Serum Glucose In Patients Research Articles

Accuracy of Continuous Glucose Monitoring in an Insulin-Treated Population Requiring Haemodialysis.

Continuous glucose monitoring (CGM) is revolutionizing diabetes care by giving both patients and the healthcare professionals unprecedented insights into glucose variability and patterns. It is established in National Institute for Health and Care Excellence (NICE) guidance as a standard of care for type 1 diabetes and diabetes in pregnancy under certain conditions. Diabetes mellitus (DM) is recognized as an important risk factor for chronic kidney disease (CKD). Around a third of patients receiving in-center haemodialysis as renal replacement therapy (RRT) have diabetes, either as a direct cause of renal failure or as an additional co-morbidity. Evidence of poor compliance with the current standard of care (self-monitoring of blood glucose [SMBG]) and overall greater morbidity and mortality, suggests this patient population as an ideal target group for CGM. However, there exists no strong published evidence showing the validity of CGM devices in insulin-treated diabetes patients requiring haemodialysis. We applied a Freestyle Libre Pro sensor to 69 insulin-treated diabetes haemodialysis (HD) patients on a dialysis day. Interstitial glucose levels were obtained, and time matched within 7 minutes to capillary blood glucose testing and any plasma blood glucose levels sent. Data cleansing techniques were applied to account for rapidly correcting hypoglycaemia and poor SMBG technique. Clarke-error grid analysis showed 97.9% of glucose values in an acceptable range of agreement (97.3% on dialysis days and 99.1% on non-dialysis days). We conclude that the Freestyle Libre sensor is accurate in measuring glucose levels when compared to glucose as measured by capillary SMBG testing and laboratory obtained serum glucose in patients on HD.

A dynamical model of combination therapy applied to glioma.

Glioma is a human brain tumor that is very difficult to treat at an advanced stage. Studies of glioma biomarkers have shown that some markers are released into the bloodstream, so data from these markers indicate a decrease in the concentration of blood glucose and serum glucose in patients with glioma; these suggest an association between glucose and glioma. This decrease mechanism in glucose concentration can be described by the coupled ordinary differential equations of the early-stage glioma growth and interactions between glioma cells, immune cells, and glucose concentration. In this paper, we propose developing a new mathematical model to explain how glioma cells evolve and survive combination therapy between chemotherapy and oncolytic virotherapy, as an alternative to glioma treatment. In this study, three therapies were applied for analysis, that is, (1) chemotherapy, (2) virotherapy, and (3) a combination of chemotherapy and virotherapy. Virotherapy uses specialist viruses that only attack tumor cells. Based on the simulation results of the therapy carried out, we conclude that combination therapy can reduce the glioma cells significantly compared to the other two therapies. The simulation results of this combination therapy can be an alternative to glioma therapy.

The effect of sulphate-sulphide mineral baths on blood glucose level in patients with knee osteoarthritis

Background/Aim: Type 2 diabetes is a common comorbidity in patients with knee osteoarthritis. Bearing in mind that obesity and insulin resistance are risk factors for the development of knee osteoarthritis, physical therapy and balneotherapy containing hydrogen sulphide (H2S) has a positive effect on the functional and metabolic status of these patients. This work was aimed to investigate the effect of sulphate-sulphide-rich mineral baths containing H2S on the level of serum glucose in patients with knee osteoarthritis. Methods: An open prospective randomised clinical trial included patients suffering from stage I and II of the knee osteoarthritis. Patients were divided into two groups of 40 subjects each: control group and experimental group. All subjects underwent inpatient physical treatment consisting of kinesitherapy and transcutaneous electrical nerve stimulation (TENS) 6 days a week. Patients from experimental group, in addition to all the mentioned treatments, also took sulphate-sulphide mineral water baths once a day for 30 minutes for 7 days, unlike the patients from control group who took tap water baths, according to the same schedule. The level of serum glucose was monitored in all patients on admission, after discharge and 6 months after the treatment. The Student t-test was used for statistical data processing and p < 0.05 was considered as statistically significant. Results: Study included 80 patients of both sexes, with an average age of 67.00 ± 5.75 years. All patients had elevated serum glucose values on admission. The initial levels of glycaemia in the control and experimental groups were not significantly different (6.99 ± 1.95 and 7.88 ± 1.90 mmol/L, respectively). At discharge, patients who performed balneotherapy had a statistically significant decrease in serum glucose values compared to patients from the control group (by 1.84 vs 0.26 mmol/L, p < 0.001). This effect did not persist six months after the end of the treatment (p > 0.05). Conclusion: The application of balneotherapy with sulphate-sulphide mineral baths containing H2S as a potent gas transmitter significantly reduces serum glucose levels in patients with knee osteoarthritis.

