Standard Deviation Of Mean Blood Glucose Research Articles

Glycemic variability indices determined by self-monitoring of blood glucose are associated with β-cell function in Chinese patients with type 2 diabetes

IntroductionGlycemic control plays an important role in diabetes management, and self-monitoring of blood glucose (SMBG) is critical to achieving good glycemic control. However, there are few studies about the relationship between SMBG-estimated glycemic indices and β-cell function. Here we investigated the association between glucose variation indices estimated by SMBG and β-cell function among Chinese patients with type 2 diabetes mellitus (T2DM). MethodsIn this cross‑sectional study, 397 patients with T2DM were recruited from February 2015 to October 2016. β-cell function was monitored using the Homeostasis Model Assessment 2 (HOMA2)-%β index. The parameters evaluated by SMBG were the mean blood glucose (MBG), standard deviation of MBG (SDBG), largest amplitude of glycemic excursions (LAGE), and postprandial glucose excursion (PPGE). ResultsHOMA2-%β was negatively correlated with SDBG, LAGE, PPGE, and MBG (r = −0.350, −0.346, −0.178, and −0.631, respectively; all p < 0.01). After adjusting for confounding characteristics (diabetic duration, triglyceride, total cholesterol, fasting C-peptide, HOMA2-insulin resistance index, hypoglycemia, and diabetic treatments) and glycated hemoglobin A1c on a continuous scale, odds ratios of SDBG, LAGE, PPGE, and MBG between the patients in the lowest and highest HOMA2-%β quartiles were 2.02 (1.14–3.57), 1.24 (1.04–1.49), 1.13 (0.86–1.51), and 2.26 (1.70–3.00). HOMA2-%β was independently associated with SDBG, LAGE, and MBG. ConclusionsIncreased SDBG and LAGE assessed by SMBG are associated with β-cell dysfunction in Chinese patients with T2DM.

Association of high circulating testosterone with increased glycaemic variability in type 2 diabetes: A cross‐sectional study in China

Testosterone affects insulin resistance, but the effect of testosterone treatment on type 2 diabetes (T2D) remains controversial. We aimed to investigate the association between circulating total testosterone (TT) and glycaemic variability using continuous glucose monitoring (CGM) in patients with T2D. A total of 248 men with T2D were enrolled in the study. Clinical characteristics and plasma for glycated haemoglobin (HbA1c) and C-peptide assessment were collected. TT was measured using a chemiluminescent immunometric assay. All patients were subjected to a 3-day CGM before making adjustments for hypoglycaemic therapy. TT positively correlated with the standard deviation of mean blood glucose (SDBG) (P<0.05), especially in older patients. Linear regression analysis showed that SDBG was associated with HbA1c (β=0.354, P<0.001) and TT (β=0.164, P=0.008) after adjusting for age, duration of diabetes, body mass index, fasting/postprandial C-peptide, and use of different hypoglycaemic drugs. The cut-off value of TT for predicting glycaemic variability was 14.76mmol/L according to receiver operating characteristic (ROC) analysis. SDBG, the coefficient of variation, the incremental area under the curve of glucose (AUC)>10mmol/L, and AUC night were increased in the group with TT>14.76nmol/L (P<0.01 for all variables). Body mass index and fasting/postprandial C-peptide were lower in the group with TT>14.76nmol/L than in the group with TT≤14.76nmol/L (P<0.05). Circulating TT levels should be assessed in patients with T2D in addition to HbA1c for predicting glycaemic variability. More frequent blood glucose monitoring or CGM is suggested for patients with T2D and high testosterone levels. NCT03519529, ClinicalTrials.gov.

The influence of blood glucose fluctuation on hippocampal tau protein phosphorylation of diabetic rats

Objective To investigate the influence of blood glucose fluctuation on ser202 phosphorylation sites of tau protein(p-Tau) in hippocampus of diabetic rats; to explore the possible mechanism of blood glucose fluctuation impacting on tau protein hyperphosphorylation. Methods Healthy male Sprague Dawley rats were randomly divided into normal control group (NC group) and diabetes group. After diabetic rats model was established, all the diabetic rats were randomly divided into diabetic continuous hyperglycemia group (DC group) and diabetic blood glucose fluctuant group (DF group). Rats in DF group were given glucose solution intraperitoneal injection twice at regular time everyday. 30 minutes after each intraperitoneal injection, insulin subcutaneously injections were given. Rats in the NC group and DC groups were given the same volume of saline subcutaneous injection. Specimens were collected in 8 weeks, the levels of p-Tau and total tau in rat hippocampus were detected by immunohistochemical staining and Western blotting. The immunoreactive positive products were analyzed by image analysis system. Glycogen synthase kinase-3β(GSK-3β) mRNA was detected by realtime PCR. Results (1) Blood glucose fluctuation of rats in DC and DF group were greater than NC group. And the mean blood glucose, standard deviation of mean blood glucose (SDBG), and large amplitude of glycemic excursion (LAGE) levels were increased significantly compared to NC group, the difference has statistical significance (all P 0.05). (2) Compared with NC group, the hippocampal p-Tau level of DC group and DF group were increased (P<0.05); Compared with DC group, the hippocampal p-Tau expression of DF group was increased (P<0.05). Compared with DC group, a higher hippocampal GSK-3β mRNA level was found in DF group (P<0.05). Conclusions On the basis of diabetes animal model, giving glucose solution intraperitoneal injection and insulin subcutaneously injection 30 minutes later twice at regular time everyday could establish experimental model of diabetic blood glucose fluctuation. Blood glucose fluctuation may aggravate the diabetic rats hippocampal p-Tau. The possible mechanism seems to be an up regulation of the GSK-3β. (Chin J Endocrinol Metab, 2017, 33: 776-780) Key words: Blood glucose fluctuation; Diabetes mellitus; Hippocampus; Tau protein phosphorylation

