Strict Glucose Control Research Articles

Persistent Postoperative Hyperglycemia as a Risk Factor for Operative Treatment of Deep Wound Infection After Spine Surgery

Surgical site infections (SSIs) affect 1% to 9% of all spine surgeries. Though previous work has found diabetes mellitus type 2 (DM2) to increase the risk for wound infection, the influence of perioperative hyperglycemia is poorly described. To investigate perioperative hyperglycemia as an independent risk factor for surgical site infection. We retrospectively identified patients undergoing operative management of SSIs occurring after spinal surgery for degenerative pathologies. These patients were individually matched to controls based upon age, surgical invasiveness, ICD-10CM, race, and sex. Cases and controls were compared regarding medical comorbidities (including diabetes), postoperative hyperglycemia, and operative time. Patients in the infection group were found to have a higher BMI (33.7 vs 28.8), higher prevalence of DM2 (48.5% vs 14.7%), and longer inpatient stay (8.8 vs 4.3 d). They also had higher average (136.6 vs 119.6 mg/dL) and peak glucose levels (191.9 vs 153.1 mg/dL), as well as greater variability in glucose levels (92.1 vs 58.1 mg/dL). Multivariable logistic regression identified BMI (odds ratio [OR]=1.13), diabetes mellitus (OR=2.12), average glucose on the first postoperative day (OR=1.24), peak postoperative glucose (OR=1.31), and maximal daily glucose variation (OR=1.32) as being significant independent predictors of postoperative surgical site infection. Postoperative hyperglycemia and poor postoperative glucose control are independent risk factors for surgical site infection following surgery for degenerative spine disease. These data suggest that, particularly among high-risk diabetic patients, strict perioperative glucose control may decrease the risk of SSI.

A Single Injection of a Liver-Directed A20 Gene Therapy Yields Long-Term Glycemic Control in Diabetic Mice to Reduce Vascular Complications

Diabetic patients suffer a two- to four-fold higher incidence of coronary artery disease and stroke and >10-fold higher incidence of peripheral vascular disease. Poor glycemic control is the most significant risk factor for heightened vascular complications in diabetes. At the molecular level, we showed increased vascular complications in patients with poor diabetes control relate to inadequate expression of the anti-inflammatory and atheroprotective molecule, A20. Hyperglycemia causes post-translational O-glycosylation of A20, targeting it for ubiquitination and degradation. Strict and sustained control of blood glucose by intensive insulin therapy and lifestyle modifications decrease vascular risk in diabetic patients. Unfortunately, few patients successfully comply with these stringent guidelines. Our objective was to explore a novel, safer and easier-to-implement means of controlling blood glucose. Our data indicate that liver-directed gene therapy of the A20 gene can achieve this goal. Seven-week-old C57BL/6 mice were rendered diabetic via five consecutive injections of streptozotocin. Six weeks after diabetes was established, we intravenously injected rAd.A20 or control α-galactosidase (rAd.αgal), measured glycemia weekly and performed a glucose tolerance test (GTT). Tissue/plasma was harvested on 10, 30, and 100 days after the mice achieved euglycemia. Remarkably, 80% of the A20-treated, but none of the α-gal-treated mice became euglycemic or significantly improved their glycemia within the first week after treatment. This result was sustained with >70% of these mice remaining euglycemic at 100 days. GTT curves either normalized (10 days) or significantly improved (30 and 100 days) in euglycemic A20-treated mice. Normalization of glycemia and GTT in A20-treated mice did not associate with increased insulin levels, but with higher intrahepatic and circulating levels of lipocalin 13 (LCN13). LCN13, a transporter protein, regulates glucose metabolism through insulin-dependent and -independent mechanisms. Increased LCN13 mRNA levels in A20-treated livers had decreased levels of gluconeogenic enzymes, PEPCK and G6Pase, and increased expression of the glucose transporters GLUT1 and two in the liver, along with GLUT1 and four in skeletal muscles. The latter correlated with higher glycogen storage in livers and skeletal muscles. Liver-directed A20 gene therapy Results in sustained glycemic control in diabetic mice. This remarkable effect is insulin-independent and can be attributed to A20-mediated upregulation of LCN13, a glucose metabolism regulator, predicting efficacy in both type 1 and type 2 diabetes. Recent development of clinically safe gene therapy vectors predict clinical translatability of this novel therapy to reduce the debilitating vascular complications of diabetes.

