Serum Glucose Values Research Articles

Assessment of glucose and HbA1c monitoring in a pancreatic cancer surveillance program for high-risk individuals.

Several studies suggest that new-onset diabetes mellitus (NOD) is an early manifestation of pancreatic ductal adenocarcinoma (PDAC). Therefore, the international CAncer of the Pancreas Screening (CAPS) Consortium recommends glucose and HbA1c monitoring in high-risk individuals (HRIs) undergoing surveillance. However, evidence that such monitoring improves PDAC detection is lacking. Our aim was to investigate the association between serum glucose and HbA1c values and the development of PDAC in HRIs undergoing surveillance. Participants were recruited from the Familial Pancreatic Cancer (FPC) surveillance cohort, which follows hereditary predisposed HRIs yearly by MRI and/or EUS and blood sampling. Those who underwent fasting glucose and/or HbA1c monitoring at least once were eligible candidates. 404 HRIs met the inclusion criteria. During a median follow-up of 41 months (range 14-120), nine individuals developed PDAC and four (without PDAC) were diagnosed with NOD. Glucose levels ranged from 3.4-10.7 mmol/L (mean 5.6 ± 0.7) and HbA1c levels from 25-68 mmol/mol (mean 37.7 ± 4.1). Mean values did not differ significantly between PDAC cases and controls. The percentage of individuals with at least one elevated value were comparable between PDAC cases and controls for glucose (33% and 27%, p=0.707) and HbA1c (22% and 14%, p=0.623). No consistent glucose or HbA1c trends over time suggested a correlation with PDAC development. In this HRI surveillance cohort, measuring glucose and HbA1c values did not contribute to PDAC detection. Larger and longer-term studies are needed to determine the final role of glucose and HbA1c monitoring in PDAC surveillance.

9391 Clinical Accuracy Of Continuous Glucose Monitoring In Post-kidney Transplant Patients With Type 2 Diabetes

Abstract Disclosure: Q. Aziz: None. K. Batra: None. S. Fatima: None. J. Splinter: None. A.L. Champion: None. A.M. Kumar: None. K.E. Izuora: Research Investigator; Self; Novo Nordisk. Background: Continuous glucose monitoring (CGM) devices provide real time blood glucose data to guide therapy in patients with diabetes mellitus. Diabetic nephropathy is a major complication of diabetes which can eventually lead to End Stage Renal Disease (ESRD). Kidney transplant is a treatment option for ESRD and patients who undergo kidney transplant are exposed to anti-rejection therapy, including high-dose steroids, resulting in significant fluctuations in blood glucose. Having a reliable system for monitoring blood glucose continuously, such as a CGM, can provide valuable information to guide optimal diabetes management. Objective This study aims to compare the clinical accuracy of the CGM data with the Point of Care Testing (POCT) glucose values as a reference among post kidney transplant patients with Type 2 diabetes mellitus (T2DM). Methodology This study was conducted at an academic medical center from September 2023 to January 2024, enrolling subjects ≥ 18 years, diagnosed with T2DM , admitted for kidney transplant. Following informed consent, a blinded CGM (Freestyle Libre Pro®) was applied. We collected all POCT and serum glucose values and downloaded corresponding CGM glucose data. Using matched pairs between CGM and POCT glucose values, bias and absolute relative differences (ARD) were calculated. Based on the ARD, the Clarke error grid (CEG) analysis was conducted to quantify the clinical accuracy of CGM and POCT by assigning glucose data points into 5 zones A, B, C, D, and E. Summary statistics for numeric variables included mean and standard deviation, whereas categorical variables were described as counts and proportions. All analyses were performed using SAS, 9.4 version. Results: A total of 22 subjects were analyzed after excluding one patient due to CGM malfunction. Subjects were 58±9.69 years old, and 82% were males. The mean body mass index was 30±6.41 kg/m2 and mean HbA1c was 6.7 ± 1.07%, at baseline. The mean duration of diabetes and ESRD were 19±10.6 years and 3±2.27 years respectively. Average CGM wear time was 76±24.5 hours. The CEG comparing CGM values with POCT values showed 83.79% values in zone A, 15.29% in zone B (combined =99.08%) with the Mean Absolute Relative Difference (MARD) of 13.24%. The CEG comparing CGM values with serum glucose showed 83.1% values in zone A, 16.9% in zone B (combined =100%) with the MARD of 13.10%. Conclusion: Our results indicate that CGM values are comparable to the POCT and serum glucose values in post kidney transplant patients with T2DM receiving high dose steroids. Therefore, use of CGMs should be considered as a useful tool, providing timely information to guide prompt interventions and improve outcomes in this patient population. Presentation: 6/3/2024

7419 Navigating The Diagnostic Maze Of Pseudohypoglycemia In A Young Adult Male With Severe Hypertriglyceridemia: A Novel Case Report