The Relationship between Diabetes Mellitus and Renal Failure in Babylon Province

This study was done at medical merjan city that included 70 blood samples have been collected from chronic renal failure patients and compared with 30 samples from apparent healthy individuals as control group, Which were collected between November, 2015 and January, 2016. The samples of patients comprised of 42 male and 28 female at the ages range from( 24-84) years while the control group included 15 female and 15 male those aged( 23-81)years. This study estimated the level of blood Urea, serum Creatinine, and fasting blood Glucose in patients who had the renal problem in diabetes case. There were high significant correlation between S. Ur and S. Cr, and non significant correlation between B. Ur and S. Glu. Aim of the study 1-Estimating the level of blood urea ,serum creatinine and fasting serum glucose in patients have chronic renal failure and diabetes mellitus compared with the same parameters in normal healthy controls and study the correlation between diabetes mellitus and renal failure .

Assessment of melatonin level and genetic aspect of type 2 diabetes mellitus patients in Thi-Qar province, Iraq

The present study was designed to assessment of melatonin level and genetic aspects of patients with diabetes mellitus type 2 in Thi-Qar province, Iraq. The sample includes 80 patients compared with 40 as control group. The results showed a significant increase in levels of serum glucose in patients with DM type 2 compared with 40 as a control group at (p<0.05). The level of melatonin showed a significant decrease in patients of diabetes compared with the control group. The genetic study was conducted to identify the potential association of melatonin receptor MTNR1B gene SNPs with the progression of type 2diabetes mellitus (T2DM). In this same locus, four new SNPs were observed and their novelty were proven, including g.10718G>C, g.10863A>G, g.10865G>A, and g.10867T>A, while only one SNP was found to be known, namely rs1431442778. The current results indicated the presence of all of the observed SNPs only in the patients’ samples.

Glucose Is Involved in the Dynamic Regulation of m6A in Patients With Type 2 Diabetes.

N6-methyladenosine (m6A) in mRNA is the most abundant and reversible modification. However, the mechanism behind the decrease in m6A in patients with type 2 diabetes (T2D) has not yet been thoroughly investigated. To clarify whether glucose is involved in the dynamic regulation of m6A in T2D and to identify a possible underlying mechanism. Liquid chromatography/electrospray ionization/tandem mass spectrometry and quantitative PCR were performed to determine the m6A content and the mRNA expression of target genes in 102 patients with T2D and 107 controls. An additional 12 patients with normal fasting blood glucose, emergency hyperglycemia, or emergency hypoglycemia, as well as HepG2 cells with high-glucose treatment and FTO knockout or overexpression were used to confirm the initial observations in patients. In patients with T2D, the m6A content was decreased, and mRNA expression levels of FTO, METTL3, METTL14, and WTAP were increased. Interestingly, the m6A content was negatively associated with mRNA expression levels of METTL3, METTL14, and FTO. Moreover, FTO was positively correlated with serum glucose. In HepG2 cells, high glucose upregulated FTO protein, whereas it had no significant effect on METTL3 or METTL14. Additionally, mRNA expression levels of FOXO1, G6PC, and DGAT2 were significantly increased and positively correlated with FTO and serum glucose in patients. Our data revealed that in patients with T2D, high-glucose-enhanced FTO mRNA expression resulted in a decrease in m6A. The lower m6A content might be responsible for the upregulation of methyltransferases. Additionally, FTO induced mRNA expression of FOXO1, G6PC, and DGAT2 and was closely associated with glucose metabolism.

Effect of diabetes mellitus type 2 on salivary glucose, immunoglobulin A, total protein, and amylase levels in adults: A systematic review and meta-analysis of case-control studies.