887-P: Development of the Noninvasive Diabetes Monitoring Method

Aims/Background: To prevent diabetic complications, strict glucose control and frequent monitoring of blood glucose levels with invasive methods are necessary. We considered monitoring of diabetes-related biomarkers in tears may be the possible methods for diabetes monitoring methods. Many studies about tear glucose levels have been reported and tear glucose levels correlate with blood glucose levels. This time, we focused on glycoalbumin (GA) levels, which reflect an average of blood glucose levels over the preceding 2 weeks, and studied the correlation between GA levels in blood and tears. Methods: We recruited 100 diabetic subjects and collected blood and tear samples. GA levels in blood were measured by an enzymatic method, and GA levels in tears were measured by Liquid Chromatography/Mass Spectrometry (LC-MS/MS). Results: The GA levels in tears of 99 out of 100 samples were appropriately measured by LC-MS/MS. GA levels in blood and tears were significantly correlated (P < 0.001). Multiple regression analysis revealed that this correlation was maintained even after adjustment for age, gender, nephropathy stage, and obesity (P < 0.001). Conclusions: GA in tears was the first measured diabetes-related biomarker. GA levels in tears were strongly correlated with those in blood, considering various factors. As GA value is a ratio, GA levels in tears were not thought to be influenced by dilution or concentration of tears and showed strong correlation with those in blood. From the above, GA in tears could be a diabetes-related biomarker that can be measured noninvasively. In the future, we plan to optimize measurement conditions, develop measurement equipment and verify the effectiveness and usefulness of this diabetes monitoring method. Disclosure M. Aihara: None. N. Kubota: None. T. Kadowaki: Research Support; Self; Astellas Pharma Inc., Daiichi Sankyo, Mitsubishi Tanabe Pharma Corporation, MSD Corporation, Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker’s Bureau; Self; Abbott, Astellas Pharma Inc., AstraZeneca K.K., Boehringer Ingelheim Pharmaceuticals, Inc., Cosmic Corporation, Daiichi Sankyo, Eli Lilly Japan K.K., FUJIFILM, Kowa Company, Ltd., Kyowa Hakko Kirin Co., Ltd., Medscape Education, Medtronic, Mitsubishi Tanabe Pharma Corporation, MSD Corporation, NIPRO Medical Corporation, Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Other Relationship; Self; Asahi Mutual Life Insurance.

Risk factors for the fever after percutaneous nephrolithotomy: a retrospective analysis.

BackgroundIt’s very common to see the onset of fever after percutaneous nephrolithotomy (PCNL), it’s necessary to analyze the risk factors for the fever following PCNL, and to provide evidence for infection prevention after PCNL.MethodsA total of 546 adult PCNL patients were included as study subjects and retrospective studies were performed. We collected clinical data of patients using a prospectively designed database. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors for the fever after PCNL.ResultsOf the included 546 PCNL patients, there were 82 fever patients and 464 no-fever patients following PCNL. Escherichia coli and Proteus mirabilis are the two most common infectious bacteria. Preoperative urinary tract infection (OR =4.38, 95% CI: 1.15–9.53), multiple access (OR =5.31, 95% CI: 1.23–10.75), diabetes (OR =4.97, 95% CI: 1.37–9.86), length of operation ≥60 min (OR =5.67, 95% CI: 2.24–13.42), estimated blood loss in PCNL ≥500 mL (OR=2.78, 95% CI: 2.32–3.61) were the independent risk factors associated with postoperative infection.ConclusionsEffective control of urinary tract infection, reduction of access number, strict control of blood glucose, length of operation control, reduction of intraoperative bleeding should be considered as measures to prevent postoperative fever for patients with PCNL.