Abstract Disclosure: C. Muojieje: None. M. Hotiana: None. Objective: This case report aims to shed light on the challenges of diagnosing and managing pseudohypoglycemia, particularly in the absence of Whipple's triad, and to explore its rare association with severe hypertriglyceridemia. Methods and Results: We present a 26-year-old Caucasian male with a history of depression, anxiety, and recently diagnosed hyperlipidaemia who presented to Cabell Huntington Hospital with intermittent chest pain and multiple episodes of syncope. Laboratory findings revealed low sodium (128 mmol/L) and significant discrepancies in blood glucose levels (52 mg/dL in laboratory tests vs. 93 mg/dL in point-of-care tests). The managing team initiated an evaluation for hypoglycaemia based on the low serum glucose values by ordering c-peptide, insulin and pro-insulin (normal findings). Endocrinology was consulted for further management of pseudo hypoglycaemia. Consultation led to further investigations, revealing severely elevated triglycerides (2,568 mg/dL), cholesterol (478 mg/dL), low HDL (26 mg/dL), and very low-density VLDL (514 mg/dL). The stat glucose test showed a level of 103 mg/dL, while the routine glucose test on the same sample was less than 10 mg/dL, and the point-of- care glucose test was 90 mg/dL. An A1c test returned normal at 4.9%, and the patient had no history of diabetes or insulin use. Conclusion: This case highlights the complexities in diagnosing pseudohypoglycemia, a condition that can present with falsely low glucose readings in the absence of clinical hypoglycemia symptoms. The significant hypertriglyceridemia observed in this patient suggests a potential novel association. The findings emphasize the need for comprehensive evaluation in cases of discordant glucose readings and suggest a potential new frontier in understanding and managing pseudohypoglycemia. Physicians should be aware of rare instances of in vitro glycolysis leading to pseudohypoglycemia and consider lipid profiles in their diagnostic process. Presentation: 6/3/2024

Effect of tarhana soup on serum lipid profile in BALB/c male mice fed a high-fat-diet

Aim: With industrialization, there has been an increase in chronic diseases due to continuous change of nutrition. Tarhana is a traditional grain-based product fermented by lactic acid bacteria in Turkish cuisine. This study aims to evaluate possible effects of tarhana on the impaired lipid profile parameters and serum glucose values in male BALB/c mice fed a high-fat diet. Materials and Methods: Male BALB/c mice were grouped into three different strain male mice groups: control group (n=10), high fat diet (HFD) (n=10) and high fat diet supplemented with tarhana (n=10). Standard pellet feed was given to the control group, high-fat feed with 60% fat content in the HFD group, high-fat feed and 0.3 mL (8-10mL/kg) of tarhana were given to the other group. Results: A significant difference was detected in epididymal fat weights, lipid profiles and serum glucose values between the groups (p<0.05). Conclusion: It may have beneficial effects in many metabolic diseases, especially coronary heart disease and diabetes with its positive effects on lipid profile, epididymal adipose tissue and glucose level.

P-331 Unlocking metformin’s potential: exploring its impact on inflammation and oxidative pathways in an endometriosis mouse model

Abstract Study question Could endometriosis-associated pro-oxidative and pro-inflammatory condition be mitigated by metformin? Summary answer Metformin treatment tends to reduce fibrosis in ectopic tissues, while up-regulating anti-oxidative response enzymes. What is known already Endometriosis is a pro-inflammatory and pro-oxidative disease, which causes pain and infertility. Hormonal treatments used to control the disease must be stopped when a woman attempts to conceive, meaning new therapies are necessary. We had shown that endometriosis reduces fertility in a mouse model, which metformin treatment led to its reversal. Metformin, in addition to reducing blood glucose, reduces inflammation and systemic oxidation. It has also been shown to mitigate the growth of endometrial implants in the animal model. The objective of this work is to evaluate the intervention of metformin in the inflammatory and oxidative response pathways associated with endometriosis. Study design, size, duration Female mice were randomly divided into groups: 1-Endometriosis (n = 24); 2-Sham (n = 12); 3-Endometriosis with metformin (n = 21); 4-Sham with metformin (n = 16). Endometriosis was surgically induced by heterologous transplantation of endometrium from a donor into recipients of the same strain. Metformin (0,5mg/mL) was administered orally for 3 months. Half of the mice in each group were mated for the fertility study. Tissues analysed are described with “Eu” for eutopic and “Ec” for ectopic tissues, respectively. Participants/materials, setting, methods The implants were confirmed and monitored by ultrasound and serum glucose, estradiol and lipoprotein values were quantified by enzymatic-colorimetric methods. Fibrosis in eutopic and ectopic tissues was quantified after computer-assisted analysis in Masson’s Trichrome images. Dual-labelling immunofluorescence was performed for the proteins F4/80 and Galectin-3 (gal-3) and Western Blot (WB) was performed to quantify their expression and also NFkB, HO-1 and GPX-1, both in eutopic and ectopic tissues. Main results and the role of chance No differences were found in serum analysis between groups, apart from a decrease in total cholesterol and an increase in estradiol in pregnant compared to non-mated mice. Masson’s Trichrome stained sections revealed increased stromal fibrosis in both eutopic and ectopic tissues of non-mated Endometriosis groups compared to Sham groups(EuEnd vs. EuSham p = 0.018; EcEnd vs. EuSham p = 0.022; EuEnd vs. EuShamMet p = 0.0008; EcEnd vs EuShamMet p = 0,001). Metformin treatment showed a decreasing trend in fibrosis both in non-mated and pregnant, particularly in ectopic tissue, although statistical significance was not reached. Both eutopic and ectopic endometrium presented positive cells for f4/80 and gal-3, with some co-localization, in all groups. Metformin treatment led to the increase of the inflammation markers in the tissues of mice with ENDO: F4/80 was increased in eutopic tissue(p = 0.0002), while gal-3 (p = 0.004) and NF-kB (p = 0.03) augmented in ectopic tissue of non-mated. Pregnancy condition, on the other hand had a tendency for the decrease of these proteins. Metformin increased the expression of antioxidant defense enzymes HO-1 (p = 0,005) and GPX-1 (p = 0,0001) in the ectopic endometrium of non-mated mice. Metformin has shown to act in the up-regulation of anti-oxidative defenses that intervene in the control of endometriosis progression, but this effect was not evident during pregnancy. Limitations, reasons for caution Caution is necessary when extrapolating animal model data to humans due to species-specific differences in endometriosis patterns. Further studies, assessing pro-oxidative species, total antioxidant capacity, and potential anti-inflammatory roles of studied molecules, are essential to clarify the unexpected results in inflammatory pathways. Wider implications of the findings These findings highlight metformin, in a subtherapeutic dose, as a novel and safe approach to alleviate oxidative stress in endometriosis, offering a promising pharmacological solution for improving endometriosis-associated infertility, once we also had shown the reversal of infertility associated with endometriosis through metformin treatment. Trial registration number not applicable