Background:Saliva is a fluid with the complex compound which can be used as diagnostic markers for type 2 diabetes (T2D). This meta-analysis evaluated salivary glucose, immunoglobulin A (IgA), total protein, and amylase levels in adult T2D compared with the controls as well as the correlation of salivary glucose levels with serum glucose and hemoglobin A1C (HbA1c) levels in both groups.Materials and Methods:Web of Science, Scopus, PubMed, and Cochrane Library databases were searched up to July 2017. A random-effects analysis was performed using the mean difference (MD) and 95% confidence intervals. The search terms were “T2D, IgA, amylase, total protein, or glucose” combination with “saliva.” The studied variables were the sample size, the percentage of male, the mean age, the condition of saliva sampling, and the salivary levels of mentioned factors.Results:A total of 25 studies were included in this meta-analysis with 1432 and 900 diabetic patients and healthy controls, respectively. MD of salivary glucose level in patients with T2D, compared with the healthy controls, in fasting and nonfasting conditions were 6.23 mg/dL (P = 0.0002) and 6.70 mg/dL (P < 0.00001), respectively. Furthermore, the fasting salivary total protein in the patients was significantly higher than the controls (MD = 167.96 mg/dL; P = 0.03). Non-fasting salivary amylase and secretory IgA levels were significantly lower in the patients (MD = −48.61 IU/mL; P < 0.00001) than in the controls (MD = −9.42 IU/mL; P = 0.0006), respectively. The pooled estimate showed a significant correlation between salivary and serum glucose in the patients (r = 0.765; P < 0.001) and the controls (r = 0.646; P < 0.001) and between salivary glucose and serum glycated hemoglobin in the patients (r = 0.721; P < 0.001).Conclusion:Measurement of these salivary factors can be helpful for diagnostic and monitoring purposes of T2D. In addition, salivary glucose as a diagnostic tool can evaluate serum glucose and HbA1c levels in the diabetic patients.

The Eosinophil Count Tends to Be Negatively Associated with Levels of Serum Glucose in Patients with Adrenal Cushing Syndrome.

BackgroundCushing syndrome is characterized by glucose intolerance, cardiovascular disease, and an enhanced systemic inflammatory response caused by chronic exposure to excess cortisol. Eosinopenia is frequently observed in patients with adrenal Cushing syndrome, but the relationship between the eosinophil count in peripheral blood and indicators of glucose level in patients with adrenal Cushing syndrome has not been determined.MethodsA retrospective study was undertaken of the clinical and laboratory findings of 40 patients diagnosed with adrenal Cushing syndrome at Chungnam National University Hospital from January 2006 to December 2016. Clinical characteristics, complete blood cell counts with white blood cell differential, measures of their endocrine function, description of imaging studies, and pathologic findings were obtained from their medical records.ResultsEosinophil composition and count were restored by surgical treatment of all of the patients with adrenal Cushing disease. The eosinophil count was inversely correlated with serum and urine cortisol, glycated hemoglobin, and inflammatory markers in the patients with adrenal Cushing syndrome.ConclusionSmaller eosinophil populations in patients with adrenal Cushing syndrome tend to be correlated with higher levels of blood sugar and glycated hemoglobin. This study suggests that peripheral blood eosinophil composition or count may be associated with serum glucose levels in patients with adrenal Cushing syndrome.

Canagliflozin use in Type I diabetes mellitus

ABSTRACTPeters et al documented the appearance of diabetic ketoacidosis without significant elevation of serum glucose in patients treated with Canagliflozin. They solicited patient reports from their practice and from other colleagues’ practices and identified nine patients, mainly with Type I Diabetes. Erondu et al evaluated the Canagliflozin development data base to describe the rate and appearance of ketoacidosis in the study patients. They found that in the research patients with Type 2 Diabetes, the rate of ketoacidosis in Canagliflozin patients was uncommon and similar to the reported rate in Type 2 patients not receiving Canagliflozin. Finally, Henry et al reported on a research program that added Canagliflozin onto insulin therapy in Type I patients, finding that there were only modest improvements in HgBA1 C levels and weight, while this therapy produced increased levels of ketosis and 6% rate of ketoacidosis in Canagliflozin patients. This information strongly suggests that Canagliflozin, and possibly the other SGLT-2 inhibitors, are not proper therapy for patients with Type I Diabetes.

Diabetic ketoacidosis, sodium glucose transporter-2 inhibitors and the kidney

Diabetic ketoacidosis is a serious metabolic condition that may occur in patients with either Type 1 or Type 2 diabetes. The accumulation of ketoacids in the serum is a consequence of insulin deficiency and glucagon excess. Sodium Glucose Transporter 2 (SGLT2) inhibitors are novel therapeutic treatments for improving glucose homeostasis in patients with diabetes. Through reductions in glucose reabsorption by the kidney, they lower serum glucose in patients with Type 2 diabetes and they improve glucose control whether used alone or in combination with other therapies. Mechanistically, these drugs increase serum ketoacids and increase glucagon production, which in some individuals, can lead to formation of diabetic ketoacidosis. This review will first focus in how the kidney normally handles ketoacids, and second will discuss how the SGLT2 inhibitors affect the kidney in such a way so as to enhance the risk for development of ketoacidosis in susceptible individuals.