Pre-Procedural Hyperglycemia Increases the Risk of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography: A Systematic Review and Meta-Analysis

BackgroundContrast-induced nephropathy (CIN) frequently occurs following coronary angiography (CAG) and is associated with worse outcomes, including both short and long-term mortality. Previous studies reported an association between procedural hyperglycemia (PH) and CIN, with or without diabetes mellitus (DM). We performed a systematic review and meta-analysis to explore the association of PH and CIN in patients undergoing CAG. MethodsWe searched the databases of MEDLINE and EMBASE from inception to January 2020. Included studies investigated CIN incidence in patients undergoing CAG. Data from each study were combined using the random-effects model. ResultsA total of eight studies were included in this meta-analysis. We found that PH was associated with an increased risk of CIN following CAG (pooled OR = 1.71, 95%CI:1.35–2.16, where PH was defined as ≥140 mg/dl; and pooled OR = 2.07, 95%CI:1.80–2.37, where PH was defined as ≥200 mg/dl). In subgroup analysis of non-diabetic patients and STEMI patients undergoing primary percutaneous coronary intervention, we found that PH was associated with an increased risk of CIN in both subgroups, where PH was defined as ≥140 mg/dl and ≥200mg/dl (p-value < 0.05). ConclusionsOur meta-analysis demonstrated that PH significantly increases the risk of CIN following CAG, in both diabetic and non-diabetic populations. Further studies are needed to evaluate whether strict blood glucose control can reduce the incidence of CIN in this population.

An Assessment of Pharmacokinetic Interaction Between Lobeglitazone and Sitagliptin After Multiple Oral Administrations in Healthy Men

PurposePatients with type 2 diabetes mellitus require strict blood glucose control, and combination therapy with a thiazolidinedione and dipeptidyl peptidase-4 inhibitors, such as lobeglitazone and sitagliptin, is one of the recommended treatments. The objective of this study was to investigate a possible pharmacokinetic interaction between lobeglitazone and sitagliptin after multiple oral administrations in healthy Korean men. MethodsTwo randomized, open-label, multiple-dose, 2-way crossover studies were conducted simultaneously in healthy men. In study 1, men were randomly assigned to 1 of 2 sequences, and 1 of the following treatments was administered in each period: 1 tablet of lobeglitazone sulfate (0.5 mg) once daily for 5 days and or 1 tablet each of lobeglitazone sulfate (0.5 mg) and sitagliptin (100 mg) once daily for 5 days. In study 2, men were also randomly assigned to 1 of 2 sequences and the treatments were as follows: 1 tablet of sitagliptin (100 mg) once daily for 5 days or 1 tablet each of sitagliptin (100 mg) and lobeglitazone sulfate (0.5 mg) once daily for 5 days. Serial blood samples were collected up to 48 h after dosing on the fifth day. Plasma drug concentrations were measured by LC-MS/MS. Pharmacokinetic parameters, including Cmax,ss and AUC0–τ , were determined by noncompartmental analysis. The geometric least-square mean (GLSM) ratios and associated 90% CIs of log-transformed Cmax,ss and AUC0–τ for separate or coadministration were calculated to evaluate pharmacokinetic interactions. FindingsNineteen men from study 1 and 17 from study 2 completed the pharmacokinetic sampling and were included in the analyses. The GLSM ratios of Cmax,ss and AUC0–τ were 0.9494 (95% CI, 0.8798–1.0243) and 1.0106 (95% CI, 0.9119–1.1198) for lobeglitazone (from study 1) and 1.1694 (95% CI, 1.0740–1.2732) and 1.0037 (95% CI, 0.9715–1.0369) for sitagliptin (from study 2), respectively. ImplicationsExcept for the slight 17% increase in the sitagliptin Cmax,ss value, the pharmacokinetic parameters of lobeglitazone and sitagliptin met the pharmacokinetic equivalent criteria when administered separately or in combination. The increase in Cmax of sitagliptin when coadministered with lobeglitazone would not be clinically significant in practice. ClinicalTrials.gov Identifier: NCT02824874 and NCT02827890.

Value of Capillary Glucose Profiles in Assessing Risk of Nocturnal Hypoglycemia in Type1 Diabetes Based on Continuous Glucose Monitoring.