A Comparison of Palm Oil, Beef Tallow, and Corn Oil Effect on Serum Glucose and Lipid Profile in Rats Fed a High-Fat Diet

This research aimed to investigate the influence of three types of palm oil products (RBDPO (refined bleached deodorized palm oi), RPO (red palm oil), and PKO (palm kernel oil)), on serum glucose and lipid profile of Sprague Dawley rats fed with experimental diet containing 20% of oils, comparing these effects with those of with animal- base oil (beef tallow) including corn oil as a representative from vegetable oil. The diet with level of fat 20% given to two groups (with and without AOM (azoxymethane)) of male Sprague Dawley rats for 13 weeks. The results exhibit that corn oil caused the lowest value of serum glucose (p < 0.05) in both AOM and non-AOM groups. Compared to other groups, beef tallow diet significantly increased serum triglycerides, cholesterol, and LDL, followed by RPO/PKO, RBDPO, and corn oil, respectively (p < 0.05). Meanwhile, corn oil diet produced the highest level of serum HDL, followed by RBDPO, PKO/RPO, and beef tallow (p < 0.05).

Effects of Tirzepatide Versus Basal Insulins in People With Type 2 Diabetes and Different Baseline Glycemic Patterns: Post Hoc Analyses of the SURPASS-3 and SURPASS-4 Trials.

This post hoc analysis assessed change from baseline to week 52 in glycemic parameters for tirzepatide (5, 10, 15 mg) versus insulin degludec (SURPASS-3 trial) and glargine (SURPASS-4 trial) in people with type 2 diabetes and different baseline glycemic patterns, based on fasting serum glucose (FSG) and postprandial glucose (PPG) values. Participant subgroups with low FSG/low PPG, low FSG/high PPG, high FSG/low PPG, and high FSG/high PPG were defined according to the median values of these measures. All tirzepatide doses and basal insulins were associated with decreased HbA1c, FSG, and PPG values from baseline to week 52 in all subgroups (P < 0.05). Within each subgroup, HbA1c and PPG decreases were greater with tirzepatide than insulin (P < 0.05). FSG decreases were generally similar. There were no differential treatment effects by FSG/PPG subgroup. In this post hoc analysis, tirzepatide was associated with superior glycemic control compared with insulin, irrespective of baseline glycemic pattern.

