P < 0.05). During the course of incubation of bovine serum albumin with d-glucose, the presence of l-arginine prevented the formation of bovine serum albumin-derived AGEs and attenuated their inhibitory effect on the rate of lymphocyte proliferation in a dose-dependent manner. Conclusion Supplemental l-arginine improved the function of T lymphocytes in diabetic rats in association with decreased formation of AGEs.

Study of 253 dogs in the United Kingdom with diabetes mellitus

Clinical information and blood samples were collected from 253 dogs with naturally occurring diabetes mellitus. Over half of them were labrador retrievers, collies, Yorkshire terriers or crossbred dogs, and approximately...

Stress hyperglycemia in sick cats: a retrospective study over 4 years

Between January 1997 and December 2000 blood glucose concentrations were measured in 2278 sick cats at the time of their initial presentation at the hospital. In 827 cats (36%) hyperglycemia (blood glucose >8 mmol/l) was documented, 1388 cats (61%) had normal blood glucose levels, 63 cats (3%) were hypoglycemic. In 674 of 827 cats (81.5%) no further investigations were performed and the veterinarian judged the hyperglycemia to be stress related. In 153 of the 827 cats (18.5%) blood glucose measurements were repeated and/or serum fructosamine concentrations evaluated. In 106 cats (69%) stress hyperglycemia and in 47 (31%) diabetes mellitus was then diagnosed. Blood glucose concentrations in cats with stress hyperglycemia were between 8.1 and 60.4 mmol/l (Median 10.3), in cats with diabetes mellitus between 8.5 and 70.0 (Median 27.7). Blood glucose concentrations in cats with diabetes mellitus were significantly higher than in cats with stress hyperglycemia. Cats with stress hyperglycemia suffered from a variety of different diseases, the most frequently encountered were surgical problems, neoplasia, heart diseases, upper and lower urinary tract diseases. Blood glucose concentrations in cats with heart diseases and in cats with neoplasia was higher than in cats with other disorders, however, the difference was not significant. Cats with diabetes mellitus were significantly more frequent male castrated than cats with stress hyperglycemia. Cats with stress hyperglycemia were significantly older than cats with normoglycemia.

Total Glycated Serum Protein Levels in Hyperbilirubinaemic and Normobilirubinaemic Non Diabetic Nigerians

Serum glycated protein concentrations as fructosamine were estimated in 30 non- diabetic patients with hyperbilirubinaemia and 20 controls using the colorimetric nitroblue tetrazolium reduction technique. This was aimed at assessing the effect of hyperbilirubinaemia on serum total glycated protein concentrations (fructosamine levels) in Nigerians. The mean serum fructosamine concentration was significantly higher (p0.05). Conjugated bilirubin correlated significantly with serum fructosamine levels (r = 0.37; p0.05). These observations show that hyperbilirubinaemia, especially conjugated bilirubin fraction positively affects the concentrations of fructosamine at level probably greater than 100 umol/L. A correction factor is thus suggested. (Key words: Fructosamine, hyperbilirubinaemia, glycated protein Sahel Med. J. Vol.6(3) 2003: 83-86

Treatment of feline diabetes mellitus using an α-glucosidase inhibitor and a low-carbohydrate diet

The purpose of this study was to determine the effect of an α-glucosidase inhibitor (acarbose), combined with a low-carbohydrate diet on the treatment of naturally occurring diabetes mellitus in cats. Eighteen client-owned cats with naturally occurring diabetes mellitus were entered into the study. Dual-energy X-ray absorptiometry (DEXA) was performed prior to and 4 months after feeding the diet to determine total body composition, including lean body mass (LBM) and percent body fat. Each cat was fed a commercially available low-carbohydrate canned feline diet and received 12.5 mg/cat acarbose orally every 12 h with meals. All cats received subcutaneous insulin therapy except one cat in the study group that received glipizide (5 mg BID PO). Monthly serum glucose and fructosamine concentrations were obtained, and were used to adjust insulin doses based on individual cat's requirements. Patients were later classified as responders (insulin was discontinued, n=11) and non-responders (continued to require insulin or glipizide, n=7). Responders were initially obese (>28% body fat) and non-responders had significantly less body fat than responders (<28% body fat). Serum fructosamine and glucose concentrations decreased significantly in both responder and non-responder groups over the course of 4 months of therapy. Better results were observed in responder cats, for which exogenousinsulin therapy was discontinued, glycemic parameters improved, and body fat decreased. In non-responders, median insulin requirements decreased and glycemic parameters improved significantly, despite continued insulin dependence. The use a low-carbohydrate diet with acarbose was an effective means of decreasing exogenous insulin dependence and improving glycemiccontrol in a series of client-owned cats with naturally occurring diabetes mellitus.