IntroductionThis study aimed to evaluate the occurrence of nocturnal hypoglycemia in type 1 diabetes (T1D) based on continuous glucose monitoring (CGM), and to explore the value of capillary glucose profiles in assessing the risk of nocturnal hypoglycemia. The study also intended to develop a predictive model to identify people with high risk of nocturnal hypoglycemia.MethodsA total of 169 participants with T1D received 3 days of blinded CGM; meanwhile, their self-monitoring blood glucose (SMBG) profiles were recorded. Logistic regression analyses were used to evaluate contributory factors of nocturnal hypoglycemia. Potential indicators were estimated using area under receiver operator curve (AUC) analyses.ResultsDuring the retrospective CGM period, 95 (56.2%) participants with T1D reported 238 events of hypoglycemia, and 69 (29.0%) of these episodes occurred during the nighttime. Increased risk of nocturnal hypoglycemia correlated with lower HbA1c, glycated albumin, and mean blood glucose (OR = 0.790, 0.940, 0.651, respectively; P < 0.05) and higher standard deviation, mean amplitude of glycemic excursions, and low blood glucose index (OR = 1.463, 1.168, 4.035, respectively; P < 0.05) after adjustment for age and duration. Of the daily SMBG profiles, fasting blood glucose (OR = 0.643, P = 0.001) and blood glucose at bedtime (OR = 0.851, P = 0.037) were associated with the occurrence of nocturnal hypoglycemia. The BGn model, which was derived from the variation of capillary glucose, could discriminate individuals with increased risk of nocturnal hypoglycemia (AUC = 0.774).ConclusionsNocturnal hypoglycemia constitutes nearly one-third of hypoglycemic events in people with T1D. Strict glycemic control and great fluctuation of glucose are potential contributory factors. Daily SMBG profiles and the BGn model could help assess the risk of nocturnal hypoglycemia in T1D, which may support further development of preventive strategies.

Application of serum glycated albumin in pregnancy

Hyperglycemia during pregnancy is associated with many maternal and infant complications, hence strict blood glucose control during pregnancy is of great importance. Glycosylated hemoglobin Alc (HbA1c), glycated albumin (GA), self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) are four main measures to assess sugar level during pregnancy. GA level is a reflection of blood sugar level in the past 2-3 weeks and is unlikely influenced by various factors, therefore holds great potential in better control of blood glucose to help improve maternal and fetal outcomes. Key words: Diabetes, gestational; Serum albumin; Glycated hemoglobin A; Blood glucose self-monitoring

Increased Postoperative Glucose Variability Is Associated With Adverse Outcome Following Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection

BackgroundGlucose variability in the postoperative period has been associated with increased rates of periprosthetic joint infection (PJI) following primary arthroplasty. It is unknown how postoperative glucose control affects outcome of surgical treatment of PJI patients. We hypothesized that postoperative glucose variability adversely affects the outcome of 2-stage exchange arthroplasty. MethodsWe retrospectively reviewed records of 665 patients with PJI of the knee and hip who underwent 2-stage exchange arthroplasty from 2000 to 2017. Of them, 341 PJIs with a minimum follow-up of 1 year, and either a minimum of 2 glucose values per day or greater than 3 overall during the reimplantation were included. Glucose variability was assessed by calculating the coefficient of variation. Adverse outcomes included treatment failure according to the Delphi consensuses criteria, reinfection, reoperation, and mortality. A subgroup analysis was performed based on patients with or without diabetes. ResultsGlucose variability following reimplantation was associated with higher treatment failure, reinfection, and reoperation. Adjusted analysis indicated that for every standard deviation (15%) increase in the coefficient of variation, the risks of treatment failure, reinfection, and reoperation increased by 27%, 31%, and 26%. Although stratifying patients with (n = 81) or without diabetes (n = 260), these associations remained robust in nondiabetic patients, but not in diabetic patients. ConclusionHigher glucose variability is associated with increased risks of treatment failure, reinfection, and reoperation after 2-stage exchange arthroplasty in PJI patients. Compared to diabetic patients, nondiabetic patients have a higher association between glucose variability and poor outcomes. Reducing adverse outcomes may be achieved with close monitoring and strict postoperative glucose control.

Strict Control of Blood Glucose with an Intravenous Insulin Infusion Decreases the Risk of Postoperative Lower Extremity Weakness After Complex Endovascular Aortic Aneurysm Repair

Strict Control of Blood Glucose with an Intravenous Insulin Infusion Decreases the Risk of Postoperative Lower Extremity Weakness After Complex Endovascular Aortic Aneurysm Repair

Strict Control of Blood Glucose With an Intravenous Insulin Infusion Decreases the Risk of Post-operative Lower Extremity Weakness After Complex Endovascular Aortic Aneurysm Repair