Abstract WP3: Serum Glucose Fluctuations is an Independent Predictor of Adverse Outcomes in Patients With Acute Ischemic Stroke Undergoing Endovascular Treatment

Background: Acute hyperglycemia may increase the rate of death or disability among acute ischemic stroke patients undergoing endovascular procedures. Objective: To explore the association between serum glucose fluctuation on post treatment symptomatic intracranial hemorrhage (sICH) and mortality. Methods: We analyzed consecutive acute ischemic stroke patients who underwent endovascular treatment over 30 months at a comprehensive stroke center. Serum glucose levels within the initial 24 hours were used to calculate the mean and standard deviation (SD). Patients were grouped by the standard deviation [SD] of the mean value of serum glucose, whether above or below 25%. Outcomes included sICH, and inpatient mortality, adjusted for confounders which included age, gender, baseline NIHSS, perfusion grade (TICI) intravenous thrombolysis, history of diabetes and HBA1c. Results: A total of 224 patients (mean age was 68.7 years (±14.3); 44.2% were women) underwent endovascular treatment. The proportion of sICH (16.7% vs. 3.28%; p=0.0006) and inpatient mortality (18.6% vs. 7.4%; p=0.0112) were higher in patients with SD exceeding 25. After adjusting for potential confounders, serum glucose SD above 25 was significantly associated with increased rate of sICH (odds ratio [OR] 5.2; 95% confidence interval [CI] 1.5-18.5; p=0.0112) and inpatient mortality (OR 3.5; 95% CI 1.3-9.8; p=0.0154). Conclusion: Serum glucose fluctuations within first 24 hours maybe be therapeutic target due to its association with increased risks of sICH and inpatient mortality following endovascular treatment in acute ischemic stroke.

Association Between Hypoglycemia and the Occurrence of Early Onset Sepsis in Premature Infants.

We examined the association between hypoglycemia and the occurrence of early onset sepsis (EOS) in premature infants admitted to the neonatal intensive care unit (NICU). We included infants discharged from 358 NICUs between 1997 and 2020 with gestational age <34 weeks, ≥1 culture collected in the first 3 days of life, and ≥1 serum glucose value recorded on the day of or day prior to culture collection. We used multivariable logistic regression and inverse probability weighting (IPW) and constructed models for three definitions of hypoglycemia: American Academy of Pediatrics (AAP), Pediatric Endocrine Society, and a definition based on neurodevelopmental studies. We performed subgroup analysis in EOS episodes caused by Gram-negative and Gram-positive organisms. Of the 62,178 infants and 64,559 cultures that met study inclusion criteria, 739 (1%) cultures were positive. The median (25th, 75th percentile) glucose value was 75 mg/dL (50, 106) on the day of or day prior to a positive culture versus 70 mg/dL (50, 95) on the day of or day prior to a negative culture. We found that hypoglycemia was not associated with the occurrence of EOS for all organisms and Gram-positive organisms, whereas there was a small but significant association between the lower AAP glucose cutoff value and EOS due to Gram-negative organisms (logistic regression: risk difference [RD] 0.24% [95% CI, 0.01-0.47]; IPW: RD 0.22% [95% CI, 0.00-0.43]). Hypoglycemia may be an early marker of EOS, particularly in episodes caused by Gram-negative organisms and when using a stricter definition of hypoglycemia.

FRI098 Triglyceride Glucose Index Is Associated With Elevated Blood Pressure, Independent Of Body Mass Index: Analysis From NHANES Study

Abstract Disclosure: H. Ayesh: None. K.D. Niswender: None. Introduction: Triglyceride glucose index (TyG) is a novel marker of insulin resistance. Elevated blood pressure is associated with significant morbidity and mortality. Early identification of individuals at-risk for cardiovascular disease is essential for effective prevention. There are multiple reports in the literature that triglyceride glucose index (TyG), is associated with elevated blood pressure. In this study, we determined the association of TyG with elevated blood pressure, independent of body mass index (BMI), age, and diabetes status. Methods: A sample of 6799 individuals from the NHANES study population (2011-2020) consisting of all individuals who are above 18 years of age and have serum glucose and serum triglyceride levels available to calculate TyG. Elevated blood pressure status was assigned based on the question“Ever told you had high blood pressure” from NHANES survey.”. TyG was calculated using the formula “ln[fasting TG (mg/dL) × fasting plasma glucose (mg/dL)/2]”. TyG values were divided into 4 quartiles as follow: 1st(&amp;lt;4.36), 2nd (&amp;lt; 4.56), 3rd(&amp;lt; 4.77), 4th(&amp;gt; 4.77). Logistic regression analysis was performed to assess the association between TyG and elevated blood pressure. The analysis was adjusted for age, BMI, and diabetes status. Results: The analysis revealed a significant association between elevated blood pressure and TyG independent of age, BMI and diabetes status. The odds of elevated blood pressure were higher in the 4th quartile TyG compared to the 1st quartile with an odds ratio of 1.39 (95% CI 1.21-1.59), P value &amp;lt; 0.001. Discussion/Conclusion: These results indicate that TyG can serve as a screening tool to identify individuals at risk for elevated blood pressure. Serum triglyceride and glucose measurement are affordable and routine in clinical practice. Implementation of auto-calculation of TyG based on serum triglyceride and glucose values in electronic health records may provide helpful screening and monitoring tools to identify individuals at risk for elevated blood pressure, especially with normal BMI. Future high-quality prospective studies will be helpful to further understand the association. Presentation: Friday, June 16, 2023