Corneal sensitivity in dogs with diabetes mellitus.

To compare aesthesiometer-determined corneal sensitivity between diabetic and nondiabetic dogs and to investigate the correlation between corneal sensitivity and duration of diabetes or status of glycemic control, as estimated by use of glycated blood protein concentrations. 23 diabetic and 29 nondiabetic normoglycemic dogs. A Cochet-Bonnet aesthesiometer was used to measure corneal touch threshold (CTT) in 5 corneal regions of each dog. At the time of ocular examination, duration of diabetes mellitus was estimated from the history, and blood was drawn for assessment of blood glycosylated hemoglobin and serum fructosamine concentrations. Median CTT for central, nasal, dorsal, temporal, and ventral corneal regions in nondiabetic dogs (1.6, 2.3, 2.8, 2.8, and 5.1 g/mm2, respectively) was significantly lower than in diabetic dogs (2.8, 4.0, 5.1, 5.1, and 6.6 g/mm2, respectively). Median regional CTT in diabetic dogs was not significantly correlated with estimated duration of diabetes mellitus or blood glycated protein concentrations. No significant difference was found in regional CTT between eyes of normoglycemic dogs with unilateral cataracts. Diabetic dogs have significantly reduced corneal sensitivity in all regions, compared with nondiabetic normoglycemic dogs. Regional variation in corneal sensitivity is similar in diabetic and normoglycemic dogs. Neither glycemic control nor duration of diabetes, as estimated, is significantly correlated with corneal hyposensitivity. Corneal nerve dysfunction may be associated with recurrent or nonhealing ulcers in diabetic dogs for which no other underlying cause can be found.

Repaglinide versus glibenclamide treatment of Type 2 diabetes during Ramadan fasting

This study compared treatment with a prandial glucose regulator (repaglinide) and a sulphonylurea (glibenclamide) in Muslim Type 2 diabetic patients who practice Ramadan fasting. Two hundred and thirty-five patients, previously treated with a sulphonylurea, were randomised to receive either repaglinide (n=116, preprandially three-times daily) or glibenclamide (n=119, preprandially once- or twice-daily) 6 weeks before Ramadan. During Ramadan, patients changed their eating pattern to two meals daily, and the daily dose of repaglinide was redistributed to two preprandial doses. After Ramadan, patients resumed their regular meal pattern and treatment dosage for 4 weeks. During Ramadan, a statistically significant reduction in mean serum fructosamine concentration from baseline was observed in the repaglinide group (−16.9±4.9 μmol/l, −3.8%, P<0.05) but not the glibenclamide group (−6.9±4.8 μmol/l, −0.8%). Difference in change in HbA1c from baseline was not statistically significant between groups. The number of hypoglycaemic events with midday blood glucose <4.5 mmol/l was significantly lower in the repaglinide group (2.8%) than the glibenclamide group (7.9%) (P=0.001). Apart from hypoglycaemia, both treatments were equally well tolerated. Type 2 diabetic Muslims using prandial repaglinide showed a trend towards better glycaemic control and had a lower frequency of hypoglycaemia than patients using glibenclamide during Ramadan.