It has previously been shown that post-operative lower extremity weakness (LEW) is associated with elevated blood and cerebrospinal fluid (CSF) glucose levels after branched endovascular aneurysms repair (BEVAR) of extensive aortic aneurysms. The purpose of this study was to determine whether a post-operative insulin infusion protocol (IIP) to achieve tight blood glucose control decreases the rate of LEW. From October 2013, blood and CSF samples were collected pre-operatively, immediately post-operatively, and on post-operative day one in asymptomatic patients undergoing BEVAR. In July 2016, an IIP was initiated to maintain post-operative blood glucose levels <120mg/dL for 48h. Data on demographics, operative repair, complications, and outcomes were collected prospectively. Between October 2013 and April 2018, 43 patients underwent BEVAR. Twenty-two (group A) underwent BEVAR before initiation of the IIP. Of these, seven (32%) developed LEW within 48h of repair. This was temporary in five (23%) and permanent in two (9%) patients. Post-operative blood glucose levels were significantly higher in patients with LEW compared with those without LEW (140±27mg/dL vs. 117±16mg/dL; p=.02). Post-operative CSF glucose levels were significantly higher in patients with LEW compared with those without LEW (102±15mg/dL vs. 77±15mg/dL; p=.001). The subsequent 21 patients (group B) underwent BEVAR after initiation of the IIP. No patient in group B developed LEW while on the IIP, but one (5%) developed paraplegia on post-operative day four. The rate of early LEW (<48h post-operatively) was significantly lower after initiation of the IIP (32% in group A vs. 0% in group B; p=.009). There was no difference in demographics, comorbidities, or operative time between the groups. An IIP to control blood glucose after BEVAR is associated with a decreased rate of post-operative LEW. Tight control of blood glucose should be considered after any extensive aortic reconstruction to minimise the risk of post-operative LEW.

Acute kidney injury increases mortality in acute stroke. A study in Hispanic population

Acute Kidney Injury (AKI) in stroke is associated with mortality that is estimated on 25% of stroke patients. Prognosis mainly depends on glomerular filtration rate (GFR), comorbidities(diabetes, arterial hypertension, atrial fibrillation and heart failure), evolution time, location, stroke type, hemorrhagic conversion, gender and age. Document prevalence and risk factors involved in the development of AKI in Hispanic cohort of stroke patients. One hundred patients with stroke admitted to the stroke unit during September 2012 to 2018 were included. AKI was established according to the guidelines KDIGO2012. Creatinine and diuresis were evaluated during the first week after the diagnosis of acute stroke. The mean age was 65.15 years (SD 15.91), 55% male and 83% of patients with ischemic stroke. The mean baseline GFR was 73.88 ml/min/1.73 m2. At admission 59% were in the category of basal GFR G2 and G3a (40–89 ml/min/ 1.73 m2). AKI was diagnosed in 54 patients (54%) most of them started 2.5 days after STROKE. In the present series, 10% of stroke patients died, 90% of them having AKI, exist association between AKI and mortality was observed (Fisher exact test p = 0.019). The analysis among risk factors and development of AKI after acute stroke showed association between glycemic variability with development of AKI (bivariate analysis with Fisher exact test p = 0.0001, OR 4.8, 95 % CI 1.79 – 13.08). The patient with AKI + STROKE is 9 times more likely to die during the hospitalization. Strict control of blood glucose, and early detection and treatment of AKI will influence mortality in the first week post STROKE.

Physical Therapy for Diabetic Peripheral Neuropathy: A Narrative Review

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus in both developed and developing countries. It is found in about 10% of diabetic clients at diagnosis, and in the majority of clients 25 years down the line. Clients with pre-diabetes may also develop neuropathies that are similar to diabetic neuropathies. Long-term hyperglycemia can cause peripheral nerve damage, resulting in distal-predominant nerve fibre degeneration. Loss of feeling in the lower limbs is a high risk for limb amputation. Despite efforts to make an early diagnosis and to halt the progression of diabetic neuropathy, currently there is no effective treatment available at a global level, except for strict control of blood glucose. Physical therapy can improve the overall quality of life of diabetes mellitus clients with peripheral neuropathy and can alleviate the symptoms of neuropathy. This paper assesses the effectiveness of interventions used by physical therapists to minimise dysfunctions in people with DPN. It reviews the different treatment strategies and presents evidence and conditions for its applications.