THU253 The Hemoglobin Wayne Variant And Association With Falsely Elevated HbA1c

Abstract Disclosure: N. Mulpuri: None. A. Bryant: None. D. Shahin: None. K. Soe: None. Background: Hemoglobin Wayne (Hb Wayne) is a rare, silent alpha chain variant caused by a frameshift mutation in the HbA2 gene. Although clinically silent, this mutation falsely elevates HbA1c values. Clinical cases: We are presenting three cases of Hb Wayne patients referred to our diabetes clinic within the last 5 years. All three cases were Caucasian-American males diagnosed with uncontrolled diabetes based on high HbA1c values of ranging from 10.1-10.6 %. One of the patients was initially started on metformin while the other patients’ treatment plan included dietary and lifestyle modifications. Review of the labs showed that renal function, complete blood count and fasting plasma glucose were within the normal range. High HbA1c value was noted by routine screening lab without having any symptoms related to DM or features of insulin resistance. The discrepancy between high HbA1c values and other glycemic index parameters (serum glucose and FSBG values) was noted. Subsequently, further work up was done (repeat HbA1c with different assay and fructosamine) to verify the diagnosis of uncontrolled DM. Fructosamine levels and repeat HbA1c with a different assay (enzymatic assay at Quest lab) were normal. Hemoglobin electrophoresis confirmed presence of an abnormal alpha variant consistent with Hb Wayne. The patients were reassured and educated about this Hb variant, and no further treatment for DM was pursued. Conclusion: Rare hemolgobinopathies may be more common than previously expected as they can be clinically silent and easily overlooked. While HbA1c has been an important clinical tool for diagnosis and management of diabetes, clinicians should look for underlying reasons which can affect HbA1c assay if there is any discrepancy between HbA1c, FSBG and plasma glucose values. The laboratory at our institution uses cation- exchange High Performance Liquid Chromatography method (Bio-Rad D-100 instrument) resulting in falsely high HbA1c values. Some hemoglobinopathies can affect the widely used HbA1c testing method such as CE-HPLC. The impact on HbA1c values will differ depending on hemoglobin variant and specific method and assay used. Given the limitations of HbA1c testing, clinicians should avoid relying heavily on HbA1c values in management and diagnosis of diabetes. It is vital that clinicians use their clinical judgment to correlate HbA1c with other clinical parameters such as continuous glucose monitoring data, glycated albumin,1,5 anhydroglucitrol (1,5 –AG), fingerstick blood glucose, plasma glucose and fructosamine values. Presentation: Thursday, June 15, 2023

O impacto da raça suína nos níveis de estresse e na qualidade da carne: um estudo em porcos Mangalita puro-sangue e Duroc x Landrace cruzados na Romênia

ABSTRACT This study aimed to investigate the impact of pig breed on stress levels and meat quality in two commercial pig farms in the north-eastern part of Romania. One farm raised 52 Mangalita pure-bred pigs and the other 82 Duroc x Landrace crossbred pigs. Serum cortisol, a biomarker of stress, and serum glucose were measured before and after slaughtering, while meat pH was measured at 45 minutes and 24 hours post-mortem. Results showed that the Duroc x Landrace crossbred pigs had higher serum cortisol and glucose values before and after slaughtering compared to the Mangalita purebred pigs. The meat pH values of the two breeds were similar, with the pH45 and pH24 values being 6.67 and 5.48 for Duroc x Landrace crossbred and 6.53 and 5.52 for Mangalita purebred, respectively. These results suggest that pig breed can have an impact on stress levels and meat quality, with Duroc x Landrace crossbred pigs showing higher stress levels and meat quality being not affected by the breed of pig. Further research is needed to confirm these findings and to understand the underlying mechanisms.

Neighborhood-Level Risk Factors for Severe Hyperglycemia among Emergency Department Patients without a Prior Diabetes Diagnosis.

A person's place of residence is a strong risk factor for important diagnosed chronic diseases such as diabetes. It is unclear whether neighborhood-level risk factors also predict the probability of undiagnosed disease. The objective of this study was to identify neighborhood-level variables associated with severe hyperglycemia among emergency department (ED) patients without a history of diabetes. We analyzed patients without previously diagnosed diabetes for whom a random serum glucose value was obtained in the ED. We defined random glucose values ≥ 200mg/dL as severe hyperglycemia, indicating probable undiagnosed diabetes. Patient addresses were geocoded and matched with neighborhood-level socioeconomic measures from the American Community Survey and claims-based surveillance estimates of diabetes prevalence. Neighborhood-level exposure variables were standardized based on z-scores, and a series of logistic regression models were used to assess the association of selected exposures and hyperglycemia adjusting for biological and social individual-level risk factors for diabetes. Of 77,882 ED patients without a history of diabetes presenting in 2021, 1,715 (2.2%) had severe hyperglycemia. Many geospatial exposures were associated with uncontrolled hyperglycemia, even after controlling for individual-level risk factors. The most strongly associated neighborhood-level variables included lower markers of educational attainment, higher percentage of households where limited English is spoken, lower rates of white-collar employment, and higher rates of Medicaid insurance. Including these geospatial factors in risk assessment models may help identify important subgroups of patients with undiagnosed disease.