Diabetes mellitus and bilateral cataracts in a kitten

An 18-week-old male domestic long-hair kitten was presented with a history of polyuria and polydipsia for several weeks. The general condition was unremarkable, but the kitten was considerably smaller than expected for the age and showed cataracts in both eyes. Serum glucose concentrations were persistently elevated and based on clinical findings and an elevated serum fructosamine concentration, a diagnosis of diabetes mellitus was established.Diabetes mellitus is not commonly diagnosed in young kittens, nor are cataracts recognised as a frequent feature of this disease in cats. The cataracts progressed in spite of the insulin therapy and the kitten was euthanised 10 weeks after referral. Histopathological examination of the pancreas revealed few and small islets of Langerhans compared to the examination of pancreas from a healthy kitten of the same age. Histopathological changes in the eyes included cataracts affecting both cortex and nucleus.

Serum fructosamine concentrations in dogs with hypothyroidism.

Serum fructosamine concentrations were measured in 11 untreated hypothyroid dogs with normal serum glucose and serum protein concentrations. The fructosamine level ranged between 276 and 441 micromol/L (median 376 micromol/L; reference range 207-340 micromol/L). Nine of the 11 dogs had fructosamine levels above the reference range. The fructosamine levels decreased significantly during treatment with levothyroxine. It is suggested that serum fructosamine concentrations may be high in hypothyroid dogs because of decelerated protein turnover, independent of the blood glucose concentration.

Deducing serum fructosamine levels from the fasting blood glucose value: a preliminary study

The determination of glycated serum proteins (fructosamine) has become an accepted index for assessing the metabolic situation in diabetic patients. The current study describes an alternative to measurement of fructosamine level, viz., to predict the serum fructosamine based on the glucose concentration in fasting plasma. A crosssectional prospective study was performed on 44 non-diabetic, 38 impaired glucose tolerance and 38 diabetic subjects attending clinics at Colombo South Teaching Hospital. Fasting plasma glucose and corresponding serum fructosamine concentrations were determined on all subjects. Fructosamine showed a positive linear correlation of r2 = 0.85 with the fasting plasma glucose concentrations. Regression equation relating to these parameters was Y = 0.8173 X - 120.4655, were Y and X represent the plasma glucose and fructosamine values, repectively. This prediction test formula for fructosamine is shown to be a useful index for assessing the effects of changes in diabetic management.

Diagnosis of Diabetes Mellitus in Cats and Dogs

This article describes the clinical presentation of diabetes mellitus in cats and dogs, including the types of diabetes, signalment, history, physical examination findings, and laboratory diagnosis. Newer diagnostic tests such as serum fructosamine concentrations and arginine response rate are also briefly discussed.

Oral Chromium Picolinate and Control of Glycemia in Insulin‐Treated Diabetic Dogs

Chromium is an essential dietary trace mineral involved in carbohydrate and lipid metabolism. Chromium is required for cellular uptake of glucose, and chromium deficiency causes insulin resistance. Chromium supplementation may improve insulin sensitivity and has been used as adjunct treatment of diabetes mellitus in humans. In this study, 13 dogs with naturally acquired diabetes mellitus were treated with insulin for 3 months, then with insulin and chromium picolinate for 3 months. Dogs weighing <15 kg (33 lb: n = 9) were administered 200 microg of chromium picolinate PO once daily for I month, then 200 microg of chromium picolinate twice daily for 2 months. Dogs weighing >15 kg (n = 4) received 200 microg of chromium picolinate once daily for 2 weeks, then 200 microg twice daily for 2 weeks, then 400 microg twice daily for 2 months. Type of insulin, frequency of insulin administration, and diet were kept constant, and insulin dosage was adjusted, as needed, to maintain optimal control of glycemia. Mean body weight, daily insulin dosage, daily caloric intake, 10-hour mean blood glucose concentration, blood glycated hemoglobin concentration, and serum fructosamine concentration were not markedly different when dogs were treated with insulin and chromium picolinate, compared with insulin alone. Adverse effects were not identified with chromium picolinate administration. Results of this study suggest that, at a dosage range of 20-60 microg/kg/d, chromium picolinate caused no beneficial or harmful effects in insulin-treated diabetic dogs.