Increased glucose variability is associated with atrial fibrillation after coronary artery bypass.

Elevated preoperative hemoglobin A1c (HbA1c) is a predictor of poor outcomes following coronary artery bypass grafting (CABG), but the role of increased postoperative glucose variability (GV) is unknown. We hypothesized that short-term postoperative GV is associated with an increased risk of postoperative atrial fibrillation following isolated CABG. Multicenter retrospective study of 2073 patients who underwent isolated CABG from January 2012 to March 2018. Postoperative GV in the first 24 hours was measured by standard deviation, coefficient of variation, and mean amplitude of glycemic excursions. Multivariate logistic regression assessed the independent association of GV with postoperative atrial fibrillation. A total of 2073 patients met the study criteria, and 446 patients (21.5%) developed postoperative atrial fibrillation. Using multivariate logistic regression to adjust for covariates, postoperative atrial fibrillation was associated with increased 24-hour GV (odds ratio [OR] = 1.16, 95% confidence interval [CI], 1.05-1.27, P < 0.01) and increased 24-hour mean glucose (OR = 1.14, 95% CI, 1.08-1.21, P < 0.01). Thus, for every 10% increase in 24-hour GV or 10 mg/dL increase in mean glucose, there was a 16% or 14% increased risk of postoperative atrial fibrillation respectively. Increased 24-hour GV and mean glucose are predictors of atrial fibrillation after CABG. Preoperative HbA1c is not a risk factor for postoperative atrial fibrillation after adjusting for postoperative mean glucose and GV. Further investigation is needed to determine the relationship between adherence to strict glucose control and adverse events following CABG.

Clinical-care protocol for preventing mediastinitis after coronary artery bypass graft surgery: A quality improvement initiative from a private hospital.

Surgical site infections after cardiac surgery are associated with severe outcomes, including reoperation and death. We aimed to describe the effect of a standardized clinical-care protocol for preventing mediastinitis in patients who underwent coronary artery bypass graft surgery (CABG). In a hospital certified by Joint Commission International, all patients who underwent CABG from January 2011 to December 2016 were compared in two periods according to the moment of implementation of a standardized clinical-care protocol for prevention of mediastinitis (CCPPM): pre-protocol (January 2011-December 2012) and post-protocol (January 2013-December 2016). The CCPPM consisted of the patient using a kit containing chlorhexidine 2% for bathing, mupirocin 20 mg/g for nasal topical use and chlorhexidine 0.12% for oral hygiene for 5 days before surgery, in addition to prophylaxis with a glycopeptide antimicrobial and strict glucose control (110-140 mg/dL) during surgery and immediate postoperative. We evaluated 1760 patients who underwent CABG in both periods. The occurrence of mediastinitis before protocol implementation was 1.44% (10 of 692 CABG). After the implementation of the protocol, there was an important reduction in the incidence of mediastinitis to 0.09% (1 of 1068 CABG) (P = 0.002). Although we did not observe a significant difference in mortality between the groups (2.3% vs 1%, P = 0.77), there was fewer in-hospital mortality due to mediastinitis after the CCPPM (0.2% vs 0%, P < 0.001). Implementation of a standardized CCPPM was associated with a significant reduction in the incidence of mediastinitis after CABG and reduction of mortality in the group of patients with mediastinitis.

TYPE 2 DIABETES: ASPECTS OF ANTIHYPERGLYCEMIC THERAPY IN ELDERLY PATIENTS

Increase in number of patients with type 2 diabetes mellitus (T2D) in old age is due to the improvement of approaches to early diagnosis of complications and, consequently, the reduction of mortality at an earlier age, and the continuous development of new drugs with a high profile of safety makes it an important task for the doctor to determine an effective and safe treatment regimen for diabetes in the older age group. The article is devoted to the peculiarities of diabetes in elderly patients. Difficulties in management of such patients are due to the small number of studies conducted, which allow us to draw unequivocal conclusions about the most appropriate treatment regimens. Physiological changes in aging, pathological processes in comorbidities do not allow to establish strict glucose control in elderly and senile patients. Authors present the factors determining the peculiarities of the choice of antihypoerglycemic therapy in the elderly. Different variants of treatment depending on comorbid pathology, degree of severity of senile asthenia syndrome are described. Tableted sugar-reducing drugs for the treatment in the elderly are considered, as well as a step-by-step approach to the correction of hyperglycemia in insulin therapy, and target levels of glycated hemoglobin depending on the severity of concomitant diseases are individualized.