Bile acid sequestrants activate novel signaling pathways in the kidney and prevent obesity‐induced renal disease (767.10)

Bile acid sequestrants (BAS) are orally administered nonabsorbable polymers that decrease serum cholesterol and serum glucose in patients and animal models with type 2 diabetes mellitus. The effects of BAS on renal dysfunction in obesity and insulin resistance or type 2 diabetes mellitus have not been studied. Our goal was to evaluate the effect of BAS on metabolic and renal parameters in diet induced obesity. Our studies were performed in C57BL/6J male mice fed a control low fat (LF) diet (10 kcal% fat) or high fat (HF) diet (60 kcal% fat). The diets were supplemented with a) no addition or b) 2% sevelamer a BAS. Treatment with BAS prevented HF diet induced body weight gain, improved fasting blood glucose and glucose tolerance, and prevented the increases in serum cholesterol as well as insulin and leptin levels in HF mice. BAS prevented the increase in urine albumin excretion and decreased the PAS staining in the kidney of HF mice. Treatment with BAS decreased the renal lipid accumulation as shown by oil red O staining. HF diet induced upregulation of profibrotic genes (TGF‐β, CTGF, and PAI‐1) and proinflammatory genes (MCP‐1, TLR2, and TLR4) in the kidney which were decreased by treatment with BAS. In addition BAS induced downregulation of extracellular matrix protein fibronectin and macrophage marker CD68 expression in the kidney. The beneficial effects of BAS were also associated with decreases in renal gluconeogenic gene expression (PEPCK and G6Pase) and renal glucose transporter (SGLT2). Treatment with BAS also and most notably increased renal expression of Nrf1, SIRT1, PGC‐1a,SIRT3, ERRa, that mediate mitochondrial biogenesis, MCAD and LCAD, that mediate fatty acid oxidation, and Nrf2, HO‐1, and SOD, that mediate anti‐oxidative stress. In summary, our study showed a novel renoprotective role for bile acid sequestrant treatment in mice with diet induced obesity, insulin and leptin resistance.Grant Funding Source: NIH, VA, Genzyme, Daiichi Sankyo

Comparison of Direct Action of Thiazolidinediones and Glucocorticoids on Renal Podocytes: Protection from Injury and Molecular Effects

The U.S. Food and Drug Administration-approved thiazolidinediones pioglitazone and rosiglitazone are peroxisome proliferator-activated receptor-γ (PPARγ) agonists developed to control serum glucose in patients with diabetes. They have been found to reduce proteinuria and microalbuminuria in both diabetic nephropathy and nondiabetic glomerulosclerosis. We hypothesized that the renal protective effects of thiazolidinediones result, at least in part, from their direct action on podocytes, similar to glucocorticoids. Treatment with pioglitazone, rosiglitazone, or dexamethasone significantly protected podocytes against puromycin aminonucleoside-induced injury (designed to mimic nephrotic syndrome-related injury), as determined by both cell survival and actin cytoskeletal integrity. Furthermore, we compared the ability of these drugs to modulate key signaling pathways in podocytes that may be critical to their protective effects. Rosiglitazone deactivated the mitogen-activated protein kinases (MAPKs), extracellular signal-regulated kinases 1/2, p38 MAPK, and stress-activated protein kinase/c-Jun NH₂-terminal kinase, whereas pioglitazone did not, and dexamethasone deactivated to some extent. Similar to dexamethasone, both thiazolidinediones increased the glucocorticoid receptor phosphorylation, and this response to rosiglitazone and possibly to pioglitazone was PPARγ-dependent. Furthermore, both drugs mimicked or enhanced the effects of dexamethasone on glucocorticoid-responsive genes in a PPARγ- and glucocorticoid receptor-dependent manner. In addition, both thiazolidinediones mimicked dexamethasone-induced effects on calcineurin activity. In summary, thiazolidinediones are able to modulate the glucocorticoid pathway and exert direct protective effects on podocytes, similar to glucocorticoids. This suggests that thiazolidinediones may have potential clinical utility as either primary or adjunctive therapy for nephrotic syndrome or other diseases treated with glucocorticoids. These findings may also lend mechanistic insight into the well established but poorly understood renal protective effects of thiazolidinediones in diabetic nephropathy.