Oral Chromium Picolinate and Control of Glycemia in Insulin-Treated Diabetic Dogs

Chromium is an essential dietary trace mineral involved in carbohydrate and lipid metabolism. Chromium is required for cellular uptake of glucose, and chromium deficiency causes insulin resistance. Chromium supplementation may improve insulin sensitivity and has been used as adjunct treatment of diabetes mellitus in humans. In this study, 13 dogs with naturally acquired diabetes mellitus were treated with insulin for 3 months, then with insulin and chromium picolinate for 3 months. Dogs weighing <15 kg (33 lb; n = 9) were administered 200 μg of chromium picolinate PO once daily for 1 month, then 200 μg of chromium picolinate twice daily for 2 months. Dogs weighing >15 kg (n = 4) received 200 μg of chromium picolinate once daily for 2 weeks, then 200 μg twice daily for 2 weeks, then 400 μg twice daily for 2 months. Type of insulin, frequency of insulin administration, and diet were kept constant, and insulin dosage was adjusted, as needed, to maintain optimal control of glycemia. Mean body weight, daily insulin dosage, daily caloric intake, 10-hour mean blood glucose concentration, blood glycated hemoglobin concentration, and serum fructosamine concentration were not markedly different when dogs were treated with insulin and chromium picolinate, compared with insulin alone. Adverse effects were not identified with chromium picolinate administration. Results of this study suggest that, at a dosage range of 20–60 μg/kg/d, chromium picolinate caused no beneficial or harmful effects in insulin-treated diabetic dogs.

Clinical value of fructosamine measurements in non-healthy dogs.

Ninety-three unhealthy dogs (including some with diabetes mellitus or insulinoma) of different ages, sex and breeds were divided into 10 groups according to their pathology. Serum fructosamine concentrations were determined using a commercial colorimetric nitroblue tetrazolium method. Diabetic dogs had the highest fructosamine concentrations (454.85 +/- 149.34 micromol/L). Dogs with insulinoma had significantly lower fructosamine concentrations (202.80 +/- 31.22 micromol/L), similar to those with leishmaniosis (202.83 +/- 99.83 micromol/L). Fructosamine concentrations in non-healthy dogs, except those with diabetes mellitus, insulinoma or leishmaniosis, were within the reference limits previously reported.

Fructosamine and glycated hemoglobin in the assessment of glycaemic control in dogs.

Fructosamine and glycated hemoglobin (HbA1c) concentrations were measured simultaneously in 222 dogs (96 healthy and 126 sick dogs). The dogs were divided into 3 groups according to the glucose concentration: hypo, hyper and euglycaemic dogs. Serum fructosamine concentrations were measured by the reduction test with nitroblue tetrazolium. A turbidimetric inhibition immunoassay and specific polyclonal antibodies were used to evaluate glycated hemoglobin concentrations. A significant correlation was found between glucose concentration and either fructosamine (r = 0.63, p < 0.0001) or glycated hemoglobin (r = 0.82, p < 0.0001). The correlation was higher in hyperglycaemic dogs for fructosamine (r = 0.80, p < 0.0001) and in hypoglycaemic dogs for glycated hemoglobin (r = 0.91, p < 0.005). We found a significant correlation between serum fructosamine and glycated hemoglobin (r = 0.65, p < 0.0001 ) when all the dogs were studied. A significant correlation was observed between serum fructosamine and glycated hemoglobin only in hyperglycaemic dogs (r = 0.82, p < 0.0003). Thus, fructosamine and HbA1c may be considered for use in screening tests for diabetes mellitus in dogs and clinical tests for monitoring control and evaluation of the diabetic animal's response to treatment. The choice of the analytical assay depends on the characteristic and analytical opportunities of the laboratory, as well as the number of serum samples to be analysed.

Evolution of fructosaminaemia and glucaemia during the growth of unweaned and early weaned half-bred zebu calves.