Gestational Diabetes: Glycemic Control in the Last Two Weeks Before Delivery Contributes to Newborn Insulinemia

Fetal hyperinsulinemia in gestational diabetes mellitus (GDM) not only is important during intrauterine life, a time when it can result in macrosomia, but also at delivery, since it can result in neonatal hypoglycemia and hyperbilirubinemia. The question is, how long before delivery does maternal glycemic control contribute to newborn insulinemia in GDM? In 72 women with GDM, we calculated Spearman's rank (rs) correlations between umbilical cord blood C-peptide at birth (a biomarker of insulin secretion), and both maternal glycosylated hemoglobin (HbA1c) and mean blood glucose (MBG) recorded in the last two visits prior to delivery. Iterative correlations were done between umbilical cord blood C-peptide at birth, and maternal glucose control, at 0, 1, 2, 3, 4, and 5 weeks before delivery. At an early visit (32.95 ± 1.8 weeks), rs = 0.353 (P = 0.07) between HbA1c and C-peptide, whereas rs = 0.244 (P = 0.186) between MBG and C-peptide. At the latest visit (35.04 ± 1.6 weeks), rs = 0.456 (P = 0.004) between HbA1c versus C-peptide, and rs = 0.359 (P = 0.023) between MBG versus C-peptide. Iterative correlations between MBG and C-peptide became significant at 2 weeks before delivery. To further reduce the risk of hypoglycemia and hyperbilirubinemia in infants born to women with GDM, besides applying a strict in-patient glucose control protocol at delivery, it is necessary to improve even more the quality of maternal glucose control during the last 2 weeks prior to delivery.

Investigating the Reliability of HbA1c Monitoring for Blood Glucose Control During Late Pregnancy in Patients withGestational Diabetes Mellitus (GDM) with and without β-Thalassemia Minor.

IntroductionPatients with gestational diabetes mellitus (GDM) need strict blood glucose control to reduce the incidence of perinatal complications in the mother or infant. The purpose of this study was to investigate whether the glycated hemoglobin (HbA1c) values of GDM patients were affected by β-thalassemia minor and to subsequently discuss the limitations of HbA1c monitoring for blood glucose control.Methods41 GDM patients with β-thalassemia minor were enrolled to serve as the study group. 93 GDM patients without thalassemia were randomly selected as a control group. Clinical data on the 134 mothers as well as their newborns were retrospectively analyzed. The blood glucose values of the participants at various times during the gestation period were compared between the groups, as were their HbA1c and ferritin levels and iron deficiency rates in late pregnancy (36–38 weeks of gestation). Pearson’s coefficient was calculated to determine the correlations between HbA1c and ferritin in both the study and control groups.ResultsThe study and control groups did not show any significant differences in newborn birth weight, maternal age, maternal pre-pregnancy body mass index (BMI), gestational age, newborn sex, gravidity, and parity. The blood glucose values of the participants at different times during the gestation period also did not differ significantly between the study group and the control group. However, the late-pregnancy HbA1c level (5.23 ± 0.49%) and iron deficiency rate (12.19%) in the study group were significantly lower than those in the control group (5.42 ± 0.43% and 58.06%, respectively); P < 0.05. Also, the late-pregnancy ferritin level in the study group (46.59 ± 18.03 ng/mL) was significantly higher than that in the control group (25.58 ± 11.42 ng/mL); P < 0.05. In addition, a significant negative correlation was observed between HbA1c and ferritin in both the study group (R = − 0.459, P = 0.003) and the control group (R = − 0.358, P = 0.010).ConclusionsThe HbA1c level is affected by many factors. Using serum HbA1c values to monitor blood glucose in GDM patients with β-thalassemia minor may lead to a mistaken assumption of low blood glucose levels, so HbA1c may not be a suitable indicator for monitoring blood glucose in pregnant women, particularly GDM patients with β-thalassemia minor.

Comparison of peripheral nerve protection between insulin-based glucose control and alpha lipoic acid (ALA) in the streptozotocin (STZ)-induced diabetic rat.