Various blood glucose parameters that indicate hyperglycemia after intravenous thrombolysis in acute ischemic stroke could predict worse outcome.

BackgroundHyperglycemia is common after stroke, and it is well known to worsen its outcome. However, it is important to consider that blood glucose (BG) levels can undergo dynamic changes during the acute stage of ischemic stroke. We sought to investigate the clinical significance of various glucose parameters within first 24 hours in acute ischemic stroke (AIS). The study focused on hyperacute stage patients who underwent IVT and investigated which parameters of glucose demonstrated to be helpful for predicting outcome.MethodsThis was a retrospective study of consecutive patients with AIS at a single stroke center. Patients were consecutively enrolled if they were treated with IV-tPA within 3 hours of symptom onset. BG was measured immediately upon arrival in ER, after IVT and every 6–8 hours during the first 24 hours after IVT. The various parameters of BG were the following: BG before IVT, BG after IVT, mean BG (mBG), maximal BG (max BG), standard deviation of BG (sdBG), and standard deviation of mean BG (sdmBG).Results207 patients (127 men and 80 women) were included in this study. Seventy seven of 207 patients had favorable outcomes at 3 months. High BG after IVT, mBG and max BG were independently associated with mRS>2 at 3 months (adjusted by age, NIHSS, and atrial fibrillation). Several parameters of BG were also independently associated with early mortality within 3 months (BG after IVT, mBG, and max BG). BG after IVT and mBG over 180 mg/dL were independently associated with early mortality within 3 months.ConclusionSerial measurements of BG might be a better predictor of clinical outcome in patients with AIS treated with IVT than single BG measurements before IVT. Therefore, these results suggest that variable parameters of BG could be important for the prediction of clinical outcome in AIS treated with IVT.

Characteristics of real-life glucose profiles monitored by continuous glucose monitoring system in persons with normal glucose tolerance

To decipher the characteristics of real-life glucose profiles in normal glucose tolerance (NGT) persons by continuous glucose monitoring system (CGMS). Forty NGT subjects confirmed by oral glucose tolerance test (OGTT) completed a 3-day period of glucose monitoring via CGMS. The values of 24 h mean blood glucose (MBG), standard deviation of MBG (SDBG), mean amplitude of glycemic excursions (MAGE), largest amplitude of glycemic excursions (LAGE) and means of daily differences (MODD) were 6.0 ± 0.7, 0.9 ± 0.1, 1.9 ± 0.8, 2.9 ± 1.4 and 1.1 ± 0.1 mmol/L respectively. Two of them experienced asymptomatic hypoglycemia defined as glucose concentration < 2.8 mmol/L. And 72.5% (29/40) subjects reached glucose concentrations > 7.8 mmol/L for 5.2 ± 4.6 hours. In addition to higher glucose concentration (FPG: 5.0 ± 0.4 vs 4.8 ± 0.3 mmol/L, MBG: 6.4 ± 0.7 vs 5.7 ± 0.5 mmol/L), the subjects with glucose concentrations > 7.8 mmol/L showed more dramatic glucose excursion represented by higher SDBG (1.1 ± 0.3 vs 0.6 ± 0.2 mmol/L), MAGE (2.3 ± 1.1 vs 1.1 ± 0.3 mmol/L), LAGE (3.3 ± 1.2 vs 2.0 ± 1.0 mmol/L) and MODD (1.2 ± 0.4 vs 0.9 ± 0.3 mmol/L) versus those with glucose concentrations within 7.8 mmol/L. CGMS provides more detailed information of real-life glucose profiles in NGT subjects. And 72.5% NGT subjects in the present study spent a considerable amount of time at pre-diabetic or even diabetic glucose levels characterized by more predominant glucose excursion.