Predictors of functional outcome after symptomatic intracranial hemorrhage complicating intravenous thrombolysis: results from the SITS-ISTR.

Several risk factors of symptomatic intracerebral hemorrhage (SICH) following intravenous thrombolysis for acute ischaemic stroke have been established. However, potential predictors of good functional outcome post-SICH have been less studied. Patient data registered in the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) from 2005 to 2021 were used. Acute ischaemic stroke patients who developed post intravenous thrombolysis SICH according to the SITS Monitoring Study definition were analyzed to identify predictors of functional outcomes. A total of 1679 patients with reported SICH were included, out of which only 2.8% achieved good functional outcome (modified Rankin Scale scores of 0-2), whilst 80.9% died at 3 months. Higher baseline National Institutes of Health Stroke Scale (NIHSS) score and 24-h ΔNIHSS score were independently associated with a lower likelihood of achieving both good and excellent functional outcomes at 3 months. Baseline NIHSS and hematoma location (presence of both SICHs, defined as remote and local SICH concurrently; n = 478) were predictors of early mortality within 24 h. Independent predictors of 3-month mortality were age, baseline NIHSS, 24-h ΔNIHSS, admission serum glucose values and hematoma location (both SICHs). Age, baseline NIHSS score, 24-h ΔNIHSS, hyperlipidemia, prior stroke/transient ischaemic attack, antiplatelet treatment, diastolic blood pressure at admission, glucose values on admission and SICH location (both SICHs) were associated with reduced disability at 3 months (≥1-point reduction across all modified Rankin Scale scores). Patients with remote SICH (n = 219) and local SICH (n = 964) had comparable clinical outcomes, both before and after propensity score matching. Symptomatic intracerebral hemorrhage presents an alarmingly high prevalence of adverse clinical outcomes, with no difference in clinical outcomes between remote and local SICH.

Effect of Obesity on Clinical Characteristics of Primary Aldosteronism Patients at Diagnosis and Postsurgical Response.

Patients with obesity have an overactivated renin-angiotensin-aldosterone system (RAAS) that is associated with essential hypertension. However, the influence of obesity in primary aldosteronism (PA) is unknown. We analyzed the effect of obesity on the characteristics of PA, and the association between obesity and RAAS components. A retrospective study was conducted of the Spanish PA Registry (SPAIN-ALDO Registry), which included patients with PA seen at 20 tertiary centers between 2018 and 2022. Differences between patients with and without obesity were analyzed. A total of 415 patients were included; 189 (45.5%) with obesity. Median age was 55 years (range, 47.3-65.2 years) and 240 (58.4%) were male. Compared to those without obesity, patients with obesity had higher rates of diabetes mellitus, chronic kidney disease, obstructive apnea syndrome, left ventricular hypertrophy, prior cardiovascular events, higher means of systolic blood pressure, and required more antihypertensive drugs. Patients with PA and obesity also had higher values of serum glucose, glycated hemoglobin A1c, creatinine, uric acid, and triglycerides, and lower levels of high-density lipoprotein cholesterol. Levels of blood aldosterone (PAC) and renin were similar between patients with and without obesity. Body mass index was not correlated with PAC nor renin. The rates of adrenal lesions on imaging studies, as well as the rates of unilateral disease assessed by adrenal vein sampling or I-6β-iodomethyl-19-norcholesterol scintigraphy, were similar between groups. Obesity in PA patients involves a worse cardiometabolic profile, and need for more antihypertensive drugs but similar PAC and renin levels, and rates of adrenal lesions and lateral disease than patients without obesity. However, obesity implicates a lower rate of hypertension cure after adrenalectomy.

Evaluation of Serum Magnesium Levels in Patients With the Diagnosis of Depressive Disorder Applied to a Psychiatry Clinic: A Retrospective Study

Objective: The role of magnesium in the pathophysiology of depression has increased the interest in magnesium. However, contradictory results regarding whether the magnesium levels decrease in depression are reported in the literature. Therefore, in this study, we aimed to evaluate serum magnesium levels in patients diagnosed with depressive disorder who applied to the psychiatry outpatient clinic Materials and Methods: The data of 1013 patients who were diagnosed with depressive disorder and whose serum magnesium levels were measured were included in the study by retrospectively scanning the data of the patients who had applied to the Psychiatry outpatient clinic of Balıkesir University Faculty of Medicine between July 2020 and July 2022. Since the serum glucose, GGT and creatinine values were above their reference ranges in 183 of 1013 patients included in the study, the data of these patients were excluded from the analysis. Results: Serum magnesium values of 12.9% of female and 9.1% of male patients were below the reference values (1.9-2.7 mg/dl). Total mean ( ±SD) magnesium value was statistically significantly different from those of female and male patient groups ( 2.02±0.15 mg/dl vs 2.01±0.16 mg/dl and 2.04±0.15 mg/dl, and P