Strict glucose control is a well-proven therapeutic approach for peripheral neuropathies in patients with diabetes. Alpha lipoic acid (ALA) has also been accepted as a therapeutic agent for diabetic peripheral neuropathy (DPN) in the respect of pathogenesis. However, the potential of ALA as a treatment for DPN in comparison to that of glucose control is unclear. In this study, we compared the neuroprotective potential of glucose control and ALA. Animals were divided into 6 groups based on the intervention used, as follows: normal, diabetes (DM), DM+racemic form of ALA, DM+R form of ALA, DM+once daily insulin glargine, and DM+once daily insulin glargine with twice daily insulin glulisine. Various sensory tests were performed after 12 weeks of treatment, and immunohistochemistry of nerve fibers obtained from the sciatic and cutaneous nerves was performed after 24 weeks of treatment. There were no significant differences between the ALA-treated and insulin-treated DM groups in the sensory tests or in antioxidant activity. The axonal diameters and myelin sheath area of the sciatic nerves and the cutaneous small nerves, as assessed based on intraepidermal nerve fiber density, were similar in the ALA-treated and insulin-treated animals, although there was a non-significant trend for a mild increase in the both basal and rapid-acting insulin group compared with non-treated DM group. In conclusion, our results suggest that the neuroprotective benefits of ALA and insulin-based glucose control may be similar, although glucose control may have had slightly more beneficial effects in this animal model of diabetes. Of note, glucose levels should be strictly controlled, including corrections for fluctuations in the glucose level, to obtain therapeutic benefits in DPN.

MP15-04 PROSTATE ABSCESS: DOES TRANSURETHRAL INCISION OF PROSTATE ABSCESS REALLY HAVE SHORTER HOSPITAL STAY IN CRITICALLY ILL PATIENTS?

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia I1 Apr 2018MP15-04 PROSTATE ABSCESS: DOES TRANSURETHRAL INCISION OF PROSTATE ABSCESS REALLY HAVE SHORTER HOSPITAL STAY IN CRITICALLY ILL PATIENTS? Chin-Fong AU, Wei-Che Wu, and Shiu-Dong Chung Chin-Fong AUChin-Fong AU More articles by this author , Wei-Che WuWei-Che Wu More articles by this author , and Shiu-Dong ChungShiu-Dong Chung More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.517AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Some studies demonstrated that prostatic abscess treated by transurethral incision of prostate abscess had a significantly shorter hospital stay and more effective compared to transrectal needle aspiration. Our study aims to evaluate the factors affect hospital stay in patients with prostate abscess. METHODS We retrospectively analyzed the medical records of patients with prostate abscess who received an interventional treatment in one tertiary hospital from August 2008 to August 2017. Patients were divided to two groups depending on the length of hospital stay: Group A, hospital stay < 14 days; Group B, hospital stay ≥ 14 days. Patient's demographics as well as laboratory data and details of the intervention were reviewed. Pearson's chi-squared test and logistic regression were applied for in order to determine the factors affect hospital stay in critically ill patients with prostate abscess. RESULTS A total of 29 patients with prostate abscess were recruited. All of the patients treated with broad-spectrum antibiotics postoperatively. A total of 21(72.4%) patients with hospital stay ≥ 14 days while 8(27.6%) patients with hospital stay < 14 days. On univariate analysis, significant factors associated with longer hospital stay were diabetes mellitus (p=0.002) and critically ill patients (p=0.002). Critically ill patients in our study were defined as severe sepsis, septic shock, concurrent with multiple abscess(> 2 sites) or pleural effusion on preoperatively. However, types of intervention, age, hypertension, liver cirrhosis and BMI were not statistically significant predictors. On multivariate logistic regression analysis, diabetes mellitus (OR=29.72, 95% CI:1.52-582.66, p=0.025) and critically ill patients (OR=47.87, 95% CI:1.57-1456.80, p=0.026) remain the significant factors associated with longer hospital stay. CONCLUSIONS We concluded that blood glucose level and general condition of the patients upon admission decide the length of hospital stay and patient's outcome. In addition to broad-spectrum antibiotics and surgical intervention, clinicians should keep in mind that strict blood glucose control in critically ill patients is also the important treatment plan for prostate abscess. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e190 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Chin-Fong AU More articles by this author Wei-Che Wu More articles by this author Shiu-Dong Chung More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...