Effects of Helicobacter pylori on blood glucose fluctuation in type 2 diabetic patients

To investigate the effects of Helicobacter pylori (Hp) on blood glucose fluctuation in type 2 diabetic mellitus. 130 type 2 diabetic patients were selected, 72 patients with Hp infection and 58 without Hp infection. Relevant clinical data: blood pressure, body mass index, cholesterol, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, glycosylated hemoglobin, insulin resistance index, liver function, and renal function were collected. The data of blood glucose levels at 7 time points, 6 - 7 am, 9 - 10 am, 11 - 12 am, 14 - 15 pm, 17 - 18 pm, 19 - 20 pm, and 22 - 23 pm in 3 days, totally 21 data, were collected. And input into the OTDMS data analysis software to evaluate the blood glucose fluctuation indexes: standard deviation of mean blood glucose (SDBG), mean amplitude of glycemic excursions (MAGE), large amplitude of glycemic excursions (LAGE). There were no significant differences in age, course of disease, blood pressure, body mass index, cholesterol, triglyceride, low density lipoprotein cholesterol, glycosylated hemoglobin, and insulin resistance index between these 2 groups (all P > 0.05). The levels of MBG, SDBG, MAGE, LAGE, (mmol/L: 9.0 +/- 1.1 vs 7.6 +/- 0.5, 3.3 +/- 1.1 vs 1.7 +/- 0.5, 6.7 +/- 4.5 vs 3.0 +/- 1.1, 8.6 +/- 3.8 vs 4.2 +/- 1.5, all P < 0.05) and incidence of hypoglycemia [16.6% (12/72) vs 5.1% (3/58), P < 0.05] were all higher in the Hp positive group than in the Hp negative group. Hp infection has a significant effect on the daily blood glucose level and blood glucose fluctuation in the patients with type 2 diabetes.

Characteristics of glycometabolism in the first-degree relatives of type 2 diabetes patients assessed by continuous glucose monitoring system

To investigate the characteristics of glycemic stability in the first-degree relatives of type 2 diabetes mellitus (T2DM) patients by continuous glucose monitoring system (CGMS). Twenty-two first-degree relatives (FDRs) of T2DM patients and 28 age and gender-matched controls underwent CGMS to obtain the mean blood glucose (MBG), standard deviation of MBG (SDBG), mean of daily differences (MODD), and mean amplitude of glycemic excursions (MAGE). Oral glucose tolerance test (OGTT) was conducted. Blood glucose, serum lipids, and serum insulin were assayed. The insulin sensitivity and resistance was assessed by HOMA-beta, HOMA-IR, DeltaI(30)/DeltaG(30) and modified beta cell function index (MBCI). There were no significant differences between the FDR and control groups in the levels of plasma glucose in OGTT, MBG, SDBG, and MOOD. However, the MAGE level of the FDR group was (2.3 +/- 0.5) mmol/L, significantly higher than that of the control group [(2.0 +/- 0.6) mmol/L, P < 0.05]. The MBCI level of the FDR group was 17.6 (16.9 - 50.0), significantly lower than that of the control group [36.0 (15.7 - 59.6), P < 0.05]. There were no significant differences in the serum lipids profile, body fat distribution, HOMA-beta, HOMA-IR, and DeltaI(30)/DeltaG(30) between these two groups. The excursion of blood glucose is greater in the FDRs of T2DM patients. CGMS is more sensitive to discover such change than OGTT.

Regulation of brittle diabetics by a pre-planned insulin infusion programme.

Eleven brittle diabetics, mean duration 11.5 years, all treated with highly purified porcine NPH insulin twice daily, were placed on highly purified porcine regular insulin 4 times daily for 2 days. Thereafter pre-planned intravenous insulin infusion was started. Insulin in an amount corresponding to the daily insulin requirement was infused by a mobile electric infusion pump at precalculated rates between 30 and 7 ml/hour during 2 days. The patients were ambulatory. Capillary blood glucose was taken every 30 min after meals and every two hours during the night. After an equilibration period of 7 hours, blood glucose fluctuations were in the physiological range in nearly all patients during the infusion period. [Only 1.3% of the blood samples showed glucose levels lower than 2.5 mmol/l and 2.9% levels exceeding 10.0 mmol/l during the infusion days]. Mean blood glucose (MBG) was 6.0 +/- 0.9 mmol/l (mean +/- s.d.), the standard deviation of MBG was 1.8 +/- 0.5 mmol/l, the mean amplitude of blood glucose excursions (MAGE) 4.7 +/- 1.4 mmol/l, and glucosuria 3.1 +/- 3.9 g/day. All these data of glucose homeostasis were significantly lower during the infusion days. The incidence of hypoglycaemic attacks was low (0.32/patient/day) and not significantly higher than during NPH treatment. It is concluded that near normal blood glucose fluctuations can be achieved in brittle diabetics by preplanned insulin infusion without blood glucose monitoring.