Emerging Ideas: The Effect of Hypercholesterolemia on Tendons

High levels of total cholesterol, triglycerides, and low-density lipoprotein are toxic to the vascular endothelium and thus have long been associated with atherosclerosis. Several clinical studies have suggested that elevated cholesterol also has a negative effect on tendon structure and function. Data from our preliminary studies show that the patellar tendons of hypercholesterolemic knockout mice exhibit reduced baseline elastic modulus and strength postinjury compared with controls. We therefore hypothesized elevated cholesterol would be associated with diminished tendon mechanical properties. Using hypercholesterolemic (B6.129P2-Apoetm1Unc/J) mice, patellar tendons from control (C57BL/6) and knockout mice will be injured surgically at two different times. Subsequently, mechanical testing will be performed and data evaluated for differences in baseline and in healing between cholesterol groups. For healing assessment, data from the injured limb of each animal will be normalized to that of the sham-operated contralateral limb. We anticipate that such studies eventually will enable us to elucidate the link between elevated cholesterol and tendon disease. If a mechanistic cause of hypercholesterolemia causing tendon disease is clarified, then potentially therapeutic interventions such as the use of pharmacotherapy may be used to help combat this. In the future, it may become worthwhile to consider the presentation of tendinopathy as a trigger to measure serum cholesterol just as one might consider measuring serum glucose in patients presenting with adhesive capsulitis.

ESSENTIAL HYPERTENSION

Background: Hypertension and type 2 diabetes mellitus also tend to coexist.The goal of antihypertensive therapy should consist of reducing cardiovascular morbidity and mortality associated withhypertension by a strategy focused on lowering blood pressure while minimizing the impact on other associatedcardiovascular risk factors like diabetes mellitus. Objectives: To observe and compare any change in serum glucosein patients with newly diagnosed essential hypertension with Atenolol and Amlodipine. Setting: Department ofPharmacology and Therapeutics, Basic Medical Science Institute (BMSI), Jinnah Post Graduate Medical Centre(JPMC), Karachi. Period: 12 weeks (90 days) Methods: Patients with newly diagnosed essential hypertension (N=70)were enrolled in this study and were divided into two groups, each comprised of 35 patients and were given tabletAtenolol 50/100mg once daily and tablet Amlodipine 5/10 mg once daily respectively for 90 days. Fasting Blood glucosewas measured on day of inclusion i.e. day 0, day 45 and day 90. At each fortnightly visit, blood pressure was recorded.Results: Atenolol raised mean blood glucose levels from baseline levels of 91.82±1.34 mg/dl to 99.73±1.33 mg/dl onday 90 (P&lt;0.001) while Amlodipine had no significant effect on blood glucose level (P= N.S). Conclusion: Atenololmay not be a good choice for essential hypertensive patient with type 2 diabetes mellitus as it is found to impair the normal glucose metabolism. Long term clinical trials in diabetic patients are needed to confirm the observation of thepresent study.

Relationship between fasting serum glucose, age, body mass index and serum 25 hydroxyvitamin D in postmenopausal women

Because it has been reported that vitamin D, given to mother or infant, can prevent type I diabetes in children, that diabetes is more common in adults with low serum vitamin D and that insulin secretion and action are related to vitamin D levels in healthy young adults we examined the relationship between serum vitamin D metabolites and fasting serum glucose in patients attending our outpatient clinics. Retrospective examination of convenience sample of postmenopausal women attending our osteoporosis clinics. A total of 753 postmenopausal women attending a university hospital outpatient clinic and not on any treatment known to affect glucose metabolism. Body weight and height, serum 25-hydroxyvitamin D [25(OH)D], serum 1,25-dihydroxyvitamin D [1,25(OH)2D], serum PTH and fasting serum glucose. On simple correlation fasting serum glucose was a positive function of age (P < 0.05), weight (P < 0.001) and body mass index (BMI) (P < 0.001) and a negative function of serum 25(OH)D (P < 0.001), but it was not significantly related to either serum 1,25(OH)2D, PTH or creatinine. When fasting serum glucose was regressed simultaneously on age, BMI and 25(OH)D, glucose was still an inverse function of 25(OH)D (P = 0.006). Fasting serum glucose increased as 25(OH)D levels fell throughout the range of serum 25(OH)D measured but the greatest increase was observed in those with 25(OH)D below 40 nmol/l.

Effect of acute and chronic administration of calcitonin on serum glucose in patients with Paget's disease of bone.

The effects of an acute injection of synthetic salmon calcitonin (sCT) and human CT (hCT) and of long term (4-month) administration of sCT on serum glucose levels were investigated in eight patients with Paget's disease of bone. The results obtained demonstrate a small but statistically significant rise in serum glucose after a single sc injection of synthetic hCT. However, the serum glucose level was not increased after 4 months of daily administration of synthetic sCT to our pagetic patients. Our results also substantiate the clinical observation that long term administration of CT does not cause clinical diabetes or significantly change fasting blood glucose concentration. Our results are also consistent with the view that the effect of CT administration on glucose metabolism is related to the secondary hypocalcemia.