The purposes of the study were to obtain the confidence intervals for serum fructosamine concentrations in unweaned and early weaned calves, to verify the changes in this glycated protein during growth, when glucaemia declines, and to assess the changes in both parameters attributable to stress or alarm. Sixty out of 120 suckling half-bred zebu calves (60-75 days old) were weaned at day 0 and then received a commercial balanced diet, while the remainder continued to suck. Blood samples were taken at 0, 7, 14, 21, 28, 60, 90 and 120 days and the serum fructosamine and glucose concentrations were measured by conventional methods. Both biochemical parameters declined with time, but there were no statistical differences between the unweaned and weaned calves. The fall in fructosamine concentration correlated significantly with the decline in glucose concentrations in both groups. The confidence interval for fructosamine concentration decreased with age, from 294-303 micromol/L at 2 months old to 215-232 micromol/L at 6 months old. At the same time, glucaemia declined from 7.5-8.6 mmol/L to 4.8-5.3 mmol/L. Acute elevations in glucaemia, especially in the younger calves, were attributed to alarms, such as those caused by handling and blood extraction. The absence of resultant increases in fructosamine concentration discounts the existence of prolonged hyperglucaemias (stress) in early weaned calves.

Efficacy of protamine zinc insulin for treatment of diabetes mellitus in cats

To evaluate effects of protamine zinc insulin (PZI) on control of glycemia in cats with newly diagnosed diabetes mellitus or poorly controlled diabetes. Clinical trial. 67 diabetic cats. 34 cats with newly diagnosed diabetes and 33 cats with poorly controlled diabetes were treated with PZI twice daily for 45 days. Control of glycemia was assessed on days 7, 14, 30, and 45 by evaluation of clinical response, change in body weight, serum fructosamine concentration, blood glucose concentration measured 1, 3, 5, 7, and 9 hours after administration of PZI, lowest blood glucose concentration, and mean blood glucose concentration during the 9-hour period after administration. Adjustments in dosage of PZI were made as needed to attain control of glycemia. For all cats, a significant increase in mean dosage of PZI and significant decreases in 9-hour mean blood glucose concentration, lowest mean blood glucose concentration, and mean serum fructosamine concentration were detected. For cats with poorly controlled diabetes, 9-hour mean blood glucose concentration and mean serum fructosamine concentration were significantly decreased on day 45, compared with day 0. Ninety percent of owners reported improvement or resolution of clinical signs by day 45. Results suggest that PZI was effective for control of glycemia in cats with newly diagnosed or poorly controlled diabetes and may be used as an initial treatment or as an alternative treatment in cats that do not respond to treatment with other types of insulin.

Reliability of history and physical examination findings for assessing control of glycemia in dogs with diabetes mellitus: 53 cases (1995-1998).

To evaluate the reliability of history and physical examination findings for assessing control of glycemia in insulin-treated diabetic dogs. Retrospective study. 53 insulin-treated dogs with diabetes mellitus. Medical records of insulin-treated diabetic dogs from June 1995 to June 1998 were reviewed, and information on owner perception of their dog's response to insulin treatment, physical examination findings, body weight, insulin dosage, and concentrations of food-withheld (i.e., fasting) blood glucose (FBG), mean blood glucose (MBG) during an 8-hour period, blood glycosylated hemoglobin (GHb), and serum fructosamine was obtained. Owner's perception of their dog's response to insulin treatment, physical examination findings, and changes in body weight were used to classify control of glycemia as good or poor for each dog. The FBG, MBG/8 h, blood GHb, and serum fructosamine concentrations were compared between well-controlled and poorly controlled insulin-treated diabetic dogs. Presence or absence of polyuria, polydipsia, polyphagia, lethargy, and weakness were most helpful in classifying control of glycemia. Mean FBG and MBG/8 h concentrations, blood GHb concentrations, and serum fructosamine concentrations were significantly decreased in 25 well-controlled diabetic dogs, compared with 28 poorly controlled diabetic dogs. Most well-controlled diabetic dogs had concentrations of FBG between 100 and 300 mg/dl, MBG/8 h < or = 250 mg/dl, blood GHb < or = 7.5%, and serum fructosamine < or = 525 mumol/L, whereas most poorly controlled diabetic dogs had results that were greater than these values. Reliance on history, physical examination findings, and changes in body weight are effective for initially assessing control of glycemia in insulin-treated diabetic dogs.