Correlation of CRP level with intermediate and high Syntax Score in patients with acute coronary syndrome

In patients with acute coronary syndromes, inflammation has a major role in plaque rupture, which results in acute coronary artery obstruction. This vascular process is not limited only to the site of plaque destabilisation but also in the systemic level. So, it may be detected by determining plasma inflammatory markers. C-reactive protein (CRP) has been frequently studied in recent years and considered to be one of the most important markers. The SYNTAX score (SXscore) is a useful angiographic scoring system that has been developed to assess and quantify the extent, severity and complexity of coronary artery disease. In our study, we investigated whether baseline high-sensitivity CRP levels are associated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore). We enrolled 128 patients with ACS who underwent coronary angiography between January 2022 and November 2022. The patients were divided according to the SXScore: low SXScore (≤ 22), and intermediate-high SXScore (≥ 23). A total of 128 patients met the inclusion criteria and was included in the study. Among those 128 patients, 98 (76%) were males and 30 (23%) were females. The mean age of patients in the intermediate-high SXScore (61 ± 12 years) group was significantly higher than the low SXScore group (57 ± 10 years) with a P-value: 0.003. Coronary risk factor frequencies such as hypertension were present in 45%, type 2 diabetes mellitus in 42% and dyslipidemia in 83% of patients with no significant difference between both groups except for diabetes with a significant P-value: 0.008. Subjects with an intermediate-high SXScore had higher values of serum glucose, creatinine, peak troponin, and uric acid levels compared to the low SXScore subjects. In addition, the intermediate-high SXScore group showed significantly higher values of high sensibility CRP than the lower SXScore (17.8 ± 6.4 mg/L versus 10.2 ± 5.3 mg/L, P < 0.001). One of the most important results in this study was that serum hs-CRP levels on admission in patients with ACS could predict the severity and complexity of coronary atherosclerosis together with multivessel disease.

Abstract #1404146: The Ups and Downs of Diagnosing Insulinoma

Insulinomas are rare neuroendocrine tumors of the pancreas. The diagnosis of an insulinoma may be delayed in the geriatric population, as older individuals often have comorbid conditions making evaluation more difficult. The case described here involves an exceptionally rare presentation of insulinoma in a 78-year-old male with underlying type 2 diabetes mellitus and heart failure. A 78-year-old man with a past medical history of type 2 diabetes, heart failure, and chronic kidney disease presented to the hospital with bilateral lower extremity edema and shortness of breath. He had been hospitalized four times during the previous six months for acute heart failure exacerbations accompanied by recurrent episodes of hypoglycemia. Of note, his diabetes was well-controlled with glimepiride and dapagliflozin only. The patient reported symptomatic hypoglycemia, primarily during fasting episodes, with nadir serum glucose values between 40 and 50 mg/dL. During hospitalizations, total insulin (range 22-68 uU/mL), and C peptide (range 6.9-16.4 ng/mL) concentrations were inappropriately elevated when glucose was low, indicative of endogenous hyperinsulinemia. However, this hypoglycemia was thought to be secondary to recent sulfonylurea use in the setting of poor diet and acute renal insufficiency related to heart failure. Both glimepiride and dapagliflozin were held, though he inadvertently continued to take glimepiride until his fourth hospitalization. During his fourth admission, the patient continued to have symptomatic hypoglycemia. As his sulfonylurea screen was negative, he underwent an Octreoscan that revealed radiotracer uptake in the distal pancreas. An endoscopic ultrasound with biopsy revealed a well-differentiated neuroendocrine tumor of the pancreas. His heart failure made agents such as diazoxide, verapamil, and phenytoin undesirable, and he was discharged on subcutaneous octreotide three times daily with a plan to follow up in the surgery clinic. The presentation of insulinomas in the geriatric population can be variable and nonspecific, increasing the risk of misdiagnosis or delay of diagnosis. Missing the diagnosis can lead to increased morbidity and mortality via cognitive impairment and falls. Our patient experienced a delay in diagnosis of insulinoma of over one year despite satisfying the criteria of Whipple’s triad during his first admission. The patient had been asked to stop all anti-diabetic medications during his third admission. However, he misunderstood and continued glimepiride. Further, his acute renal insufficiency, heart failure, and decreased appetite provided alternative causes for his hypoglycemia. Insulinomas are extremely rare pancreatic neuroendocrine tumors that typically present in patients between 40 and 60 years of age. However, there have been reports of these rare tumors in older individuals, who often have comorbid conditions making their diagnosis more difficult. This case report highlights the importance of including insulinoma as a cause of persistent endogenous hypoglycemia among the geriatric population.

Hyperglycemia Is Associated with Intraventricular Extension Among Patients with Spontaneous Intracerebral Hemorrhage (P6-5.011)

<h3>Objective:</h3> We aimed to evaluate whether elevated serum glucose is associated with intraventricular extension in patients with intracerebral hemorrhage. <h3>Background:</h3> Stress hyperglycemia is a common finding in spontaneous intracerebral hemorrhage that may be associated with poor outcome. Intraventricular extension is also associated with poor prognosis among patients with intracerebral hemorrhage. Whether intraventricular extension is associated with hyperglycemia is currently unknown. <h3>Design/Methods:</h3> Demographic information, risk factors, and laboratory values including admission serum glucose levels were collected from a prospective database of consecutive non-traumatic ICH patients admitted to a single referral center between 2007 to 2018. Hemorrhage volumes were calculated from baseline computed tomography (CT) scans using the ABC/2 formula, and CT scans were reviewed for the presence of intraventricular extension. Serum glucose values on admission were compared between patients with and without intraventricular extension in univariate and multivariate models. <h3>Results:</h3> 856 patients with spontaneous intracerebral hemorrhage were included in the analysis. The mean age of the cohort was 71±15 years and the proportion of females was 44%. The mean hemorrhage volume was 32.7±40.6 mL, and intraventricular extension occurred in 318 (37%) patients. Among those with intraventricular extension, the average admission glucose was 159.7±74.1 mg/dL compared to 135.5±56.7 mg/dL (<i>p</i> = 0.01) in those without intraventricular hemorrhage. In a multivariable regression model, admission serum glucose (aOR 1.01, 95% CI (1.00–1.01), <i>p</i> &lt; 0.01) was independently associated with intraventricular extension after adjusting for age, sex, hypertension, diabetes, and hemorrhage volume. <h3>Conclusions:</h3> Admission serum glucose is associated with intraventricular extension among patients with spontaneous intracerebral hemorrhage. Such findings may reflect a stress response that occurs due to the presence of blood products within the ventricles. While further studies are needed to further elucidate the pathophysiological basis for this phenomenon, elevated serum glucose may be a reliable peripheral marker for intraventricular extension. <b>Disclosure:</b> Dr. Das has nothing to disclose. Elizabeth Heistand has nothing to disclose. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation. Dr. Fehnel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for XRHealth. The institution of Dr. Fehnel has received research support from National Institute on Aging . An immediate family member of Dr. Dearborn-Tomazos has received personal compensation for serving as an employee of PTC Therapeutics. An immediate family member of Dr. Dearborn-Tomazos has received personal compensation for serving as an employee of Alexion Pharmaceuticals. Dr. Dearborn-Tomazos has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Qmetis. An immediate family member of Dr. Dearborn-Tomazos has stock in Alexion Pharmacueticals. The institution of Dr. Dearborn-Tomazos has received research support from BMS. Dr. Lioutas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Qmetis. Dr. Lioutas has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. Dr. Kumar has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for CRICO. Dr. Selim has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MedRhythms Inc..

Fetal Epicardial Fat Thickness: Its Role as Marker for Gestational Diabetic Mellitus.

Background There are very few studies on the association between fetal epicardial fat thickness (EFT) and gestational diabetes mellitus (GDM). Aims To evaluate the role of fetal epicardial fat thickness as a marker and use it in pregnancies to screen for GDM. Settings and Design A cross-sectional analytical study was conducted in the Department of Radiodiagnosis and Imaging at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, after the due clearance from the institutional research and ethics committee. Materials and Methods The study included pregnant patients at 24 + 0/6 to 28 + 0/6 weeks of gestation scheduled for a 75 g oral glucose tolerance test from December 1, 2020 to March 30, 2022. Antenatal ultrasound was performed on Voluson E8 Expert BT12 (Wipro GE) ultrasound machine. Out of 180 patients, 60 patients were selected, that is, 30 patients with raised 75 g OGTT results (cases of GDM) and 30 patients with normal 75 g OGTT results. Statistical Analysis The collected data were transformed into variables, coded, and entered into Microsoft Excel. Data were analyzed using the Shapiro-Wilk normality test, student's t -test or Mann-Whiney U test, chi-square test, or Fisher's exact test and statistically evaluated using the SPSS-PC-25 version. Results Fetal EFT was found to be significantly more in the GDM group in comparison to controls without GDM, and the increased fetal EFT was positively associated with 2-hour OGTT serum glucose values. The mean fetal epicardial fat thickness (EFT) in mothers with GDM was significantly larger, i.e., 0.17 ± 0.02 cm than in mothers without GDM, i.e., 0.12 ± 0.01 cm ( p < 0.001). The receiver operating characteristic (ROC) curve plotted from values calculated from our results shows high sensitivity (i.e., 96.67%) and specificity (i.e., 90%) of fetal EFT as a predictor for GDM with an AUROC value of 0.96 and 95% confidence interval of 0.92 to 1.0. Conclusions EFT was significantly higher in fetuses of diabetic versus nondiabetic mothers. The mean difference in EFT of GDM cases and controls was relatively small but was statistically significant. The study concluded that measuring the epicardial fat thickness in fetuses can serve as a novel marker in GDM.